McDonald’s wants to open five new locations in the Netherlands every year. Hints? Mail to real [email protected]. KFC and Burger King also have such a website. McDonalds is currently not making five new locations a year, but fast food chains continue to look for places where many people congregate, preferably where you don’t have to leave your car for a hamburger or a bucket of chicken.
In the meantime, municipalities, and now also the State Secretary for Health, are looking for ways to stem the rise of unhealthy food. Because what they see: it is precisely poorer neighborhoods where people live much shorter healthy lives that are magnets for fast food companies. And if they want to prevent further expansion of the catering industry, they will be left empty-handed.
Read also: This report about fast food in the poorer neighborhoods of The Hague
Every time an alderman or state secretary cautiously starts talking about intervention, the same rebuttal is heard. Fast food doesn’t have to be unhealthy. And even if you agree that fast food is mostly junk food—ultra-processed foods high in salt, sugar, and saturated fat—how can you prove that fast food is what makes people fat?
I ask Martijn Brouwers, internist-endocrinologist at Maastricht UMC+ and he starts talking about his evolutionary interest. And that processing and cooking food once, when food was still scarce, was beneficial because it cost the intestines less energy to digest food. He cautiously raises: “Does ultra-processed food cost the intestines even less energy? Does that contribute to weight gain?”
You would think it doesn’t matter what you eat. A calorie is a calorie, whether you eat pizza or wholemeal bread. Yet there are more and more studies that do show a difference. The more calories there are in a bite, the shorter you have to chew, the less hard the intestines have to work. And the more calories people tend to eat.
Famous are the experiments of the American researcher Kevin Hall, who showed in the lab that people of ultra-processed foods – if they are allowed to eat unlimited – eat more calories than from unprocessed, self-prepared food. An indication that ultra-processed food does indeed make you fat, whether it comes from Burger King or from the supermarket, where 80 percent of the supply falls outside the Wheel of Five. Your body simply does not have time to let you know that you have eaten enough.
What Brouwers discovered himself: that fructose (fruit sugar) from soft drinks and fruit juice was indeed related to fatty liver, but not fructose in fruit. “That continues to amaze me. Fructose is fructose, isn’t it?” Hypothesis: the intestines cannot keep up with the rapid supply of sugars and allow part of it to pass to the liver. In the hospital, Brouwers – fast forward – sees the consequences: type 2 diabetes, cardiovascular disease, liver inflammation, cancer.
Whopper
Even if it is no longer under discussion that ultra-processed food is unhealthy, you can say: no one is forced to eat it, people can decide for themselves whether they eat a carrot or a Whopper. But why do some people eat Whoppers more often than carrots? And what happens if there are more Whoppers than carrots for sale in the area?
Recent research in the US of more than one million people showed that a a bigger selection of fast food was associated with a higher weight. Okay, America is not the Netherlands. But then a Dutch example. Groningen epidemiologists dug into the large Dutch biobank Lifelines and saw that people in poorer neighborhoods with at least two fast food providers less than a kilometer from their home heavier on average were than people who did not have fast food nearby. Remarkable: it didn’t matter if there were also healthy providers in the area.
Whoever demonizes the hamburger also demeans the people who eat it
Of course you never know what else is going on with people who are surrounded by unhealthy food. And you also don’t know what the order is: do people eat junk food because the supply is so large, or is the supply so large because those people already had an unhealthy lifestyle? But put all these findings side by side. Or take a walk in Amsterdam-West, where KFC, for example, is so clever to sit next to a swimming pool to sit down, with a shutter on the sunbathing area, and then you understand how difficult it is to resist fast and greasy. And how limited the freedom to choose healthy is in some places.
Perhaps the association with poor neighborhoods, with social class, makes it so sensitive to find something of fast food and to advocate for regulations against its rampant growth. Whoever demonizes the hamburger also demeans the people who eat it.
If you link low incomes and a lower level of education to poor food, do you mean that those people outside your elite bubble – politicians, policymakers, doctors – are doing it wrong? That your great green protein bowl better than their frikandel special? Will the whole grain eaters soon determine what other people eat? Before you know it you’ll be a moralist. No worse, you patronize.
Marketing
In Groningen, Erik Buskens, professor with health policy as an expertise, once wrote a flaming argument before patronizing. Because health inequalities are widening. Because there are also rules for other environmental factors (air and water). Because companies patronize just as much as the government. “But then it’s called marketing.”
Proponents of patronizing usually soon find a few liberals in their path. You can try to contradict that. But Buskens also wants to supply some ammunition to liberals who don’t necessarily find the umpteenth McDonald’s an asset, especially if it comes next to their children’s school. “Food, like water, is a basic supply. If the food environment causes damage, the government must protect citizens.”
And when that doesn’t impress, take a look at the cost: if an unhealthy environment leads to an unhealthy population, less productive years and higher health insurance premiums, don’t we want to intervene? Is a growing health care budget appropriate for a small government? Buskens: “That’s just not a good business case.”
Patronizing sounds like: you are no longer allowed fries. But what is meant is: not everyone is allowed to sell unlimited fries everywhere. A slightly smaller selection of fries, pizza and döner kebab does not reduce the freedom to make unhealthy choices. Those who have cravings for snacks can still get their money’s worth. And then light up a cigarette. It has never been taken from anyone.