I find much or most of the debate on the obesity explosion puzzling. Many major American cities are trying to pass laws severely limiting fast food outlets or banning them entirely, blaming them for our increasingly fat population. The sheer violence of the debate (cruise pertinent online discussions and you'll see what I mean) suggests that more is going on here than a discussion of nutrition, but I'll be damned if I can figure out just what, though I will speculate below.
As I've said here more than once, obesity, like most health issues, is more complex than most of us would like to admit. It's about calories but not only calories, and contrary to conventional wisdom, one calorie is like any other calorie…if you're a calorimeter. Sugar calories do different things in the body than fat calories, yet you wouldn't know this trying to get a grip on the problem online. The speed with which I dropped belly fat when I basically gave up sugar was startling. Sleep loss is also a factor, according to the Mayo Clinic. (Alas, the Mayo Clinic still believes in the BMI, which does not distinguish at all between fat and muscle. Ummm…and you guys are doctors?)
I've read a lot of speculation as to what kicked off the obesity epidemic in the midlate 80s. That's when high-fructose corn syrup went mainstream and drove cane sugar out of soft drinks. It was when our high-speed, high-stress always-on culture kicked into high gear and 60-hour weeks became a commonplace. It's when the overall inflation-adjusted price of food fell to historic lows. And it was also the time when something else happened: an explosion of low-end “sit-down” restaurants fielded by national franchises. You see them everywhere: Red Robin, Applebees, Black-Eyed Pea, TGI Friday's, and so on. They are legion. And if you're a true calorie believer, the caloric content of their dishes will take your breath away: One order of Outback's Aussie Cheese Fries appetizer contains 2,900 calories. Even expressed by weight, it is to boggle: A large Maggiano's pasta dish gets you over two pounds of noodles on a 15-inch plate.
Wow.
The tirade against fast-food restaurants is peculiar in that it does not recognize that fast-food portions are generally smaller than those at sit-down restaurants, and more to the point, fast-food items are what old-time IT guys would call “unbundled”: You can get menu items separately if you want them. You can get a single small burger—or a Triple. You can get fries or no fries, and fries in sizes. On the much simpler sit-down restaurant menus, you must get the potatoes with the steak, and the portion size is always…lots. And anyone who says with a straight face that there's more fat in fast food than at casual dining sit-downs is either lying or doesn't get out much.
We didn't go to restaurants much when I was a kid, in part because back then, sit-down restaurants were higher-end, and expensive. We had to dress up on special occasions to go to Llandl's or the Kenilworth Inn in Lincolnwood. The notion of “casual dining” was still pretty uncommon, and probably considered a contradiction in terms by dining purists. (What there was fell into the separately interesting category of “greasy spoons.”) Since 1985 or so, sit-downs went mainstream on a huge scale, as corporate restaurant franchises gobbled up key slots at the corners of megamalls and major intersections. Your average American went from dining out a few times a year to a couple of times a week, with portion sizes that I still find boggling.
My point here is that crucifying fast food as though it were the sole cause of obesity (or even the major contributor) is magical thinking, and has more than a whiff of politics in it. (When reading things like Fast Food Nation I see union opportunism and attacks from the Vega System.) Nothing is ever that simple, and if we keep insisting that it is, no progress will ever be made. It's not about McDonald's. It's about genetics, metabolism, portion control, exercise, sugar, stress, and sleep—and probably fifteen other things, most of which we still haven't defined. Let us not pull the trigger with the wrong guy in our sites, just to be shooting something.
