Monday, September 21, 2009

Health Care Policy Debate

Our discussion of food takes place during a heated health care policy debate. I highly recommend this op-ed piece by Michael Pollan published in the New York Times. Pollan foresees a battle between the health insurance industry and the food industry, a clash of the titans if ever there were one! Here's the link:

Also, here is an email I wrote to President Obama, with copies to Senator John Kerry and Congressman Michael Capuano:

Dear Mr. President,

I am a loyal Democrat who voted for you and supports universal health care. I am a psychologist in the private practice of psychotherapy and almost all of my patients use health insurance.

So you can imagine how disappointed I am when I hear you criticize doctors for making health care decisions for patients based on how much they will be reimbursed by insurance companies. I know that you are commenting on the fee-for-service strategy but you end up insulting doctors.

And when you say these things you sound uncharacteristically ignorant because, first, most doctors are honorable and make decisions based on what their patients require, and second, when you talk about a doctor deciding between prescribing medication or performing surgery, you ignore the obvious fact that the same doctor would not be providing these different services and thus decision making based on reimbursement does not make sense.

One more thing . . . you have spoken a lot about lifestyle changes that would make Americans healthier and cut health care costs, such as quitting smoking, losing weight, and exercising more. However, I have not heard you speak about how these changes are to be accomplished. Clearly, if admonitions by primary care doctors to quit smoking were effective, millions of Americans would have quit years ago. Behavioral changes like these are supported by behavioral health clinicians, mental health providers such as psychologists. Please acknowledge us in the future.

Thank you for your attention and good luck with your efforts to make health care universal.

Maureen McCormick, Ph.D.

Why Aren't We Addicted to Broccoli?

This question about being addicted to food comes up over and over again in my practice, and I hear it in the media very often too. Here's a question that has intrigued me for a long time: why don't we become addicted to broccoli? Why cocaine, tobacco and chocolate?

Let me recommend a book that lays excellent groundwork for a discussion of our relationship to food: The End of Overeating: Taking Control of the Insatiable American Appetite by David A. Kessler, M.D. A former FDA commissioner, Kessler explains how the food industry has figured out how to make the foods they sell as luscious and appealing as possible. Not surprising at all. But food consultants take this a step further - or many steps further - and literally engineer the taste, texture and other sensory properties of food with chemicals. So there are very good reasons why, for example, "you can't eat just one" of just about anything that comes in a package.

So what are those food consultants doing? Are they addicting us to food? Can our brains become addicted to food? Well, yes and no. I've heard dozens of patients swear to me that they feel addicted to food. And we've surely all had the experience of eating something - chips, nuts, cookies - and not being able to put the brakes on. Even when we tell ourselves we have to stop, this is out of control, and we know we are going to feel sick when we finish, we can keep on going to the bottom of the box, wipe out the remaining sugar and salt with our finger, enjoy that last lick, and even wish for more.

It certainly feels like addiction. There are a couple of issues with this stance, however. First, we are clearly not addicted to all food. As much as you might like carrots or apples or tuna, have they ever evoked the same "I just can't stop" feeling you get from a bag of chips? I doubt it, unless you were beyond hungry.

And second, addiction has such a negative connotation that I have always advised my patients to avoid making food the enemy. We have to come to a peaceful coexistence with food. Unlike cigarettes and cocaine, food nurtures us and is necessary for our survival. Further, we cannot expect to eliminate even the least nutritious foods from our diet forever. Even the most health conscious person will have birthday cake, Halloween candy or holiday treats at some point. Unlike illicit drugs, sugary salty fatty food is all around us and is part of mainstream culture. We don't have a Dunkin' Cocaine on every corner or an eager grandma urging us to smoke her special Thanksgiving blend of tobacco!

And yet, we cannot deny the pull of certain foods. Kessler explains that we are not addicted to food, but we can become addicted to sugar, fat and salt. Our brains respond with more pleasure to sugar, fat and salt than to other nutrients. Experiments have demonstrated that animals will work harder to get them and will eat more of them. (Ditto cocaine.) Daily overeating of sugar, fat and salt condition us to eat more and more and more to get the same amount of pleasure.

Now, it may sound that we are doomed to overeating, ill health, obesity and feelings of failure. That's the "half-empty" reading of this piece. The "half-full" conclusion is that we are not overeaters because we lack willpower; rather, we have trained our brains to behave in a certain way. And what can be trained can be untrained.

Read Kessler's book. You won't be disappointed. As we go on, I will explore what we can learn from gastric bypass patients about the brain-food relationship.

Sunday, September 6, 2009


Welcome to my blog. The name GourMind is meant to suggest the intimate relationship between our emotional love of food, our biological need for food, and our attempts to negotiate between the two. GourMind allows me to report on what I read and keep it organized, while also inviting comments from readers.

I spent my first few years of graduate school observing, railing against, hearing criticism for, worrying about, and finally accepting my writing process. It’s primarily a thinking process. I read and think and read some more and fit things together and read and read and read and think and fit and read. Then some internal equivalent of an oven timer goes off – usually shortly before a due date – and I write and write and write and write.

So, without the constraint of a deadline, you may correctly conclude that I have been thinking about writing this blog for quite some time. Here’s what I have been thinking about:

Why is it so difficult to eat well and maintain a proper weight in a prosperous nation?

Why does “I should” so often lose the battle against “I want”?

What can we learn from those who do lose weight and keep it off?

Are we battling our own bodies and brains (because that is certainly what it feels like sometimes)?

What is a craving?

How can we understand the so-called French Paradox? And why are French women starting to get fat? Mon Dieu !

How can we take advantage of the concept of taste satiety to eat a more varied and more healthful diet without overeating?

What can we apply to eating problems from the research on addiction to alcohol and drugs?

What can we learn from those who have had bariatric surgery, especially from the 12- to 24-month “honeymoon period” after gastric bypass?

I’ll approach these questions with the curiosity of a journalist and the tools of a Ph.D. in psychology. I’ll include anecdotes and describe trends from my clinical practice. And I’ll contact researchers for their input as well. Some of the rock stars in my psycho-neuro-cuisine iPod are Nora Volkow, Kelly Brownell, Wolf Singer, Antonio Damasio, Julia Child, Thomas Keller and Ana Sortun.

Using a multidisciplinary approach, I intend to use the GourMind blog:

to summarize and clarify the state of the art research in the neuroscience of appetite, the experience of taste satiety, the portability of the French Paradox, the workings of the diffuse enteric nervous system, and the neuropsychological effects of bariatric surgery

to raise questions for research that will fill the gaps in our current knowledge

to translate these findings into useful tools for the daily life of the omnivore in a toxic environment

I anticipate an interesting and delicious journey.