Rand Corporation’s Dr. Deborah Cohen On The Obesity Epidemic

Episode 112

Video Transcription

Jackie Keller: Welcome to Food Exposed, where, each week, we take a close
look at what’s on your plate. My name is Jackie Keller, and I’m the
founding director of NutriFit, Los Angeles’ leading healthy food
company. Today, we’re taking a close look at why we put stuff on our
plates, literally, our eating habits as a country in general. This is
serious stuff, because, as you know, two-thirds of adult Americans are
overweight or obese, as are one-third of our children. What do
hypertension, heart disease, type 2 diabetes, and cancer have in
common? Obesity is an underlying cause of all of these chronic
diseases that are killing more than 100,000 Americans every year.
We’re going to get to the heart of this problem with our guest, but
before we do, I thought that it would be interesting to take a look at
where we’ve been with dieting trends over the last few years, and look
back even further to see how little has changed since the 1930’s in
general. So, here’s a quick tour through the history of dieting

In the 1930’s and 40’s, you could blame Lucky Strike. Smoking was the
way we got thin back then. The cigarette brand used the line, “Reach
for a Lucky, instead of a sweet.” Yuck! Literally, heart disease and
lung cancer, that’s what we got, not skinny. That’s not the only thing
that debuted back then. The lemonade diet was popular, which is
remarkably like, well, wait for it, today’s Master Cleanse. In the
1950’s, we were praying for weight loss. The Christian dieting
industry was born, and followed Reverend Charlie Shedd’s book, “Pray
Your Weight Away”. This was followed by, “I Prayed Myself Slim,” and,
“Help Lord- The Devil Wants Me Fat!” Fast forward to 2002, and Don
Colbert publishes, “What Would Jesus Eat” cookbook. I mean, seriously.

In the 1960’s, we all shared the love, right? When it came to dieting,
we grew support organizations like Overeaters Anonymous and Weight
Watchers. We ate the cabbage soup diet to bloat our stomachs up so
we’d feel full and lose weight. Well, not. In the 1970’s, the era of
miracle pills, from Dexatrim to Fat Blocker. Where have we heard more
about this recently? This gets revived again, just a few years later,
with Fen-Phen and other miracle diet pills. Oh yeah, the cookie diet.
Turns out it’s not so new. It started in the 1970’s. By 1980, the
Scarsdale diet came in with hardcore, high-protein, low-carb, low
calorie, and you thought starving was new?

In the 1990’s, Dr. Atkins took Scarsdale one step beyond, and
introduced high-fat to the no-carb picture. So, why does this sound
familiar? In 2000, we’ve had an explosion of diets. Since then, you
have your choice. There are cleanses. There is Paleo, which is one of
the worst diets of 2013, according to the U.S. News and World Reports.
The DASH diet, the South Beach diet, the Mediterranean diet, and
there’s even a new one called The Ice Cream Cleanse! Yep, it just made
the scene, straight from right here in Venice, California. Yet, as a
nation, we keep getting fatter. So, what really works, and how can we
get a grip on our waistlines? Well, my guest today is an expert in
this area. In fact, she’s a senior natural scientist and a leading
researcher at Rand Corporation, an M.D. with a Master’s in public
health, and the author of a recently published book, “A Big Fat
Crisis: The Hidden Forces Behind The Obesity Epidemic, and How We Can
End It.” Dr. Cohen, welcome to Food Exposed.

Dr. Cohen: Thank you for inviting me.

Jackie Keller: Well, you know, in your book, “A Big Fat Crisis,” you talk
about changing the conversation around obesity. Tell me more about
that. I hear people talk about diet all day long, and clearly, as a
country, we’re awash in food. Everywhere you turn, there’s an
opportunity to eat, and we all know you can’t eat constantly. I own a
food business, and a lot of industry is driven around food business.
How do we reconcile that segment of the economy with having too much
food and temptation?

Dr. Cohen: Okay. The problem we have now, with the obesity epidemic, is
that we generally consider this an individual problem. If we continue
to do that, we will never change this issue. We have to think of this
as a public health crisis at this point. You mention the statistics.
Two out of three adults are overweight or obese and we have this huge
increase in chronic diseases like type 2 diabetes. It’s making our
health care costs soar. So, instead, we have to really look at what’s
underlying this epidemic. In my view, the problem is that we have
allowed our country to be turned into a food swamp.

Jackie Keller: Oh my.

Dr. Cohen: So, and you’ve mentioned it! There’s food everywhere you go.

Jackie Keller: That’s true.

Dr. Cohen: The problem is that when we see food, it makes us feel hungry.
If it’s convenient, if it’s in front of us, it encourages impulse
buying and impulse eating. Unfortunately, that’s the way human beings
are designed. It’s in our DNA to eat when food is available. There are
so many studies that show that if you serve people more than they
need, they will eat more than they should. So, if we really look at
the underlying causes, the problem is our restaurants- they serve way
too much food, too much salt, too much sugar, too much fat, too many
calories- and it’s our supermarkets, which encourage us to buy foods
that increase our risk of chronic diseases.

Jackie Keller: Oh. So, there are many people who literally can’t control
their urge to eat, and eat the wrong foods?

Dr. Cohen: Well, look, that’s most of us. Remember, two out of three
people are eating more calories than they burn in physical activity.
So, that’s the normal person.

Jackie Keller: Wow.

Dr. Cohen: As I said, we’ve done studies where you serve people too much
food. People automatically eat more than they should. The problem is
that we have this misperception of human nature. We tend to think that
people are in full control of everything they do. We think that if we
choose something and put it in our mouths, it was our deliberate
decision. The truth is that most of our behaviors are actually
automatic, and they occur without our intention or conscious control.
So, just think about eating. If you were watching a movie and had a
bowl of popcorn in your lap, as you’re watching the picture, you can
take your hands, put them in the popcorn bowl, put the popcorn in your
mouth, chew it, and swallow it all without paying attention, without
directing that to happen. We can do it automatically. We can keep
eating, and we won’t even know that we’re finished until there’s
nothing left in the bowl, right? That was an automatic behavior. We
can do it unconsciously, without intention, without deliberation, and
without any effort. We were designed that way. Eating is an automatic

Jackie Keller: My goodness. You mention in the book- and, by the way,
what a great title.

Dr. Cohen: Thank you.

Jackie Keller: It’s a wonderful book- that we don’t fully control our
senses. How does that tie into advertising and personal choice?

Dr. Cohen: Okay. So, we don’t control our senses much, at all. You know,
if we hear a sound, you know, we’ll automatically turn toward that
sound. We don’t think, “Oh, I heard a sound. I better turn my head.”
It’s the other way around. You know, if we see a tempting food, we
will automatically start salivating. We don’t tell ourselves, “Okay
body, start salivating and feel hungry.” No! That happens as a
reflexive response to food. That’s the problem. We have food all
around us, and it’s causing this reflex, which we cannot control. No
one can control that. It makes us feel hungry. What we can partly
control is whether we act on those feelings of hunger and desire.
Basically, the market has figured out what increases the chances that
we will act on those desires. So, they’ve set up restaurants and
supermarkets to lead us to buy more and eat more than we really

Jackie Keller: So, you talk in the book about the food environment being
at the root of the problems today. One example might be the
supermarket example. Can you give us some others?

Dr. Cohen: Yeah. So, I mean, let’s go back to restaurants. Right now, when
we go out to eat, we’ll be, 95% of the time, increasing our risk of a
chronic disease, just by going to a restaurant.

Jackie Keller: Oh, my goodness.

Dr. Cohen: Yeah! That’s because restaurants will serve you more food than
you need, right? If you get too many calories at one meal, it’s very
hard to compensate later, because people also have a very limited
ability to track what they eat. You know, they’ve done all kinds of
studies. They ask people, “What did you eat in the last 24 hours?”

Jackie Keller: Right, a recall.

Dr. Cohen: Most people under-report by anywhere from 200 to 1,000
calories. The average person doesn’t remember eating what constitutes
a full meal.

Jackie Keller: Wow.

Dr. Cohen: So, you know, four to five to 600 calories, we won’t even
realize. Again, it’s because we’re not paying attention to what we’re
eating. You know, we can eat, and I can talk to you , or drive a car,
or watch T.V., and that means we’re not tracking what we’re eating.
What we’re swallowing, we can’t really keep track of that.

Jackie Keller: So, I’ve heard a lot about this, sort of, eat following
your intuition, your body will tell you. So, what you’re saying is
that’s not so.

Dr. Cohen: That is absolutely not so. People were designed to be able to
eat more than they need. That’s why we have a pathway where we can
convert the extra calories into fat. If we could only eat what we
needed, we wouldn’t be storing fat. So, we’re actually designed to eat
more than we need.

Jackie Keller: So, what would you recommend that we push for? Is this
something that should be legislated? How does that work with personal

Dr. Cohen: Okay. Well, we legislate a lot of things to protect people who
are at risk. So, we legislate the quality of the water that’s in our
pipes and comes through the faucet, so people don’t automatically get
exposed to toxins and things that will make them sick. Well, we can do
something like that when it comes to the food environment, because
right now, we’ve allowed businesses to put all of us at risk. We’re at
risk every time we dine out. We’re at risk every time we go to the
supermarket. One of the things I proposed in restaurants is to have
standardized portion sizes. So, when we buy something, when we order
something, we should be able to get that in an appropriate portion
size, a standard portion size which is appropriate for one person to
eat at a single serving.

Jackie Keller: Well, that’s pretty controversial, because that takes away
the whole value proposition…

Dr. Cohen: Well, but right now…

Jackie Keller: …from the equation.

Dr. Cohen: Okay. But right now, if you go to the restaurant and they serve
you more than what’s appropriate for you, you’re going to get sick.
You’re going to increase your risk of obesity or chronic disease. If I
wanted to go out and eat, and not get sick, I don’t have that option.
So, if every restaurant would just have it available in a single,
standardized portion, then it would be up to me. It would be up to
every consumer to decide, to choose one portion or not. If someone
wanted two portions, they could, but right now, we have no way to
estimate what we’re getting. I have to tell you, we already have
portion standards when it comes to alcohol. If we order a drink,
whether it’s a beer, wine, or a shot of liquor, the amount we get only
has 0.6 ounces of ethanol.

Jackie Keller: Okay.

Dr. Cohen: Right, so we can gauge our risk of becoming drunk. You know, if
you renew your license at the DMV, you’ll get some information that
tells you how many drinks you can have and then it would be safe to
drive, right? People can gauge that by counting their drinks. We don’t
have that for food, and that’s all I’m proposing. It’s not taking away
people’s right to choose to eat as much as they want. It’s just a
system that will allow people to track how much they’re getting, and
to not be put at risk every time they go out to eat.

Jackie Keller: Fascinating. Wow. Well, speaking of personal choice, I
thought we’d take a few minutes today, in the kitchen, for putting
together some great choices for managing a healthy diet.

Dr. Cohen: Okay.

Jackie Keller: I know that portion control is a big issue for many, many
people, and i think that food labeling in restaurants and fast food
operations is a step in the right direction, but I think it’s going to
be awhile before we get to the point where the government is going to
step in further. I know that there have been some attempts to do that.

Dr. Cohen: Yeah. You know, every restaurant already has portion sizes,
they’re just different for every single restaurant.

Jackie Keller: That’s very true.

Dr. Cohen: If they would all get on the same page, then people would have
the option to choose. It would give people the power to choose how
much they’re eating. Right now, we don’t have that choice. We just get
whatever they give us. If it’s too much, tough on us; tough on us! You
know, people actually don’t have the capacity to estimate volume just
by looking at it. We have a limit when it comes to, you know, figuring
out how many jelly beans are in the jar, right? That’s what they’re
asking us to do.

Jackie Keller: Yeah.

Dr. Cohen: Most people can’t do that. In general, we underestimate. The
larger something is, the less we think is in it. So, it really puts us
at a huge disadvantage. I mentioned about what restaurants can do, but
one of the things we need to do with supermarkets is to do something
about all the impulse marketing that they have, candy at the cash
register, chips and sodas on the end of aisles. It turns out that
where they place the food in the supermarket determines what we buy.

Jackie Keller: Yeah. I’m not surprised.

Dr. Cohen: Who would think that the placement of something would make us
buy something or not? But it does. So, when they put that stuff that
we need to avoid in front of our faces, it triggers our impulse
buying, and again, it’s a risk factor for making us sick.

Jackie Keller: Well, I think understanding that association is something
that we need to talk more about.

Dr. Cohen: Right, absolutely.

Jackie Keller: That’s why I’m so glad that you put it in this book.

Dr. Cohen: And you know, one of the things that we do, at least for
alcohol, is that we don’t allow alcohol to be sold at the cash
register. We don’t allow it in vending machines. There are some
regulations that don’t allow alcohol within five feet of the register
in California. It’s against the law. Or, five feet of the front door
when you go to a gas station. So, we could certainly have a regulation
on where things could be placed. It wouldn’t prevent people from
getting whatever they want, but it would assure that, when we got
something, it was deliberate. If we have to go and look for something
at the third aisle, on the bottom shelf, then you know you really
wanted it.

Jackie Keller: Right.

Dr. Cohen: But if you’re just grabbing it because it’s there, and it’s an
automatic, sort of unconscious thing, that’s something we could
protect people from without limiting their free choice.

Jackie Keller: Well, very interesting. We’ll have to see how that

Dr. Cohen: Yes!

Jackie Keller: Now, let’s go to the kitchen and talk about choosing
fruits and vegetables.

Dr. Cohen: All right!

Jackie Keller: All right.

Dr. Cohen: Let’s go.

Jackie Keller: So, today I thought we’d spend a few minutes talking about
the value proposition for foods that are healthy. I think there’s a
perception that healthy foods are expensive and that people don’t buy
things that are healthy because they cost too much, and availability
is an issue if it’s healthy food. But, you know, as you and I both
know, in the world of plants, economy is the byproduct of it being
plant based. Also, availability, we’re fortunate. We live her in
California, and we have fruits and vegetables in abundance. I wanted
to share a recipe for a vegetable curry, which I thought would be
quick, easy, and fun to make. I’ve cut up a bunch of vegetables here,
that we can put into the pan all at once. It’s one of those one pot
wonders, you know. You don’t have to mess with it. The longest part of
preparing a dish like this, of course, is cutting everything and
chopping. Once you have that down, or you buy frozen, which is another
option, it’s really a quick fix as far as healthy meals are concerned.
Let’s talk for a minute, if we could, about portion sizes and value.
So, I brought along an onion. We talked before the show, and you
mentioned that it looked like a really big onion, and it must be at
least a pound of onion. In fact, weighing it, we realized, yes it is a
pound of onion.

Dr. Cohen: Yeah. That’s an extra large onion.

Jackie Keller: That’s an extra large onion. Of course, I have some here,
chopped and ready to go, but…

Dr. Cohen: So, you would probably be able to get three of those in this
one onion.

Jackie Keller: Exactly. That one onion might cost $0.69, $0.79. In a
cheap market, or a less expensive market, it might cost half of that.

Dr. Cohen: Maybe 30 or 40 cents, yeah.

Jackie Keller: So, that’s three or four servings of onion…

Dr. Cohen: Yeah.

Jackie Keller: Depending on your recipe. I also prepared a little bit of
broccoli, and I brought a broccoli stalk, and this one is just about
six ounces, so about one-third of a pound of broccoli.

Dr. Cohen: Okay.

Jackie Keller: Clearly, you would get at least this much out of it, if
not more. This is a 12 ounce cup.

Dr. Cohen: Yeah. I think a pound of broccoli is something like 10

Jackie Keller: So, you know, we see, quickly, how inexpensive it is to
put all these together. So, let’s start by seasoning our pan with a
little bit of the onion that I brought. I’m going to add in a little
bit of curry powder, because, you know, I think a vegetable curry is a
really easy dish to prepare.

Dr. Cohen: How do you know how much to shake out? Do you ever measure it?

Jackie Keller: Well, I’ve been doing this for a long time. I no longer

Dr. Cohen: Just covering up the onion.

Jackie Keller: Exactly, exactly. By toasting the curry, it brings out the
flavor in the curry powder. It tastes a little bit of the… Curry can
be pretty sharp. Doesn’t that smell wonderful?

Dr. Cohen: It smells so good!

Jackie Keller: Let’s talk for a minute, while the vegetables are
sauteing, about smell and purchase decisions. That’s probably
something you’ve researched a bit, too.

Dr. Cohen: Not really.

Jackie Keller: No; because, I know you talked about the physical
appearance of food at the register affecting a purchase decision?

Dr. Cohen: Yeah.

Jackie Keller: Do you think that the smell, as well, makes a difference?

Dr. Cohen: Well, I think most vegetables don’t have much of a smell. Some
of the leafy green vegetables might smell, like arugula has a fabulous
smell. But I haven’t noticed a smell for broccoli or celery, just when
it’s cold. Maybe after it cooks, it has a smell.

Jackie Keller: Right. Well, you know, I ask because I know, when you’re
selling a house, they bake cookies or do something that has cinnamon
to make the house smell good, because it affects people

Dr. Cohen: Yeah. I think fruits have a wonderful smell.

Jackie Keller: Let’s talk for a minute about, I brought a cantaloupe.

Dr. Cohen: You brought a cantaloupe. That probably has a great smell.

Jackie Keller: Of course, a cantaloupe like that weighs about a pound.
Usually, you buy them by the piece. Quite often, a cantaloupe like
that will be maybe $2.00 or something like that. Two dollars, two for
four, or something like that.

Dr. Cohen: Uh-huh.

Jackie Keller: Typically, again, servings, I would guess that you would
get eight average servings, so, again, about $0.25 per serving.

Dr. Cohen: Right.

Jackie Keller: So, I’ve put in here, our onion, carrots, bell peppers,
and celery. We can add in some broccoli. We’ve got even a little bit
of cauliflower here. You see, what’s here, visually, is we’re creating
something that has this wonderful pallet of color.

Dr. Cohen: Yeah, beautiful.

Jackie Keller: Really, we eat first with our nose. So, we want to make it
smell right. If it passes the nose test, it goes to the eyes, because
after the age of three, you no longer put things in your mouth that
look bad or smell bad. Then, if it passes the eyes and the nose, we’ll
taste it.

Dr. Cohen: The purple is beautiful.

Jackie Keller: Isn’t that pretty?

Dr. Cohen: Yeah.

Jackie Keller: You know, just a little bit of purple cabbage. And again,
talk about affordable, this is maybe 10 cents a serving. The other
vegetables range in price. Some zucchini here form 15 or 20 cents a

Dr. Cohen: Yeah.

Jackie Keller: So, we put in, let’s see, one, two, three, four, five,
six, seven, eight different kinds of vegetables. All right, and let’s
say, on the average, there in a little bit more seasoning, because our
volume here has grown. Let’s say 25 cents an average serving size. So,
we’ve created a dish here that will easily serve four or five people,
maybe with a little brown rice at the bottom. Maybe some potatoes
could be added to it to complement the vegetables. But, we’re talking
about something that has a price point per serving.

Dr. Cohen: Right. It’s affordable, definitely affordable. You know, the
USDA has done research on what vegetables do cost, and I don’t think
anywhere in the country, vegetables are more than, at the most, 50
cents a serving. You know, the USDA guidelines for Americans say that
the average person needs four and one-half cups of fruits and
vegetables every single day.

Jackie Keller: Wow.

Dr. Cohen: Four and one-half cups. That means, if you divide it across
three meals, that’s one and one-half cups per meal.

Jackie Keller: Right.

Dr. Cohen: You know, fruits and vegetables, people forget that they need
that every day, and if they don’t get it every meal, then they’re
going to somehow have to compensate.

Jackie Keller: Right.

Dr. Cohen: If you didn’t get it at breakfast or lunch, try getting all
four and one-half cups at dinner.

Jackie Keller: Yeah, it’s…

Both: Not going to happen.

Dr. Cohen: Right?

Jackie Keller: Right.

Dr. Cohen: That’s why it’s really important to spread it out, because it’s
pretty hard to eat it all at once. The volume is so great. What’s so
nice about it is that it does fill you up.

Jackie Keller: Right. All that fiber really makes you feel full. I am
wondering, now that we’ve got this colorful, wonderful, beautiful

Dr. Cohen: Uh-huh.

Jackie Keller: Is your salivary glands, are we feeling it a little bit?

Dr. Cohen: Yeah, I’m feeling it. Especially that smell, it’s so lovely.

Jackie Keller: How about if I ask you to taste, will you take a bite?

Dr. Cohen: Okay.

Jackie Keller: All right, let’s dish it up. Just a little bit, because I
know it’s hot; again, just realizing that the color is so lovely and
so welcoming.

Dr. Cohen: All right.

Jackie Keller: Here you go.

Dr. Cohen: All right.

Jackie Keller: Now, obviously, a little bit more time, and we…

Dr. Cohen: I’m going for that carrot, uh-huh. Yummy, that is really good.

Jackie Keller: Thank you. Thank you so much!

Dr. Cohen: I’m going for these carrots.

Jackie Keller: That bright orange color really attracts us, right? It’s
the color of health. So, Dr. Cohen, Debra, I know that people will
want to follow your work. Of course, your book is available on Amazon.

Dr. Cohen: Yes.

Jackie Keller: That’s where I found it.

Dr. Cohen: It is a Kindle book, too.

Jackie Keller: A Kindle book, too. It’s an easy read, a great read, but
how else can people find you?

Dr. Cohen: Well, I’m at the Rand Corporation. You can look at the Rand
website and see the work that I’m doing. I do hope that you’ll read
the book, and in the book there’s a chapter on what people can do
about this obesity epidemic. I think the first thing is really that we
have to stop blaming ourselves. You know, nobody wants to be fat. I
don’t think anyone is deliberately trying to eat too much and exercise
too little. It’s really the environment that’s creating this situation
that is undermining our long-term goals. So, we’ve got to do what
we’ve done with other issues in public health, you know, have some
standards, and have some way to control the environment so that it
doesn’t put as at risk every time that we step out the door. We have
standards for cars, so we don’t crash, so cars don’t explode, and so
cars don’t catch fire. We have regulations that check that out. We
have standards for water. We have standards for air. We have standards
for housing. Just imagine if we didn’t have railings on stairs. We’d
be falling, and would we blame ourselves? No. We realize that, by not
having a system that keeps us safe, we’re at risk. That’s what’s
happened with the food environment. We have nothing that protects us
from being overwhelmed with too much food making us feel hungry when
we don’t need to eat. That’s the problem. Just, let’s target where the
source is, and then we can all be healthy effortlessly.

Jackie Keller: Wouldn’t that be great?

Dr. Cohen: Right. That’s what it would be.

Jackie Keller: Yeah.

Dr. Cohen: If people didn’t serve us too much and make us buy food that
would make us sick, we would be healthy.

Jackie Keller: Well…

Dr. Cohen: That’s the way I look at it.

Jackie Keller: It’s a great read. We’ll definitely keep in touch, and see
how we’re doing as a society.

Dr. Cohen: Okay.

Jackie Keller: I hope you’ll come back and visit us again.

Dr. Cohen: All right. Thanks for having me.

Jackie Keller: Thank you again for coming.

Dr. Cohen: All right. My pleasure.

Jackie Keller: My coaching moment today is about the experience of
choice. In his book, “Why We Do What We Do,” Edward D.C. says, “At the
heart of human freedom is the experience of choice.” As a coach, I
talk to people in terms of making their own choices and forging their
own path all the time. The entire premise of coaching, in fact, is
built on the assumption that if you can help people unlock their own
intrinsic motivation, they will be empowered to do most anything. So,
it’s surprising, then, that we don’t expect our experts to open the
doors of decision making for us. We expect to be told what to do, but
research shows that, while being told or controlled is the easy
answer, it assumes that the promise of reward or the threat of
punishment will make the offenders comply. Anyone who’s ever raised a
child, or tried to compel somebody to do something, knows just how
true that is. However, when we’re controlled or compelled to do
something, we act the part, but we don’t necessarily live it. So
consider this; compliance and defiance exist in an unstable
partnership. We’re often told to do it someone else’s way to survive
or succeed, yet fulfillment lies in living the most unique expression
of ourselves.

A very wise boss of mine once told it to me like this, and I will
always remember Neal Salinger for telling me, “We all operate out of
our own mutual self-interest. The trick is to find people whose self
interest is mutually aligned with yours.” John Steinbeck, in his book
, “East of Eden,” says that the Hebrew word, timshel, “thou mayest,”
that gives a choice. It might be the most important word in the world.
That says, “The way is open,” and that throws it right back on a man.
For, if thou mayest, it is also true, thou mayest not. That’s my show
for today. Join me next week on Food Exposed as we take a look at
what’s on your plate. For more Food Exposed, check me out on
empowerme.tv, and until next week, remember: Make food your best
friend, and exercise your companion for life.