Welcome to the continuing diary series "Let's Read a WHEE Book Together!" This week, we're continuing with David Kessler's The End of Overeating, Chapter 29. If you're just discovering this diary series, you will find links to the previous installments at the bottom of this diary.
WHEE (Weight, Health, Eating and Exercise) is a community support diary for Kossacks who are currently or planning to start losing, gaining or maintaining their weight through diet and exercise or fitness. Any supportive comments, suggestions or positive distractions are appreciated. If you are working on your weight or fitness, please -- join us! You can also click the WHEE tag to view all diary posts.
The End of Overeating, by David Kessler, M.D.
Chapter 29: Why We Don't Just Say No
In chapter 29, Kessler defines the term used as the title for Part 3 of the book: Conditioned Hypereating.
"Conditioned" because it becomes [emphasis mine - Ed] an automatic response to widely available food and its cues, "hyper" because the eating is excessive, driven by motivational forces we find difficult to control...[it] works the same way as other "stimulus-response" disorders in which reward is involved...such disorders are characterized by a high degree of sensitivity to sensory stimuli, and they typically lead to a perceived loss of control, an inability to feel satisfied, and obsessive thinking...
How does conditioned hypereating override the executive control functions of the healthy human brain that should allow us to say no to highly palatable food?
...
Three powerful and interdependent forces engage fundamental neural mechanisms that interfere with executive control: cues, priming, and emotions.
Primed by Kessler's use of the cue word "becomes," you may feel the emotion of wondering how conditioned hypereating develops. However, in chapter 29, Kessler focuses on describing how the disorder works out in practice, rather than detailing the way in which a victim of the disorder comes to be conditioned to hypereat.
Cues, as Kessler originally defined in chapter 6, are sensory stimuli associated with another sensory stimulus. For example, the location in which food has previously been obtained, and events in the environment at the time when food was obtained, can come to be cues for that food in the future. In chapter 29, Kessler identifies the outside of an In-and-Out Burger restaurant as an example of a cue for the food sold within the restaurant:
As I near the restaurant, I'm expecting to see it and thinking about how good a hamburger and fries would taste. At once excited by the thought and uneasy about the action, I start a silent debate with myself.
Yes, today I will stop. No, I shouldn't. Yes, no, yes, no. My continued ambivalence allows me to think of nothing else. [emphasis mine - Ed] Discomfort settles over me, an anxiety of my own creation. If I pull into the restaurant, I can resolve the ambivalence and subdue the arousal. For the moment, my discomfort will disappear.
But I will be putting other forces into play. If I make that stop often enough, my response will become automatic behavior, a habit. At that point, any efforts to suppress it will only intensify the power of the cue.
This narrative begs a number of questions. For one, does this happen with every restaurant he passes on his drive home, or just some of them? If only some cues are salient (that is, standing out from the others), do the salient ones have characteristics that distinguish them from the others? If on the other hand all restaurants cause him this mental response, does he believe that most other people share this conditioned response? Does he think that the majority of the millions of overweight and obese Americans share this level of response? And finally, where did this level of internal dialogue come from in the first place? Kessler does not say.
If his internal dialogue allows him "...to think of nothing else...", one might wonder how "...efforts to suppress it..." (or anything else) could possibly intensify its power? Kessler talks with a clinical psychology professor for more insights:
You're thinking about it and you're approaching it in your mind, and that feeds the affective power of the craving," says Kavanaugh...
"The thoughts become larger and larger?" I asked.
"You get a much more elaborate image. You're aware of taste and smell and size and sensation in your mouth. As you elaborate that and make the image more complex, it becomes affectively more powerful and more motivating."
At this point, one might wonder what makes Kavanaugh so certain that the process that apparently goes on in his head ("...you're approaching it in your mind...you get a much more elaborate image...as you elaborate that and make the image more complex...") is the same one that goes on in Kessler's head ("...the thoughts become larger and larger..."). One might also wonder if Kavanaugh noted the similarity of his description of his mental process to the speech patterns used by hypnotists.
Kavanaugh and Kessler agree that motivating cues -- "I want that" -- conflict with desires for control -- "I shouldn't want it," "I shouldn't eat it." However, resolving this conflict by giving in to the temptation strengthens the association between the cue stimulus and the reward, bolstering the motivating power of the cue each time.
A single small "dose" of a palatable food can trigger a much larger response. Kessler says, "We call that effect 'priming.'" The problem with this definition is that it conflicts with the Wikipedia definition of priming:
Priming in psychology occurs when an earlier stimulus influences response to a later stimulus. For example, when a person reads a list of words including the word table, and is later asked to complete a word starting with tab, the probability that subject answers table is higher than for non-primed people.
What Kessler refers to as "priming" actually seems to be another form of cue, which helps explain a fact that puzzles Kessler:
Although the underlying biology of priming isn't fully understood, the same neural circuitry that responds to cues seems to be at work.
Yes, it's almost as if the EXACT same circuitry is at work in both situations!
Whether called "priming" or "cuing," the idea is that a small stimulus can lead to a much greater response. According to another academic mentioned in the book, a period of abstinence from a cue priming stimulus can increase the effect when one does finally give in. Another thing that can increase the effect of a small dose of food is hunger - according to Kessler, hunger can make almost any food a stimulus for conditioned hypereating. When one is not hungry, however, only hyperpalatable foods are likely to lead to hypereating.
What happens when "priming" leads to conditioned hypereating?
Martin Yeomans at the University of Sussex, in England, has done experiments in which he keeps interrupting people as they eat to ask them how hungry they are. Halfway through their meals some people rate their hunger levels higher than before they started to eat.
At the end of the section on priming, Kessler draws a final distinction between priming and cues: the effect of priming wears off after off after a short time, while cues can threaten for a longer period.
Note: Kessler wraps up chapter 29 by talking about the influence of emotions. Unfortunately, it's late, I promised to have this diary published tonight, and there will be a LOT to say about emotional eating. Since chapter 29 is so long, I am going to continue this discussion in my regular Wednesday evening diary slot. Feel free to comment in this diary, or if you prefer, hang on to your comments until Wednesday, and we can hash it out then - Ed.
Previous chapters from The End of Overeating:
Part 3: Conditioned Hypereating Emerges
Chapter 28: What Weight-Loss Drugs Can Teach Us (reviewed by Clio2)
Chapter 27: Overeating Becomes More Dangerous (reviewed by me)
Part 2: The Food Industry
Chapter 26: Purple Cows (reviewed by Clio2)
Chapter 25: The Science of Selling (reviewed by me)
(there are links to Chapters 14 through 24 in my Chapter 25 review)
Part 1: Sugar, Fat, and Salt
Chapter 13: Eating Behavior Becomes a Habit (reviewed by me)
(there are links to Chapters 1 through 12 in my Chapter 13 review)
Scheduled WHEE diaries:
December 6
Sun AM - ???
Sun PM - Holiday Fit Club - kismet
December 7
Mon AM - NC Dem (A look at your butt...I mean glutes)
Mon PM - ???
December 8
Tues AM - ???
Tues PM - Clio2 (Kessler, Ch. 30)
December 9
Weds AM - ???
Weds PM - Edward Spurlock (Kessler, Ch. 29, part 2)
December 10
Thurs AM - ???
Thurs PM - ???
December 11
Fri AM - ???
Fri PM - ???
December 12
Sat AM - ???
Sat PM - Edward Spurlock (Kessler, Ch. 31)