counter that the arkin have the pediatrician or i could think through maybe we could go to the schools or two parents and really change the way they're dealing with kids. we can change the incentive structure. lot of schools got budget cuts what do they do? get rid of gm and after-school activities. a very bad the situation. we have to empower the health-care system to think innovatively about how to help us be healthier as well. parts of the thinking going into our plan is to try to do that or create the incentive structure that will make that possible. thank you very much [applause] >>10 -- . ..

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david kessler former commissioner of u.s. food and drug administration explains how american bodies and minds have been reprogrammed by too much sugar, salt and a job. politics and prose bookstore in washington, d.c. hosted this event. it lasts about one hour. >> it is very special to be here at politics and prose. to carla and barbara, the owners, the fact is this is without doubt my favorite bookstore and the whole world. [applause] there's another reason why this is so special. and for those of you who are not part of the food and it drug administration who are here, indulge me if you would.

this is a very special week and there are very special people here that i have had the privilege to work with and as you just heard the united states congress voted 79 months amateurs in the affirmative and 307 members of the house of representatives in favor of fda regulation of tobacco. there are people here, i can't name all of you who spent much of your adult lives working on this and my hat goes off to all of you. thank you for what you have done. [applause] let me tell you the journey tobacco took 15 years since the

day we started it took 15 years to get where we are, and along that path it's a long time and but if you're unwilling one of you in the audience i still remember to this moment we went around the table and i asked people what they thought and you heard what you would expect to hear, it's the big money, it's political suicide. yes, it's the right thing to do. but if you do with its quick to take all the energy and everything you have and then one of you looked at me and said if you're willing to take on tobacco i'm willing to spend dressed of my career working on this. that taught me more than anything else one could imagine. and along the way in the 15

years you will excuse me but we had the opportunity to do a couple of other things while tobacco was cooking many of you continue to work on it very hard. i was sitting in my office about 17 years ago and was at yale with a group of residents and fellows and having learned from tobacco and having left that i asked a very basic question. what do we know -- what is the evidence if you want to stay alive what are the things you can do to prevent diene from the major killers, and three-quarters of costs are going to die from cancer, heart disease or stroke. and tobacco is easy. the number one preventable cause certainly when we started the number one preventable cause one today but what are the other

things you can do when you look at cardiovascular disease, stroke, and certainly many forms of cancer when? i noticed something, we are pulling all of the articles i had this library and at yale helping me pull all the articles and i noticed that along the way as she was doing this over the three month period she lost 30 pounds. [laughter] because all the articles on prevention -- we know that excess weight isn't good for us but it was striking, the contribution to health. and just one whoa, very basic numbers. ten years ago there were four cases per thousand of type two diabetes. four cases per thousand. today, there are nine cases per thousand. we spent, in 2000, $7 billion on

drugs for diabetes ii. today we spend $13 billion. diabetes type to i could write excess weight in the medical chart because that is the mechanism that contributes mildly to the disease. we all want health reform. no one in this town is not talking about health care reform, but how are we going to be able to get a handle on these costs when we can't get a handle on something as basic as excess weight? what's going on. i asked my friend, kathryn, at the center for disease control now has weight change over the decades, a little weight? tell me that in the 60's was going on and what's going on today and what was different and when she sent me the draft when you saw and what i saw was back in the 60's you entered your 20s

and you may gain a few pounds until your forties and fifties but are relatively stable. a few pounds and then you plateau and then you lost a few pounds and you're 60's and 70's and in your senior years. the wait is relatively stable over an adult lifetime. today, you entered your adult years and the weight keeps on rising. certainly on till you're 50s it doesn't plateau but what is the most striking is when you enter your 20s back in the 60's if you were here, today you're entering your 20s. so as with tobacco, excess weight really does begin in childhood and adolescence at least for a significant part of the population. about what to do about this, don yet and exercise, if it were everybody would be doing.

so i started trying to understand why was this so difficult? why couldn't we get a handle on it? what was going on in this country and that has been the journey the last seven years. so one my time watching the daily rerun of oprah. [laughter] and by listening to this woman very well-educated, very well-dressed and successful in all aspects of her life. and she was being interviewed by dr. phill. don't get me started on dr. phill, please. [laughter] that i was listening to this woman and what she said was i eat when my husband leaves for work in the morning. i eat before he comes home at night. i eat when i happy. i eat when i'm sad. it when i'm hungry. i eat when i not hungry, and in

that moment she said i don't like myself. so i was sitting there listening and trying to listen as a clinician, as a doctor because i don't think that we as a medical profession than thinking or doing the research to understand why was this woman successful in all aspects of her life, doing things that she didn't want to be doing and doing it in any way knowing that it wasn't good for her? what was going on? what was going on clinically, what was going on scientifically and how was the journey the last seven years of wanted to understand so with colleagues a number of great institutions, let me give you four pieces of the science. and then try to put together this proposal, this mystery. why does that chocolate chip cookie have such power over me? that really is the question.

i could relate to the woman on oprah. i have suits in every size and i probably gained and lost my body weight over my lifetime several times, over. what was going on with that woman? colleagues at the university of washington published an article recently bought the typical scientific title for a scientific journal, it was called to constructing the fun a la milkshake. [laughter] what do you think it is about a vanilla milkshake that drives and take? the sugar, the fact, you think it's the flavor? how many of you think it's the sugar? raise your hands. how many of you think it's the fact? how many of you think it's the flavor? let me tell you how we actually did the experiment. very simple experiment because we wanted to know what drives intakes of how do you measure that in animals and humans? well, in animals but we were

looking for was how hard an animal would work to get their food. by that you understand because that test called self administration, that's the test that the fda used to control substance but the question is how hard the motivation, how hard will an animal works when you do is give them the food that makes them press twice then give them the food than waste they have to press for times, then they have to press 16 times before they get it and 32 times and 64 times, 128 times before they get food so you get a sense of what the break point is. what do you think they will work the hardest for? the answer is sugar. sugar was the main driver but when you add to the sugar you add fact it's synergistic. second piece of science.

with my colleagues and italy one of the great pharmacologists he has indicated his career to understanding how drugs highjack the brain. he studies amphetamines, cocaine, and what we know is when you add minister the drugs like amphetamines and cocaine were you see is a bump in the brain's circuitry involving fat amine. tuzee this elevation in dopamine and dopamine is the chemical responsible not for pleasure it means responsible for locking in our attention, that preoccupation. it engages the circuits of what you end up thinking about. and what gitano found working with him, we were working together, i said let's test food.

it was always assumed drugs elevate dopamine levels. food you get a bump the first time but then you don't get the ball. i said let's make food, let's not just take sugar but let's make food highly palatable. multi sentry mixture and what happens to dopamine? and gitano, i remember the e-mail the subject line was important results. dopamine continues to be elevated every time you make food you take sugar and fat together rather than just sugar you get elevations in the brain dopamine on a repeated basis. it doesn't habituate. third piece of science i want to know how many people, i want to understand this woman on oprah what was on a hearing and how common was that in the

population? that me give you three characteristics. let me describe them to you. first is loss of control in the face of highly palatable food. a hard time resisting favorite food. number two, lack of space station, lack of feeling full when you're eating, a hard time stopping. third, preoccupation, thinking about food between meals. sometimes thinking about food when you're eating, as your eating your thinking about what you are going to be eating next. [laughter] sort of bizarre but the characteristics, loss of control in the face of highly palatable foods, like association or preoccupation, thinking about food. those three characteristics. sometimes i say that to people and there is a small percentage of the population who have no idea what i'm talking about. they look at me with absolute

blank stares. those are the people i feel we should be studying. [laughter] those are the ones that are the most interesting scientific. but we look at the epidemiology and with my colleague what we did is looked how many people self report those characteristics, and we found 15% of the obese individuals, 30% of overweight individuals and 20% of healthy weight individuals scored very high on all three characteristics. so certainly more people who are bigger have those characteristics but a significant percentage of people have those characteristics and if you extrapolate and there are risks of extrapolation that turns out to be some 70 million americans who self report loss of control, lack of space station or preoccupation

thinking about foods. last piece of science and this is the most interesting. we took those individuals who have the constellation of characteristics, what we call condition hyper eating because those are the characteristics of a conditioned and driven behavior. and we study them and we study the bureau imaging. we designed the experiment and to phase is to read the first is the anticipation if we are not eating, the power of food comes from what? from the taste? yes, but it's also the anticipation of food. every time on a land at san francisco, every time the plane hits the taxi way i start thinking about these chinese dumplings. [laughter] the plan has to land in the taxi

and i start thinking this place in the food court has these -- if i could only make it to the baggage claim it is out of my working memory. and i'm walking down the street in san francisco and start thinking about chocolate covered pretzels. why? because six months earlier i had been on that street, powell street and i went into a place and why it forgotten all about it but just the location, that fought entered my mind and of those thoughts of wanting so we did in this experiment is we took people who have loss of control, cc asian and preoccupation with food and scanned their brain. first we cued them, we just gave them the smell. you can give them the smell, the site, sometimes the location, just getting in your car can be

a cue. the car drives -- because you've driven past and once you get in the car you start thinking about what you're going to eat because you've been there. there's always a past experience that drives that anticipation that the first part of the experiment is we cued people and we saw people that had these three characteristics, the condition hyper eating syndrome. it is not a disease but it's very much a normal part of our new make out. what we saw is the people that have this condition have hyperactive asian during the anticipation phase in the edna padilla and reward pathway in their brain and was pronounced and what we further salles is when they act like consumed the food and tasted the food that elevation which we always

thought, had a -- the nero pathways remained activated and will hyperactive feet until all the food is gone. so for the first time we have evidence. certainly evidence is emerging was that lack of control, hard time resisting it's not a matter of willpower. literally the brains of millions of people are being hijacked by this highly palatable food. let me put it together. "the washington post" -- "the washington post" outed me because i wanted to know -- i want to understand the science but i also wanted to go inside

the industry. and we worked at the fda, and number of you together, we worked -- you know that nutrition facts panel that we worked on, someone in the food industry said to me kessler, the obesity epidemic is all your fault and i looked at him and i said what are you talking about? he said you folks at the fda were so successful with that nutrition facts panel you kept some of check on what was being put in the food supermarket. what happened was exploded in restaurants and that's when the real problem lies. they know, the food industry knows what the inputs are. they understand the outputs. fat and sugar, fat, sugar, and salt, they fought with the three points of the compass, but they

stimulate, they stimulate intake. i thought i was eating two felmy op. tuzee seagate, fat and sugar, fat, sugar and salt stimulate intake. they make you work harder. it's not just conditioned behavior, it is conditioned behavior. you can tell what is on processed food in the supermarket you can see the label but to go into a restaurant and try to understand but is in there so i went dumpster diving for about six months because it is not easy to find out when you just ask the major chains what's in the food and even for me as a physician -- i was in charge of regulating food, it was all i opening. the grilled marinated chicken, we think it's healthy. it's based in sugar and fat syrup. our food is injected with

needles. pick any -- any favorite american negative. pick an appetizer. pick buffalo wings. what are they when you think about it? >> it's the fatty part of the chicken fried in a manufacturing plant, rafer ayaan de restaurant the red sauce, what is it? fat and sugar. the white creamy sauce, fat and salt. schumer, it tastes good. what is it? fat on fat on fact, sugar on fact. i could go through an entire basket. the food industry said all we are doing is giving consumers what they want. that's the argument.

he we now know what is going on as our brains are being hijacked. let's put this together clinically so everyone understands the cycle of consumption. how does it work? past memory, past experience is. that learning, the learning circuits of the brain get activated so you get queued. dennett que activates the brain circuitry and arouses you, it grabs your attention and locks you and and then you consume the food and then the next time you get queued what do you do? you do it again and every time you engage in that cycle, you strengthen the nero circuits and come back for more. so you all remember path of, you understand the condition behavior's but this is more than conditioned behavior is and this

is the science of the last decades. it's conditioned and driven behavior because it's not just learning circuits. it's the learning and motivational circuits. try to stop that cycle in the middle. that inner dialogue. once you have been queued in your brain is activated that inner dialogue, yes, i would love it, no, it's not good for me. yeah, that would be good and no, i shouldn't have it. that dialogue, it only increases the reward value of the food. you try to stop it and this is the difference between conditioned behavior, you try to stop and suppress that fought and increase the report value of the food and in that wanting it more and that's the stuff of obsessions and cravings. what has been the business plan? what has been the business plan of the modern american food company?

it is to take fat, sugar, and salt, put it on every corner and make it available 24/7 and make it socially acceptable to eat any time of day. how did the french control and take? devah always had highly palatable food. what is the difference? >> [inaudible] >> the culture, right? >> [inaudible] -- there's external control on human nature we're here has said satiates the appetite more. >> so what we have done is taken down barriers because you can eat any time, because it is socially acceptable. the french, the canadians, too, when i was growing that we tended to eat all meals, we didn't slack to lead chris mackall they longbow but what is

happening now is that, sugar, salt available 24/7, and it is acceptable. the social norm to eat any time, you could be sitting here reading and no one would think any different. i was invited to talk to a major food manufacturer and i said let me give you a comparison and we have to be careful with comparisons with tobacco but let me see if i can explain how this works. nicotine. nicotine is a moderately reenforcing chemical. if you look at humans and how it works, nicotine is moderately reinforcing. add to that nicotine the smoke. the throat scratch, the crinkling of the pack, the color of the pack, the imagery the industry created for become 40 years that was sexy, glamorous to smoke.

the image of the cowboy way that you need it. the time of day. what took a reenforcing chemical and made it into a significantly addictive and deadly product. i give you a package of sugar and i say have a good time. [laughter] you're going to look at me what are you talking about. add to that sugar fact, texture, temperature, add color. put it on every corner. say you're going to do it with your friends, say its entertainment. had the emotional advertising. you will love it, into the food courts at union station. watch the kids -- it is a few carnival. of what do we end up with? av reinforcing substance, and we have made it into one of the great public health crises of

our time. we now know we have the evidence that millions of americans are being hijacked by sugar, fat, and salt. the industry understands the input, they understand sugar, fat and salt stimulate, they understand the outputs, the understand people come back from more and they understand neuroscience but they understood what works. once we have the evidence what are we going to do? does the food industry need to change? op simply. does the government have an increased role? absolutely. the implications, school lunch programs, the subsidies, advertising. but just because our brains are being hijacked mechanics brinton the woman on oprah and millions of people it's not your fault but just because your brain is being hijacked doesn't mean you can't take responsibility and