Getting religion about health

What things has Arkansas done to help adults shape up?

We're trying to focus on giving people reasons and incentives to make healthier choices, as opposed to creating prohibitions and penalties. We offer $20-a-month discounts on health insurance to all state employees who do a health risk assessment. We had 18,000 state employees sign up in the very first enrollment period, a far greater number than we expected.

In the Arkansas Fitness Challenge, companies challenge other comparably sized companies over the course of a month to see how many employees quit smoking and how many steps they take, measuring them with pedometers. Over 400 businesses immediately contacted us to sign up.

One thing we kept hearing from people was: "I know we need to get out and walk, but I don't know where to go." So we compiled a list of every walking trail in the state, and it's constantly being updated.

We're trying to change the culture of health from one of disease focus to one of health focus. And we're looking at ways to change even more things. For example, it frustrates me that my own insurance plan as a state employee will pay for a quadruple bypass but will not pay for me to visit a nutrition counselor. That's crazy. The nutrition counselor might cost me $75 for a session that could save me from having the quadruple bypass.

Your initiative with former President Clinton calls for stopping the increase in childhood obesity in the U.S. by 2010. How are you hoping to do that?

We want to work with food companies to encourage them to promote healthier food choices. We realize that the food industry is at the mercy of the marketplace, and we're not blaming them for the fact that Americans are overweight. I certainly don't blame the fast-food industry for making me overweight. They sold what I demanded.

The second thing is to make more parents aware of how little exercise their kids are getting, and how many calories their kids are getting. Many of the things that parents do to show love for their kids are not necessarily in their best interest. For example, you take your kids to pizza not because you hate them but because you think that you're giving them a treat. And if a medium pizza might actually meet the nutritional needs of three or four kids, the large one shows that you have no limits to your love.

It's part of the whole culture of food. We let food become the reward. It's one of the most important things that I had to learn about why I'd never been successful in getting control of my health. I've heard people on talking-head shows chastising parents for overfeeding their kids and making parents feel terrible about it, as if they've done an abusive thing. And I want to just scream and say, "Obviously, either you're not a parent or you don't understand why parents are doing what they're doing. They're not doing what they're doing because they hate their kids.

There's not a parent in America that's saying: "Here, son, here's another 3,000 calories today. We'd like for you to be so fat that you have a heart attack by your 27th birthday."

So how do you hope to get parents to think about this in a different way?

A lot of it will be through the information we present in everything from public service announcements to trying to get doctors to put a new focus on [nutrition and exercise] when they talk to their patients. The entire community has got to become involved.

I liken it to the early '60s when Lady Bird Johnson led the Keep America Beautiful campaign. We had an incredible litter problem -- not that we still don't -- but it was so much worse then. People would just throw things out, and there was no social penalty for that. There was no sense of this is wrong. And through that awareness, people changed their image of litter.

The same thing has happened with tobacco. Whereas smoking once was considered glamorous and all the cool people did it, it's increasingly becoming something that is considered obnoxious. We don't tolerate it on airplanes. We insist on no-smoking rooms in hotels. Restaurants and workplaces are going smoke-free. By the same token, I think we have to change cultural attitudes about being overweight and about poor health.

Now, this is a tricky one because you don't want to go out and make people feel an extraordinary sense of shame and guilt.

You talk about that in your book -- how when you were overweight, you certainly knew that it was socially stigmatized.

It was one of my greatest personal points of pain. It wasn't like I didn't know that I was overweight. And it wasn't like I wasn't aware that people were disgusted with me over it. But the guilt trip did not help me get control of my health; it did not move me to action. That is going to be the dicey thing for us. But I think that instead of focusing on weight loss, you focus on health.

Americans are obsessed with weight, and that's the wrong obsession. It's ideal to have a body-mass index that's in the normal range, but I think that most any doctor in America will tell you that a person who eats well and exercises regularly but may be a few pounds overweight is much better off than the person who is skinny but eats junk food and is sedentary.

Next Page: Call off the grease police and the sugar sheriff!

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