Why are we so fat* and Italians so skinny?  

Mark Schatzker’s latest book is The End of Craving: Recovering the Lost Wisdom of Eating Well. He strings together disparate perspectives into a theory on obesity. He tells us what causes it, and how to overcome it. The idea he presents is so simple and yet so profound. Could he have uncovered the magic formula for success? It is a solution that has evaded so many scientists and physicians. To make that judgement, you will need to read the book. I will provide some clues.

A tale of two countries

The End of Craving takes us to two countries—Italy and the USA. Both nations faced severe nutritional problems early in the 20th Century. They came up with very different solutions to these problems. In the 21st Century one population emerged much healthier than the other. Were the different approaches to nutritional deficiencies responsible for these health outcomes? The premise that they were lies at the heart of book.

Pellagra is a deficiency disease that plagued both the USA and Italy over 100 years ago. Pellagra brought with it the 4 Ds—diarrhea, dermatitis, dementia, and death. It devastated poor populations in both countries. Advances in nutritional science had the answers. Niacin was the vitamin deficient in the diets of these Italians and Americans. The challenge was to defeat the disease.

Americans took on the challenge by fortifying grain products. They added niacin, thiamin and riboflavin to white flour and pasta. Vitamin addition occurs by enrichment or fortification. The results were immediate and exceeded all expectations! With this success, vitamins became a miracle solution for all our nutritional problems.

Italians took a different approach. They focused attention on three foods—bread, rabbits, and wine. The government ordered all bread baked in communal ovens. Rabbit meat was an inexpensive source of vitamins and protein. Cheap wine was not well filtered and contained excess yeast. Yeast was a ready source of niacin. It wasn’t clear whether factories enriched or fortified the bread. The Italian solution took a longer time, but it also worked to defeat the ravages of pellagra.

Fast forward to today. Obesity in the USA (37%) is almost twice as high as it is in Italy (21%). If we look at life expectancy, Italy (84.0) exceeds the USA (79.1) by almost 5 years. Can we explain health differences in the two nations by the they overcame pellagra? Schatzker thinks so.

bottle of Italian sausage and garlic spaghetti sauce
Product designed to its bliss point! Does that make it addictive?

The bliss point as discovered by Howard Moskowitz appears in the book. Moskowitz, a colleague and Facebook friend, related taste to product acceptability. The bliss point became famous in a TED talk by Malcolm Gladwell. Critics of processed food claim it as evidence of Big Food’s tricks which lead to food addiction. Don’t fall for the mischaracterization of Gladwell’s point. Watch the video and decide for yourself.

BTW, Moskowitz developed the bliss point for spaghetti sauce and not Twinkies. Is there something wrong with a food company trying to make a product more appealing to a mass audience? Do home cooks not try to learn family response to a new dish to make it more appealing the next time? Do restaurant chefs not tweak recipes on the basis of feedback from diners? The point of the Moskowitz research is that flavor supersedes nutrition when we eat.

Calories separated from desire when eating processed foods confuses us. Then we overeat suggests the book. Commercial products separate wanting from liking overriding a sense of fullness. The End of Craving links a wide-range of studies to arrive at this conclusion. The author relies on brain scans as proof of his suppositions. Such studies are controversial. He likens overeating to gambling. This idea is in direct contradiction to theories on processed food addiction. Researchers in food addiction consider it as a Substance Use Disorder. An alternate perspective is that an eating addiction is a Process Use Disorder. An eating addiction makes more sense to me than a food addiction.

Poverty breeds obesity is a conundrum. Why are a nation’s poor more likely to become overweight or obese than those who have higher incomes? One explanation is that of the uncertainty of where the next meal is coming from. Famine may be around the corner, so feast when enough food is available. Families may not be hungry, but they may be food insecure. The fear of not enough food to eat later is greater than the fear of eating too much now. Cheaper food also may be higher in calories and lead to weight gain. Food insecurity appears to be a bigger problem in the southern part of USA than in rural Italy.

Americans eat like pigs, and Italians do not. No, not in the way you think! To fatten up hogs, farmers supplement their diets with B vitamins. Enrichment and fortification release large amounts of B vitamins into the American diet. Could our vitamin supplements as well as those enriched and fortified foods be fattening us up like hogs? That is what The End of Craving implies.

Artificial sweeteners separate sweetness from calories. The End of Craving suggests that processed foods are messing with our body’s metabolism. Sweet, sour, salty, bitter, and other flavor sensations raise certain expectations. Our brains do not know how to react, and we can’t stop eating. I’m not sure that I agree. Won’t table sugar, honey, and maple syrup do the same thing? Or have we evolved to handle processed sugars but not artificial sweeteners?

Critical questions separate the American and Italian relationship with food. Two quintessential questions separate how these cultures respond to food:

Americans ask “How will this affect my body?”

Italians ask “Is this the best recipe?”

The author concludes Americans have become obsessed with food. Any time we eat we visualize a direct link to health and wellness. Contrast this response with that of the Italians who view food as a source of social interaction and enjoyment.

Although I disagree with Schatzker’s view of processed foods, he has uncovered a key insight into how Americans view food. Is food only important to Americans when it contributes to either good health or chronic disease? Are we focused too much on individual foods and not enough on meals, diets, and health? Do online articles on what to eat and not eat contribute to this obsession? Likewise, are books like this one and blogsites like mine making the situation worse? The author’s perspective aligns with the Intuitive Eating movement. The description of the problem is similar. The solution is very different.

Wisdom of the body is what Italians have and what Americans have lost. Schatzker provides an elegant theory on how we can end craving and reduce obesity. I have provided the main clues behind his solution. All interested in how the author came to this conclusion should read the book. Is his explanation the reason twice as many Americans are fat* and that Italians live 5 years longer than we do? Can we improve our heath by eating a Mediterranean diet? Do we need to abandon most processed foods? Should we focus more on meals and the social aspects of eating them and less on specific foods? I don’t know. Do you?

* I use the word fat instead of obese. Most of us have a better concept what it means to be fat than what it means to be obese. I apologize to anyone offended by my terminology.

Next week: The End of Craving from another point of view

9 thoughts on “Why are we so fat* and Italians so skinny?  

  1. I don’t consider the Prego Sauce addictive. But the sauce is made with tomato purée instead of whole peeled Italian tomatoes. The sauce substitutes canola oil for olive oil. And while sometimes sugar is necessary in a home made sauce to balance acidity from tomatoes, I bet that’s not why sugar is listed in the Prego product. What I would say about Prego is that it’s not made with quality ingredients.



    1. The point of suggesting the Prego sauce might be addictive was that Howard Moskowitz developed the bliss point on Prego sauces. Critics of processed foods use the bliss point as proof that Big Food is trying to addict us. You appear to have a very high bar as to ‘quality’ ingredients. Not everybody is as picky as you are. I consider tomato puree to be a quality ingredient. Yes, olive oil would preferable to canola oil, but canola oil is superior to many other vegetable oils. Sugar is low on the ingredient statement suggesting that it is there to balance out the acid and not to provide sweetness. Prego provides flavor qualities that loyal consumers enjoy at a price they can afford and convenience that permits home cooks to prepare a pasta dish with limited time to cook supper.


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