The Centers for Disease Control and Prevention (CDC) reports that "nearly all" Americans tested have BPA in their urine, "which indicates widespread exposure to BPA in the U.S. population." The American Chemistry Council has called for a ban on BPA in baby bottles and sippy cups (which California and several other states have already done), and some food manufacturers are already moving away from using BPA in their packaging. On Monday, Campbell's Soup announced it will stop using BPA in the lining of its cans. The Food and Drug Administration (FDA) is scheduled to decide by the end of March whether to ban the chemical's use in all food and beverage packaging.
Vom Saal believes that BPA is only the most prominent example of many substances in our food supply and environment that functions as an obesogen. "If people really want to solve the obesity, diabetes, and cardiovascular disease epidemics," he says, "it isn't a wise thing to be ignoring any contributor to this. And we're not obese just because of HFCS, or because of BPA. I also know that nicotine and PCBs and other chemicals are implicated in diabetes and metabolic disease as well."
Lustig echoes vom Saal's belief that a wide range of substances in our food supply and our environment are likely leading to obesity and metabolic disease based on hosts of studies of various substances. These include soy-based infant formula, phthalates (used in many plastics), PCBs (found in coolant and electrical equipment), DDE (a type of pesticide), fungicides, and atrazine (a common pesticide).
If the obesogen theory comes to be accepted and casts doubt on the energy balance model, the food industry will be in trouble. It would be harder to keep promoting diet and "health" foods that may be low in calories but that also contain an array of substances that may actually prove to contribute to weight gain.
The emphasis that industry places on personal choice puts the onus back on the individual and leaves the consumer with tough decisions to make about industrial food products and additives. The food industry does not disclose what kinds of potential obesogens, like certain organotins or BPA, are in its products, because these substances are not required to be listed on labels and are difficult for the FDA to regulate. With an emerging debate in the scientific community and an absence of information on labels, consumers are left making their best guess on the safety and health of foods.
"People say to me all the time, 'What do I do?'" vom Saal says. "And the answer is, there's not much we can do, because industry has no legal mandate to tell you, and so they refuse to tell you the way they're using these chemicals. How do you avoid something you are blind to?"
The energy balance model also diverts responsibility back to the consumer because conventional wisdom says that the spike in obesity and diet-related disease is the result of people consuming more foods than ever before. But a review of the literature in The Obesity Epidemic: Science, Morality, and Ideology by Michael Gard and Jan Wright asserts that there is no evidence that food intake levels have increased in industrialized countries, or that activity levels have declined. According to Gard and Wright, some studies even suggest a reduction in energy intake over the past several decades.
Julie Guthman, a professor of community studies at the University of California, Santa Cruz, points out in her new book, Weighing In, that the amount of calories consumed across racial lines and income levels varies little, according to a study by the United States Department of Agriculture (USDA). This is despite the fact that obesity and overweight do vary across racial lines and income levels: Poorer people tend to be more obese, and African Americans and Latinos have higher rates of obesity than do whites. This means there must be some other mechanism, Guthman says, besides excess calories, in the varying levels of obesity. In her book, she refers to the possible role of environmental factors like exposure to obesogens and other toxins, stress, and non-nutritional aspects of food.
Guthman would like to see stronger regulation on the part of the government, and a discussion that focuses more on how food is produced and not just on how much is eaten. "I think people would like to say that weight loss is simple and that it's all about changing personal behavior," Guthman says. "So there's an emphasis on trying to make people have better lifestyles or on changing the built environment."
This seems to fit with Marion Nestle's approach to educating people on weight loss. Nestle is the co-author of a new book on the subject, Why Calories Count. "BPA, PCBs, and other such contaminating chemicals can't possibly be good for health," she said in an email. "But it's really hard to prove that they cause demonstrable harm. They might have something to do with obesity -- I suppose it's not impossible -- but why invoke complicated explanations when the evidence for calories is so strong? Let's say obesogens affect a body weight regulatory factor, which they very well might do. But so what? Weight is regulated by more than a hundred biological factors, and these are redundant, which means that if something goes wrong with one of them the others fill in the deficit."
The "so what," Guthman says, is that "We really don't understand the science enough, and there's new evidence in the science that completely re-shifts how we think about these things."
According to Blumberg, the food industry would like to discredit emerging research on obesogens. "What industry typically does is fund studies that produce the opposite conclusions, thereby shedding doubt on the science," he says. "If you take BPA as an example, the vast majority of studies performed by independent government and academic scientists show that it has numerous deleterious effects on health. In contrast, not a single industry-funded or -conducted study has found any hazard associated with BPA."
Can we afford to continue to frame the discussion simply in terms of calories in and calories out? Or by looking only at conventional categories like fat, protein, and carbohydrates and diary, meat, grains, and vegetables? Given the proliferation of industrial pollutants and the ultra-processing of foods in our current food systems, it seems that we can't.