174512 Pathways to Obesity: Below Awareness and Beyond Individual Control

Monday, October 27, 2008: 12:30 PM

Deborah Cohen, MD, MPH , RAND Corporation, Santa Monica, CA
Pathways to Obesity: Below awareness and beyond individual control

Background: A global obesity epidemic is occurring simultaneously with ongoing increases in the availability and salience of food in the environment. Obesity is increasing across all socioeconomic groups and educational levels, and occurs even among those with the highest levels of education and expertise in nutrition and related fields.

Methods: A review and synthesis of the literature on automatic behaviors and neurophysiology to identify mechanisms whereby people can be led to consume excessive calories in a manner that defies personal insight or is below individual awareness.


Ten mechanisms were identified. These pathways include reflexive and uncontrollable neurohormonal responses to food images, cues, and smells; conditioning, priming, automatic stereotype activation, mirror neurons which cause people to imitate the eating behavior of others without awareness; and limited cognitive capacity to make informed decisions about food.


Given that people have limited ability to shape the food environment individually and no ability to control automatic responses to food-related cues that are unconsciously perceived, it is incumbent upon society as a whole to regulate the food environment, including the number and types of food-related cues, portion sizes, food availability, and food advertising.

Learning Objectives:
Objectives 1: To understand the role of environmental influences in eating behaviors and the economic view of obesity and personal responsibility 2. To identify neurophysiologic mechanisms that trigger hunger and lead to eating without awareness or control 3. To identify potential policy responses to controlling the obesity epidemic by reducing energy consumption

Keywords: Obesity, Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conceived of the analysis, conducted the literature review, and developed the overall framework for the paper.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.