Why are Americans so much fatter than Europeans?

I have a lot to catch up on after a month of qualifying exam craziness and 3 weeks tooling around Germany and Italy. (If it was supposed to be relaxing, why did we bring the kids?). I’m working to improve my blogging efforts, so I’m treating you all a different blogging style for a while. I vow to no longer spend 2 weeks “perfecting” a post—you have no idea how challenging this internets thingy is to us old folks—and instead I will try to bombard you with random stories and thoughts incoherently melded together by my overriding simmering impatience with the current food/nutrition situation. When I get boring or redundant, let me know.

“That can’t be good for you.”

The carbs vs. fat debate took on a new perspective for me in Germany, where—at least where we were, in Bavaria—the population seems to love both! The question floated in and out of our conversations over lovely meats and cheeses, tomatoes and mangoes, bread and olives (my husband’s family were the most wonderful hosts!): Why are Americans so much fatter than Europeans?

Here’s a menu item from a Munich restaurant.

Loosely translates to “fat with fat”

Crispy pork fat is mixed with lard and spread on dark bread. I ordered it, and it was delicious.  The Bavarian people seem to love saturated fat in all its many forms, but most especially when it comes from pigs.

At the same time, I’ve also never seen such a healthy bunch of old people.  We visited the German Alps (a popular vacation spot for older Germans) and the town was filled with people in their 80s and even 90s out toddling around.  Those with canes took the easier walks around town, but many were hiking (yes, even with canes) and there were plenty of older folks up on the harder trails as well.  Oddly enough, they didn’t look super fit or anything, just not too fat (although most were what we would call a little “heavy”).

The Germans do love to be outdoors, and they love to walk, but they don’t seem to be exercise fanatics the way Americans are. I overheard a group of Germans discussing an American friend they knew who “ran 6 or 7 miles a day.” After a few murmurs that I couldn’t quite interpret at first, one young lady seemed to speak for the group when she concluded, “That can’t be good for you.”

Surprise! All calories are NOT created equal

As with exercise, the culture that surrounds food seems to be very different. No one seems to really care about calories. Serving sizes were enormous. Menus, however, do designate if an item contains artificial colors, sweeteners, added “antioxidants” –and whether the ingredients are likely to be frozen or the items prepared off-site. Only about 25% of the retail space in a grocery store is given over to processed foods (which leaves lots of room for a wide variety of beer!). Everywhere we went (even after hiking an hour or so up a mountain), people were hanging out in beer gardens, eating and drinking and generally having a lovely time of it.  Everywhere we went, the food was excellent.

Of course, I must point out that Germany is also experiencing an increase in obesity. It may take longer for it to catch up to the Bavarians, who tend to be skeptical about “progress,” which means they may be more likely to resist the relatively new-fangled low-fat approach to nutrition adopted by the US 30 years ago. Good thing, too. While we were in Germany, a new study done by David Ludwig at Harvard was released which adds to the body of literature that seems to indicate that USDA/HHS-recommended low-fat diets are not going to be the answer to our obesity crisis. The reaction to that study by the arbiters of nutrition fashion at the NY Times was very interesting.

In a surprising reversal from his many years of advocating for the “eat less, move more” approach, Mark Bittman seemed ready to acknowledge that, hey, maybe not all calories are created equal. I was thrilled to see this (even though Bittman didn’t bother to add “My bad for the previous 13 years worth of misinformation”) not just because it is scientifically accurate, but because of the adverse affects that I feel the “calories in, calories out” approach has had on how Americans relate to food. “Calories in/out” not only misses the metabolic effects of food, but—by treating food primarily as fuel—it also dismisses food as a part of our social tapestry and our cultural heritage. This approach also easily lends itself to creating an ethics of “good” eating behavior vs. “bad.”

Embracing sacrifice?

The savory handful of meaty goodness that is a doner kebab

If food is just fuel for the body, there is no reason to enjoy it, to savor it, to wax poetic about it (as my kids did over the Turkish doner kebabs–“savory handfuls of meaty goodness”–we had in Munich). You just eat it, as “ethically” as possible, and carry on with your hair shirt weaving.

James McWilliams (who is probably a really nice guy, but strikes me as being someone who would be a real buzz-kill at a party) exemplifies what may be a uniquely American notion, that eating should be a Puritanical experience of acquiring nutrition in the most joyless way possible:

“To really eat ethically more often than not means to avoid the primacy and exclusivity of taste. It means to forgo foods usually associated with “fine dining”—rich cheeses, meat, luscious desserts, and seafood dished out in fancy restaurants—in exchange for (as Mark Bittman’s work quietly reiterates) a humble bowl of beans, greens, and whole grains cooked up at home (with the leftovers eaten all week for lunch). It means, in essence, embracing sacrifice, even asceticism. Any committed vegan will have some sense of what this entails.”

I’m inclined to extend that young German woman’s assessment of her American friend’s exercise habits to this approach to food: That can’t be good for you. It may adequately feed your body (of course, it may not do that either), but it seems like it might shrivel your soul up just a little.

I find it difficult to imagine the Germans ever adopting this approach to food (ditto the Italians). Would McWilliams then consider the entire culture of food we encountered in Europe to be “unethical?” Germans and Italians were all about the “primacy of taste.” If the food police in America extend their current crackdown to saturated fat, I’ll be joining my father-in-law and his wife in Munich, where lard will never be four-letter word. (Yeah, I know. In German, it’s more like a fourteen-letter word.)

Connection vs. alienation

I’ll be the first to admit that the problem is a complicated one, but it is worth considering: maybe what helps make Americans fatter than Europeans is our attitude towards food. It seems counter-intuitive, but maybe if we cared more about food and what it means to us, we’d actually eat differently. It’s not a matter of quality over quantity, but a matter of connection vs. alienation. And it’s not just a white people thing either.

My friend, Elisa Maldonado wrote a terrific article about her experience with the standard American approach to “healthy eating.” You can find her article here. A friend of hers commented on the article, saying that “being both mexican american and native [her] body always felt weird and unhealthy” when she tried follow standard recommendations. Elisa and her friend make a case for the possibility that our ethnic background influences what dietary pattern will work better for us. If we can connect to (rather than be alienated from) both our traditional food cultures and the messages our own bodies send us in response to food, we may stand a better chance of discovering what foods leave us satisfied and healthy—in both body and soul. And we won’t have to “embrace sacrifice” to get there.  

How to Choose Foods Wisely?

I don’t have the answer; I’m just askin’ the question.

I’m not much for food rules. I’m not much for rules in general (ask my mother). Still, I feel an obligation to provide some guidance that counterbalances the Government-Approved Information on Nutrition (code name: “GAIN”) that screams at us from every shelf in the supermarket.

There are a lot of “how to” guides on choosing foods wisely, from Michael Pollan’s 7 rules to the How to Find Real Food at the Supermarket from Darya Pino to a grass-fed, organic approach from Healthy Eating Politics to a more academic approach from Carlos Monteiro (scroll down to his discussion on meat and bread).

I like all of these.  At the same time, I want something I could give to patients and clients that will help them make reasonable choices—yes, even if they are buying food at a gas station. Most importantly, I want to make this something everyone can do regardless of income level. We have to acknowledge that, at least for now, many “cleanly produced” foods (grassfed beef, farmers’ market eggs, organically-raised produce, etc.) are WAY more expensive than their grocery store counterparts.  Still, I think I would recommend grocery store pork chops over organic “convenience” foods like this

even though all 25 ingredients are “organic”!! even the tofu!

Here’s my initial stab at a “choose wisely” approach. However, I think my own brain capacity is quite limited (especially when I’m trying to wrap it around biostatistics). I’d love some feedback and suggestions for improvement from the community of folks who are doing their best to “choose wisely” on a daily basis. This is not geared toward any particular “dietary approach,” although—as it happens—reducing processing tends to reduce unnecessary carbohydrates. Hmmm. How truly convenient.