Obesity Trumps Smoking As American Health Burden Reporting in the American Journal of Preventive Medicine, researchers write that the American obesity epidemic is eating away at gains in health and life expectancy achieved by anti-smoking campaigns. Ira Flatow and guests discuss the trend, and how Americans can trim fat.

Obesity Trumps Smoking As American Health Burden

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Next up, America's number one New Year's resolution, maybe you made it yourself, right? What is it? It's losing weight and with good reason, because one recent study predicts that nearly half, half of all Americans, will be obese by 2020, 10 years from now, certainly putting a burden on the nation's health system.

You know what used to be - smoking used to be the biggest cause of preventable death and disease, and today, as fewer people smoke and obesity rates creep up, obesity has now surpassed smoking as the biggest burden on America's health, according to a study out this week in the American Journal of Preventive Medicine.

And we also saw life expectancy march up into octogenarian territory in the last decade, but the obesity epidemic could be slowing down that trend.

Well, what are we going to do about it? How about a war on obesity. We already had a war on smoking. It was pretty successful, but how much of that can you apply? How many of those lessons learned there actually can apply, can be applied to an obesity epidemic, or do we need a different approach?

That's one of the things we'll be talking about today. Our number, 1-800-989-8255, 1-800-989-TALK. Also Twittering. You can tweet us @scifri, @-S-C-I-F-R-I, or in Second Life, you can join folks there.

Let me introduce my guests. Dr. Erica Lubetkin is an associate medical professor in the Department of Community Health and Social Medicine at City College here in New York. She's also author of that study in the American Journal of Preventive Medicine, and she's here in our studios. Welcome to the show, Dr. Lubetkin.

Dr. ERICA LUBETKIN (Associate Medical Professor, Department of Community Health and Social Medicine, City College of New York): Thank you, great to be here.

CONAN: Were you surprised at your own results, what you found in the study?

Dr. LUBETKIN: No, I wasn't surprised. Our results were something that people have spoken about for a long time, and you could see the trends emerging, but we had was the trend data, which we had a big data set, and we were able to show it.

FLATOW: And how fast is it moving? How fast is the trend going?

Dr. LUBETKIN: Well, we're not quite sure. As of 2008, the paths crossed one another, where obesity became an equal, if not greater, contributor to the burden of disease, and by burden of disease, I mean shortening of healthy life because we examine both the effects of the length of life and the quality of life.

FLATOW: When you mean shortening, it actually takes years, it takes years off of people's lives statistically?

Dr. LUBETKIN: Well, we looked at something called quality adjusted life years. We were able to look at the quality of life - activity limitation, disability - as well as the length of life. So we were able to look at those in a single number, whereas a lot of previous studies looked at premature deaths - both morbidity, sickness and then mortality.

FLATOW: Also with us is Matthew Gillman. He's professor and director of the Obesity Prevention Program in the Department of Population Medicine at Harvard. He joins us over the phone. Welcome to SCIENCE FRIDAY, Dr. Gillman.

Dr. MATTHEW GILLMAN (Professor and Director, Obesity Prevention Program, Department of Population Medicine, Harvard Medical School): Thanks very much. Happy to be here.

FLATOW: What is the difference between overweight and obesity? Because we keep talking about overweight. We have obesity, and does it make a difference?

Dr. GILLMAN: Well, we have some definitions that are typically based on something called body mass index, or BMI, which some of your listeners may have heard of. That's an index where we divide the weight in kilograms by the square of the height in meters, and it's a pretty good measure of fatness, at least for clinical and population use.

In adults, obese is defined as a BMI above 30 and overweight between 25 and 30, and between 18.5 and 25 is normal.

In kids, where weight gain accompanies our growth, how much we grow in height, we have to compare ourselves with other kids the same age and sex, and so we use what's called percentile. So over the 95th percentile is considered obese, and between the 85th and the 95th is considered overweight.

FLATOW: All right, I'm going to have to stop you there because we have to take a break, but we will come back and talk about it some more with Dr. Lubetkin and Dr. Gillman. Our number, 1-800-989-8255 if you want to talk about the obesity epidemic. Also tweet us @scifri, @-S-C-I-F-R-I. Stay with us. We'll be right back.

(Soundbite of music)

FLATOW: You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow. We're talking this hour about America's obesity epidemic with my guests, Dr. Erica Lubetkin, she's at City College here in New York; Matthew Gillman and Harvard Med School. Our number, 1-800-989-8255.

Dr. Gillman, you know, we talk about being overweight and eating, but how much of our epidemic is due to the proliferation of junk food and, you know, fast food because it's a lot cheaper, and maybe there is a difference in people who can't afford to buy good food, and the junk food is cheaper.

Dr. GILLMAN: Well, it's a really good question about what's caused the obesity epidemic, and I think most people think it's multi-factorial. You know, if you go back in evolution, it sort of makes sense that when we're faced with extra food, it pays to pack it on because in the past, we wouldn't know where our next meal was coming from.

But in today's world, where it's feast all the time and very little famine for most people, it's hard to keep the extra calories off. And I think there are many things in our environment that have helped us to overeat, whether it be the food industry, who make profits from selling more food, so the ubiquitousness of fast food, as you say, sugar-sweetened beverages and things like that, but also the lack of physical activity, and a lot of the, you know, the energy-saving devices we have, whether they be cars or elevators or things like that, tend to keep us from getting as much physical activity as we'd like.

And recently we've, you know, been learning about some other factors. For example, watching too much television, which may have its effect through either physical activity or overeating, and things like too little sleep, which may have a direct effect on hormones that tend to have us overeat.

FLATOW: Dr. Lubetkin's sitting here like a bobblehead doll, shaking her head up and down about all these things. You agree.

Dr. LUBETKIN: Oh, I agree entirely. I think that the big contributors are the changes in the food in terms of, you know, eating more food, bigger portions, fast food, changes in the physical activity, especially - I'm an internist, so I see adults, but certainly at the pediatric level, in terms of less exercise, more TV-watching, static activities.

FLATOW: Video games.

Dr. LUBETKIN: Video games, exactly, and that's been correlated, as well as changes in health care in terms of lack of health insurance, not having a primary care provider - other aspects.

FLATOW: What about, you know, when I go to a fast-food restaurant, and - what has helped me are the calorie things. You know, if I'm saying gee, maybe I'll have a vanilla shake today, and I look and see that it has 600 calories in it or something, it actually changes my habits. Has that contributed or helped people to stop eating, you know, some of the fast foods at all? Does it work, that kind of approach?

Dr. GILLMAN: I think both of you are actually sitting in New York City, which has led the way in posting calorie counts on menus. Some other cities, counties, states are following that lead, and there's ongoing research to determine whether it's really effective in getting people to eat fewer calories. It's a very interesting approach, and it makes sense, as you say.

FLATOW: 1-800-989-8255. Let's get some listener calls here. Victor(ph) in - I'm going to get - this is Oconomowoc, Wisconsin.

(Soundbite of laughter)

VICTOR (Caller): Boy, did you blow that one. Oconomowoc, Wisconsin.

FLATOW: Oconomowoc, of course. I left one letter out, but an important one. Go ahead. Welcome to Science Friday.

VICTOR: Yeah, I just wanted to say the great fitness guru Kate Moss said nothing tastes as good as skinny feels, and that's supposed to be a joke. We all know she's a coke-addled supermodel, but she's right, like a broken clock, twice a day. And I've lost 30 pounds over the last three months by just getting used to being just a little bit hungry, not going for seconds, cutting out the sugars.

And by the way, why are we subsidizing the U.S. sugar industry? I'm going to hang up and let you...

FLATOW: Chew on that, okay.

VICTOR: Oh, yes, you have a question?

FLATOW: No. That's okay. Bad joke on my part. What do you say to that, Matthew?

Dr. GILLMAN: Well, I think your guest may actually have some good advice for people who either want to lose weight or actually may not want to gain weight, and that is small changes over a long period of time can be very helpful.

You know, our physiology, as I was talking about it before, because of evolution, tends to resist weight loss. When we gain weight, we come to a new physiologic set point or something like that, and our hormones in our body, when we lose weight after that, say oh, geez, you might be starving. Let's keep eating.

So a lot of times, it's easier to keep from gaining weight than to try to lose weight.

FLATOW: There, you know, there are various weight-losing shows on TV now, where they're actually contests, where very obese people come on to lose 20, 30 pounds, what, a week. Is this a healthy way to lose weight?

Dr. GILLMAN: Well, you know, as a clinician and public health researcher, especially who deals with - well, I deal with both kids and adults, but my view is that we really ought to be talking about prevention of weight gain starting very early in life. And a lot of our research deals with what things happen during pregnancy and infancy and early childhood that lead to either more or less weight gain.

And we're learning things like the amount of weight that a woman gains during pregnancy, whether she gets diabetes, even whether she smoked can have an impact on her child's obesity. And once the kids are born, breastfeeding, the amount of sleep they get, these things are very important, I think, for having people not gain weight in the first place and not having to face the question that you're actually asking.

FLATOW: Yeah. Adam(ph) in San Antonio. Hi, welcome to SCIENCE FRIDAY.

ADAM (Caller): Hi there.

FLATOW: Hi there.

ADAM: You know, I think it's great what you just brought up. I can't remember which researcher it was, but talking about early in life. There's two things I'd like to talk about regarding that. The first is I think legal reform, on what is allowed in schools, in public schools, would be great.

I think Coke and Pepsi are not all that different from, say, tobacco companies in that they try to get, you know, young people started on junk food as early as possible, and they do it in such a way that allows them to look like heroes because they enter into these contracts with public schools, and you know, they're like, you know, Powerade is a proud sponsor of this, whatever school, and it allows them to look like they're helping. And in my opinion, they're definitely causing a lot of hurt.

But secondly, I'd like see a healthy-eating ad campaign of some sort that would allow us to feel, perhaps patriotic, you know, at least good citizens for eating well. You know, when we eat well, and we take care of ourselves, we're able to go to work. We're able to make money. We're able to take better care of our families, and we're just better people all around, and few people are proud to eat well. More people are...

FLATOW: Let me get a reaction from our guests. Erica, what do you think of a campaign like this?

Dr. LUBETKIN: Well, in terms of the former campaign with regard to the school-based setting, I think it's an excellent place, in terms of these habits are formed very early, and it's a good, regulated environment in terms of healthy lunches in the cafeteria, physical activity regulations, which vary from state to state, and really an emphasis on nutrition and prevention. And so I think that that's a wonderful place to start, and especially keeping the sugar, the sweet juices and sodas out of the school environment.

And the second thing is, I think, in terms of our quality of life, there's been a lot of studies in terms of obesity. And certainly, if you look at - we measure what's called health-related quality of life, which is your physical, your emotional, your social well-being, and a lot of the literature has shown that obesity in particular leads to worse outcomes with regard to how you feel about yourself.

FLATOW: Thanks for calling. But you can tell this to people, but do they have the willpower? Do they have the means? Do they have the money to change their lifestyle to become thinner, or to stay thin, or to change their diets or their exercise habits?

Dr. GILLMAN: That's a very good question. You know, I think there's been a lot of emphasis on what some people call personal responsibility in changing lifestyle behaviors, but we also have to recognize that we live in an environment that restricts our behavior. And if you're living, for example, in an urban neighborhood where it's not safe to go out and get some exercise, and the only food that's available is from a fast-food restaurant or bodega or mom-and-pop store, it's very, very hard to change your behavior.

And if you're a kid, and if you're living with a single mom, and she's working two jobs, and you're a latch-key kid, it's very hard to get the physical activity or to eat right.

So I think while we have to address individual behavior change, it's really important that we think about changing the obesogenic environment.

FLATOW: And how would you do that? Any suggestions?

Dr. GILLMAN: Well, I think we've already heard, on this program, some ideas about how to do that, whether it be in the child-care setting, school setting, medical setting, the built environment. I think people are starting to do this in different ways. We heard earlier about menu labeling in restaurants.

FLATOW: Could you subsidize? Let's say - I'm just going to think off the top of my head. Let's say a lot of people get food stamps now. Could you get more food stamps if you buy healthier food: fruits, vegetables and things, disproportionately just to getting the stamps in general. How about that as a suggestion? So you can afford to buy healthier food.

Dr. LUBETKIN: I think that's a wonderful idea, and in terms of combating the obesity epidemic, you'll need multiple, multiple strategies. One size doesn't fit all in terms of policies, but certainly we all know that going to McDonald's, it's a lot cheaper to get a meal there than, you know, a healthy salad at a salad bar.

FLATOW: Right.

Dr. GILLMAN: You know, you brought up the issue of smoking at the top of the program, and I think there are a lot of lessons to be learned about the antismoking campaigns. For example, there was, you know, the combination of individual behavior change, like doctors telling their patients to stop smoking or never start. But - plus environmental interventions like taxing cigarettes that helped us really reduce smoking in the country.

FLATOW: Mm-hmm.

Dr. GILLMAN: However, you also have to say that it's a little bit more complex with obesity because eating behavior is neither legal nor illegal. There's a big gray zone about what's healthy and what's not healthy.

Still, some people are talking about taxing sugar-sweetened beverages.

Dr. LUBETKIN: Right.

Dr. GILLMAN: A lot of these beverages really are empty calories and there's no sort of redeeming social nutritive value to them. So we can probably agree on some strategies that are fairly translatable from our experience in smoking to our experience in obesity.

FLATOW: Mm-hmm. 1-800-989-8255 is our number. We have a question in from Silver Wing Benwarren(ph) in Second Life, says: Do artificial sweeteners help people lose weight or reinforce their need for sweets? If you taste that sweetness, you say I've got to have the real thing, I guess is the question. Any thoughts on that?

Dr. GILLMAN: This is an area that's sort of still up for grabs. There have been - excuse me - some studies, both short-term and sort of larger epidemiologic studies looking at this and I don't think they're conclusive yet. But you know, there are some interesting animal studies that suggest that if you give somebody artificial sweeteners - somebody, some rat, I guess - some artificial sweeteners, they tend, actually, to eat and drink more after that because it sort of fools their appetite systems into thinking they are getting a lot of calories with sweeteners in it.

FLATOW: Mm-hmm.

Dr. GILLMAN: Christina(ph) in Oak Park, Illinois. Hi, Christina.

CHRISTINA (Caller): Hi. How are you?

FLATOW: Hi there.

CHRISTINA: I think this is a great discussion that you all are having. I think this needs to be discussed more. I'm a parent of three children, one of whom who has a disability, and I think the food has just been crucial in terms of his healing. And so, you know, I'm wondering why we aren't questioning more the subsidies of corn and soybeans where - I mean, it's too expensive for an average American family to eat real food, real food with real ingredients, not processed. It's cheaper for me to, you know, drive down the street and get fast food.

But we find that, you know, when our kids are actually eating food that, you know, I cook at home with organic ingredients, that their health improves. I mean, I think any discussion about obesity in America has got to start with policy, policy that's going to talk about, you know, changing what's - what the American family can afford.

FLATOW: Mm-hmm. We're talking about obesity this hour on SCIENCE FRIDAY from NPR News. I'm Ira Flatow with Dr. Erica Lubetkin and Dr. Matthew Gillman.

Dr. Gillman, any reaction to that?

Dr. GILLMAN: A very interesting comment. You know, our U.S. Department of Agriculture was not really set up as a health agency. And a lot of it is set up to actually support industry, and it hasn't been surprising, I don't think, over the years, that, you know, the farm bills and other bills that have come out have really, you know, supported production...

FLATOW: Mm-hmm.

Dr. GILLMAN: ...but haven't really looked at the health impact. And I think, you know, there's more talk now, you know, both in scientific as well as political circles about relooking at these issues and seeing whether, you know, whether we squeeze the balloon in one area, it really pops out in another and you have the law of unintended effect, so if you produce more sugar or corn that it may be good in the short term for the farmers, but not good in the long term for the health of the public.

FLATOW: You know, Christina asks about the subsidizing and how it's more expensive. But in some places - and Erica, you can't even buy healthy foods in some inner-city stores and some supermarkets. It's not even there, even if you want to pay for it.

Dr. LUBETKIN: Right. There's a lot of disparities in terms of neighborhood effects. And where I work, which is Hamilton Heights, Upper Harlem, there's a lot of bodegas - and it's much harder to access those fruits and vegetables and healthy foods. There's a lot of processed foods. And certainly there's been more of a movement in terms of having farmers, green markets, coming and delivering fruits and vegetables, and having - people have a means to pay for it. But certainly access to date has been a big issue.

FLATOW: Mm-hmm.

Dr. GILLMAN: You look at photographs of inner-city grocery stores, sometimes all you can see is soda.

(Soundbite of laughter)

Dr. GILLMAN: You have to pick apart the aisles to get anything else.

FLATOW: Mm-hmm.

Dr. GILLMAN: Maybe a bit of an exaggeration, but it sure seems like that.

FLATOW: Mm-hmm. Well, might people argue, well, if there were demand for it, they would have it in the store? I mean, then again, in those stores it would be so expensive you probably couldn't afford it without having some sort of subsidy, I would think, having been in lots of those stores.

Dr. GILLMAN: I think we may come back to these issues of, you know, chicken and egg. And if we live in a society where we're bombarded with media messages about eating more and eating bigger portion sizes and that's what faces us when we go out our doors, and that's what role models do, it's hard to pin it on the demand side of it.

Dr. LUBETKIN: And it's also different with regards to children and adults where - with children those messages are just so in front of them in terms of, you know, walking by a McDonald's or a fast food and seeing the Happy Meal and the product and that marketing to kids and being so susceptible, or going to the drugstores and seeing all the candy on the lower shelf, where a child - it's marketed of a movie or some other character. And so, you know, as a parent...

FLATOW: Mm-hmm.

Dr. LUBETKIN: ...with our two kids, it - we feel very strongly in terms of -it's so out there and accessible and so familiar...

FLATOW: Mm-hmm.

Dr. LUBETKIN: ...in terms of that recognition.

FLATOW: So are you - 10 years from now, when we get to that point, are you hopeful or not hopeful about the future?

Dr. LUBETKIN: Well, slow and steady. I think that the gains with smoking, which were - it decreased by about 18 and a half percent over the last 16 years. But New York City, in particular, has just done a wonderful job, but they also use taxation. They used a number of different policies.

FLATOW: Mm-hmm.

Dr. LUBETKIN: Education, a lot of mass media. Provider - they gave nicotine replacement therapy. They did a multi-pronged approach. And it's - again, it's not a one-size-fits-all scenario.

FLATOW: Mm-hmm. Dr. Gillman, are you hopeful?

Dr. GILLMAN: I am. And part of the reason is that there've been some recent national data suggesting that the epidemic may have started to peak, and at least in some demographic subgroups, like white women, may be starting to come down.

FLATOW: All right. We've run out of time. I want to thank both of you for joining us. Dr. Matthew Gillman of Harvard Med School. Dr. Erica Lubetkin, who is at City College in New York here in New York City. Thank you both for taking time to be with us today.

Dr. GILLMAN: Thank you very much.

Dr. LUBETKIN: Thank you.

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