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Doctor Empathy
This doctor wants you to lose weight sensibly. How long should you stick with his diet? Forever.
Select text to jump ahead in the clip:
In recent years he's lost 20
pounds and he'd like to lose
another ten. Doctors need
empathy, he says. So this is
our... this is going to be
our empathy test here. That's
correct. ALDA:
These empathy suits are made
to simulate about 40 pounds
of fat. I was too tall for
mine but George Blackburn
showed me what he wants
doctors to learn. Now, what
we want to do, we can...
Well, you look really good.
Don't I? It's a good fit. So
now, you would ask a doctor
to wear this, right? That's
right. And the doctor would
see how hard it is
to put on a pair of pants and
a jacket when you have this
much bulk. That's right. You
have to be careful you don't
topple over there. This is a
comedy suit. It's not... I
know it's a serious subject
but it's very hard to get
into this without laughing.
You would need suspenders--
why? Because the belt would
slide down. I see. See,
you're hipless. But crossing
your legs is essentially out
of the question.
Yeah. And getting your shoes
on... Yeah, yeah. How much do
you think an average person
should look forward to taking
off in how long a time? Well,
we talk about two to four
pounds a month
is a healthy weight loss--
one that you're likely to be
able to keep off. And
whatever you did to do that--
eat less and be more active--
you could do for the rest of
your life. ALDA:
Laura has been working with
Heather McCormick a
nutritionist at Blackburn's
center, for four months and
she's losing a modest two
pounds a month. Above all,
Blackburn wants goals that
are moderate and realistic.
Okay, good, you can let it
out. Okay, you can step down.
ALDA: Looking at Laura when
she was young-- a little girl
of normal weight-- you might
imagine that she now has
some kind of mysterious
problem with metabolism.
Okay, says Blackburn, let's
be realistic here, too. So
everyone gets what's called
their resting metabolism
measured-- that's the energy
our bodies use up just
existing.
If it's normal, you can't
blame your weight on glands
or something. At 2,000
calories a day, Laura's
metabolism is absolutely
normal. In Blackburn's
program, everyone has to
become more active.
They check your condition at
every visit, about once a
month. Activity has a double
benefit. It burns calories
directly, and as muscles
develop more calories are
needed just to run them.
McCORMICK: Things like fried
foods the Chinese fried rice
we want to try to stay away
from. ALDA: Food diaries are
another part of the monthly
visit.
Heather's looking to make
helpful, small changes--
nothing extreme, nothing too
scary. One day you had, you
know, two ham- and-cheese
sandwiches and instead, you
know, maybe having one
sandwich.
Okay. And then the potato
chips-- you want to try to
stay away from them and have
something, you know, if you
need the crunch carrots or
pretzels or something like
crackers instead of the
potato chips. LAURA:
One of the things that I was
kind of nervous about was
changing the way that I eat
and just cutting down all the
portions that I eat and going
completely to salad all the
time or something like that.
These are fears that you get
from watching different fad
diets and things like that.
What I really liked about
Heather was she said,
'Listen, let's just take this
one step at a time.
' Get up here? Get on the
scale for me. Okay, and
you're not holding on
anywhere? No, I'm not holding
on. ( laughing ) Well, we
just... But I'm exhaling. I'd
like patch pockets with a
belt in the back.
( laughing ) NURSE: And
you're not holding your
breath? No, I'm not holding
my breath. It's instinctive.
NURSE: The other item
I need from you-- this is
based on your age, your sex,
your weight and your height.
So... You want the frequency
of sex? No, no, no. Oh, I'm
sorry.
( laughs ): I'd like to know
your, uh, age. My age is 64.
Same as my waist. All right.
Well, no, your waist is much,
much improved. ALDA: I had a
little fun with the center's
terrific staff
but there's a serious point
here. Paying detailed
attention to weight like this
is very unusual. Most doctors
never raise the subject even
with obviously obese patients
and that's something that
Blackburn says has to change.
My resting metabolism, by the
way, was normal. This is
Diane Scott, a graduate of
Blackburn's program. SCOTT: I
was extremely overweight.
I was over 200 pounds. I was
a heavy smoker. Ck I rarely
exercised. I watched a lot of
TV. I was constantly getting
colds and upper respiratory
infections. It was a struggle
if the escalator was broken
at the T--
and I work in Boston-- to get
to the top of the stairs. And
I realized I wasn't even 40
and I was just really
compromising my health. ALDA:
Working with the
nutritionists, Diane, who's
an avid chef
learned how to greatly reduce
the fat in her cooking while
maintaining its appeal. So,
for example, cornstarch with
chicken broth is a nonfat way
of giving the same smooth
texture in the mouth
that we get from high-calorie
fat or oil. We're going to
compare a George Blackburn
style of menu to a couple of
popular extreme diets. What
are you folks up to? WOMAN:
Oh, I'm starting the sauce
for the high-fat diet. And
what I have in here is
some... a little bit of
butter
and then I'm going to add a
lot of heavy cream-- two cups
of heavy cream-- because
we're in high fat. We've come
into the enemy's camp here.
( all laugh ) How long are
you cooking the fish? Uh, the
fish will probably take five
minutes to cook. And what
we're going to do is
basically get a sear. This
one I put in first. ALDA:
Here's the first menu-- very
low fat, vegetarian. Grilled
portobello, pepper and onion
burgers... cucumber salad
with horseradish and dill...
pumpkin tofu cheesecake.
Looks pretty good to me.
In your opinion, what's wrong
with this diet? That sounds
like a good diet. I mean, if
you can stick to it, it
sounds great. BLACKBURN: And
that would be exactly our
point-- that we have to have
a diet that you can live with
for the rest of your life.
And this is the challenge.
This is such a departure from
the normal food that people
would see to adhere to this
really requires a lot of
motivation
a lot of belief and a lot of
training. ALDA: Menu two--
high protein, high fat, low
carbohydrate. Avocado cream
soup with bacon... beef
tenderloin with parsley cream
sauce...
fried Brussels sprout
crisps... and strawberries
with heavy cream. Wow! This
is no fat. No fat. This is...
All fat. ( laughing ): All
fat.
What's good about this diet?
All that fat delays gastric
emptying and therefore you
fill up very fast. And,
therefore, it turns out that
all the calories one consumes
when it's all protein and fat
is about 1,200 calories a
day. And you're so satisfied
you don't want to eat one
more thing. Right-- but if
you keep this up
for 15 or 20 years, what do
you do to your body? Our
greatest concern is that the
delicate lining of your
arteries will be injured by
that saturated fat. ALDA:
Okay, here we're making
Blackburn's menu.
He allows some fat, and he
wants a lot of different
ingredients so flavors are
complex and fun. He wants you
to like this food. BLACKBURN:
It's moderate in its calorie
intake per bite
and it's nutrient... very
dense. Variations of this
diet people could tolerate,
you know every day of their
life and enjoy it. ALDA:
Because calories are moderate
you can eat enough volume of
food to fill up. You know
what Miss Piggy says? Never
eat anything larger than your
head. ( laughs ) That's... I
think that's a good idea.
Well, she's got the serving
sizes. If we could just get
it
to her hand or her paw, we'd
be okay. This is really good.
Mmm-mmm. Well, just enjoy
yourselves. Now, what's this?
ALDA: You find some
unexpected treats on a
Blackburn menu
but in carefully modified
versions. Basically a type of
a trifle. ALDA: Trifle I
happen to love. And this is a
safe trifle or this is an
ordinary trifle? Listen, this
is
an antioxidant power trifle.
ALDA: It's low fat so a
generous portion's only about
200 calories. That's not too
bad. CHEF: This is a trifle
without cream.
No cream in this trifle?
Right. But just, you know
wait till you taste the
ambrosia of this and realize
you don't need cream in it
you know, that it's... Why
does that taste so good?
What's in this? It's a simple
sugar syrup with fruit. We
want people to be chefs. We
want them to have elegant
recipes because by taking
the time to have all these
ingredients you get all the
taste that a shortcut would
require you put a lot of
cream on it. ALDA:
Moderate dishes like these
that you can eat essentially
forever are a key part of the
Blackburn strategy because if
you try to lose weight too
fast hunger signals become
very hard to resist.
We don't fully understand the
mechanism but our bodies
naturally try to maintain a
particular weight. Depriving
your body of no more than
about 500 calories a day is
the only way to avoid
triggering those signals,
says Blackburn.
Otherwise you'll just become
a yo-yo dieter. SCOTT: I've
been a yo-yo dieter most of
my life. I mean, I've tried
the extreme diets of, you
know... grapefruit juice
diets and boiled egg diets
and cabbage soup diets. I've
tried... I tried Fen-Phen.
I've tried the Atkins diet.
And a lot of them I was very
successful at. I mean, I lost
a lot of weight. Some of them
I lost more weight than I
have up till now
but I never kept it off. As
soon as the diet ended, then
the whole... all the changes
that I had made in my
lifestyle to lose that weight
stopped and I went right back
to my old ways of eating.
ALDA: Diane's no longer a
yo-yo dieter because she's
staying within Blackburn's
maximum weight loss limit of
four pounds a month
equivalent to 480 fewer
calories a day--
not enough to trigger hunger
signals. And because she
doesn't feel deprived she
knows her new way of life is
permanent. Laura's got that
message, too. It really is a
lifetime commitment.
It's not... you can't just
not have potato chips now
because you're on a diet. You
know, you really need to make
sure that, you know...
Instead of me picking potato
chips going forward
that I have a carrot stick or
I have a piece of fruit
instead. It's wanting to be
healthier and putting better
things in my body because
this is what I'm going to be
walking around in
for the next, hopefully, 50
more years at least, so...
ALDA: Our next two stories
are about kids. Fifty years
ago, fat kids were virtually
unknown. Now one in four
American children is obese
Obesity Begins at Home
Were you told to stay away from sweets? This parental ploy may be backfiring.
Select text to jump ahead in the clip:
and it's getting worse.
They're heading for adult
lives of heart disease,
stroke or diabetes. Somehow,
our kids have become too
inactive or they're eating
too much, or both.
Hey, guys, welcome back. Now,
do you guys know why you're
here today? GIRL: To eat.
Right, to eat lunch. Now, do
you have to eat everything on
your plate? No, right,
you can eat whatever you want.
Anything you don't want you
can leave it on your plate,
okay? ALDA: This classic
experiment explores our most
basic relationship with food:
the judgment we have of the
right amount to eat.
There are five children,
between three and five years
old. Their lunches are the
right size for this age
group: about 400 calories.
They're told to just eat what
they want and as the meal
ends, three trays still have
food.
But a couple are almost empty
and they belong to the older
kids. That's because young
kids listen to their bodies
telling them when to stop,
whereas older kids and adults
are controlled by outside
influences.
As kids get older, because we
try to socialize them into
eating when it's time to eat
and finishing what's on their
plate they begin to really
learn that there are other
things in the world
that can control their
eating. WOMAN: day these
slices are going to be about
twice the size that they were
in yestition. ALDA: The next
day, the same five kids come
for lunch.
This time, their portions are
doubled-- much more food than
they need. And now the split
between younger and older is
obvious. The two
five-year-olds have cleaned
their plates
just like you're supposed to.
BIRCH: What children may be
learning when we serve them
larger portion sizes and
encourage them to finish
those portion sizes is that
that's the amount that's
appropriate for them to eat.
ALDA:
There's nothing wrong with
finishing your food so long
as what was on your plate was
the right amount. BIRCH: I
would like a Happy Meal with
cheeseburger a
Quarter-Pounder with Cheese
a medium fries and a medium
Coke. Thank you. ALDA: Leann
Birch, who has been studying
children and eating for 25
years believes that our view
of appropriate portion sizes
has been steadily going up.
What you see here is a Happy
Meal which has about 630
calories in it. This is, for
a young child, probably
nearly half the energy that
the child should have for a
whole day. ALDA:
Large portions are regarded
as appropriate for adults as
well, with the trend to
'super-sizing.
' The super-size meal, which
has about 1,830 calories
would just about do it for me
for the entire day with my
2,000 calories. And yet,
these are the kinds of
portion sizes
that are out there that are
supposed to be consumed in a
single meal. ALDA: We're back
in the lab for another
experiment on kids' attitudes
to food. We're going to turn
one of these foods
into forbidden fruit. WOMAN:
In the beginning of this
study we basically are
offering children a wheat
cracker and a Goldfish
cracker and we're offering
them in equal amounts
because we want children to
have the ability to have
equal sort of access to both
of these foods. ALDA: First
they want to make sure the
kids will at least eat
Goldfish.
In fact, they all eat a bit
of both but not a lot of
anything. But now, the status
of Goldfish is about to be
transformed. FISHER: In the
second part we're actually
going to change the rules
so that they can still have
as many wheat crackers as
they want but the Goldfish
crackers are going to become
off limits. FISHER: When I
ring the bell you guys are
going to be able to eat
the Goldfish crackers, okay?
So there are no Goldfish
crackers until we ring the
bell. ALDA: For an agonizing
five minutes those delicious,
desirable, fantastic Goldfish
are absolutely unobtainable.
FISHER:
In one more minute, I'm going
to ring the bell. Do you know
what that means, when we ring
the bell? FISHER: Okay.
CHILDREN: Yay! ALDA: At last,
it's Goldfish time
and you don't have to be a
psychologist to figure out
what happens. The kids pig
out. It's a 'forbidden fruit'
effect. She got a lot. ALDA:
Clearly, this isn't the way
to change kids' eating
habits.
FISHER: Paradoxically,
restriction not only is not
an effective way of promoting
moderation but it seems to
promote the behaviors that
parents intend to avoid by
using that practice. WOMAN:
Do you know what tummy that
is? GIRL: Empty. That's an
empty tummy, right. What kind
of tummy is this? Um... You'd
be full, right? How do you
feel right now? ALDA: In our
next experiment
we're working with kids
who've just had a meal. They
shouldn't feel hungry. Full.
It's full... okay. We've got
pretzels... peanuts... ALDA:
Now Elizabeth is shown a
large tray of snacks:
chips, ice cream, cookies...
and popcorn, which she likes.
And chocolate chip cookies,
all right? Now, I need to go
next door for about ten
minutes to do some work, all
right? I'm just going to
leave this.
This is extra food that we
have. If you don't want it,
you don't have to eat it but
if you want to, you can eat
anything you want. And we
also have this box of toys
here This pen here... it's a
gel pen, so you can write on
that.
So, I'm going to leave this
box with you and I'm also
going to leave the tray with
you. ALDA: Elizabeth, once
left alone behaves in a way
that might surprise you. She
ignores the food.
BIRCH: So far, at least
Elizabeth is not terribly
interested in eating. ALDA:
It takes a while before,
bored with the toys she
finally gets around to trying
just some popcorn--
her favorite food. Now take a
look at Morgan. When he's
left alone, he digs in.
Here's the important point.
Morgan comes from a home
where access to these
attractive sweet or salty
snack foods
is strictly controlled,
whereas Elizabeth is
unrestricted. BIRCH: Parents
who tended to use a fair
amount of restrictive feeding
practices-- namely, parents
who are concerned
about their kids consuming
too many of these kinds of
palatable foods and who
restricted their kids'
opportunities to eat those
things-- actually had the
children who ate the most.
If you came home and you had
any one of those snack foods
without asking your parents
first would they be upset?
And when you have ice cream
can you have as much as you
want or does your mom dish
out a certain amount for you?
She dishes out a certain
amount for me. And if you
want more, does she let you
have more? No? Just one.
Restriction actually tends to
foster consumption in the
absence of hunger in children
and increased interest in the
very foods that parents think
children shouldn't be eating.
And, conversely pressuring
children to eat, uh, healthy
foods tends to turn them off
with respect to those foods.
So what do you do instead? I
mean, I think, as a parent,
that's really the tough part.
I think there are a couple of
things. One is, we need to
help parents to understand
what are reasonable portion
sizes for children
so that parents have
reasonable expectations about
how much foods kids need to
eat. The other thing is, we
need to help parents to
appreciate how children learn
to like foods
that aren't sweet and that
aren't salty. And the way
that you do that is you have
to, I think, be pretty
patient as a parent. We know
that kids initially reject a
lot of new foods
unless they're sweet or salty
and it's only with repeated
presentations-- noncoercive
presentations-- that kids
learn to eat a lot of those
foods. ALDA: Without that
kind of perceptive parenting
our kids are caught in two
terrible traps. First we say,
'Finish your food.
' Then we put too much food on
the plate. Then we say that
high-fat, high-calorie snack
foods are forbidden so kids
want to binge on them. But it
gets worse. Take a look at
our next story.
Couch Potato Kids
Television is making kids less active. It's a pattern that could last a lifetime.
Select text to jump ahead in the clip:
Come on, guys, time for
lunch. ALDA: This is the
Watson family, in Buffalo,
New York. It's summer,
school's out and the kids are
free to do what they want.
Nine-year-old Taylor is, of
course, interested
in seeing if she can annoy
her younger brother. TAYLOR:
Dwight, how come you look
like a monkey when you eat?
ALDA: But apart from that
Taylor's going to have a lot
to do this summer.
She's part of a University of
Buffalo study looking at the
relationship between physical
activity in kids and eating.
WOMAN: Hi, Taylor, hi,
Deborah.
Hi, come on in. It's good to
see you again. WOMAN: Okay,
Taylor, this is the activity
monitor and I'm going to
show... it's just this little
box here.
Take it out of this pouch.
Okay, it's just going to kind
of be like a belt. You might
put it on your belt loops,
through your pants or you can
just put it right around your
waist. ALDA:
Taylor's going to wear the
activity monitor for the next
nine weeks. At the same time
th?
e TVs and computers in the
house are going to have their
activity monitored. Every
time one's switched on or
off, that will be recorded.
And there's no cheating
allowed. ALDA:
So now there's a minute-
by-minute record developing
of how active Taylor is and
how much TV and computer time
she puts in. How'd the
families do this week?
SCHOLL:
The families did great...
ALDA: The study was conceived
by psychologist Len Epstein.
All the 24-hour recalls were
conducted. EPSTEIN:
Now one-quarter of kids are
obese. That's doubling in the
last 20 years. And part of
the reason for that, most
people think is the increase
in sedentary behaviors:
the amount of TV kids watch
the amount of computer games
kids watch. If you look at
prospective data, you can
identify which kids are
likely to become obese over
the next five years
as a function of how much TV.
ALDA: Ten-year-old Brian
MacDiarmid is another of the
13 kids in the study. You can
see what he likes to do.
Brian, how did you do on the
spelling bee? ALDA:
While the kids had to wear
their activity monitors the
mothers were asked to keep
careful track of everything
their children ate. The
information was called in
regularly.
Hi, Sue, this is Tammy from
the University of Buffalo.
I'm just calling to conduct
the 24-hour recall. ( on
phone ): And what was the
first thing that Brian had to
eat or drink after he woke
up?
Okay, about 9:00 in the
morning he had four mini
waffles...
and about two teaspoons of
syrup. SCHOLL: And was he
watching TV or on the
computer or playing video
games? He was watching TV.
DEBORAH: Okay, Taylor
you need to fill out your
booklet. ALDA: There were
activity logs as well. The
show ended at 8:00. ALDA:
Taylor's mother was surprised
at how things were looking.
We had always thought that
they really weren't avid TV
viewers that... maybe an hour
here, two hours here an
unusual day where there'd be
more than that.
But when you looked at the
numbers over the course of a
seven-day period we were
somewhat astounded by that--
that our children could be
spending 12, 15
upwards of 20 hours or more a
week in front of a television
or at a computer not doing
anything else and that's
almost an entire day out of a
seven-day period. So that was
kind of shocking for us.
ALDA: After three weeks all
the activity monitors, TV and
computer records and activity
logs were compiled. It turned
out that the average time
spent in front of the TV or
computer
was 24 hours a week-- 3½
hours a day. So now that they
knew the normal behaviors of
their wired-up families, the
researchers set about
changing the kids' activity
levels. EPSTEIN:
It could be that, as kids
become more sedentary that
eats into their physical
activity time and they're not
as physically active. Or it
could be that a lot of kids
when they're sedentary, are
also eating. ALDA: For the
next three weeks, the kids
were asked to increase their
TV and computer time by half:
for Taylor, nine more hours a
week
and for Brian, 20 more hours.
They got a few dollars'
reward if they succeeded and,
amazingly, they all managed
it. One result was that
eating in front of the TV
went up a whopping 45% on
average;
total calories consumed
increased ten percent and
physical activity decreased
by more than two hours a
week. So it seems TV and
computers have a double
effect-- kids are less
active, and they eat more.
For the final three weeks,
the researchers reversed
things. Now the kids had to
decrease their original TV
and computer time by half.
DEBORAH: I think in many ways
it was sort of a culture
shock for our family
because all of a sudden this
ubiquitous presence in the
house-- the TV that's always
on, or on quite a bit-- was
gone. And initially, it was a
little bit awkward and yet it
was a very good experience
for us
because Taylor, for
instance-- she rode her bike
more, she read books more she
did more athletic activities
be it swimming, whatever...
playing basketball. And we
started to realize we really
didn't miss it that much.
Can you just clean the house
for me? ALDA: In fact, Taylor
and all the other kids found
plenty to do. Not all of it
was physically active, of
course but a lot was.
The average increase in
activity was more than 3½
hours a week and they ate a
few percent less, too.
EPSTEIN: In our study, we
found that about one-third of
the time that they reduced
from being sedentary
they reallocated to physical
activity. So if they... if
they reduced 20 hours a week
sedentary time seven hours
were dedicated now to being
physically active. So you
don't have to have a
one-to-one change.
You don't have to take every
single minute you were
watching television in being
physically active. But
reallocation of one-third of
their time really produces
most of the activity anybody
would need.
MAN: Right, turn. ALDA: So
the study revealed another
trap our kids are falling
into. They could be more
active and eat less but
instead, they're becoming
less active and eating more.
It's a trap that will last
for life. Kids who are
sedentary when they are young
become sedentary adolescents,
become sedentary adults.
Really active kids become
active adolescents
and become active adults. So