Watch Online

				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