Always Hungry? Avoidable Cravings, Distraction and Dysfunction in Ourselves and Our Kids

Have a New Year's resolution to lose weight, but feel like you don't have the willpower to eat less? Or maybe you've tried losing weight before, but wound up heavier than when you started?

Are you struggling to cut calories, but feel constantly hungry and fatigued? Do you feel deprived and think about food to the point of distraction at home and at work?

Are your kids distracted, too? Do they have trouble focusing at school? Do their teachers report inattention and poor concentration?

I was delighted when renowned endocrinologist, and nutrition and obesity expert, Dr. David Ludwig asked me to review an advanced copy of his book, "Always Hungry?" If we were any more on the same page, our names would literally be on the same page: i.e., I would be listed as a co-author for his book. Alas, Ludwig wrote it alone, and I have to admit, he did an excellent job.

Ludwig and I are in near-perfect agreement on issues related to nutrition, weight and health for ourselves and our kids. We recognize fundamental causes of diet-related disease and diet-related distraction.

For those of you suffering from such distraction to the point of being able to read no further, you can watch a short video of the basic premise (or an even shorter clip for those of you really suffering). But for those able to read just a bit more, salient points appear below. Additional details are in a short paper, and more expansive details can be found in Ludwig's book, which covers all the relevant ground in very accessible, plain language.

While framing for the book, the paper and the videos centers on weight loss and weight management, more broadly, messages are about healthy eating and better health for everyone in the family. The bottom line is this: forget about calories and focus on food quality; and to achieve better quality, focus on food from plants (the living botanical kind, not the industrial processing kind).

To illustrate, take a cup of soda (product from an industrial processing plant) and a handful of nuts (food from a living botanical plant). Even though these items may have the same number of calories, they have very different implications for our bodies. When it comes to metabolism, fat cells, weight and overall health, it is not the number of calories that matter; it is the type.

Specifically, calories from highly refined carbohydrates (found in ultra-processed products like soda) are the problem. These carbohydrates -- including added sugars and refined starches -- promote expansion of our fat cells, induce food cravings and program us to eat more. If we futilely try to resist the biological changes these carbohydrates induce (e.g., by trying to eat less), we feel fatigued, hungry and irritable -- until we ultimately can hold out no longer and wind up overeating. Then comes the guilt, the shame, the feelings of failure, the gain of weight and worsening health.

As Ludwig's book may help break this unhealthy cycle and explains in detail: "Overeating doesn't make us fat. The process of fattening makes us overeat."

In the same way, trying to eat less won't make us thin, and it absolutely won't make us lean if what we eat is refined carbohydrates. We need to stop creating and blaming victims with advice to "eat less" (e.g., by reducing portions or counting calories). We need to place blame on the food products -- and on the industry that created them -- that make "eating less" less possible.

Particular detrimental are the wide array of "low-fat" products in which higher-calorie fats and oils have been replaced with lower-calorie starches and sugars. The association between consumption of these products and the rise of obesity and diseases like diabetes is compelling. These foods drive us to "eat more" (and also to "move less") -- or feel cranky, sluggish and famished if we try not to succumb to the physiological changes such consumption produces.

Ludwig reviews the evidence for the physiologic changes, as well as other supportive research in his book, providing nearly 200 citations to the medical literature for those interested in the science. He spends several pages discussing alternative explanations for obesity and why they don't hold up, and provides helpful everyday analogies for complex concepts and mechanisms that are on the forefront of our understanding.

I would recommend Ludwig's book both for clinicians and for patients who are looking for better understanding and useful solutions. There is a great section on personalized dieting and individual variation, and step-by-step guidance to conquer cravings and lose weight permanently.

But the focus of Ludwig's book extends well beyond weight. For instance, he reviews the data linking consumption of refined carbohydrates to impaired memory, attention and other brain functions. And in an epilogue, he talks about system failures in prioritizing health, including in our schools.

This is another area where Ludwig and I are on the same page, almost literally. In fact, on the same day of his book release, I published a piece in JAMA describing the problem of school foods.

Through snack programs, class parties, teachers' rewards, vending machines, field trips, sports events, bake sales and other fundraisers (to say nothing of breakfast and lunch offerings), our children are being fed a steady diet of ultra-processed products, usually high in added sugars and refined starches. Besides issues related to dental caries and obesity, there is the inattention, poor concentration and memory deficits to concern us. Why are we choosing diet-related distraction, poor school performance and compromised health for our kids?

I think Ludwig and I agree: Whether child or adult, whether at work or at school, to avoid distracting cravings, to achieve and maintain a healthy weight, and to promote optimal health, we need to avoid ultra-processed products, forget about calories and focus on food quality.

Sean Lucan, M.D.,M.P.H. is an attending physician at Montefiore Health System and associate professor of clinical family and social medicine, Albert Einstein College of Medicine. Dr. Lucan is a practicing family physician in the Bronx, New York, treating children and adults. He is also an award-winning NIH-funded investigator who has published numerous peer-reviewed articles and op-eds on food-related issues. Additionally, he has co-authored one textbook on nutrition and another on preventive medicine and public health. Dr. Lucan's research focuses on how different aspects of urban food environments may influence what people eat, and what the implications are for obesity and chronic diseases, particularly in low-income and minority communities. Another focus of his work is the critical examination of clinical guidance and public health initiatives related to nutrition.