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• Bio on Dr. Kaufman
• About Diabesity
• American Diabetes Association
• Dr. Kaufman featured on The Road to Health

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Tavis: We continue our 'Road to Health' tonight with Dr. Francine Kaufman, a highly respected expert on diabetes who served as president of the American Diabetes Association. She now heads the Comprehensive Childhood Diabetes Center here in L.A., just around the corner from this studio, in fact. She's also the author of a new book detailing the growing link between diabetes and obesity. The book is called 'Diabesity: the Obesity-Diabetes Epidemic That Threatens America and What We Must Do to Stop It.' Dr. Kaufman, nice to have you on the program.

Dr. Francine Kaufman: Thank you. It's good to be here.

Tavis: I'm almost scared to ask this question, but I suspect it's the best place to start. How bad is this problem?

Kaufman: Well, it's a pretty significant problem. We have, I think, really two pieces of evidence that show how bad it is. One is one in 3 children born in or after the year 2000 is expected to have diabetes sometime in their life.

Tavis: One of 3?

Kaufman: One of 3.

Tavis: Wow.

Kaufman: And it may be actually even more if you're a child of color.

Tavis: Uh-huh.

Kaufman: And this generation of children may be the first generation to live less longer than their parents as a result of obesity-related diseases.

Tavis: And I think I know the answer. Let me ask it anyway. You're the expert. The reason for kids being more obese now than ever before is...

Kaufman: Well, it's really two things. One is we have genes inside all of us that were designed for us to live in a very austere environment 40,000 years ago, and our genes have not changed. These genes enable us to store calories and to, you know, really be able to withstand those tough days with not much food. But what's changed is our environment. Our environment is toxic at this point, and that environment and our genes are on a collision course.

Tavis: That's a wonderful explanation. I think I heard somewhere up in there, though, and maybe I didn't--if I didn't, you'll tell me--that it really has to do with--logically with just overeating. I mean, you say environment. How does our eating bigger portions, eating more unhealthy, eating--how does that fit into this whole environment argument you make?

Kaufman: Well, the environment is 2 pieces. One is how much we put into our bodies, so how much energy we put in, in the form of French fries and soft drinks and all that junk food, and then there's how much energy do we expend in a day, so whether or not we're in energy balance, and most of our children are not in energy balance. They're putting in way more calories then they expend every day, and the reasons are complex. I mean, there's environmental--look at some of our communities, particularly our communities of color. Fast food restaurant after junk food store after liquor store, no playgrounds, schools have, you know, kind of lost the physical activity environment, they're selling junk food as well, and then you just kind of, you know, have that, and it just keeps escalating. Children are marketed to from the time they're 2 to want junk food and to want these kind of things that aren't good for their health, and it's just coming to a point where too many people are affected. So many--30% of our children now are overweight or obese.

Tavis: What you have just defined as complex--let me play devil's advocate if I might, and it's awfully bold of me since you're the expert and I'm not, but let me just risk making myself look ignorant and play devil's advocate here. What you see as complex, I see as rather simple. Let me just take some of the issues that you've just thrown out. If it has to do with the fact that schools no longer at the level they used to when I was in school, when you were in school, force kids, make kids participate in P.E. classes, physical education, that ain't a difficult problem to solve, is it? Why is that complex? Put physical activity back on the regimen.

Kaufman: OK, well, then we have "leave no child behind," so the schools are really incentivized, are scared to not have as much time at that desk as possible because those kids aren't gonna do well on the achievement exams. There's budget issues. There's not only like--who gets the money when these kids buy a soda in school? Who gets the money when these kids buy something off a snack line? How does that compete with the national school lunch program?

Tavis: OK, stop. You call it complex; I call it simple. If parents demand that schools stop selling their kids junk food and selling out their kids, quite frankly, to big corporate business, that problem could be solved. How complex is that?

Kaufman: Well, I guess I agree with you. In some ways, all the reasons we're here are complex. I mean these are historical issues about, you know, a number of mechanisms that got put in place. The answers, and that's why I wrote my book 'Diabesity,' the answers are as simple as you say. We have got to demand that we can live our lives healthy. We've got to demand where we go to work that we have good food options. We've got options for some physical activity during our day. We have to demand that of our schools, of our communities, of our health care system, and of our government, and I think this is a movement I'm hoping will start. It actually has started in a number of places across the country with a large number of interest groups who care about the next generation of Americans, and we've got to demand these things, and we've got to demand them pretty soon.

Tavis: Respectfully I was only pursuing that line of questioning to get to that point that it may seem complex, but on the surface--you dig a little deeper, it's really not that difficult if people start to make these demands. In that regard, though, the things we've just talked about. Schools, government, places of employment. What we have not talked about, really, and I think one could make the argument legitimately that so much of this problem exists because parents don't hold the line with their own kids. Now there is one I won't even argue because that really is complex. I don't know how you get parents--how does anybody make parents hold the line with their own kids and understand that when they feed their kids whatever they want and however they want it and as much as they want, what they're really doing is endangering their kids' lives down the road?

Kaufman: Well, again, let me suggest there's a number of reasons. One, it is cheaper to buy sugar and fat calories than it is to buy fresh fruits and vegetables, so I think there are some people who don't have the option.

Tavis: I've heard that before many times. Why is that? That makes no sense to me. Why is it more--why is that?

Kaufman: Well, again, you know, a lot of historical reasons. Our government subsidizes high fructose corn syrup. Our government subsidizes some other food products, particularly inside the school, a lot of dairy products, a lot of meat products that maybe have more fat in them than other ways to get meat products. We don't have a lot of fresh fruits and vegetables subsidized to give to children inside schools. So I mean there's a huge number of economic issues around that. There's a huge food industry that's made a lot of money over the last, you know, 3 decades on selling big packages of food, and the food inside, those chips, maybe those fries, they're not the expensive thing. Matter of fact, the packaging often costs more than the food inside, so there's no reason not to give you more and more and more. We have what we call portion distortion. I mean we have a program over at Children's Hospital Los Angeles. The kids come in. It's an obesity program, a family center program we have to teach the parents how to reach a food label. What is a portion? The first thing we ask them to do is pour out a serving of corn flakes. They pour--however big the bowl is, they fill it. They don't understand that, you know, a portion is a cup, period. Doesn't matter if that bowl can fit 2 cups, that bowl can only fit half a cup. A portion's defined. So there's a lot of education, a lot of people have missed out on that education in school, and we have to educate people. We have to change a lot of the structures so that these things are available for people. You know what, people always ask me, "Isn't this all about personal responsibility?" In a lot of ways it is, but in a lot of ways, how can we take, you know, a mother maybe working 2 jobs, has 3 kids, trying to raise them on her own, coming home from, you know, work, picking up those kids here and there, how is she gonna have time to go to the grocery store? How is she gonna have the money to buy those fresh fruits and vegetables? How is she gonna have, you know, the opportunity to make this wonderful meal like Ozzie and Harriet used to have? And she doesn't, so we have to look to ways to make her life liveable, have those kids be healthier. Her work ought to offer better food on her way out. A fresh salad. She can stop by maybe the cafeteria on the way from work, and we have to get those kids off TV. There's a whole industry luring them onto TV, luring them onto these video games. We got to get those kids off that, that family's out moving and walking and going to the museum and going to the parks, and it's a social movement.

Tavis: And yet while it is a social movement, people of color disproportionately seem to be impacted by these problem areas, of diabetes and obesity.

Kaufman: Absolutely.

Tavis: Yeah. Why?

Kaufman: Well, it's both genetics. I mean there's clearly a differential in genes across the different ethnic racial groups, and aboriginal people, native people, African people, Asian people have more of the genes that promote this. Indian people from India probably have maybe the most, and we can look kind of through the eons of evolution and try to understand, and there are a lot of people who are trying to understand why these genes differentially are in people of color compared to--European-derived Caucasians have the least amount of these genes. So some of it is, you know, is a real genetic influence, and then you take poverty on top of that where you can't afford those fresh fruits and vegetables, you can't afford the gym membership, you can't afford, you know, to send your kids to the schools with the big gymnasiums and all these other things, and it becomes, you know, just an on-going cycle. Your neighborhoods aren't safe, no place to go for a walk on the weekend, and we see an explosion.

Tavis: All right, you win; I lose. It is complex. Ha ha ha! It's very complex. It's not simple at all. I laugh about that, but on a serious front, with all due respect to the book and to the many conversations that I've been in and will continue to be in because sometimes it's about preaching to the choir over and over and over again until they get it and start to sing in key. With all respect, though, to the work that you do and others do, how bad is it going to have to get? What's going to have to happen honestly for us to get it given that I can look and read stuff anywhere and hear that Americans are now more obese than ever before? Hate to break this to you. You ain't the first person to tell me this.

Kaufman: I'm sure.

Tavis: When do we get it? What has to happen for us to get it?

Kaufman: Well, I think when it costs more to take care of it than it costs to prevent it, and which we're already at, and I think the real movement is gonna come from inside the employer. The employer is paying for this. Take something like GM or Ford. 10% of their work force has diabetes. 60% of their work force is obese. They're paying for it in hypertension medications; they're paying for it in hospital visits; they're paying for it in lost productivity. And, you know, we're all hearing now how much of that first amount of that money going to make that car goes to that health insurance for the big automakers. When it becomes so painful that we can't continue to compete in any way, you know, as far as our productivity's concerned, people are gonna look to put prevention, to put treatment inside the work force, to put it back in the schools, to make it a priority inside our communities.

Tavis: I guess it's a sad reality, but I haven't had one conversation ever in my entire career when the problem did not eventually boil down to one thing: money, and here we are again. Anyway, nice to have you on the program.

Kaufman: Thank you so much.

Tavis: Nice to see you. Up next, from a real-life doctor to a guy who plays one on TV, actor Omar Epps from the new medical drama 'House.' Stay with us.