NPR : Fresh Air

Pounding Away At America's Obesity Epidemic

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The numbers are staggering: One-third of Americans are obese; another third are overweight. Some 26 million Americans have Type 2 diabetes. An additional 79 million more are pre-diabetic. Thanks to these figures, the children of today have a good chance of becoming the first generation of Americans to die at younger ages than their parents.

A new HBO documentary series, The Weight of the Nation, explores how our country got this way and what can be done to tackle what has become a growing national health crisis. Divided into four parts — "Consequences," "Choices," "Children in Crisis" and "Challenges" — the series looks at the public health challenges posed by an increasingly overweight population, as well as the public policy debates around trying to solve the epidemic. It also profiles regular folks across America who have tried — and tried again — to lose their excess pounds.

"Very rarely do you hear the human stories [behind the epidemic]," says psychologist Kelly Brownell, who is featured in the documentary and directs the Rudd Center for Food Policy and Obesity at Yale. "There are medical consequences to obesity, but there are also psychological, social and financial ones that matter, that really bear down on people and can really make their lives very, very unhappy."

Brownell tells Fresh Air's Dave Davies that only part of the issue in dealing with obesity is preventing it.

"The other part of it is also making our environment more accepting and welcoming for obese people, to eliminate biases against them," he says.

The number of obese Americans soared during the 1980s and 1990s, doubling among adults in the U.S. and tripling among children. Sedentary lifestyles and changes in eating habits have contributed to weight gain, as more Americans work at desk jobs, use electronic devices and get served increasingly larger portions at restaurants.

"More than 50 percent of the food dollar is spent outside the home now, and that's a big difference [from] what it was several decades ago," says Brownell. "People are eating outside because they're on the move, they have crowded schedules, they want to take the family out for a treat — and there are so many restaurants out there now to cater to this need. ... The problem is when you go out, you tend to eat more and you tend to eat worse than when you eat at home."

The excess weight has dire consequences for our bodies. Obesity is associated with a slew of medical ailments, including diabetes, heart disease, cancer, high blood pressure and sleep apnea. That means more visits to the doctor — and increased health care costs.

"Health care costs are estimated now at $150 billion a year, and about half of that is born by public funds for Medicare and Medicaid," says Brownell. "So all of us who may or may not be affected by the problem ourselves — and may not even have family members affected by it — have our wallets affected by it, because we're paying for a good share of the health care costs."

Interview Highlights

On changes in the food environment

"We could count 100 ways or more that the environment has changed in ways that I call toxic. Serving sizes have increased. What used to be the large size at McDonald's is now the small serving of fries. A muffin used to be smaller than a baseball; now it can be as big as a softball. And this gets multiplied by many products in the food system. Marketing of unhealthy foods is out of control completely. The industry is doing a very poor job of policing itself in that respect. And kids are targeted in a predatory way by the industry."

On marketing to children

"As an example of how much marketing there is, the Robert Wood Johnson Foundation is now, by far, the largest funder of work in this country on childhood obesity. They're spending $100 million a year on the problem. The food industry spends that amount every year by Jan. 4, just marketing junk food — just to children."

On the argument that the government shouldn't intervene in people's personal habits

"As a country, we sometimes believe that certain health-related issues sometimes reach a certain point of importance where we believe government has a role. For example, we could teach people to drive at the speed limit and be safe and not fall asleep at the wheel — or we can put airbags in cars. We could hope people brush and floss, or we can put fluoride in the water. We could hope that parents get their children immunized before they go to school, or we can just require it. So the question is whether obesity has reached a certain level of crisis, like we felt we reached with tobacco. ... I obviously believe we're there, and I believe, more and more, the country is believing that."

On food deserts

"There are places, especially in poor areas of cities, where individuals simply don't have access to healthy foods. You get corner markets, bodegas, fast food restaurants. Even when those places might carry healthier options, they tend to cost more than what people pay in the suburbs. Even if those people living in those circumstances wish to eat a healthy diet, it becomes hard to do it. That becomes one of the things where government can play an active role, creating incentives for supermarkets to open in those areas."

On pop diets

"Some of them are sound, but the results of them are terrible for the most part. The beauty of the diet industry is that they keep promising miracles, and there's very little regulation on what they can promise people. And since none of the programs really work very well, then you have this growing clientele of people who want to try one program or another after another in hopes that something might finally work. There's this funny paradox is that nearly every diet works and nearly no diet works at the same time. A diet may be effective in the short term because you're cutting your calories. So you can do that with cabbage soup, molasses, chicken tenders. If you cut your calories back, you're going to lose weight. But the diets can be very unsafe. But they also tend to not work in the long term, because people can't stay on them very well."

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