What does President Bush's top health official have to say about battling our bulge?
WebMD Weight Loss Clinic - Live Events Transcript
Event Date: June 2003
Obesity is a big problem in the U.S. Some say it's an epidemic, with statistics revealing that as a nation we are heavier now than we've ever been. The impact on our health care system and our economy make curbing obesity everyone's concern. Health and Human Services Secretary Tommy Thompson and WebMD's weight management expert, Kelly D. Brownell, PhD, joined us to discuss the heavy cost of obesity.
The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to WebMD Live, Sec. Thompson.
Thompson: Thank you very much. Thank you for giving me this opportunity to speak on WebMD; I'm delighted to speak on the topics of obesity, diabetes, heart disease, and Medicare. In other words: wellness. Wellness is the absolute thing that we should do in order to improve the health conditions for all Americans. We are spending 90%-plus of our money in Medicare to treat people after they become ill, and spend thousands of dollars getting them well again, but just a very small percentage of dollars to keep them well in the first place.
My mission at the Department is to transform those percentages and put the emphasis on prevention.
- Don't smoke
- Eat properly
- Lose weight if you need to
If you follow those rules, you can be a lot healthier, more productive, and be able to have a very long and successful life.
Moderator: How are you going to sell prevention to the American public? We've all heard the messages before.
Thompson: In a number of ways:
- I am using my bully pulpit. In fact, I have just given two speeches on it today to thousands of individuals.
- I am asking the restaurant association, the fast food industry, and the soft-drinks industry to work with us to put healthier items on their menus and help promote good nutrition, as well as good exercise.
- I am encouraging health insurance companies across America to step up and give health credits for good lifestyles when they purchase health insurance, like automobile insurance companies give credits for good driving habits when you purchase automobile insurance.
- We are putting on a prevention program in the Department of Health and Human Services to get more information out to individuals in several different languages.
- We are starting a program called Healthy Cities, in which cities will be able to receive grant dollars from us for reducing diabetes, obesity, asthma, and by putting in recreation facilities for walking and exercising. For that money, and those results that will derive from these cities' good behavior, they will be able to be designated as the healthy cities in America.
- Finally, we are putting a huge emphasis on information and direct involvement with minority groups all across America to educate, encourage, and hopefully change lifestyles in minority communities as it relates to proper nutrition and exercise in order to drive down or reduce the epidemics of obesity, asthma, and diabetes in those communities.
Member: What about getting insurance companies to provide benefits for weight-reduction programs and nutritional assistance?
Thompson: I happen to believe that that is a very good concept. The only problem is how to regulate it to make sure that people who get the credit are actually doing it. But I am very favorably disposed to that concept, the same way automobile insurance companies now give credit to good drivers and good driving habits when you purchase automobile insurance.
I just got done speaking to the Association of Health Plan Managers and Owners this afternoon, several thousand of which were in Washington, D.C., and I asked them to assist me in getting involved in doing those things that will help stimulate changes of lifestyle, such as good nutrition, proper exercise, and to be involved more directly in disease management. I pointed out why it would be a good investment for them and their companies, their shareholders, and their patients, to do just that.
Member: Britain and Australia are considering a VAT (value added tax) on unhealthy foods to counteract the high cost of obesity related diseases. Is this possible in the U.S.?
Thompson: At this point in time I think it is doubtful, but that doesn't mean we shouldn't look at accomplishing the same objective a different way, such as giving inducements to companies and discussing with these companies their corporate responsibility for providing healthier diets and more information about nutrition, diets, and exercise.
Member: What stands in the way of requiring restaurants to provide nutrition information about the food products they serve?
Thompson: There is nothing that prevents a restaurant from doing just that, and I have been meeting with many restaurants, their association, the fast food industry and the soft-drink industry, to accomplish just that. I have been somewhat heartened, or at least encouraged by their responses, and I think we're already seeing some results by some of the companies that are putting out more information about nutrition and also putting out some items on their menu that can be classified as very heart healthy or otherwise helpful as far as good nutrition practices.
Member: Secretary Thompson, regarding your statement that the government should single out fast food places that make us fat, I disagree. Good health is based on personal choice. It is common knowledge that fast food places offer selections that aren't healthy, and selections that are. People who want to eat healthier need to start making healthier choices. Why should the U.S. government be expected to force Americans to only eat certain foods? All fast food places offer healthy food choices, and publicly post the nutritional information for ALL the food they serve. It is not the government's responsibility. What happened to the concepts of personal responsibility and personal accountability for one's decisions?
Thompson: I happen to be very much in the camp of allowing people to have personal choices, but I also happen to be in the business of health care. And when you look at the numbers that are driving health care costs and costing the economy, and especially the taxpayers, billions of dollars, it's time that we start reflecting and trying to influence and change personal decisions that will improve their health conditions.
- We spend $155 billion a year on tobacco-related illnesses, and 400,000 Americans die from those illnesses each year.
- We spend $132 billion a year on diabetes-related illnesses, and 200,000 Americans are dying each year. You can change those individuals who are pre-diabetic, which amounts to 16 million more Americans, by encouraging them to lose 10 to 15 pounds, and by walking 30 minutes a day five or six times a week.
- We spend $117 billion a year on obesity-related illnesses, from which 300,000 Americans die. Upwards to two-thirds of Americans are fat and obese.
Those three, tobacco, diabetes, and obesity, are causing tremendous financial hardships for individuals who are trying to develop and improve our health care system. It is necessary for government to try and improve the health of its citizens and that is what we're doing by discussing it here, getting out information to people all over America, and trying to convince Americans to eat properly and to exercise.
Moderator: Mr. Secretary, why not ban cigarettes? They have no redeeming qualities. It would certainly reduce the tobacco related illnesses and expenses.
Thompson: We need to regulate tobacco and as long as it is a commodity that is legal. People have become addicted to tobacco, and it is necessary for us to try and influence those individuals and offer the 70% of smokers that want to quit the opportunity to do so with programs that will assist them in accomplishing that objective. By banning the products outright, you will encourage black markets, smuggling, and other ways to circumvent the law, and it does not appear that anyone is willing to ban tobacco completely.
Member: Mr. Secretary, You lost a lot of weight recently. How did you do it?
Thompson: I have asked the whole Department of Health and Human Services, for those that need it, to go on a diet. If I am out asking people to change their lifestyles and to start watching what they eat and exercising, it would be hypocritical of me personally not to do the same thing. Therefore, the people in the Department of Health and Human Services have been advised by me to look healthier, be healthier, and to watch what you eat and to exercise.
I personally have reduced my food consumption and have reduced my starches and have increased my exercise program. I do 50 pushups in the morning and 50 pushups in the evening and I have a pedometer that I hand out to a lot of individuals to register how many steps I take each and every day, and it has become an addiction! I check throughout the day how many steps I've done, and if I am not close to my 10,000 steps, I decide to walk up the steps instead of taking the elevator, and at the end of the day I walk around the blocks to make sure that I have reached my goal of 10,000 steps today. I just looked at my pedometer and I have 6,284 steps today, which means I will have 4,715 steps to take before I finish the day. That is what I have done to lose 15 pounds.
Moderator: Well, we had better let you go get the other 4,715 steps done! Thank you for joining us today Sec. Thompson. We'll look for HHS support and information to help those who want to prevent disease by living a healthy lifestyle.
Thompson: Thank you very much for having me on today.
Moderator: Our discussion continues with Kelly Brownell, PhD, WebMD's own healthy weight management expert. Welcome back to WebMD Live, Dr. Brownell. Would you like to respond to the secretary's comments?
Brownell: One thing very positive the Secretary emphasized is the need to make sweeping changes in order to address the obesity problem. Having opportunities for people who seek help for their weight makes all the sense in the world. It is also nice that he is working with multiple parts of the business world to help this process along. History will tell whether working with the food industry to encourage changes will be successful or will be like working with the tobacco industry in the early days of the war on tobacco-related illnesses. If I were the president of a large food company, I would be happy to hear what the secretary is saying. I would be in the enviable position of introducing some healthier products, knowing that the majority of the population will continue to eat my high fat, high sugar, and high-calorie products.
In the presence of unhealthy but good tasting foods, introducing a few healthy options will probably make little difference. For example, putting water and juice into soft drink machines at schools is not likely to have an impact, because children already have those options and are selecting the soft drinks. More aggressive action is needed than to simply ask the food companies in a polite way to help solve the problem. The only way for the obesity problem to be solved is for people to eat less food and the food companies will make less money.
Moderator: Why is obesity such a problem in America?
Brownell: There are many factors that contribute to obesity. The most prominent is that people are exposed to what I call a toxic food environment. Calories are available as never before, unhealthy foods are pushed relentlessly by a powerful food industry, and even institutions that should protect citizens, like schools, contribute to the problem. Combine this with rapidly declining physical activity and we have a recipe for obesity. This is why I believe that the environment must be changed or else we will make no progress on the obesity problem.
Member: Don't you think that the government already has too much control on our personal lives? It's not so much what we eat that makes us obese, it's how we choose to overeat and not exercise that makes us that way. Do you really think that what is served in fast food places is really the government's business? The only thing they have the right to monitor in restaurants is the safe handling of food, nothing more as far as I am concerned. Fat is a good source of energy if you use it properly but it's the consumers who choose not to do that.
Brownell: You are absolutely right, except that the situation has spiraled out of control. As a nation, we rely on personal responsibility as the default solution to most problems. I favor this as the most attractive approach, but in some cases, personal responsibility is not solving the problem. Such is the case with tobacco, for example. We have decided as a nation that too many people die from tobacco-related diseases, hence we are not willing to simply rely on personal responsibility. Therefore, we protect our children from the tobacco companies, we impose high taxes on cigarettes, and we take other dramatic actions in order to address the problem.
You may believe differently than I do, but it seems to me we are approaching the point where obesity is having an impact on poor health, equivalent to that of smoking, and all signs are that the rates of the problem are increasing. So, we can sit by and hope for personal responsibility to resolve this problem. But my prediction is that this stance will leave us with the problem growing worse rather than better.
Member: Should we target the makers of fast food? It seems that calorie labeling on menu boards or something must be done!
Brownell: Fast foods are certainly part of the problem, but not the sole contributor to obesity. Snack foods, soft drinks, and even normal foods eaten in the home are a problem, because of high calorie levels and large portion sizes. That's why it does not make sense to target one food, one company, or one category of companies. Rather, large changes will be necessary in order to create an environment that makes it easy, rather than difficult, for people to eat a healthy diet, and for parents to raise healthy children. Right now, the environment makes it just about as difficult as possible for parents to encourage their children to eat a healthy diet. We owe our parents more, and we owe our children more.
Member: As a registered dietitian I have been looking at this issue a lot and a lot of research points to declining physical activity among kids as the primary issue related to childhood obesity. Calorie intake has remained relatively stable over recent years. So I hope we can focus more on physical activity as the solution.
Brownell: You are absolutely correct that physical activity is a major issue. The stable calorie values in the population get cited very often in the press and by people like the food companies who want the focus to be only on exercise. It is hard for me to believe, with the increasing amount of food available, and the large portion sizes, and the large increases in average body weight, that declining exercise is the only explanation for obesity. Therefore, I agree with you that physical activity must be considered and should be addressed aggressively, but I have very little confidence that addressing only activity and ignoring the food part will allow us to make much progress on the obesity problem. Thank you for pointing out the importance of activity. We need to work on both it and on food.
Moderator: What can parents do at this point to help their children become healthier eaters?
Brownell: Parents can do many things:
- They can model healthy eating and regular physical activity.
- They can create an environment where food is considered necessary for good health, vitality, and happiness.
- They can help buffer their children against the relentless advertising of unhealthy foods. They can do this by engaging their children in a discussion of what the food advertisements are designed to do, and help convince the children that they are in control of their lives if they resist these inducements and instead, eat the food they know is good for them.
- Parents can have a major impact in their communities, beginning by working with the schools. In several places in the country parents have worked with school officials to rid schools of soft drinks and snack foods. This sends a strong message not only to the children, but also to the community in general that schools are institutions that will protect children rather than collude with the food companies to sell them unhealthy foods.
Member: Dr. Brownell, do you consider weight loss surgery as a ridiculous and very dangerous way of being a "tool for permanent weight loss"? I am a 39-year-old female and weigh 450 pounds, and was considering the surgery in the past, until I realized that it's nothing more than "controlled starvation." You still have to eat right and exercise, shouldn't we do that anyway without endangering our health? What are your thoughts/comments?
Brownell: For people who are capable of losing weight by changing their diet and exercise, surgery should not be an option because it does carry some risk. But for the people who have not been able to lose weight on their own, surgery can be a life-saving procedure. I am working with a person now for whom the surgery has had an enormously beneficial impact. I believe it is a viable tool to consider as an option for people who have a great deal of weight to lose.
Member: My family had observed the weight distributions for normal, obese, and extreme obesity. We had to wonder where or how did they determine those numbers? As a family, my kids and I have been extremely active in multiple sports. My son, specifically, is considered quick, agile, and small as a baseball player, but yet is on your "obese" scale. He is stocky, but lean. Most people considered him heavy-boned to account for his weight, a deception to most people since his birth. I am the same way, although I feel I could lose maybe 20 pounds with a diet, but I don't consider myself extremely obese as the scales designate me. Medical checkups label me as very healthy. Should not this obesity scale contain a qualifier on the physical fitness of the person and not just weight alone? If you could run distances, participate in sports, are strong and agile, should the obesity scale slide some?
Brownell: You raise a very good point. In general, the weight tables, most recently the body mass index charts, are a helpful means for many people to find where they stand in comparison to an ideal weight. There are, however, many people who get misclassified by these tables, including people who are stocky for genetic reasons, people who are quite muscular, and people who may appear to be overweight but are quite physically fit.
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Dr. Steven Blair, in Dallas, has done very interesting research on whether it is possible for people to be fat but fit. His research indicates that a person is at lower risk if they are heavy but fit, than if they are thin and unfit. Not all the research agrees with this point of view, but it is clear that one can greatly reduce risk for serious disease by being physically active. Congratulations to you and your family for having such a commitment to physical activity.
Member: Do you see the public education funding crisis as part of the issue with kids -- reductions in extracurricular activities, physical education classes, resources for educators to be trained, and to teach more about nutrition and physical activity?
Brownell: Absolutely. The funding problems affect diet, exercise, and weight in several important ways. Schools become vulnerable to invitations from the soft drink and snack food companies to sell products because the schools get a cut. Physical education is one of the first programs to suffer, and schools have a budget crisis. Schools cutting back on after-school activities are contributing as well.
In addition, the way new communities are being built, very few children have the opportunity to walk or bike to school. The trend is toward larger rather than smaller schools hence children have less opportunity to participate in sports teams. For instance, there will be only boy's soccer team or one girls swim team, so a larger school means less opportunity for an individual to participate.
In the fight against poor diet and obesity, schools are where I believe the first victories will occur. The victories will begin with schools cleansing themselves of soft drinks, snack foods, and fast foods. Subsequently, there will likely be important changes in opportunities for children to be physically active.
Moderator: Our thanks to Kelly Brownell, MD, for sharing his expertise with us today.
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