Growing up too fat

It seems like we've really engineered a society that's designed to make people fat. We take elevators instead of stairs. We drive instead of walk. Some of the suggestions in this book seem to go against America's culture of convenience, like getting off the bus earlier and walking the last few blocks to work, or parking farther from the grocery store. We've made our lives super-convenient, and now we have to purposely inconvenience ourselves to become healthy again. Won't that require a kind of reverse engineering of the whole American lifestyle?

I think that it would make it easier if there were more reverse engineering. I talked to people trying to think about how to do this, who said that companies should make stairways more inviting. They should put signs near the elevator that say take the stairs up three flights or whatever. They should have the stairwells nicely painted and have pictures hanging on the wall. Where I work, the stairwell is pretty grim. Buildings should be reengineered to make stairs both more accessible and more attractive, more brightly lighted.

But it's hard. I find it hard. I feel like I should be parking father from work, and so far I haven't found a parking garage located in the direction that I would have to walk to head home. It takes a lot of conscious planning.

The people at the National Institutes of Health who give grants on obesity prevention have become so sensitized that they do things like throw away the remote control on their TV, and put the washing machine a flight down, so they have to go up and down stairs with loads of laundry. They really have tried to engineer their homes to make everybody move around more.

A new report published in the New England Journal of Medicine argued that for the first time in two centuries American children will have shorter lives than their parents, because of obesity. What do you think are the odds of reversing this trend?

If we're going to reverse it it's going to take decades, because there are millions of children who are affected, and so much of this is so engrained in American society. But I think that with tobacco, we've seen a huge change in the social norms. You've seen a real reduction in the acceptability of smoking. I think that can happen with unhealthy foods. But it's going to take years until doughnuts are no longer an accepted way to raise money in schools.

If obesity is really an epidemic, especially among kids, why isn't it being treated like one? Does the public fail to understand that it's dangerous?

Most people have still not realized just how dangerous it is. But when they read stories that say that the life expectancy is going to go down they'll start to.

If the child doesn't have any obvious medical health problems yet, then the parents are less inclined to take it seriously. In some cultures, when babies or young children are really hefty, hearty eaters, it's considered a sign of good parenting. So, it just hasn't been considered a health problem. And doctors and healthcare providers have to do a lot of education to convince parents that it is.

Is part of it that some obesity-related diseases don't show up for some time?

Yes. You have lots of kids who are developing what used to be called "adult onset diabetes" because we have so many more children who are severely overweight, who are severely obese compared with 20 or 30 years ago. Those children are developing complications such as diabetes, high cholesterol, bone problems, joint problems.

But many of the kids who are really overweight now don't have diabetes yet. They might have abnormal handling of glucose in their bodies, but that could only be diagnosed by a blood test. And they may not be getting the blood test. Or, they might have high cholesterol that hasn't been picked up, or they might have high blood pressure. But to the eye, they don't look like they have any health problems, except that they're overweight. So, a parent might not realize that the child's long-term health is being affected.

Do you see this really as a parenting problem, or as a societal problem?

It's a societal problem, because it's an epidemic that happened because of some combination of changes in the modern environment. And parents aren't any less equipped now than they were 20 or 30 years ago. Parents today know as much as parents did then, but it's just not enough anymore, because they're dealing with a different environment. Parents today have to be more equipped than they were in the past. They just have to be more conscious and more educated about nutrition.

And what about at the civic level? What are one or two things that should happen that will actually make a dent in this epidemic?

There are a lot of school systems around the country that have begun to try to do things about vending machines and the a la carte food choices in schools, and a lot of that has been impelled by parents.

It's hard for schools because they often depend on vending machine revenues. But if schools can make a commitment to having healthy food and drink choices in school, and getting the unhealthy ones out of there, I think that would make a difference.

At the schools that I visited in Boston, they're putting in place curricula that have been tested and found to be pretty effective -- Planet Health and Eat Well & Keep Moving. What I saw was that in the course of teaching all these lessons about nutrition and physical activity, the teachers and administrators themselves were becoming a lot more sensitized to the problem.

And they were changing their behavior. Some of the teachers weren't ordering Chinese lunches anymore, they were bringing their own lunches. And they were drinking water, and going for walks. At PTA meetings they were no longer serving soda. They were serving water. So, the schools can have a huge social impact. They're sort of little nodes of change, and if you can get the people in the school to do something about this problem, then they can impact a lot of people.

Next Page: Why even fast food chains are now marketing health

• View blog reactions