Episode 58

From Starving to Stuffed

Published on: 19th November, 2024

From Starving to Stuffed: The Evolution of Obesity in America

The rise of ultra-processed foods in the United States closely parallels the surge in obesity rates and increased caloric intake observed from the 1980s onward. Starting in the 1970s, shifts in food production and consumer habits paved the way for these foods to become dietary staples, ultimately contributing to the obesity epidemic we see today. Let’s explore how these changes unfolded and their direct link to America’s rising weight problem.

1970s: Setting the Stage for Ultra-Processed Foods

In the 1970s, the food industry underwent dramatic changes that laid the groundwork for the proliferation of ultra-processed foods.

  1. Economic Shifts and Agricultural Policies
  2. In 1973, new agricultural policies began to encourage farmers to produce more crops like corn, soy, and wheat. These policies made ingredients, particularly high-fructose corn syrup (HFCS) from corn, much cheaper for food manufacturers to obtain (Nestle, 2002). As a result, companies could produce food more cost-effectively and in larger quantities, leading to affordable, calorie-dense, ultra-processed foods.
  3. Rise of Convenient Snack Foods and Fast Food
  4. At the same time, the popularity of fast-food chains and processed snacks grew. Brands like McDonald's, Coca-Cola, and Frito-Lay expanded their offerings and marketed these convenient, hyper-palatable foods to the masses. They loaded these products with refined sugars, fats, and additives to enhance flavor and shelf life, making them hard to resist and easily accessible.
  5. The “Diet” Food Craze
  6. The 1970s also saw a surge in demand for high-protein diet products due to growing concerns about carbohydrates. Low-carb became the flavor, and at any given time, 10% of the country was on low-carbohydrate diets. Ironically, these “diet” foods often contained as many or more calories as regular options.

1980s: Ultra-Processed Foods Take Center Stage, and Obesity Rates Start to Climb

By the 1980s, ultra-processed foods had fully embedded themselves in American diets, creating a foundation for the obesity epidemic.

  1. Processed Food Production Surges
  2. Food companies expanded their product lines in the 1980s, launching a wide range of snack foods, frozen meals, and sugary drinks. These foods were not only inexpensive but also tasty, thanks to the addition of refined sugars and fats, as well as preservatives to prolong shelf life (Monteiro et al., 2013). Marketing highlighted their convenience, appealing to busy families and individuals.
  3. Caloric Intake Climbs
  4. Alongside the rise in ultra-processed foods, average daily caloric intake also increased. Between the late 1970s and early 2000s, Americans consumed over 200 more calories per day. This rise came largely from high-calorie processed snacks and sugary drinks that were easy to consume between meals (Wright et al., 2004).
  5. Obesity Rates Begin Their Upward Trajectory
  6. During the 1980s, obesity rates started climbing. From 1980 to 2000, the obesity rate in U.S. adults jumped from 15% to 30% (Flegal et al., 2012). Children and teenagers weren’t spared either; childhood obesity rates nearly tripled, aligning with the increased availability of ultra-processed foods.

1990s: Fast Food and Convenience Foods Dominate the American Diet

The 1990s brought even more ultra-processed foods, solidifying their role in the American diet.

  1. Fast Food Reigns Supreme
  2. Fast-food outlets exploded across the country in the 1990s, offering cheap, calorie-dense meals that were easily accessible. These chains embraced supersizing, encouraging customers to choose larger portions for just a small price increase. As a result, Americans began consuming more calories per meal, often in ultra-processed fast food.
  3. Sugary Beverages Become a Staple
  4. Consumption of sugar-sweetened beverages (SSBs) like sodas and sweetened teas, also skyrocketed during this decade. Many of these drinks relied on HFCS, delivering a heavy dose of empty calories without satisfying hunger. Studies show that sugary drinks don’t curb appetite the same way solid foods do, leading people to consume extra calories without feeling full (Malik et al., 2010).
  5. Caloric Intake Peaks
  6. By the end of the 1990s, Americans’ average daily caloric intake had reached new heights, with ultra-processed foods making up a significant portion of the diet. Research indicates that nearly 60% of Americans’ daily calories came from ultra-processed foods by the late 1990s (Monteiro et al., 2013). The rise in these calorie-dense, low-nutrient foods is directly correlated with increasing body weight and obesity rates.

2000s to Present: Ultra-Processed Foods and the Obesity Epidemic

As we moved into the 2000s, ultra-processed foods remained a dominant force in the American diet, pushing obesity rates even higher.

  1. Obesity Reaches Public Health Crisis Levels
  2. By 2020, nearly 42% of American adults and 20% of children were considered obese (Hales et al., 2020). Studies have consistently linked this trend with ultra-processed foods, which are designed to be “hyper-palatable” and, thus, difficult to resist. Their addictive taste profile has fueled a snacking culture, where more people consume larger portions and eat more frequently throughout the day.
  3. Calories from Ultra-Processed Foods Remain High
  4. Research shows that 60-70% of the average American’s daily calories now come from ultra-processed foods (Juul & Hemmingsson, 2015). These foods are often low in fiber, protein, and essential nutrients, which leaves people unsatisfied and more likely to overeat. Additionally, foods high in refined carbs and sugars cause blood sugar spikes and crashes, leading to frequent hunger pangs and cravings.
  5. The Health Toll Beyond Obesity
  6. Ultra-processed foods haven’t just contributed to obesity; they’ve also been linked to type 2 diabetes, cardiovascular disease, and certain cancers. Their high-calorie density, poor nutritional profile, and use of additives have been shown to negatively impact health, making them a major public health concern.
  7. Efforts to Combat Ultra-Processed Food Consumption
  8. Despite public health campaigns promoting whole foods, ultra-processed options remain attractive for many Americans due to their affordability and convenience. In many low-income areas, they’re also more readily available than fresh, whole foods, perpetuating health disparities.

Conclusion: Ultra-Processed Foods and America’s Obesity Epidemic

Since the 1970s, the rise of ultra-processed foods in the United States has closely tracked with an increase in calorie consumption and obesity rates. As companies produced more of these convenient, highly palatable foods, Americans’ eating habits changed, leading to greater calorie intake through frequent snacking, sugary drinks, and supersized portions. The dominance of ultra-processed foods in the diet has not only contributed to rising obesity rates but also to an increase in related health issues like diabetes and heart disease.

Although efforts to reduce ultra-processed food consumption continue, their deep-rooted presence in American culture and food systems makes reversing the trend challenging. For a healthier future, we need a multifaceted approach that includes improved access to nutritious foods, public health policies, and greater awareness about the risks associated with ultra-processed foods.

References:

  • Malik, V. S., et al. (2010). Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care, 33(11), 2477-2483.
  • Monteiro, C. A., et al. (2013). Ultra-processed products are becoming dominant in the global food system. Obesity Reviews, 14(S2), 21-28.
  • Nestle, M. (2002). Food Politics: How the Food Industry Influences Nutrition and Health. University of California Press.
  • Hales, C. M., et al. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief, (360), 1-8.
Transcript
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>> Dr. Terry Simpson: M Today we're tackling a topic that's as big as the

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problem itself. Obesity in

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America. How did starving in

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the Mississippi Delta in the 1960s to

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a nation grappling with an obesity

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epidemic. It's a fascinating story

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of policy, agriculture, culture itself and

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food science. So grab a fork and or a

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notebook and um,

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I am your Chief Medical Explanationist, Dr. Terry

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Simpson and this is Forku

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Fork University where we make sense of the madness

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in this case of obesity in America and bust

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it away.

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In the early 1960s America faced a

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shocking paradox. The land of plenty was

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also home to profound hunger.

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Images of children in the Mississippi Delta

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shocked the nation. Hunger wasn't just an

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abstract concept. It was a grim

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reality, especially for marginalized

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communities in rural America. Not only the Mississippi Delta,

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but also the Appalachians

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presidential campaign. In 1964, President

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Lyndon Johnson declared a war on

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poverty which included efforts to address

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malnutrition through uh, programs like food stamps and school

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lunch initiatives. These programs were life

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saving for many but

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scratched the surface of a much larger

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issue systemic inequality

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in food access.

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Forward to the 1970s where a different

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problem was brewing. Richard Nixon Secretary

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of Agriculture transformed

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how America produced food.

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Butts mantra was get big or get out.

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And farms shifted to monocultural crops

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meaning corn, soybeans, wheat, all

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heavily subsidized by the government.

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This surplus of cheap

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ingredients that became the building blocks of

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ultra processed food. We had

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ultra processed and highly processed food in the

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1960s and it consumed 6 to 10% of

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our diet. But now we had an

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abundance. High fructose corn

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syrup, hydrogenated oils and refined flours

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flooded the food supply making the

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ingredients for calorie dense nutrient poor

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products that became affordable and

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accessible. More so than ever,

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what started as a solution to hunger

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inadvertently laid the groundwork for

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obesity. Enter the age of abundance.

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By the 1980s, portion sizes in

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America began to balloon. Fast food

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chains eager to attract customers larger

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servings for just a few cents more. A

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strategy known as value marketing.

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This trend extended to sit down restaurants,

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uneven home cooking. What used to be

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a reasonable portion became a laughingly small

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compared for example the

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typical hamburger at McDonald's was about

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two and a half ounces. The

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Junior Whopper today is

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about double that.

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Meanwhile, ultra processed

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foods that were packed with sugar, fat and

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salt began to dominate the shelves.

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These foods weren't just cheap, they were engineered

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to be shelf stable, hyper palatable.

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Meaning they really taste good and

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almost impossible. You

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remember the Lay's potato chip ad from the 1970s?

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I bet you can't just eat one. The

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combination of bigger portions and calorie

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dense, nutrient poor foods begin

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the process of obesity.

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Waistlines expanded and although at this time, and

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not as much as they have become, so did the

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backlash. The low carb movement, championed by the

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likes of Dr. Atkins, promised weight loss by

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cutting out carbohydrates. Now the

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trick is that the term generic

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carbohydrates, he was mostly referring to

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junk food as opposed to fruits,

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vegetables, beans, whole

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grains, all of which aren't junk food, but a part

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of a healthy balanced diet that are made of predominantly

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carbohydrate, which do not tend to contribute to

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obesity. So while this low

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carb approach was effective for some, the

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diet often led to an increased consumption of calorie

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dense meats and fats, potentially

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undermining its benefits for calorie.

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Meaning people who bought into the

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low carb education

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believed that meats and fats did not produce

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fats and they were themselves in fact diet

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foods. Nothing like a, ah, 1200

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calorie thinking it's a diet

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food. On the other end of the spectrum,

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vegetarianism gained traction partly again as

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a response to the environmental and health concerns tied

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to industrial agriculture. So by

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focusing on whole food plant,

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vegetarians attempted to counteract the over processing

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of the modern diet. Both movements were

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reactions to the rise of ultra processed foods. But each

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had its own challenges in addressing the obesity

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epidemic holistically.

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The obesity epidemic isn't just a matter of

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personal choice. It's deeply intertwined

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with industrial practices and cultural norms.

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Addressing it requires more than just telling people to eat

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less and move more. It demands systemic

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from reforming agricultural subsidies to

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redesigning our food environments to make us easily

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have more available, healthier choices.

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But on an individual level,

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awareness is the key. Understanding the

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history power us to make

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more informed choices.

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But hope also has arisen, as you know, because among the

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obesity epidemic sciences introduced one

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promising new tool besides surgery,

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which are uh, the GLP1 receptor agonists

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were first introduced in 2005 by

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the brand name of Baeda, which was

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predominantly used for type 2

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diabetes because they proved

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remarkably effective in helping people

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manage their diabetes by

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decreasing insulin resistance. They did it by two

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mechanisms. They increased the production of

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insulin by the pancreas and

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they increased sensitivity of insulin

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from the tissue cells. What scientists

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know producing these drugs to patients with

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diabetes is that these patients started

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to lose weight. And weight loss, as

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you might think, is a remarkable option.

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The next generation of glp, uh, receptor agonists, you know

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the names of Ozempic, Zap

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found or Mounjaro. They also

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began to come in and it showed remarkable

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in diabetics that they were losing weight. So they

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began to test them, um, on people who were simply

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overweight and with amazing

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results have now become

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introduced. So how do they work?

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As you know, GLP1 stands for glucagon. Like

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peptide 1, it's a hormone that plays a

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role in regulating appetite and digestion. They mimic the

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action of actual GLP1, that

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which slows down gastric emptying, signaling, uh,

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your brain that you're full. So normally

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Your body makes GLP1 when it says, all right,

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we've had enough to eat, we're getting some food here,

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so we're going to slow down digestion so you're going to feel

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full. So works in the

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brain, it signals the brain that

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you're full. It is that head

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hunger that gets shut down when you

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eat food. Now here's what's

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fascinating. The GLP one

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lasts just a few minutes,

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but oftentimes these cells, which are

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located in the distal part of the small intestine, are

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destroyed by bacteria.

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Bacteria that happen to thrive in an environment

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of ultra

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foods. Now there's a lot of speculation of

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what I'm going to say now, but we do know the following

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facts for certain Certain bacteria

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clearly destroy the cells that make

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GLP1. And

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certain fibers like

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inulin allow those cells

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to thrive. Inulin is found in things

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like Jerusalem artichoke, chicory,

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etc. Also another group of fibers

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called beta fructans, which are found in whole grains

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and bananas. Cells to thrive while

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the ultra processed foods change the microbiome to bacteria

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that actually kill those cells. Let's get

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back to medication. These

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medicines blunt

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food noise or what we call the hedonic

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drive. You're seeking almost

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compulsive craving for ultra processed

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foods. Bet you can't just eat one.

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So while we like to think that big food is

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tricking our brain into the reward system,

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they simply discovered that

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salt and sugar and fat

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together, you are going to love it, especially with

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flavor. I mean, consider the book called the Dorito

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Effect, where we know that a Dorito has a lot more flavor than

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bland chicken. That's also why

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you can play through a bag of chips or a

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pint of ice cream without even realizing it.

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There's no fiber to stop you. You have that hedonic effect. But

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the GLP1 medications break this

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cycle. By reducing or blunting the

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brain's response to these foods, they

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enabled to regain control

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over their eating habits. So what's

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revolutionary about the GLP1 medications is how

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they're helping shift the narrative around obesity.

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For years, obesity was framed as a failure of

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willpower, even though those who studied

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myself and the AMA declared it a

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disease as early as 2013.

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These medications underscore the biologic

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underpinnings of obesity, showing that it's not

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just about eating less or exercising more, it's

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about addressing the in

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our bodies and brains that drive food

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intake. For many,

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GLP1s are creating a, uh, window of

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opportunity. People who once felt powerless

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against their cravings are finding it easier to make

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healthier choices, not m only to lose

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weight, but sustain those

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losses. This isn't a magic

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bullet. These medications

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clearly in clinical studies, work best when

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they are combined with diet and lifestyle

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against a problem that's decades in the

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making.

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Imagine realizing that you need

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to eat the pint of ice cream. A taste is enough.

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Redesigning your relationship and

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the lifestyle changes by eating more foods

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that contain fiber and contain the fibers like

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inulin and beta fructans. Allow your

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own natural GLP1s to

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repopulate.

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Now, between

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allowing your natural GLP1s to Repopulate

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to not needing the medications.

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And I want you to frame it in your brain this way.

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We want you to build a healthier relationship with

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food. We want you to enjoy whole.

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We want you to realize that grains are not the enemy.

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Whole grains actually reduce obesity, et cetera. Refined

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grains are, ah, not necessarily the problem, but they can be.

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But the closing message is this.

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You didn't gain the weight because of high fructose corn

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seed oils. You gained the weight because all of these

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things were processed together in uh, a tightly wonderful

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package that tastes delicious. But some

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ultra processed foods are quite good for you. Take whole grain

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bread. It's actually quite healthy.

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All ultra processed foods together.

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But with GLP medications, we are seeing how science can

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help counteract the damage caused by decades of ultra

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processed foods and oversized

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portions. And it's a reminder

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that solutions aren't, uh, just about an

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individual effort. They're about

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understanding the systems that created the problem

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and leveraging modern medicine to help reverse

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that trend. That's the promise and

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the challenge of the road ahead.

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Thank you for joining me on this episode of Forku.

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You can find references for this in my blog, which

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is@ah, yourdoctorsorders.com and

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forku.com so if you like

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today's discussion about obesity, ultra processed food

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and medications, hopefully it's given you something

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to chew on. Please be sure and share and

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describe. And always remember, your

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fork is a tool. It's not a weapon.

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Use it wisely. I'm

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Dr. Terry Simpson, and while I a

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doctor, I am not your medical

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doctor. If you seek to have GLP1

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medications, I'm not the guy to ask about them. I would

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ask you to please find a board certified

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medical physician who specializes in obesity

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medication. Plenty of doctors selling plenty of

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little GLP one like things out there which may or may not

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be good for you. So that's why I

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advocate people go to someplace like Accomplish Health, who, by

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the way, has not paid for that endorsement.

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Today's podcast was distributed by our

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and the pod God, Mr. Evo

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Terra. Thanks for listening, everybody. Until next

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time, enjoy your food, don't feel

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guilty, and if you need help, find a good board

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certified physician to ask for it.

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Hey, Evo, you know what I like about the new

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GLP1 medications? I like that we're

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empowering people to have a

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way forward with their fork.

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I kind of think it's fun.

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So here's the thing, doc. You gotta stop

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trying the, uh, food wordplay.

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It just makes me dig deeper into bags

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of ultra processed, uh, potato chips.

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You're not helping my problem.

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About the Podcast

Fork U with Dr. Terry Simpson
Learn more about what you put in your mouth.
Fork U(niversity)
Not everything you put in your mouth is good for you.

There’s a lot of medical information thrown around out there. How are you to know what information you can trust, and what’s just plain old quackery? You can’t rely on your own “google fu”. You can’t count on quality medical advice from Facebook. You need a doctor in your corner.

On each episode of Your Doctor’s Orders, Dr. Terry Simpson will cut through the clutter and noise that always seems to follow the latest medical news. He has the unique perspective of a surgeon who has spent years doing molecular virology research and as a skeptic with academic credentials. He’ll help you develop the critical thinking skills so you can recognize evidence-based medicine, busting myths along the way.

The most common medical myths are often disguised as seemingly harmless “food as medicine”. By offering their own brand of medicine via foods, These hucksters are trying to practice medicine without a license. And though they’ll claim “nutrition is not taught in medical schools”, it turns out that’s a myth too. In fact, there’s an entire medical subspecialty called Culinary Medicine, and Dr. Simpson is certified as a Culinary Medicine Specialist.

Where today's nutritional advice is the realm of hucksters, Dr. Simpson is taking it back to the realm of science.

About your host

Profile picture for Terry Simpson

Terry Simpson

Dr. Terry Simpson received his undergraduate, graduate, and medical degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. Until he found he liked people more than petri dishes. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2018 and 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.”