Episode 382: The Trial of Big Food

24:38And why is that such a problem? Yeah, I don't actually think that we have a super clear understanding on this just yet. I think if you ask Dr. Hall that, who I've heard him be asked this type of question, he finds it super intriguing and there are some hypotheses and some ideas, but we still don't have a perfect understanding of this. To the extent we do have some ideas, it can inform some potential ideas for things that we can do, mainly in the realm of what's called food reformulation, trying to make products that do hit these satiation centers and things like that. Of course, the challenge then is, well, what's the incentive for food companies to do that, to make foods that are more fulfilling and satisfying that people are going to consume less of?

25:17But we know, for example, that when there's less bulk fiber, water content, of course, there's less of that mechanical stretch that's going to happen in the stomach and downstream hormonal signaling. If there's foods that even melt in your mouth, then don't even require chewing. We know that people tend to spontaneously consume more calories from, you know, sugar-sweetened beverages that go down quick and easy and are tasty and carbonated and cold and things like that compared with, you know, other forms of equivalent calorie intake. And then, yeah, all of this downstream hormonal signaling, we can see a lot of these things when they are measured.

25:51Not all of them show meaningful differences. Some of them do. And then the question is, well, how much of a role are these even playing? Is it kind of an epiphenomenon? Is it happening at the same time, but not driving the difference in intake? Or is it actually driving the difference in intake? And so that means that that should be a target for intervention. So I do not have a confident answer for this, and I don't actually think that anybody does. That's why Dr. Kevin Hall's research was so useful and important and why it is so unfortunate that he is not currently doing any more of that research by virtue of having been kind of pushed out of the NIH this past year.

26:24But that is a prime area for us to get better understanding. And then from there, we need to, you know, on a different level than setting up the food environment for people, we almost need to set up the business environment for companies to be able to spontaneously formulate foods that achieve the health goals that we're looking for for the public. There are so many layers of complexity there and policy there that are well beyond our expertise, but it's an interesting way to think about it. It's like we need to identify these variables, figure out which ones are most potent in terms of achieving the impacts we're looking for, and then set up that business environment so that it becomes the natural, rational path of least resistance for these companies to make the products that are compatible with our public health goals.

27:06Yeah. Yeah, that's actually, that raises an interesting question for the lawsuit against big food. Because the food industry's defense isn't just, hey, look, we make tasty food. Their defense is that they're simply following the rules. They're meeting every USDA and FDA guideline for shelf-stable, fortified, and convenient foods. But if our regulatory bodies don't even recognize the food matrix and the satiety profile of foods as important variables, Are the companies the villains or are they just taking the most efficient path in a flawed game? Now, we're going to take a quick break to hear from our sponsors.

27:38But when we come back, we're moving from the intent of the manufacturers to the physical toll on the consumer. We're going to look at the 14 percent of adults who meet the criteria for food addiction and the hard data on just how much this flawed game is hurting us. Stick around. This podcast is brought to you by Biggs. At Barbell Medicine, we spend a lot of time talking about what it takes to build a body that can handle high-level performance, but the recovery and health side is just as critical. Over the last six years, an incredible team of healthcare professionals did something that most people thought was impossible.

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29:13And the data suggests that they aren't exaggerating. According to research by Gearheart in 2022, 14 % of adults and 12 % of children now meet the clinical criteria for food addiction using the Yale Food Addiction Scale. This scale applies the same DSM-5 criteria used for alcohol and tobacco, things like loss of control, continued use despite harm, and intense cravings to continue these food practices. Now, to put that statistic into perspective, that is a prevalence rate that's comparable to alcohol use disorder, and it's significantly higher than tobacco use disorder. So this suit argues that the industry's bliss point, again, that perfect ratio of salt, sugar, and fat, is engineered to hit the brain's reward center so hard and so fast that it decouples eating from actual calorie needs.

30:03So the lawsuit sits right in the middle of a major academic divide regarding food addiction, And there are two major theories here. The first model is the substance model, where addictive substances are rarely single agents, just as cigarettes are a complex mixture engineered to deliver nicotine as fast as possible. While highly processed foods are complex mixtures of refined carbohydrates and fats designed for rapid absorption. Here, the food is the drug. And then there's the second model. This is the behavioral model. So again, true substance use disorders require a single identifiable chemical compound, That directly activates the central nervous system, like nicotine, ethanol, or cocaine.

30:42In the food world, we haven't found that nicotine. People don't abuse pure sugar or butter outside of some weird social media trends. Instead, they overconsume a wide variety of foods that differ in texture, flavor, and composition. Therefore, the addiction isn't to a substance. It's to the act of eating in a specific context. So for example, after food restriction and weight loss, humans and rodents' behavior usually changes to a markedly increased intake in calories. And this isn't because the food has changed, it's because the physiological state of the person or the rodent has changed. So what we're calling addiction is actually the brain's natural homeostatic response to dieting or restriction.

31:24And the environment, in this case, triggers a specific uncontrolled pattern of eating behavior. So this particular model favors like addictive-like behaviors or uncontrolled eating. Now, Austin, I tend to favor this behavioral model here. What do you think about that? Yeah, I agree. I think it's quite, it's maybe a little bit, feels too straightforward because when you, well, when you look at the substance model, you're right that people don't just sit in front of a bowl of pure granulated sugar and just binge on that or drink a gallon of olive oil or something like that. And not only that, but people will end up developing, say, obesity and its associated complications when it comes from overconsumption of certain foods.

32:06There's a wide variation in the types of foods that people tend to consume. So it cannot be a single substance model when there's so much variation. Whereas with alcohol, it's like, yeah, there's different forms, be it wine or liquor or beer or something else, but we have identified the specific component in there, the ethanol, that is driving the behaviors. And so, of course, there's also psychosocial context and all sorts of things around the use of that substance, but the ethanol itself is the kind of the determining substance there, and that is what we don't have for food. So different people get there through different means, but kind of the commonality is the experience.

32:40And so that's why I think I agree that the behavioral model is by far the better explanation compared with a single substance model. Now, the individual aspects of these substances, the sweetness, the saltiness, the savoriness, the satiating value or lack thereof, all those things do play roles as well. But I don't think that we're ever going to identify, oh, this is the single food component or certainly nutrient that contributes to overconsumption. yeah the substance model is interesting because again it almost requires like a specific mixture right of yeah maybe it's a specific mixture of salt fat acid you know whatever and sugar um which which would maybe support that but then you're still taking it out of the context right and out of the environment which i think it plays a very strong role so it'd be hard to be like a hard substance model person and just ignore the behavior stuff so yeah is it as far as it you know, appearing relatively straightforward.

33:35I think it's because we recognize that the context is important, but people can be forgiven for saying, well, look, it doesn't have to be a single nutrient, but like it can be a combination of things. And I feel like that's reasonable, but yeah, you can't remove it from the context. Now here's where things get even more interesting. Now look, if only 14 % of adults meet this clinical criteria for addiction and ignoring any potential problems with that definition, well, that leaves 86 % of individuals with obesity who don't. So why is addiction a major part of this lawsuit? Well, in a public nuisance case, you don't have to prove that everyone has an addiction to food and that subsequently causes harm.

34:12You only have to prove that the manufacturer knowingly created a product that subverts the health of a significant proportion of the community. You think of it like a dangerous bridge. If a bridge is engineered and built so poorly that 14 % of cars drive off the edge of the bridge, we don't say, well, look, 86 % of people made it across, so the bridge is fine. We fixed the bridge. Now, the 14 % of folks who meet this Yale food addiction criteria are the canaries in the coal mine here. They prove that the product has the biological capacity to override human agency. Now, once that is established, the industry's personal responsibility defense, the idea that everyone is just choosing what to eat, collapses.

34:52So you establish that the bridge is broken, that human agency is being overridden, the next logical question for the court is, what is the actual damage? In a public nuisance case, you have to prove special injury or widespread harm to the community. And there's some pretty good evidence here. A recent British medical journal umbrella review of nearly 10 million people is helpful at assessing the cost of the modern food environment. So high intake of ultra-processed foods is associated with a 50 % increased risk of cardiovascular disease-related death. For every 10 % increase in the proportion of ultra-processed foods in the diet, that's associated with a 12 % increased risk of type 2 diabetes, a dose-dependent relationship there.

35:36There's a 55 % higher risk of obesity, 22 % higher risk of major depressive disorder, and a number of other common medical conditions all increase with increased consumption of ultra-processed foods. Now, if you read the headlines on this, they often claim these risks remained even after researchers adjusted for total calorie intake and BMI, which is unlikely, if not implausible. The industry's defense is always, well, a correlation doesn't equal causation. These people just have bad lifestyles. But in a public nuisance case, you don't need a single smoking gun. You need a preponderance of evidence.

36:11When nearly 10 million people show that every 10 % increase in these foods correlates to a 12 % jump in type 2 diabetes, the lifestyle excuse starts to look a lot like a cover story for a rigged deck. Now, Austin, there's another layer here. Many of these studies try to adjust for calorie intake and then claim that the harm still exists, but we know that self-reported dietary data is notoriously unreliable. People consistently under-report their energy intake, especially when it comes to highly processed foods that they're, quote, addicted to or otherwise over-consuming. If the primary nuisance of these foods is that they drive a massive, spontaneous calorie surplus, does it even make sense to try and find a risk independent of calories?

36:52Are we missing the forest for the trees by ignoring that overeating is the harm? Yeah, I think that you're right, that underreporting of calories is super common in the same way that overreporting of energy expenditure through exercise is also common. We have direct data looking at this where the randomizing groups to receive these ultra-process predominant diets versus more quote-unquote whole food diets leads to the spontaneous overconsumption. So you're right that the overeating is the spontaneous result. It is quite apparent. It is very difficult to refute or deny at this point. I do think that there is some increase in risk independent of calories.

37:30And for example, we have evidence that we are able to make health-promoting food substitutions and swaps that lead to improvements in health outcomes even if people don't lose weight, for example. That's a well-known phenomenon. But I do think that the bigger kind of beast that we're wrangling with here is the overall energy intake and its impact on, you know, body mass and the downstream consequences of excess adiposity. Yeah. Yeah. I think the biggest lever that's changing is that, look, people are spontaneously consuming more calories and that's due to the engineering of the food, but that doesn't mean that nothing else is going on under the hood.

38:05Like if you strip out enough fiber and then you took that same group of people and you had them add in foods with add more fiber, but they didn't lose any weight or didn't change calorie consumption, we'd likely see some health benefits. Those would be modest compared to if this also controlled for energy intake. Exactly. Yes. So to me, overeating is kind of the feature here. But this brings us to the ultimate pragmatic question for 2026. If the core problem is that these foods have broken our internal satiety meters and we see this body count mounting in the data, why are we waiting on a 10-year legal battle to fix the food supply?

38:41We've got these GLP-1 medications and other anti-obesity medications that literally bridge that signaling gap pharmacologically. Is this lawsuit a slow-motion solution to a biological problem that we've already solved? I think it is a potential solution, but also the pragmatic aspects of this create challenges, and it's part of why I think attacking these from both ends is worthwhile. while. What I mean by that is that, yeah, we have essentially, quote unquote, solved this biologically or pharmacologically with the medicines, but we're still faced with the practical reality of like, okay, so is our solution to continue letting the food environment run rampant and get every single human on one of these medicines?

39:21Some people, some companies, in fact, would love that idea. I think there are a lot of challenges to that, both cost, financial, tolerability, not everybody can safely take these medicines for various reasons, things like that. And so to the extent we can address the food environment, I mean, that's the bigger umbrella aspect of this whole situation that for some people, still not for everyone, but for some people would obviate the need for the medicines or, you know, attacking it on an individual level. People are just super different. Some people, even with a perfect food environment, will manage to develop obesity.

39:51This has been recognized, you know, as long as recorded history has existed. And those folks are the ones who are most likely to benefit from these anti-obesity treatments and metabolic bariatric surgery and things like that. It's only once the environment reaches this critical level that we're at right now, where a much larger swath of the population ends up being impacted. And that big additional swath, those are the people who, yep, they can benefit from these medicines. I see it and do it every day in practice. But also, if we did manage to shift the environment substantially, they might not need them either.

40:21And so kind of like it's worth attacking this both ways. Yeah. Yeah, I think we obviously agree on that. And I think most people would agree. Yeah, por qué no las dos. Let's do both here. But when you start thinking about what would be needed to meaningfully change the food environment, you're like, okay, so, yeah, this lawsuit has to be won. And then there needs to be a massive overhaul of, like, subsidies, food company manufacturing practices, and then the built environment. Like, so many things would need to change and, like, how long that would take if it even was accepted and, like, all these things were, like, it's almost like you're paying lip service to it.

40:59You're like, yeah, yeah, no, we should do that for sure. But like pretty skeptical that anything would change enough to really, again, obviate the need for nobody needs to be on GOP ones anymore because the food environment is awesome. Like, yeah, I don't see that as a realistic end state. But and you're right that there's the complexity of both a very legal legalistic litigious society that kind of bogs things down for years to decades at a time working through those types of processes. And then there's also the cultural component, right? They're like in the US, at least the culture of, you know, very strong individualism.

41:36And I get to choose whatever I want to the extent that they're actually choosing, et cetera. You can trust that because there are other societies around the world that have much more favorable food environments and built environments around them for exercise and spontaneous physical activity and all sorts of other sorts of things. But the idea that we're going to transpose that onto our society and that it will work and be accepted and get rapid uptake and things like that, yeah, super, super unlikely. So I agree that the realistic kind of from a pragmatic perspective, and that's why the medicines are doing what they are right now, whereas the state of our food environment is not like meaningfully improving, I would say, day to day, week to week or year to year.

42:14Can you imagine? So let's just let's let's go to bizarro world here. The lawsuit is one. Okay. Policies changed. The incentives for food manufacturers also change. Right. And everything just overnight, you made wave a magic wand. Boom. It's different. It's perfect. The food environment is. People still are going to remember these hyper palatable foods. Yeah. Is this like a prohibition era like type thing? It starts popping up. There's like a speakeasy, but it's for like snacks. Yeah. People are going to be ordering, you know, these things off eBay from like, you know, years prior when they still when they still used to make this particular food product.

42:53Oh, yeah, totally. You got Twinkies, bro. Where did you get these? Yeah. So we've established that the current food environment is problematic, but if we're going to fix it or if the court's going to regulate it, we have to define what it is. And right now, the legal and scientific world is obsessed with the NOVA food classification system. We've talked about this a few times, but NOVA, it's not an acronym. It's just a four-letter word. It's capitalized, oddly, for some unknown reason. that groups foods into four categories, with group four being ultra-processed. But this is problematic from two major perspectives.

43:29First, classifying a high-quality whey protein isolate or ultra-filtered milk in the same category as an Oreo just because they're both group four ultra-processed foods is like saying a bicycle and a Boeing 747 are the same because they both contain metal. One is an engineered tool designed for a specific performance or health outcome, and the other is an engineered trap for overconsumption. By lumping them together, we aren't helping people change their behavior. We're just confusing them. Because the public doesn't really understand this anyway. This is the second point. And even if they did, does it really change behavior to just know better?

44:02Most people know that broccoli is healthier than a Twinkie, irrespective of intricate knowledge regarding processing or the NOVA food classification system. But that doesn't stop them from eating the Twinkie. Just imagine if we labeled all of these ultra-processed foods Group 4. It's like a red sign on the front. Is that meaningfully going to change food behavior? There are some countries that have experimented with the so-called traffic light system, and there is some impact on food-related behaviors. Whether that is enough to, again, just shift the entire population's risk profile, drop population-wide BMIs by a few points, put diabetes into remission, less and less likely.

44:41But I also don't think that it's realistic to expect that a single intervention like that is itself going to be unlocking this entire problem. It's likely going to be multi-pronged, multifactorial, incremental benefits from a variety of different things, whether labeling, reformulation, all sorts of other things that could be trialed. Yeah. You're not going to get a 20 % benefit from one thing. You're going to get a 1 % benefit from 20 things. You've got to do all of them to make a significant difference. And I think the core issue here regarding processing and narratives around just don't eat any processed foods is that processing isn't just one thing.

45:16So there can be functional processing, which includes things like freezing vegetables or making Greek yogurt or making canned beans shelf-stable or ultra-filtered milk. Yeah, they're processed, but the processing is used to improve shelf life, convenience, and nutrient density without necessarily hacking your satiety signals. And then there's hyperpalatable processing. This is the nuisance. These are products engineered for that bliss point, stripping the fiber out, adding the perfect ratio of salt, sugar, and fat purely to drive consumption. They're both processing. They're just different and lead to different outcomes.

45:50So let's say that the Nova system is refined to a satisfactory level, properly identifying only the foods that cause unique harm through overeating and any other unique mechanisms. That would be awesome, right? Well, our food supply would have more satiety stoplights, so less people would be likely to overeat, and all would be well in the world. You have this magic wand. We wave it and make every calorie in America minimally processed. We would likely see a massive, spontaneous reversal in the obesity epidemic. But there's a catch. Sure, it's generally better for humans to eat a minimally processed whole food diet, but we have to be careful to not turn health into a luxury good.

46:30We tell everyone, avoid all group four foods. are we creating a health literacy barrier that only the wealthy can cross? Imagine a single parent living in a food desert, and they can only afford group 4 shelf-stable foods to feed their kids and their family. Are we as clinicians doing more harm by pathologizing their only accessible food source? In the real economy of 2026, fresh produce and minimally processed meats are increasingly expensive. By reducing access to all ultra-processed options, the cost of groceries could go up even more for folks who are currently the most victimized by this food environment.

47:05We're basically telling them that, look, you're poisoning yourself and you can't afford a whole food lifestyle, so tough luck. And this is why I get so frustrated with the silly targets that are currently hijacking the conversation. We've got RFK Jr. focusing on red dye 40 and seed oils and removing the advice to reduce saturated fat intake in the latest guidelines, none of which help people make healthier food choices more accessible or more affordable. It just makes the still processed food more expensive. Focusing on food dye while ignoring a 500 calorie satiety gap is like trying to fix a sinking ship by repainting the lifeboats.

47:40The nuisance isn't the seed oil or the food dye. The nuisance is the engineered lack of satiety and the energy toxicity that has subsequently resulted. Now, Austin, if we spend our limited behavioral capital with patients telling them to hunt for red dye 40 or avoid canola oil, we don't have anything left to help them address the actual big levers like their micro food environments, their food preparation skills, and so on. So as a clinician, how do you help a patient navigate a world where minimally processed is the goal, but ultra processed is the reality? How do we give them a strategy that works for their budget without making them feel like they're only affordable food options or a moral failure?

48:18This is a very challenging question and one that I don't think a lot of clinicians are necessarily very well equipped to address directly outside of the dietetics field where they have much more extensive training in how to assess a patient, their current situation, their needs, and how best to achieve their goals for the best health outcomes and things like that. because obviously, you know, we can talk about this at multiple levels. We've already addressed it at the macro level, like the big food environment that we all live in, as well as what you described as kind of the more micro environment, your immediate surroundings.

48:51Those are different things that might require different strategies to help somebody work through. Recognizing that somebody's food and eating related behaviors are somewhat, at least somewhat automatic and a little bit less consciously controlled than we would like. and also there's all sorts of other influences like what types of foods they grew up with, what types of foods they know how to prepare, what types of foods they prefer, and whether they have any experience making, eating, or even ideally enjoying certain types of foods as well can be a perfectly healthy and normal part of life. And so when we're doing our own assessments and talking to patients, getting a sense of what does their habitual diet look like and what are some reasonable and accessible potential substitutions because there are, in fact, highly economical options that can be substituted into people's diets to displace or substitute for some of the less health-promoting options.

49:42But figuring out what those are on an individual level that fit their kind of cultural practices and what types of foods they are comfortable and have the access and the ability to prepare might be the challenge, right? So there have been these kind of guideline statements that have come out, you know, over time that advise a very particular dietary pattern. Let's call one, for example, the Mediterranean diet. Well, if this person that I'm talking to is from, you know, a village in rural Africa or they're coming from, you know, Southeast Asia or something like these are just fundamentally different diets.

50:10And so it's very difficult to transpose one on the other and expect it to work. So when we look at, you know, our most highly satiating foods, looking at things like very high foods with very high contents of fiber per calorie and things like that, we're looking at legumes are a very predominant aspect of my diet, your diet. a lot of the diets that we end up recommending. Certain types of seafood, to the extent that that's accessible to the person. Frozen foods, to include frozen vegetables and fruits, very common, very accessible for a lot of people. You mentioned ultra-filtered milk. That has a little bit of a price premium on it compared with more traditional milk.

50:47It kind of depends on somebody's preferences and their tolerability, but definitely looking for these foods that are accessible to the person, preferable to them, that contain plenty of protein and fiber per calorie and are within their budgets and things like that. So those are some of the features that we might look for early on to find substitutions to compare with what they're habitually consuming on a regular basis. Yeah. And knowing you and the way you go about talking to a patient, interviewing them, you're leading more with open-ended questions. Tell me what you eat. What do you like to eat?

51:17Tell me about your cooking experience. Basically trying to get a sense of where they're at to, again, find threads, opportunities for potential improvement, as well as opportunities to leverage the resources that they already have access to. Because you could lay out the perfect dietary pattern for somebody, make them a grocery list, macros, calories, the whole thing. And they're like, I don't know how to cook. Right. Go back to square one. Yeah. Yeah. And it's like, yeah, you probably should have picked that up earlier. You don't need the plan first. You need to, you know, where is this person starting for?

51:49And then as the professional, help them navigate that roadmap. at ultimately trying to make them more competent at navigating this environment. But yeah, most people jump right to the solution. And it's like, are you sure this is like universally applicable or? Yeah, I mean, to go back even further from where you were starting, my question is like, why is this person talking to me? Like what led them to talk to me today? Right. Because then, as I've talked about in many other contexts with behavior change, it's like trying to find what is the thing that I can advise that ties into something meaningful to you?

52:18Like, why do you care about this? And how can I make what I care about also something that you care about? Yeah, exactly. And even if this whole conversation just went sideways, the person recognizes that their dietary pattern could be improved. They recognize that they have some elements that are controllable and they can make those changes, right? But they can't make all of them or they can't make a significant amount of them just for whatever reason, right? Whether it's time, whether it's financial resources, so on and so forth. That doesn't mean they can't get any benefit out of making some change.

52:52And perhaps they're more amenable to a different sort of health-promoting behavior, like increasing exercise, for example. If a person was originally there to talk to you about their weight and whatever, and then ultimately you couldn't come to a satisfactory resolution as far as this is our initial plan moving forward. It's checking all the boxes. It's the perfect patient. Yep. And you brought up, you know, how do you feel about exercise? And they were like, hmm, yeah, I would be open to that. Like, again, you've just benefited this person and they've benefited their own trajectory there. So a lot of different options here to help them be more competent in navigating this environment.

53:28Now, we spent this whole episode talking about how the food industry has engineered a public health crisis. But lawsuits take years and your health is happening right now. We can't just wait for the courts to fix the food supply. We've got to take some action. So here are some strategies for navigating a rigged game. First off, we're starting in the grocery store. So if you have hyper palatable, ultra processed foods in your house, the really tasty treats, you're going to have to use willpower every single day to resist them. Your dietary RPE is going to be high, at least for most folks. But if you make a commitment to avoid buying those things in the first place, when you go to the grocery store, you only have to use your willpower budget once.

54:09If the bliss point isn't in your pantry, the environment can't exploit your satiety signals at 9 p.m. on a Tuesday when you're tired. Second part is going to be related to food preparation. Now, based on survey data, six out of 10 adults ate food from either a fast food or full-service restaurant in the past 24 hours. This is a problem that has mostly to do with calories. The more meals that are consumed from fast food or full-service restaurants per week, the higher someone's BMI is on average. By contrast, the more meals that are prepared inside the home tend to be lower in calories, tend to have smaller portions, and are more satiating than when eating out.

54:44When you cook at home, you're the engineer. You're more in control than if you go to a restaurant. So spending some of this behavior change budget on learning how to prepare and store food, in addition to shifting towards preparing more meals at home in general, I think that'd be a good use of resources. The third part of this strategy is going to be changing your micro food environment. You can't really do much about the built environment around us, at least not in the short term, but we're trying to make the path of least resistance more healthy. in the places you spend the most time. So we're trying to kind of add friction towards behaviors that we don't want while reducing friction to behaviors we do want.

55:22So again, if you have these hyper palatable snacks, maybe they're for the kids, you can't avoid buying them or for guests that come in the home. Well, keep them out of sight. There's been some thought to place them in like opaque containers and place them high in the pantry, keeping them out of sight and out of mind and ultimately reducing the marketing sort of drive or desirability drive. and instead keeping high satiety tools, fruit, vegetables, ultra-filtered milk, jerky, whatever, at eye level or otherwise easily accessible. And the office is often a high-density food swamp of donuts and vending machines and other treats that people bring in.

55:57But you could treat your desk like a little micro-oasis. You could bring your own protein powder, other high-protein, high-satiety snacks so that you aren't forced to rely on willpower in the break room. Presumably you go to work on most days, so that would be a good change. And lastly, you can change the eating environment. This is something that people probably have the most control over. So when you're sitting there eating while scrolling your phone or watching TV, you're essentially muting your brain's ability to monitor satiety signals, feelings of fullness. You're increasing this biological blindness to how full you are, how many calories you're consuming.

56:32So we advise or I advise often trying to eat distraction-free, no screens, all right, to allow both the mechanical and chemical stop signals to be heard and otherwise realized. And eating at the same time also appears to have some benefit. So we eat at similar times each day that tends to help regulate hunger hormones like ghrelin, for example, and your body starts knowing when to expect energy, how much energy it's getting, and so these spikes in hunger become more predictable and easier to manage and ultimately can lead to more successful outcomes. Now, all of that in place, there are still going to be individuals in this modern environment that are going to have trouble regulating their body composition and their body weight to a level that sort of optimizes their health trajectory.

57:19So Austin, what are some other interventions that can be useful here? Yeah, a lot of this depends on the additional kind of details of the person. So to the extent that there are some of these experienced psychological aspects around their eating behaviors, working with some form of a therapist or a dietician might help to work through some of that person's individual issues, predispositions, tendencies, behavior patterns that they're having a little bit of difficulty kind of working through managing or need some additional input on strategies to handle. What form of therapy or dietician strategies that might involve are going to be super individualized.

57:54So that would be one place to start. Working with a physician around this, particularly if they have obesity or certainly obesity-related complications, things like high blood pressure, cholesterol, cardiovascular disease, fatty liver disease, diabetes, etc. Those are stronger and stronger candidates for what we'll call higher intensity interventions to include things like the medications like GLP-1 receptor agonists, multi-agonists, and some of our other weight management related medicines, basically because the aim here is to improve people's health outcomes, improve their longevity, reduce the risk of complications related to obesity, and to give them essentially more control over their day-to-day life.

58:30And that is one of the most interesting and compelling things that I see and hear from patients in whom I use these medicines now on a daily basis, where they tell me, look, I was able to lose weight repeatedly over the years. I've lost and regained the same 30, 50, 100 pounds multiple times over the years. I know how to do these things, but the use of this medicine gives me control to do and sustain those things that I already knew I needed to be doing, right? And so it makes it so that they don't have to have that high RPE, that daily, I have to wake up and go to war every day just to, you know, avoid the things that set them down the wrong path.

59:07Because to your point, I tell people a lot, if it's in the house, it's going down the hash for a lot of people and because of how automatic this is. So these tools give people more control and let them do the things they already know that they wanted and needed to do. And then finally, we have metabolic bariatric surgery, which I still am quite proud of that podcast episode that we did a couple years ago. I think it was an exceptional kind overview of that topic. And I still think that it is an underutilized, under-referred for resource, particularly for those who have been struggling with this the most and for the longest.

59:35So these are some kind of higher level interventions, things that are worth discussing with your physician to see if they're appropriate for you if you're in this situation. Yeah. I think a lot of this, you know, reticence to maybe use medications or therapy or metabolic bariatric surgery, accessing that has to do with this sort of like moral underpinning to like, it matters how you got there. Oh, how did you lose the weight? How did you maintain the weight loss. And it's like, look, if these, you know, pick yourself up by the bootstrap sort of efforts, you know, just try harder, eat less, move more.

1:00:05If those were more successful, we would be bigger champions of people doing that, you know, in isolation. But unfortunately, because of the modern environment and because most food-related practices have at least some element of subconscious, you know, integration going on. They're just not that successful. And so ultimately, we want people to be successful and to put them on a better health trajectory. And so having additional resources can be useful. All right, let's wrap this up. The San Francisco lawsuit against Kraft, Hines, and others is more than just a legal battle over cookies and soda.

1:00:46It is a reckoning with the idea that the personal responsibility defense has reached its expiration date. As the obesity epidemic has grown over the last 50 years, we've been told that health is a solo mission of macros and willpower. But the data shows that when you put a human in a precisely engineered environment, the outcome is predictable. And for most folks, it isn't good. The industry has spent decades using the playbook from big tobacco to ensure that the path of least resistance leads directly to the bliss point. They turn the satiety stoplights green and cut the brake lines, and then they blame the consumer for the crash.

1:01:18Proving that these foods are a public health nuisance isn't about calling people addicts. It's about acknowledging that human agency cannot thrive in a rigged environment. But as practitioners, we've got to be honest. A decade-long courtroom drama won't fix your health tomorrow, and we cannot let silly targets like food dyes or seed oils distract us from the actual structural problems of energy density and food matrix integrity. We can't turn health into a luxury good that only the wealthy can afford. Now, ideally, this lawsuit would allow the food industry to create healthy, low-cost, desirable foods.

1:01:49But banning all hyperpalatable foods seemed problematic, perhaps creating a black market for these types of food as if we were back in the Prohibition era. Future concerns aside, what should you do now? Your action plan is to stop playing defense against a rigged food environment and start playing offense on your micro environment. When you shop for food, aim to limit how much hyperpalatable ultra-processed foods you buy. Using willpower once a week is likely to be more successful than doing it every day after the kids are asleep. Don't throw the baby out with the bath water. Not all processed food is bad.

1:02:19If a processed food provides 30 % or more of its calories from protein and has more than one gram of fiber per 10 grams of carbohydrates, it can be a tool for your success, not a trap for your satiety. You can engineer your own environment. Use friction. Put high reward foods out of sight and high satiety tools at eye level. Turn your home and your desk into a micro oasis. You can reclaim your signaling by eating undistracted. Let your brain hear the signals your gut is trying to send. And if all of those signals are still not quite right, speak to your physician about additional tools, whether it's therapy, metabolic bariatric surgery, or anti-obesia medications, we now have to repair them.

1:02:56The city of San Francisco is suing to fix the environment for the community, but until that bridge is fixed, you are the architect of your own environment. Let's go to work. For Dr. Austin Baraki and the entire team at Barbell Medicine, I'm Dr. Jordan Feigenbaum. Thanks for listening. We'll see you next week on the Barbell Medicine podcast. Thank you.