‘Weight of the Nation’: U.S. Obesity Crisis Tackled in HBO Special
They’re the new minority in the United States: “healthy” waistlines. With a third of the nation’s adults weighing in as overweight and another third registering as “obese,” America’s collective eating disorder has relegated those with a healthy body mass index to the fringes.
That’s why officials from the Centers for Disease Control, the National Institutes of Health, and Institute of Medicine — to name a few — joined up with HBO recently to produce a four-part documentary series outlining the scope of the problem, some common myths and the costs of inaction. “The Weight of the Nation,” slated to begin airing later this month, shares its name with a CDC conference taking place in Washington this week and a report released by the IOM on Tuesday.
The documentary series’ producer, John Hoffman, stopped by the PBS NewsHour studio recently to talk with Ray Suarez about the multi-faceted project. Watch the video above and visit the HBO website for additional information on how to catch the full series.
And, of course, there’s more to come on the PBS NewsHour. On Tuesday’s broadcast, we’ll have a full report on the epidemic’s financial costs and a discussion with NIH director Dr. Francis Collins.
Ray Suarez: Welcome back, I’m Ray Suarez. I’m here with John Hoffman, who is the producer of the new HBO series … And, really, we’ll talk about it, but it’s more than that, the Weight of the Nation. John, welcome.
John Hoffman: Thank you.
Suarez: How did you embark on this enormous topic, enormous project and assemble this impressive list of partners?
Hoffman: Well, starting with the addiction project in 2007, which we did with the NIH, HBO has really tried to create a platform for public health, using its invitation into 30 million homes, but then all cable and satellite households when we open the signal, and when we put all this material online for anybody with access to a computer to watch. We’ve realized that we can use our platform every few years to really engage in public health. And not just public education but public health. Where, when we partner with the Institutes of Medicine, the NIH, the CDC, it really sends a message to the nation that we’ve gathered the most important voices on the topic to shape a dialogue that the country has to have about a health issue.
Suarez: Well, this is quite literally an existential crisis. This is going to drive health care costs, going to drive life expectancy. [We're] looking at the first generation of children that will likely be less healthy than their parents and grandparents, in many cases. You’ve made a big commitment, but how do you engage in storytelling around something that’s got so many moving parts, is such a challenging story to tell, but also wants to deliver a health message?
Hoffman: Well, it’s our belief, and I think the material shows this, that people did not recognize that the slow weight gain that was happening for themselves, for their families, and really seeing in the communities around them, that this was having health consequences. And what’s happening, when you have too much weight around the middle, the changes in blood pressure, the changes in blood sugar, in cholesterol, these are silent processes. You don’t feel any of those effects. So, I think for far too long, people had a rather benign view of this weight gain that was happening. And, it’s now catching up. Now we have those generations of people who, in their 40s, 50s, 60s, are having heart attacks and strokes, and we’re undoing these monumental gains in public health that we’ve made.
Especially in heart disease. It’s still the No. 1 killer but these … We’ve had just these miraculous changes in the public health around smoking cessation and because of statins. But we could undo all that with this weight gain.
Suarez: Just today, a report came out from Duke University that said one out of every nine adults will be at least 100 pounds overweight by 2030. And a lot of our visual cues, a lot of what we think about when we talk about the overweight, are those people — the super-overweight. But a very touching moment in the film comes when one of the people you profile reflects on the fact that they’re merely overweight. Not super- obese, but still in trouble. Let’s take a look.
["Weight of the Nation" excerpt]
Suarez: Of course, the man that we see there is confined to a wheelchair because of his amputation. It’s really had a tremendous impact on their lives.
Hoffman: Yes, this is what diabetes is going to do to the nation. It’s one out of three children born in the year 2000 will develop diabetes in his or her lifetime. One out of two if that child is African-American or Latino. It’s not just developing diabetes. If that child develops the diabetes before the age of 10, his or her lifetime will be cut by 19 years, and the life will be an unhealthy one. It will be a painful one. It will have kidney failure or amputations, heart attack or stroke. So, diabetes is an awful disease, but because we are able to manage it to a great extent, I think that people are not reacting with the sense of alarm as if they were given a cancer diagnosis. But any doctor will tell you, the same sort of alarms should be happening, if you are at risk for diabetes as if you are at risk for cancer.
Suarez: I was interviewing one of the people who was one of the lead authors behind the Institute of Medicine study and she said, “You know, a lot of people compare this to quitting cigarettes, but it’s very different. Because once you stop smoking you’re not constantly surrounded by cigarettes. You don’t have to smoke for any reason. But you do have to eat. And you’re surrounded by food. Decisions around eating, around changing your life, are just very different from making other lifestyle changes. Did you find that to be true when you went around the country?
Hoffman: Oh absolutely. And you have to also factor in that the foods that are at arms-reach. The foods that are so affordable, are the high fat, high sugared foods that are activating the pleasure centers of our brain in the same way that drugs do. It’s the dopamine system. It’s the pleasure-reward system of the brain. And so we’ve refined these food products to be as potent as we can for that reward. So you’re going to ask people to not experience pleasure? You’re going to ask them to turn away from these foods that give those momentary bursts of dopamine, that light up the pleasure centers of our brain? So that makes the challenge all that much more difficult if we have to really re-imagine the food environment that we should all be living in.
Suarez: The shape of Americans has changed drastically, just in the last 30 years. Now that you’re steeped in this topic, did you come away optimistic that we can stop, as Mike Huckabee says, “digging our graves with a knife and fork?”
Hoffman: I’m optimistic because the other public health experts who have studied trends in public health in this country have optimism. Because they see that with smoking, with seat belt use, we have really changed cultural norms, and that it is possible. They find hope in those examples, but I am pessimistic at the same time about the willingness and the ability of the food industrial complex and the agricultural industrial complex to make the transformations that really have to occur if we’re going to succeed. The profits that they’re making from the unhealthiest foods are so enormous. We have an expert in the fourth show who says, “if every American were to reduce his or her intake by 100 calories a day, that would cost the food industry between $30 and $40 billion.” What sector of the economy is going to willfully reduce the size of their industry by $30 to $40 billion?
Suarez: Yet at the same time, obesity is costing us some $200 billion a year.
Hoffman: I actually think the employers are where the leverage point might come. Because the health care costs are bankrupting not only the country, but they are seriously compromising the competitiveness of too many of the employers in this country. And so, we profile a small construction company. Well, it’s a large construction company, it’s the largest one in Arkansas, Naybolds Construction. One thousand employees — almost all of them men. Over half of them overweight or obese. And they used a carrot approach. Not the stick, they used the carrot to incentivize their employees to do better on their weight, their smoking, their cholesterol, their blood pressure and their blood sugar. Three hundred dollars if they reduced in all those categories. Last year, they saved $600,000 in health care costs.
If they avoid one heart attack or one stroke in that company, they will drastically reduce their health care costs as a company. That’s an incentive. So there are models of the employer saying to the employee, ‘We’re not going to punish you for your weight, we’re going to reward you for improvements. And those kinds of cultural norms I think could be the leverage points this country needs, which will enable this country to really make progress.
Suarez: One striking visual moment — you got a chance to look inside as doctors compared the hearts of two people, young people, and we saw what the heart of a man who is severely obese really looks like. Let’s watch …
["Weight of the Nation" excerpt]
Suarez: That’s medicine you have to use sparingly, when you’re doing this kind of documentary, right? I mean, you can’t keep hitting people over the head with that kind of thing, but it is important.
Hoffman: I genuinely think we don’t know enough about how our bodies work. And so, we at HBO have an ability to not have to resort to euphemisms, both visually and with our words, to explain very hard subjects. So, we’re able to show what the body looks like through these autopsies, when it has lived with obesity. The man that we just saw, 51 years old. That’s not old. But at 500 pounds … what kind of heart you have to have to pump blood throughout a 500-pound body. We are not designed … There is no precedent in the history of mankind for this kind of weight. And so our biology just does not have an ability to adapt to this kind of inexorable weight gain. So, what we are able to show through the generosity of these doctors is the serious consequences. I mean, in that scene, you go on and you see the aortas of people with heart disease and it’s a very disturbing sight. And it is unsettling and it is purposely unsettling because we need to know how our bodies are reacting inside to this weight gain. It’s not a silent process. We just don’t hear it.
Suarez: The HBO documentary series is called “The Weight of the Nation.” It’s available to people who are not HBO subscribers. Go to the website for more information. It’s also available in Spanish. It’s also got an accompanying book and all kinds of information and graphs. John Hoffman is the producer. Thanks a lot.
Camerawork by Victoria Fleischer and Jason Kane.