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interview: james o. hill

We have a huge diet industry in this country. … How would you characterize its success and its failure?

The popular plans only help you with weight loss.  They don't help you with keeping it off, and that's where the real issue is.

Well, I think that's a great question. It's successful in the fact that lots of people go on these diets, the popular diets, the popular plans. It's unsuccessful in the sense of, I think they only give you part of the solution, and that's the losing-weight part. So where people fail is not in losing weight. They go on the Atkins Diet, the South Beach Diet, the Ornish Diet, and they lose weight. The problem is, they can't keep it off. So I think what we have to realize is, the popular plans only help you with weight loss. They don't help you with keeping it off, and that's where the real issue is.

What are the stats on keeping it off, roughly?

We actually don't have very good stats. What you hear is a number like 95 percent of people who lose weight gain it back. We actually went out and did a telephone survey, and what we found is, if you define success as losing at least 10 percent of your weight and keeping it off a year, success is more like 20 percent. It's not good. So 20 percent would be the best case. Most people who lose weight gain it back.

James O. Hill is a pediatrician and director of the Center for Human Nutrition at the University of Colorado Health Sciences Center in Denver. The Center is a leader in obesity research and a sponsor for the "America on the Move" program, which encourages people to become more physically active. In this interview, Hill explains why diets are not necessarily a long-term solution to healthy living. "We can rarely find anyone who's lost weight and kept it off without increasing physical activity," he tells FRONTLINE. "Less than 9 percent. So yeah, it can be done, but what's your odds?" This interview was conducted on Jan. 29, 2004.

So that's at a year. What about five years?

It's probably lower, because what you find is, a lot of people will gain their weight back after one year, but a few more after two years and so forth. So the way we approach weight loss is we go and help people lose it off, and then they gradually regain it. What's missing is helping them keep it off, and I think what we have to realize is, the way to lose weight may not be the right way to keep weight off.

So from a public health standpoint, [would you] characterize the diet industry as a failure?

I would characterize it as incomplete, because everybody who has tried these diets knows that they do work to lose weight. What's really interesting is when we go on one of the diets and we lose weight and we gain it back, we don't blame the diet. We blame ourselves, when in fact, maybe it's not the diet that's failed, but maybe the diet has only given us part of the solution.

So the diets are usually based around some kind of nutritional trick to limit one or another macronutrient, right? Do you think this is simplistic, compared with the reason why we're fat in the first place?

Well, there are a couple of things here. One is that we gain weight over years. And in fact, the average American gains one to two pounds a year. So you put on 20 pounds over a decade. We want to lose it in 10 weeks. So there's a unrealistic idea of how quickly we want to lose it, number one.

And number two is, when you go on the diet, people do usually give up something. They give up carbohydrates, or they give up fat. And this is a great way to lose weight. If you avoid one sort of nutrient, sure, you're going to lose weight. It doesn't matter what the nutrient is. And the history of the popular diet says, whatever you're told to avoid, you lose weight.

The problem is, you can't live your life that way. We need protein, we need carbohydrates, we need fat. Trying to get that out of your diet is at best a short-term strategy. It's not a long-term strategy. …

Now, you'd have to say that some good things have come out of this nutritional history, like good carbs versus--

Great. And in fact, if you look at what happened with fat a few years ago, the American public felt like the goal was to get zero fat in your body. Anything that has fat's bad. Get it out. And what they didn't realize is you can't just get rid of fat. It's about calories too. So they watched fat, not total calories, and they gained weight.

What we taught them is that hey, it's not that all fats should be avoided. There are good fats and there are bad fats. We know saturated fats, trans fats, are fats you should avoid. Omega-3 fatty acids, mono-unsaturated fats are a little bit better.

We're the same way with carbohydrates now, where we want to avoid them all, and I think where we're going to go to is, hey, there are some carbohydrates that are better than others. The simple sugars, the refined products, are probably ones you should avoid, but fruits and vegetables, complex grains, these are the things that you absolutely need.

Now, what happened to America that it should end up in this particular state?

I like to think that our obesity epidemic is an unintended consequence of societal development. What I mean by that is, if you look at our ancestors, what they desired more than anything else was to have a constant source of food that was good-tasting and inexpensive, and to not have to work very hard. In fact, if you fast-forward to today, that's the environment we've got, where we've got this wonderful food supply. You go in the grocery stores and there are thousands of items. They taste great. They're inexpensive. And you know what? Technology has made it such that you don't have to be very active anymore during the day.

So we've gotten what we asked for, but as an unintended consequence of that, we're now obese, because our genes essentially tell us, "Eat when food's available, because you never know when you're going to have a famine. And don't be active if you don't have to, because you need to save up your energy to get food and shelter and so forth." So we have these genes that are great for a different environment. ...

So [the U.S. obesity problem is] really predictable.

It's very predictable, and in fact, you see 65 percent of Americans are overweight or obese. What's amazing is that people can actually live in this environment and not become obese. And if you look at why that's the case, maybe there're a few that are just genetically protected. These are people that should have died out in the famines years ago, but somehow they survived. Or alternatively, people that are actually using their head to push back against the environment. So if the environment says, "Eat when food's available," what you have to do is not give into sort of that physiological urge, but say, "No, I'm going to limit this," or "I'm going to watch my fat or calories," and consequently to say, "I'm going to go out and exercise, even though my physiology says to sit and rest. I understand it's good for me, so I'm going to go out and exercise." So in a way, people are using their cognition to overcome their physiology.

If we go back 40 years, and obesity levels were lower than they are today, is this something that's really been exacerbated over the last three or four decades?

… Clearly, in the last few decades this is a problem. So our ancestors, if you go back three or four generations, yes, there was some obesity, but it wasn't a big problem like it is now.

So what we are looking at is the changes in technology and society. And part of the issue, I think, is that people try to say: Is it food, or is it activity? I don't think we're ever going to separate those, because at the same time you have this food supply where there are more and more products, they're high in energy density, at the same time you have technology causing more and more of a decline in physical activity. So I think those two things were happening simultaneously, and I think it's difficult to blame it totally on food or totally on physical activity.

If we go back in time 50 years, talk about some of the things in the environment that were different than today, particularly for children, because you're a pediatrician. And perhaps you can introduce this idea of energy imbalance. Because what you're really saying is, in long term, calories matter.

I think it is all about energy balance and calories. So if you go back to a previous environment, I think our energy balance was working completely different. It was physical activity that was driving the system. In most cases, you had to be physically active to get food, shelter. Kids were physically active. There wasn't TV and video games [as reasons] to be inside, so they naturally were outside. They were playing. They had to work and do chores. We lived in a society where everybody had to do a pretty high level of physical activity. You had to do it to get through the day. The challenge then was eating enough to maintain your energy balance.

So physical activity drives the system, which pulls along food intake. If you fast-forward to today, we have the most sedentary society ever. Our kids are slugs. Their parents are slugs. We get no physical activity. Now the challenge is very different. The challenge isn't to eat enough to match your physical activity. The challenge is restrict your intake to meet a low level of physical activity. We didn't develop the physiology to restrict. All our physiology is geared toward eat, eat, eat, because we needed to eat to match a high level of physical activity. We're in an abnormal situation now, where the challenge is to try to restrict intake to match a low level of energy expenditure.

This is why I say that it's impossible to maintain a healthy weight without increasing physical activity. You just can't restrict enough to be a slug, and eat so little to match that. You've got to increase physical activity. And I think the bright side, particularly for kids, is we aren't going to go back to the previous environment where you're spending eight hours a day in physical labor. I don't think we need to. I think if we increase our physical activity just a little bit, we increase our body's ability to match food intake to energy expenditure, which means we have to restrict less.

You talk about energy balance, that this growth in weight can be an insidious thing. You could be out just by a little, over a day.

If you look at an extra 10 calories a day, that's a Lifesaver [candy]. One more Lifesaver than you need each day, theoretically can lead to a pound of weight gained in a year. Now, there's some adaptive mechanism so it may not quite be that way. But what we've estimated and what we did is, we looked at population surveys, where you look at weight over time in Americans. What we estimate is that 90 percent of weight gain could be stopped by modifying energy balance by only 100 calories a day. And 100 calories a day is less than one soft drink. It's a few bites of your hamburger.

This is the extra positive energy balance, which means you're taking in more calories than you expend, that's causing weight gain. It's very tiny. It doesn't happen from going out and overeating 1,000-2,000 calories a day. It's this little bit of eating more than you need, day after day after day, and what happens is you gradually gain weight over time.

So this model of energy balance is a much more slow type of concept, isn't it? It says we got the way we are [from] being off by a little bit. We're going to get better by readjusting this. The good news, it's only a little bit. But the bad news, it's going to take a long time.

Well, that's the case. What people have to realize is, they didn't gain those 20 pounds over 20 weeks. They gained it over 10 years, or 20 years, and even though you want to reverse it, we know the body works such that if you restrict your calories a lot, you compensate. And that's the way we want to do [it]. We want to go out and eat less and lose weight, but the body compensates.

A better strategy may be to try to reverse it with small changes. ... If you can modify your energy balance by only 100 calories a day, and we put that into some specific things, like if you could walk 15 minutes more a day. Who can't walk 15 minutes more? If you could do that, you would stop weight gain with that simple little change. Now you go on and do some small changes to begin losing weight. This is the way I think we could reverse it and maintain weight loss.

The problem is, the mindset of Americans is, they aren't willing to take that long-term approach. They want to go out and do it all at once, and despite decades of failure with that approach, that's still the way we approach weight management.

Now, try to explain some of the public health things that are at stake here, because this might be a difficult choice for an individual middle-aged person, but talk about the risks to children if nothing's done.

What is really depressing and pessimistic is our kids, because what we're seeing in kids is astonishing. We're seeing adult diseases developing in kids. We're seeing type 2 diabetes, which is a devastating disease that traditionally has developed in overweight people who are in their 50s and 60s and 70s -- we're seeing it in 14-year-olds. We have no idea what that's going to do to the life span of a 14-year-old. We're seeing the beginnings of heart disease in 12-year-olds and 13-year-olds.

So what's happening as our kids are becoming obese [is] they're getting the diseases they usually get in middle age, in childhood. And now pediatricians, who weren't trained to deal with these diseases because they never saw them before, are seeing adult diseases in kids. And this is a direct result of our kids becoming more and more obese.

Is this a major public health issue that's going to be with us a long time?

This is, I think, the public health issue of our generation. We right now are assigning our kids to a decreased quality of life. They're going to have chronic diseases. They're going to be on multiple drugs at age 20. …

I think people don't understand what we're doing to our kids. This is absolutely unacceptable as a society, that we can take a disease such as obesity, which is totally preventable, and doom our kids to all the consequences of being obese. ...

Now, this idea of Colorado on the Move, I want to turn first to the idea of 10,000 steps. Did this come from your studies of these very long-term people who kept weight off for five years?

Yeah. In fact, we have studied a group of people in a registry we call the National Weight Control Registry. And this is over 3,000 people that have actually … lost weight and kept it off. On an average, they've lost 67 pounds and kept it off for six years, which is pretty good. I wish we could do that with everybody. We can't do it.

What we try to do is to learn from them about what they're doing. One of the biggest things that comes out is high levels of physical activity. In fact, in the registry, we can rarely find anyone who's lost weight and kept it off without increasing physical activity. Less than 9 percent. So yeah, it can be done, but what's your odds? Are your odds being in the 91 percent who do it with physical activity, or the 9 percent who do it without?

Now, you had this idea of 10,000 steps and pedometers. What is [it] that 10,000 steps [accomplishes]?

... One of the public health recommendations out there is for people to get 10,000 steps [a day], and I have no problem with that. If everybody got 10,000 steps, it'd be great. But what we did, we went out and did a survey in Colorado, and then we did a national survey, to see how many steps people take right now. Nationally, people take about 5,500. So what you're asking people to do is double their physical activity. We have to realize, that's a huge increase. Even in Colorado, the average is about 6,500.

The problem with going out with the 10,000 step goal is if you're at 4,000 steps -- which a lot of people are -- and you go out and you get real active and you increase your physical activity, and you're only up to 8,000, you're a failure because you haven't met the 10,000 step goal. But in fact, going from 4,000 to 8,000 is a huge success for you.

What we like to do is tell people, "Start where you are." If you're at 4,000, go to 6,000. Everybody can do that. Then generally people say, "Well, that was pretty easy. Maybe I'll go to 8,000." They get to 10,000, but they get there in steps, where you give them interim goals that they can succeed at. If you give them the 10,000 step goal, what we've seen is, people go out, they get real excited, they get more active, and they aren't close to 10,000 and they say, "Well, heck. I'm going to give up, because I did all I could, and I couldn't get close." If you go with small, gradual steps, you can get there.

Tell us about this pedometer. This is a way of measuring just how sedentary our life is?

The pedometer is one of these devices that's just so simple, but so useful. … The beauty of the pedometer now is it quantifies your physical activity and gives you a number. We love numbers. And we can change those numbers. So you can strap on this simple little device, costs less than 20 bucks, very cheap, and it tells you how many steps you take, and that gives you a goal. You're taking 4,000 steps now, you can set your goal at 6,000. And at the end of the day, you can look and see if you made it. And throughout the day, you can look. So it's noon, you've only got 3,000, you know you need 3,000 more. People, when they get feedback about what they're doing, they can develop a plan for reaching their goal. ...

You're a pediatrician, and I visited the Children's Hospital pediatric clinic which was an obesity clinic for kids. And they have this concept here where they say that if you get someone who's 10, because they're growing so fast, if you hold their weight constant, their problems will sort of go away as they grow. Is there an analogy for society here?

One of the things that we have to look at as a society is: What's our strategy going to be for dealing with the obesity epidemic? We have 65 percent of adults that are overweight or obese, and somewhere between 15 and 25 percent kids. So what are we going to do? Are we going to take all those people that are overweight or obese, have them lose weight, keep it off, and that's the way we solve the problem? We don't know how to do that. I don't know how to do that. Yes, we can help people. We can produce some weight loss. I think that's not the way we're going to get out of the epidemic.

Now let's look at a different strategy. A different strategy would be to say: Let's take all adults, no more weight gain. If you're overweight, obese, no more weight gain. Let's take kids and say: No more abnormal weight gain. It's a little tougher with kids because they're growing anyway, but let's look at a trajectory which is a healthy trajectory. What you would do there, that could be achieved with small changes, and what it does is, over time, you essentially grow out of the obesity epidemic. So the next generation will be less obese than this one; the one after will be less obese than that one.

I think personally this is the only way we're going to succeed. I think it's going to take us two or three generations to solve the problem, and I think the way we do it is to start implementing small changes now, so we accept we aren't going to solve the obesity problem in our generation. Our kids hopefully can be a little less, their kids a little less. But if we're going in the right direction with small changes, in two or three generations maybe we get populations that are actually able to achieve and maintain a healthy body weight.

Let's talk about some places where you could have interventions, where you could start to implement. Let's start with the schools.

Well, everybody starts with the schools, because that's where kids spend a lot of time. So that's a great place to start. In America we love to play the blame game. Who's to blame for obesity? So schools are certainly one place that's blamed.

They're blamed because there's no P.E. anymore, so very few kids have mandatory P.E. They're blamed because the school lunches aren't the greatest. They have to be self-sufficient, and they're not so healthy. They're blamed because they get money from vending machines. Somebody has to pay for the band uniforms and so forth, and the vendors can pay for that. So they're blamed for creating an unhealthy physical activity environment and an unhealthy food environment.

Here again, I think we could apply our idea of small changes. One idea is: Let's go in and totally uproot everything. Let's change the curriculum, put in P.E. Let's get healthy food in the lunchroom. Let's get vending machines out. I don't see that happening. I think that's going to be hard to do. But I do think what we could do is start doing small changes over time.

We're in schools trying to get kids to be more active, maybe even during the curriculum. A lot of information now suggests these kids can do active learning. They don't have to sit in a class, in a seat, and learn all the time. They can be up and about. You can find activity breaks, 10 minutes here and there, for the kids. You could look at how you can begin to make small changes in the cafeteria, how you can put better products in the vending machines. I think the whole idea of small changes would work well in schools, and I think schools are willing to do that. I think it would be tough to just tear everything out: whole new food in schools, whole new physical activity curriculum. Yeah, maybe we need to get to that over time, but we've been talking about that for a while and it hasn't happened. So maybe we ought to try the small change approach. ...

That's kids. What about the workplace? Can you see any initiatives there?

The workplace is actually one of the better ones. And what we're finding now is the economic data coming out, showing the healthcare costs of obese employees have now led employers to get interested in this. Now, if employers are interested, and they see that their employees being more healthy can save money, then there're lots of things they can do. So we have America on the Move work site programs where we encourage the employers to provide incentives. You get step counters, you get step goals, you achieve that step goal, you might get an incentive. That incentive literally ranges from hats and T-shirts to days off.

Same way on the food side. If you provide incentives for employers to be healthy, and if you provide them a place to do that -- so if you're asking them to eat better, and to be physically active, they have to have A), the opportunities to do that, and B), a reason to do it. Now that the employers have a reason to provide incentives to the employees, because their healthcare costs are so high, it works beautifully in a work site. …

[How does] this obesity epidemic differentially affect the poor?

If you look at what's happening, the lower your socio-economic status, the more poor you are, the more obesity you have. Now, if you look at actual increases across time, obesity's increasing in all socio-economic groups. It's just that poor people started out worse. But this is a problem, because oftentimes poor people have it rough. How much money they spend on food makes a difference. The cheapest kinds of foods are fat and sugar. [If] you want to eat fruits and vegetables, complex grains, that's the most expensive kind of diet. So one of the things that we have to realize is, what we're telling people to eat is actually the more expensive part of it.

The other thing is, on the physical activity side, you often live in neighborhoods where safety is more of a concern than obesity. I'd rather have my child obese than to be shot in the streets. So you say, "Well, why aren't their kids outside and playing and so forth?" Well, it's not safe to be outside and playing. We have to make sure that whatever we do, we can't ignore the groups that are really suffering most from this epidemic.

The black community is very affected. Are there any initiatives involving black churches?

Yeah, we actually started one of the initiatives in black churches very early on. And the reason we did it is because they came to us. And they said, "Look. When it comes to obesity, we've got it all. We've got all. We've got obesity, we've got all the consequences of obesity, heart disease, hypertension, dyslipidemia, etc." They said, "Whatever you've got, we need it." So they came to us and said, "Help us do that. We're ready for it."

And so we started this simple program, Colorado on the Move, which is two simple changes: Move 100 calories more, eat 100 calories less. We started in the black churches, and they took it and ran with it. It's been so gratifying to see what they've done, because the pastors have gotten involved, the black church association has gotten involved, so the pastors will go out on walks, and the nutritionists in the black community have gotten involved. This is a community initiative, where they've taken our simple little idea and they've made it culturally appropriate to their situation. We feel like it's beginning to make a difference. We've got a long way to go, and we need to keep it going. Now, they're continuing to keep it going, even without us. We're providing a little bit of support, but they're doing it.

... You get older, you put on weight. Is it inevitable?

Some of it is, unfortunately. I wish I could say different, as I'm starting to age, myself. A lot of it is preventable. The single best thing you can do to prevent weight gain as you age is to maintain your level of physical activity. For most of us, we're very active in our youth, [but] we get married, we get a job, [activity] goes down a little bit, goes down [more]. That decline in physical activity now allows our body to gain a little weight. You can prevent most of that within increased physical activity.

I also was an actor when I was young, in Leave It to Beaver. I was Jerry Mathers -- the Beaver's -- friend Gilbert. And, you know, I also was born and raised in Los Angeles. And there was a certain lifestyle that was portrayed in the show. It's become a clich. But actually it mirrored my own kind of family, where kids, for instance, were very, very active. As a kid, we were on the loose. There were no organized sports. We had bicycles. We ran around. If we could get to the beach, we went swimming. It was a very active life. Kids today don't seem to have that.

It really was. And think about it -- you didn't have video games. You didn't have CDs. You had a T.V., but you probably only got three stations and two of them didn't come in that good, and there wasn't that much on. ...

[So] it was easy to go outside. And what happened is, gee, you didn't have organized sports. You weren't looking around for -- "Where's some adult to organize the game?" You made it up. You had five people, you figured out the baseball game. And I think that's something kids today have lost.

But I think your question goes even deeper, and illustrates that obesity is a societal issue. Let's go back to that lifestyle. That lifestyle is: The family comes together in the evening, the wife is home, taking care of things, and dinner's on the table. You have time to spend hours preparing the healthy food. The family interacts. We've lost that as our life gets busy, and both parents are working, and the kids rarely are together to eat. And so I think part of what's resulted in obesity is the fact that our society values have changed over time in this information age. ...

You've been quoted as saying that being obese these days is a natural response to the American environment.

It really is. What amazes me is that anybody maintains a healthy weight in this environment, because think about it: Everywhere you go in America, it's okay to have food. It's okay to have food in your car. In fact, we put in cup holders, and now we have TVs in our car so it's okay to eat in your car. It's okay to eat at your desk. It's not that way everywhere in the world, and hasn't always been that way here. But the fact that we say, "Bring food everywhere" -- keep in mind, our genes say, "Eat whenever food's available."

And then the fact that you never have to be active -- you don't have to be active in your work. Kids don't have to be active in school. Yeah, you've got gyms and plenty of places to work out, but the thing that's decreased is this activity that we normally spent getting around our environment. We don't require that anymore. ...

But my old friend, the Beaver, Jerry Mathers, as he grew up, put on a lot of weight. By his own account, he became obese. He ran a catering business. He says he ate all the food. Part of it was going back to the old strategy: June Cleaver, the mother, saying, "Eat everything on your plate." These days, with the super portions that we're served, eating everything on your plate is hazardous to your health.

It is. And I think you bring up a great issue here. So I can tell people, "Eat 100 calories less. Go out and get a step counter and walk 2,000 more." But the fact of the matter is, they go out into an environment that's not conducive to that. So I'm telling you to eat 100 calories less; you're going into restaurants, they're giving you larger serving sizes, etc. So it points out the fact that for this strategy to work, we have to modify the environment to help doing that. But the beauty is that we have a specific target for modifying the environment. Lots of people are now saying, "Gee, the environment's causing obesity. Let's modify the environment."

One thing is, we're not going to go back. Unfortunately, we're not going to go back to the era of the Beaver, because we're not willing to give up our video games and our computers and our remote controls and so forth. So I think number one, we're not going to change the environment back to one where you don't have to worry again. But I think what we can do is to say: If we have some behavioral goals -- and I've just given you two -- now how can we change the environment to do that?

Let's look at the food environment. One of our strategies is, we actually want to work with the private sector to do this. We want to work with food companies and restaurants to say: If we're telling people to eat a little less, can you help do that? And can you do it in a way that actually may give you a competitive advantage?

But that's flying in the face of the whole trend now. I drive by in my neighborhood a McDonald's that right now has an ad in all its windows, "Buy one Big Mac, get another one free." The whole thrust is: We'll give you more food. It's such a great deal.

Absolutely. And this is where the restaurants and the food companies have to help. One of the good things now is they're in the game. Whether they're there because they've been blamed or threatened [with a lawsuit] or whatever, just about every restaurant and food company I know now is interested in what they can do to help. It doesn't mean they don't have a long way to go. And part of the problem is, they're still struggling on what to do as well. And what we think is our message of modifying by 100 calories, is something they can actually do. We aren't saying, "Get rid of McDonald's." We aren't saying, "Get rid of particular products." What we're saying is, "Help the consumer do this."

Let's imagine you walk into a restaurant, could be a fast food restaurant or a regular restaurant, and now on the menu or on the sandwich board are: "Here's some ways, if you want to lose 100 calories, you can. You can leave your cheese off your cheeseburger. You can leave your mayonnaise off. You can ask us to cut a little portion." Easy ways that the restaurants could do right now, that would help people make this [change]. Now, people still have to decide they want to do the behavior, but now it's easier for them to do it.

Same way on the expenditure side. We're telling people to go out and walk 2,000 steps more, but we're building communities without sidewalks and cul-de-sacs, and we aren't giving people reasons to walk. So for our strategy to be successful, we have to actually go out and change the environment to help people do these behaviors. ...

We talk a lot about education these days, and the old trend of just passing a kid along to the next grade, whether he or she had learned to read or do arithmetic or not. In a way, it's kind of the same thing with the seriously overweight kid. You know, everyone looks the other way. You don't want to offend the kid's parents, get a lawsuit, trouble. It's a hassle for the teacher. But basically, when you're not dealing with this problem when they're young, you're harming the kid.

And this is the issue. Whose problem is it? Schools have traditionally said, "Well, that's the parents' job to teach about nutrition and health and so forth." The parents have said, "Hey, we're too busy. Why isn't the kid getting it in school?" People are looking toward the government. People are looking toward private industry.

At some point, all these places are going to have to take some personal responsibility. Schools are going to have to say, "You know what? The health of the kid is important. Because now we know health relates to learning. The kids that are overweight and unhealthy and inactive aren't learning as well." So it's the school's problem, but at the same time, I don't think we can put it off and say, "Well, let's let the school take care of that."

The parents need to learn how to be role models. Part of the problem is, the parents are overweight and inactive and unhealthy themselves. How do we get into there? What can the government do? This is the issues that we as a society have to struggle with.

But what we can't do is to let any sector off scot-free, saying "It isn't my problem." Because you know what? It's all our problem, and it's only if we do programs in schools, it's only if we do programs at home, in the grocery store, in the hardware store, in the parks, that's the only hope we have of doing it. I don't give anybody a free pass. If you say "It isn't my issue," it's wrong. ...

As part of this program, I went in to my doctor. I am 5'11", I weighed in with clothes at 210. That put me on the BMI index dangerously overweight. So the doctor says, "Look, these are all the consequences that may befall you. You better lose some weight." So I pick a diet. In my case, it's the South Beach Diet. I take it, three weeks I've been on it, I've lost 13 pounds. So it's worked. And it's also given me that psychological quick kick that I probably needed -- "Aha, there goes some of that belly fat." What are my chances for sticking with this?

Keep in mind that somewhere between 80 and 95 percent of people in your situation will regain it. You're at a very high risk of regaining. Now, you've got some questions. Is the South Beach Diet something you can stick with forever which is largely allowing you to restrict what you eat?

Right. Can I do it?

Can you do it? The statistics would say no, that unless you can increase your physical activity, and unless you can increase that physical activity fairly substantially, your chances of keeping it off aren't good. …

You have said that obesity is a national health crisis. This may be the biggest public health crisis that we're going to have to face as a society in our lifetimes. It makes me think of smoking. I mean, smoking was the same kind of crisis. And yet somehow, after a long battle, we've come to terns with that. People don't smoke in bars in New York, something I never thought I'd ever see.

See, I'm basically an optimist. And even though all the data about obesity tells me I need to be pessimistic, I'm an optimist. And the analogy is, in 1950 if somebody had said, "Oh, we're going to get Americans to quit smoking, I mean, people would have said, "Oh, you're crazy. There's no hope."

Doctors smoked in their offices.

Exactly. We're at that stage right now, where you look at it and you say, "Boy, I don't see any way we're going to do it." But I think the American people have this ability, when they internalize a problem, to do what it takes to do it. And let me give you one example that I think maybe helped in smoking.

One of the things in smoking is the second-hand smoke report. So now, whether you smoke or not, it's not just your personal decision. It now influences me. If it doesn't influence me, I don't care if you smoke or not, but now it's influencing me.

I think what we're looking at is: What's the analogy in obesity? Is it that suddenly you're paying more in your healthcare costs because I'm living a poor lifestyle? Maybe that's the second-hand smoke analogy. I think we can learn a lot from smoking.

I think obesity is far more difficult, and as a generation, this is going to define us. How we respond to obesity, future generations are going to judge us, because we're at a very critical stage right now. We're at the stage where we know it's an issue, we know we have to do something. I think we're going to be judged by future generations on our actions within the next few years, in terms of how we begin to deal with this problem. ...

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posted april 8, 2004

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