Sizing Up Americans In 'The Weight Of The Nation'

A new four-part documentary airing on HBO next week looks at America's growing weight problem. John Hoffman, vice president of HBO Documentary Films and executive producer of The Weight Of The Nation, describes his three year-project to document the causes and effects of being overweight and obese in America.

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IRA FLATOW, HOST:

You're listening to SCIENCE FRIDAY. I'm Ira Flatow. You heard the statistics before: Americans are getting fatter and fatter with each passing year, and the trend isn't about to end. According to a new study out this week from the Institute of Medicine, by the year 2030, more than 40 percent of American adults will qualify as obese.

Add in the overweight folks, and that accounts for somewhere around 68 percent of Americans. More than two-thirds of us are carrying around extra pounds, taxing our hearts, our livers, our health care system and passing those bad habits on to our kids. So what is it going to take for us to slim down?

That's one of the questions asked in a new documentary series called "The Weight of the Nation." It will air on HBO starting next week. John Hoffman, vice president of HBO Documentary Films and the executive producer of "The Weight of The Nation" is here with us at our New York studios. Thank you for taking time to be with us today.

JOHN HOFFMAN: Glad to be here.

FLATOW: Why HBO, an entertainment channel, tackling such a heavy issue, if I might put it that way?

HOFFMAN: Well, starting in 2007, when we aired "Addiction," which was a co-presentation with the National Institutes of Health, and then we followed that with "The Alzheimer's Project" in 2009, also with the NIH, I - we tried to really establish ourselves as a place to really inform Americans about issues that are really important to their health and the health of the nation.

And we are going against our model, being an entertainment company, and we're also going against our model when we're making this content available however we can, wherever we can, on all platforms. And it really - it's corporate citizenship at its best, when we're really using this invitation into 30 million homes to tell people important things about their health.

FLATOW: And you think you can succeed where everybody else has failed over the years in getting Americans to change their habits, their diets, whatever?

HOFFMAN: I don't know if it's - succeeding is really something that we are aspiring to, so much as sending up as many flares as possible and really igniting a conversation. It's going to take a long time to turn this around. It was rapid changes over 30 years. But I think to undo these tremendous changes in the culture that really in many ways play to our most basic pleasures in terms of responding to sugar, fat and salt, and also being leisurely when we can to conserve energy. We have really advanced the technologies that enable us to live this way, and to ask people to go back is not something that we're going to do.

We're going to have to think our way out of this in creative ways.

FLATOW: And you were - you got some great names, I mean, very big-time scientific names in here, including the Institute of Medicine, correct? Probably the most respected place in all of America for doing science.

HOFFMAN: Well, we went to the IOM at the beginning of this when we really realized that it's not going to be solved, obesity is not going to be solved by simple changes in the - I shouldn't say it that way. Really it's not going to be solved by the changes that are going to be discovered in the laboratory.

It's really going to be changes that happen in society, and the IOM has been looking at this for the past 10 years, and when they release a report, the ground shifts, and we recognized, and we saw that in the literature. And so we went to the IOM. We went to the NIH, went to CDC, and we brought them all together to really make this concerted effort.

FLATOW: And did you get any cooperation of the food companies themselves?

HOFFMAN: We didn't - this is not a piece of journalism. This is a piece of public health. And so we really are informing people about all the issues that pertain to the health and future of this country. And we have a really unique character who was part of the IOM committee, Phil Marineau, who is the former chairman and CEO of PepsiCo North America and Quaker Oats, who sat on this committee, that we followed for 18 months, as an industry representative.

And he has a completely unique person, also being on the Kaiser Permanente board of directors, who really wears a lot of hats and has a combined set of experiences that really informed the series, in terms of this intersection of industry and health.

FLATOW: And so you have a four-part series. Do you make - you study it. Then do you make recommendations about what Americans should be doing or a direction health care should go?

HOFFMAN: There are strong recommendations about what people can do in their daily lives. I think the loudest one is that sugar-sweetened beverages, whether that be in juice, in sports drinks, in energy drinks, in sodas, that there is no reason for these to be in our lives. They are not something that were part of the human diet until recently, and we don't have the biology that knows how to compensate for those - that fast rush of sugar.

So we have many experts who say that this is the number one change that could happen in the American diet.

FLATOW: Do you go as far as to say they should be taxed, made more expensive than non-sweetened, non-sugary...?

HOFFMAN: That issue is not brought up in the series. It's brought up in the IOM report that was just released this week at the Weight of the Nation conference.

FLATOW: What other rec - what other steps do you recommend?

HOFFMAN: We have got to really renovate tremendous aspects of our culture, and it's going to take a tremendous amount of invention and tremendous amount of intervention to really re-engineer our lives. Far too many people don't even have access to places to - safe places to run, bike or even walk. And when you have this problem in certain communities and certain neighborhoods, you are really having people have a double- or triple-whammy working against them in terms of trying to lead healthy lives.

FLATOW: There's already been a bit of a backlash, a criticism not only against the Institute of Medicine report. The - an op-ed in the Wall Street Journal today talked about the nanny state. I'm sure you're familiar with this: They're telling us what to eat again. And they want to tell us everything, how we should live our lives. Do you talk about that in the series?

HOFFMAN: Well, you know, if we look to the government to make sure that the food supply is safe, that we are not going to get sick with salmonella or E. coli, we rely on the government. We don't think of that as the nanny state, to make sure that we don't get any kind of infectious bacteria from the food that we eat.

I think that it's fair to argue, and many of the experts that we talked to would argue, that the food supply is making people sick because it's promoting diabetes, which is driving stroke and heart disease in this country. And so I think it's a fair discussion that has to go on about the future health of this country, as to whether the food supply is, in fact, safe.

FLATOW: I think one of the surprising things that - I had known sort of peripherally, being a science reporter all these years, but you pointed out very well in one of your pieces is the effect that being overweight has on your liver. You don't think about your liver as being, you know, affected.

HOFFMAN: Yeah, I think that in part one of the series, called "Consequences," this is what people talk about more than anything, and this is the work of Sam Klein at Washington University in St. Louis. And the liver is in many ways the canary in the coal mine, and it is the people who have excess fat in their liver.

Twenty-five percent of Americans are walking around with excess fat in their liver right now, that when it reaches a tipping point, it is then what drives the spiking of cholesterol. It's the rise in the blood sugar. It's really the promoter of diabetes. And so we - Sam does a study that is striking, in which a volunteer, a woman who courageous volunteers to add a fast-food diet with 1,000 to her daily routine.

And her - in just 10 weeks of that diet, her liver fat goes up by 161 percent, and so if the fatty liver is this canary in the coal mine, and this fast-food diet that too many Americans are eating is promoting excess fat in the liver, then we really have what's coming as a tidal wave of liver disease.

FLATOW: What - you've been working on this for, what, three years now. What - every producer goes in thinking one thing, and then they get surprised by something. What was one of the great surprises that you discovered while working on this?

HOFFMAN: So I think that the coming - the awareness that we are living in what we describe as a mismatch, that the genes that evolved in a time of scarcity and want, are now existing in an environment of plenty. And that our genetic makeup is just not designed for this current modern-day environment. And that no matter what we do, there's too many of us who are having responses to food that are operating below our awareness and that when you have two-thirds of the population that is overweight or obese, you have to say that it's more than just a failure of personal will and responsibility.

Something more powerful is going on, which is compelling people to eat a little bit more than they should and to move less than they should. And it's this evolutionary biology which was the - I think the big aha for me.

FLATOW: It's also interesting that I think a lot of people avoid dieting or losing weight, let's put it that way, eating correctly, they say I'm just so fat, losing a few pounds is not going to make any difference. That's not true.

HOFFMAN: Not at all. Not at all. And this is what is now coming online, I think, which the research is very powerful that shows that a seven to 10 percent weight loss - so if you're 200 pounds, that's 14 to 20 pounds. It's not 50 or 60 pounds that you have to lose. That seven to 10 percent can have profound impacts on your metabolic health. And we hope by sending out this message in these shows - that message is repeated - we hope that people will find some comfort and some confidence that that is a weight loss that they could attain.

FLATOW: 1-800-989-8255. Let's see if we can get a phone call or two in here. Ron in Louisville. Hi, Ron.

RON: Hi. I just wanted to make a comment. I've heard a lot of people talking about taxing sugar beverages and that type of thing. But I think a much better route - which would raise the cost of these things and get the votes of people who don't want to continue these farm subsidies - is we make grain so cheap.

And corn is used to make high-fructose corn syrup and the subsidies make that extremely cheap. It also makes our meat a lot less healthy because of the feedlot beef being fed on corn is vastly different in its nutrition profile than grass-fed beef, which is what beef is supposed to be fed on. And so I think that you won't have the nanny state people going after you if you try to do away with subsidies.

And there are a lot of people who - and I mean you're - if you're taxing and then you're doing subsidies at the same time, well, you're spending twice as much money to accomplish nothing. And then it would just be better to do away with the subsidies to start with, and then you don't spend money on both.

FLATOW: Good point. In fact, the Institute of Medicine makes this point in one of its recommendations.

HOFFMAN: Yeah. The issue of the subsidies that are going out to farmers is fundamental to the discussion of the obesity crisis in this country. And we've got to really redistribute these farm dollars to enable a very different food supply to be produced and to give farmers the confidence to plant fruits and vegetables. Right now, less than 3 percent of American farmland is devoted to fruits and vegetables. More than 50 percent is devoted just to two crops, corn and soy.

And so when you have this kind of imbalance, and which is almost entirely due to the confidence of the farmer to plant different crops, then you are - we're not going to solve this problem. And the caller outlines it perfectly in terms of the food supply chain.

FLATOW: We're talking about this HBO documentary series coming up next week, "The Weight of the Nation," airing on HBO, talking with John Hoffman on SCIENCE FRIDAY from NPR, four parts divided up into different ideas. Tell us about the parts.

HOFFMAN: Part one is called "Consequences," and it outlines for the viewer the health effects on the body and talking about changes in - to the internal organs when you're carrying too much fat around the middle, changes in metabolism. It's the liver fat that we discussed earlier. And it talks about the extent of the problem in the population.

Part two is "Choices," and it really highlights the most evidence-based science about what we know about achieving weight loss, and more importantly, sustaining that weight loss. Ninety-five to 98 percent of the population regains the weight they've lost within five years. But when you have a population as large as we have that has lost weight, then even that 5 percent is a large number of people. And those people have been studied, and we know what they do to sustain that weight loss. And those messages are in the part two, "Challenges."

Part three is "Children in Crisis." It is a tremendous problem. Obviously we know there's a lot of focus on childhood obesity. But the social determinants of what is driving this increase in weight in children have to be discussed. It's the marketing of unhealthy food to children. It's the unhealthy food that's being served to them in schools. It's the lack of physical activity. Less than 2 percent of children in high schools get physical activity every day. Four percent of children in elementary schools get the physical activity recommendation, is an hour of vigorous activity every day.

Part four is called "Challenges," and it tries to look at, from a high altitude, about what are all the reasons that are driving this complex problem. And it then ends with, I think, some very inspiring stories of communities that are really now trying to recognize this and make the communities, national in particular, a healthier place to live.

FLATOW: Will there be any distribution outside of HBO of the series?

HOFFMAN: Absolutely, and this is truly a public health campaign. We have wonderful partners - Kaiser Permanente and Michael & Susan Dell Foundation - that enabled this to go from public education to public health. The entire series - 12 short films that go along with it, in English and in Spanish, are being distributed free of charge to 40,000 community-based organizations. This is an unprecedented level of grassroots distribution and organizing.

There's a website which gives people over 75 actions that they can take to try to move the dial in their communities and in the nation. All this content is available in perpetuity on hbo.com. These screening kits are available to any organization that wants to organize a community by going to hbo.com.

FLATOW: You know, it seems like it's almost too good to be true, this kind of generosity that, you know, Viacom, HBO, whatever, are giving out.

HOFFMAN: Time Warner.

FLATOW: Excuse me, Time Warner. I mean, who sat down and said we should do this? Does this go way to the top at Time Warner or HBO or...

HOFFMAN: It does start at the top in that...

FLATOW: I mean this is so generous to give this stuff out to people who don't even subscribe to HBO.

HOFFMAN: You know, I work for a successful company. And it's - every now and then we do have the ability to give back and to really show that HBO and Time Warner cares about the health of the country, and we have a powerful platform. And at the very beginning you described us as an entertainment company, and that's what we are. But when we go against our model and when we turn our lens towards these complex social issues, then other media, you are a great example, notice it. And so we've recognized that when we go against our typical platform of presenting great entertainment and look at health, then we get the cooperation of a tremendous number of other media outlets, and it just magnifies the message.

FLATOW: And begins next week, what day?

HOFFMAN: Monday and Tuesday, two episodes a night starting at 8:00.

FLATOW: Eight o'clock. Thank you very much, John Hoffman.

HOFFMAN: Glad to be here.

FLATOW: He's the vice president of HBO Documentary Films, executive producer of "Weight of the Nation," coming next week. And that means "Boardwalk Empire" will still be going on, right? OK. We'll get to see some of these(ph) shows also. We're going to take a break and when we come back, we're going to talk about a medical mystery, a stomach virus you don't want to have but so many people get it. It's an interesting history and a mystery. So stay with us. We'll be right back after this break. I'm Ira Flatow. This is SCIENCE FRIDAY from NPR.

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