FAT: What No One is Telling You

* "I'm embarrassed about my weight. It doesn't reflect who I am inside and what I like to do." Carla

* "You become depressed when you notice that you don't have control over yourself. That your food addiction is uncontrollable." Rocky

* "I think I developed my sense of humor early in life because I was covering up so much pain." Mary

* "Weight loss is not a simple balance between energy in and energy out. If it were, we would have solved the obesity problem long ago." Dr. Lee Kaplan

Fat is a thing you can't hide. Carla, Rocky and Mary know this. They have struggled for a lifetime with the uncontrollable urge to overeat, the frustration of diets that don't work, and the stigma in a society that worships "thin." Is it genes? Is it metabolism? Is it stress, evolution, or the lack of willpower? Why can't the brain control hunger? What drives us to keep eating when we know we're full? As the number of obese Americans climbs to frightening levels, the quest for answers is becoming even more urgent. Obesity experts have a growing - and sobering - awareness of the complex human puzzle that is driving this epidemic and creating so much personal pain.

"Open abuse of fat people is our last accepted prejudice. A license for cruelty," says Naomi Boak, executive producer of FAT: What No One is Telling You, premiering April 11, 2007 at 9:00 p.m. (ET) on PBS. "One of the first things we can do to solve our country's obesity epidemic is take a new look at fat people and honor the complexity of their struggle, a struggle that too often is labeled with the epithet, "Fat!" The two-hour program gives viewers a window into the intense human dramas that rage inside people who have been labeled obese and how hard their weight problem is to solve. Even the most disciplined effort is beyond the abilities of many people - not because of weakness, but because of the complex mix of environmental factors and biology that make it a lot easier to gain weight than to lose it.

"Being fat is not a moral crime and not just a matter of personal responsibility," says Ms. Boak, whose 2004 Primetime Emmy Award-winning documentary The Forgetting: A Portrait of Alzheimer's was the first up-close look on television at the ravages of Alzheimer's disease. At 5-foot-3 and 200 pounds, she has waged a personal war on fat since childhood. "I couldn't have made this film without the intimate experience of growing up fat."

The Forgetting provided the model for this season's primetime PBS Health Campaign. Like that landmark program, the last thirty minutes of the two-hour special offers practical advice for confronting this challenge. Focusing on preventing obesity in children, which leads to almost insurmountable long-term weight and health problems, doctors, nutritionists and community activists will address questions from parents in a studio audience who want to help their kids avoid a lifelong health trap.

The Second Brain

As a young man, Michael Gershon, professor of medicine at Columbia University, went against the wishes of his father and the advice of his professors who urged him to study the brain. Instead, he set off on an exploration of the bowel. Intrigued by some long- forgotten 20th century scientific discoveries about an independent nervous system in the gut, Dr. Gershon's research uncovered how this sophisticated physiological wiring functions essentially as a "second brain." The gut, it turns out, has a mind of its own and plays a major role in deciding when and how much we eat. When the brain in the head says eat less and in moderation, the "second brain" in the gut can override the brain in the head and propel us to eat more and without restraint.

Obesity expert Dr. Lee Kaplan and his team at Massachusetts General Hospital compare the body's hunger drive to the human body's response to running up six flights of stairs. You can force yourself to breathe slowly for a few seconds, despite this exertion, but ultimately your body will demand more oxygen and you'll breathe faster. When it comes to decisions about how much to eat, a similar battle occurs between your conscious will and your subconscious. And if your subconscious brain wants more food, it wins and you eat more.

A study of gastric bypass surgery has led Dr. Kaplan to a compelling discovery about how the body regulates food consumption, and the hope that someday surgery can be avoided altogether. Dr. Kaplan has found that weight loss in surgery patients is not just a result of making the stomach smaller. The surgery actually reduces the feeling of hunger by cutting some of the nerves in the bowel, which changes the signals that flow between the gut and the brain. It also alters the way the hormonal system gets its information from food and sends it to the brain. "By manipulating the gut, even in a small way, we end up changing the communication to the brain and the brain acts differently to manage our weight and metabolism," says Dr. Kaplan. His goal now is to completely replace surgery by developing a pharmaceutical that alters these intricate circuits in the same way that an invasive operation currently does.

Intense Human Struggles

A familiar face on television, actress Mary Dimino's battles with food and dieting are the hysterical heart of her stand-up comedy. As the documentary opens, we see Mary sweating through one of her daily three-hour gym sessions on the treadmill. Acknowledging that it's a lot of exercise, she explains, "I have to work just as hard, even harder, just to maintain this level of chubbiness." Like many people who struggle with weight control, Mary has persistent fat cells in her body that were added during years of overeating. Now the weight may come off, but the cells remain - always hungry -constantly crying out for more calories and defying Mary's willpower.

"There was something haywire," says Rosie Delhi, whose words confirm the burden every fat person knows who has tried and tried and tried to lose weight. A retired school principal, her bariatric surgery was, until now, a secret from everyone but closest family members. "You can't believe how awful it is," says Rosie who yearned to play on the floor with her grandchildren, and get up again. "If I didn't make a change, I was headed for a death sentence." The rewiring effect of the bariatric surgery, which Dr. Kaplan has identified, seems to be helping Rosie to sustain her weight loss by helping to suppress her hunger impulse. Now her disciplined effort to maintain a healthy weight has a shot at success.

As a senior in high school, Rocky Tayeh utilized his budding talent as a journalist by producing a radio documentary on his own battle with obesity. Raised in Brooklyn, Rocky laments the everyday temptation of food available in his neighborhood. "If I'm hungry at 4:00 in the morning, I just have to walk a block down," says Rocky. "There's a Dunkin Donuts here, a McDonald's here, a fast food restaurant here, a Chinese restaurant and they deliver." Despite the disapproval of his family and his own doubts about "taking the easy way out," Rocky makes a decision to have surgery, loses 150 pounds and faces the prospect of a new life in college without the embarrassment, shame and stigma.

Carla Hurd has gained about 120 pounds over the last twelve years of her job as a marketing executive at Microsoft. Carla and her overweight husband David signed up for a comprehensive weight management program funded by Microsoft. Even with the no-holds barred support of all the best personal trainers, doctors, dieticians and psychologists and a profound motivation to get pregnant, her success in the battle to lose weight is elusive. In videotaped diaries, Carla tracks her uncontrollable urges and her struggle to resist the comforting temptations of food that calms her stressful life.

Public health nurse Pat Lyons, who describes herself as a professional fat woman, knows there is very little justice or sympathy for fat people. "There are happy, healthy people of all shapes and sizes." Pat's mission is to uncouple the idea that physical fitness and activity is only useful in regard to losing weight. Everyone should be active, regardless of size. You should be the healthiest you are at whatever weight you are.

Prevention in Children

Eating habits are established and crystallized very early. Cornell food psychologist Brian Wansink, who is studying the link between what kids eat and their parent's behavior at home, has determined that we make an average of 119 decisions a day about food and eating, usually subconsciously and cued by things other than hunger. By tracking kids as they make the choice between cake and carrots and super-sized portions versus what fills me up, Dr. Wansink is proving that parents can stem the tide of obesity by paying attention from the start.

A driving force behind Latino Health Access in Santa Ana, California, America Bracho sees the health crisis unfolding on the streets of her neighborhood and fears that overweight children are on their way to a lifetime of disease. "These kids who are 11 are 250 lbs, they are probably going to be blind by 25, amputated at 28. How urgent is that for a nation, how urgent is that for the family, how urgent is that for the individual - very urgent," says Dr. Bracho. "In public health, saying a kid needs a polio vaccine is easy," she says, "but talking to people about the way they eat needs more information and training." To get the best results, Latino Health Access has discovered that the work is best done at the community level by the people who live there. "Participation. That's how we change this epidemic. Once you get involved then you learn the rest."

© Copyright PBS 2008 | Privacy Policy