Blackstone Audio Inc. - The weight of the nation: to win, we have to lose

Contents

PART I:

PART II:

PART III:

PART IV:

by Harvey V. Fineberg, M.D., Ph.D.

APPENDICES

Acknowledgments

We would like to begin by thanking Heather Maclean for her significant contributions to this book.

We also would like to recognize the many contributions of our partners, the Centers for Disease Control and Prevention and the National Institutes of Health, with whom we worked on the development and production of the HBO series, The Weight of the Nation . We are especially indebted to the Michael & Susan Dell Foundation and Kaiser Permanente for all their collaboration and for their support of a national public health campaign to extend the reach of the HBO series and this book.

We are grateful to the senior management of HBO and the Institute of Medicine of the National Academy of Sciences. In particular, we would like to recognize HBOs Chairman, Bill Nelson; Richard Plepler, Co-President; Sheila Nevins, Documentary Films President; and Michael Lombardo, Programming President, for fostering an environment that allows projects like The Weight of the Nation to flourish. At the Institute of Medicine (IOM), we would like to recognize Dr. Harvey V. Fineberg, President; James Hinchman, National Research Council Deputy Executive Officer; and the dedicated program staff of the IOM for their unwavering support of this project. We would also like to thank all those at HBO and the National Academy of Sciences who have gone above and beyond in their efforts to make The Weight of the Nation a success.

Additional thanks to everyone who helped shape our thinking about the obesity epidemic and the science of weight loss, as well as to all the people who so generously allowed us to share their stories.

Special thanks to the following people for their contributions to the research, writing, and editing of this book: Nazenet Habtezghi, Tomek Gross, and Sonia Dulay Ricci at HBO; and Linda Meyers, Lynn Parker, and Emily Ann Miller at the IOM. We are also grateful to Bill Dietz and his team at the CDC for lending their expertise.

Finally, we would like to thank the dedicated team at St. Martins Press: Elizabeth Beier, Michelle Richter, Amelie Littell, Eric C. Meyer, Eliani Torres, Rowen Davis, Jason Ramirez, Matt Baldacci, John Murphy, Laura Clark, and Nadea Mina; and recognize the work of HBOs agent, Brian Lipson.

John Hoffman and Judith A. Salerno

Foreword

At first glance, body weight seems simple to understandpeople eat more than they burn off through physical activity, and their weight goes up. The remedy seems simple as wellpush away from the table, exercise, and take some responsibility. There is some truth to each of these propositions, but they both skirt the most important questions:

Why do so many people struggle with their weight if the problem is so simple?

What in the world can be done?

If one scratches just below the surface, it quickly becomes apparent that obesity is one of the most fascinating and vexing problems of modern life. A half century ago, obesity was scarce. Then it was a problem only in a few developed countries such as the United States, England, and Australia. Then it stampeded throughout the world. Who would have imagined the day when overnutrition and obesity would join hunger as a leading nutrition problem in countries such as China and India?

Something profound has changed to cause this. A combination of conditions has eroded the ability of vast numbers of people to make healthy choices, even though most people know the rudiments of healthy livingmost people know that fruits and vegetables are good and junk food is bad, and that exercise is beneficial. What is driving these problems?

This book answers that question, but it also goes further. It provides sound advice for people wanting to lose weight and keep it off. Based on groundbreaking films produced by HBO in conjunction with the prestigious Institute of Medicine, this book shows that forces working against us make obesity an understandable, even predictable consequence of our environment. The chapter titles capture the daunting challenges people face in everyday life: Fast Food vs Us, Restaurants vs Us, Big Food Companies vs Us, Marketing vs Us, Desks, Cars, and Computers vs Us, and so on. The authors show how an environment of toxic food and low physical activity has led us to an epidemic, and they do so in a most accessible and vibrant way.

At the end of the day, the most important challenge is discovering what to do about obesity. Many parties must take part: governments, schools, the media, health professionals, food companies, and, of course, individuals. Individuals can become political actors and cry out to their elected leaders for needed change. Individuals can also address their own behavior and their family environment. This combination of activating people to have a voice and also to adopt new healthy eating and activity patterns is what makes this book unique and so important.

John Hoffman and Judith A. Salerno have made a compelling case for the benefits of weight loss, even in surprisingly small amounts. For people wanting to lose weight, this book brings together the most advanced scientific discoveries into an easily understood and engaging set of guidelines and suggestions designed to bring about sustainable personal change. This information will be helpful to every reader.

It is heartening that The Weight of the Nation is also addressing the issue of weight bias, stigma, and discrimination. Overweight people are treated differently from their normal-weight peers in educational, medical, employment, and other settings, even when their qualifications are the same. There is a stunning social penalty for being overweight. And behind the statistics are heart-wrenching stories of children being teased in the cruelest ways by peers, parents being critical of their own children, bullying, and many other forms of mistreatment aimed at people who deserve better.

Some people justify such mistreatment by believing that bias is a form of social pressure that will motivate people to lose weight. Far from the truth, this attitude perpetuates unfair and hurtful behaviors that undermine dignity and good health. It is possible and necessary to fight obesity while showing compassion for the people who have it.

After many years of neglect, governments, public health officials, and society have turned attention to one of the worlds most significant public health issues. The result is an amazing series of discoveries, more knowledge than ever about what causes the problem of overweight in America, and more helpful information on how to bring about change. When the history of obesity is written, The Weight of the Nation will be seen as a significant milestone.

Kelly D. Brownell, Ph.D.

Professor of Psychology, Epidemiology, and Public Health Director, Rudd Center for Food Policy & Obesity

Yale University

Introduction

Youve heard it a million times: America is fat. As a nation, were getting fatter every day, our kids are fat, its making us sick, and many of us may die earlier because of it.

No one is immune. If youre not currently struggling with your weight, you know someone who is, most likely no farther away than your immediate family. The obesity problem in America affects our already strained health-care system, our national productivity and security, and our quality of life.