9:42am

Mon May 14, 2012
Your Health

Pounding Away At America's Obesity Epidemic

Originally published on Mon May 14, 2012 10:37 am

The numbers are staggering: One-third of Americans are obese; another third are overweight. Some 26 million Americans have Type 2 diabetes. An additional 79 million more are pre-diabetic. Thanks to these figures, the children of today have a good chance of becoming the first generation of Americans to die at younger ages than their parents.

A new HBO documentary series, The Weight of the Nation, explores how our country got this way and what can be done to tackle what has become a growing national health crisis. Divided into four parts — "Consequences," "Choices," "Children in Crisis" and "Challenges" — the series looks at the public health challenges posed by an increasingly overweight population, as well as the public policy debates around trying to solve the epidemic. It also profiles regular folks across America who have tried — and tried again — to lose their excess pounds.

"Very rarely do you hear the human stories [behind the epidemic]," says psychologist Kelly Brownell, who is featured in the documentary and directs the Rudd Center for Food Policy and Obesity at Yale. "There are medical consequences to obesity, but there are also psychological, social and financial ones that matter, that really bear down on people and can really make their lives very, very unhappy."

Brownell tells Fresh Air's Dave Davies that only part of the issue in dealing with obesity is preventing it.

"The other part of it is also making our environment more accepting and welcoming for obese people, to eliminate biases against them," he says.

The number of obese Americans soared during the 1980s and 1990s, doubling among adults in the U.S. and tripling among children. Sedentary lifestyles and changes in eating habits have contributed to weight gain, as more Americans work at desk jobs, use electronic devices and get served increasingly larger portions at restaurants.

"More than 50 percent of the food dollar is spent outside the home now, and that's a big difference [from] what it was several decades ago," says Brownell. "People are eating outside because they're on the move, they have crowded schedules, they want to take the family out for a treat — and there are so many restaurants out there now to cater to this need. ... The problem is when you go out, you tend to eat more and you tend to eat worse than when you eat at home."

The excess weight has dire consequences for our bodies. Obesity is associated with a slew of medical ailments, including diabetes, heart disease, cancer, high blood pressure and sleep apnea. That means more visits to the doctor — and increased health care costs.

"Health care costs are estimated now at $150 billion a year, and about half of that is born by public funds for Medicare and Medicaid," says Brownell. "So all of us who may or may not be affected by the problem ourselves — and may not even have family members affected by it — have our wallets affected by it, because we're paying for a good share of the health care costs."


Interview Highlights

On changes in the food environment

"We could count 100 ways or more that the environment has changed in ways that I call toxic. Serving sizes have increased. What used to be the large size at McDonald's is now the small serving of fries. A muffin used to be smaller than a baseball; now it can be as big as a softball. And this gets multiplied by many products in the food system. Marketing of unhealthy foods is out of control completely. The industry is doing a very poor job of policing itself in that respect. And kids are targeted in a predatory way by the industry."

On marketing to children

"As an example of how much marketing there is, the Robert Wood Johnson Foundation is now, by far, the largest funder of work in this country on childhood obesity. They're spending $100 million a year on the problem. The food industry spends that amount every year by Jan. 4, just marketing junk food — just to children."

On the argument that the government shouldn't intervene in people's personal habits

"As a country, we sometimes believe that certain health-related issues sometimes reach a certain point of importance where we believe government has a role. For example, we could teach people to drive at the speed limit and be safe and not fall asleep at the wheel — or we can put airbags in cars. We could hope people brush and floss, or we can put fluoride in the water. We could hope that parents get their children immunized before they go to school, or we can just require it. So the question is whether obesity has reached a certain level of crisis, like we felt we reached with tobacco. ... I obviously believe we're there, and I believe, more and more, the country is believing that."

On food deserts

"There are places, especially in poor areas of cities, where individuals simply don't have access to healthy foods. You get corner markets, bodegas, fast food restaurants. Even when those places might carry healthier options, they tend to cost more than what people pay in the suburbs. Even if those people living in those circumstances wish to eat a healthy diet, it becomes hard to do it. That becomes one of the things where government can play an active role, creating incentives for supermarkets to open in those areas."

On pop diets

"Some of them are sound, but the results of them are terrible for the most part. The beauty of the diet industry is that they keep promising miracles, and there's very little regulation on what they can promise people. And since none of the programs really work very well, then you have this growing clientele of people who want to try one program or another after another in hopes that something might finally work. There's this funny paradox is that nearly every diet works and nearly no diet works at the same time. A diet may be effective in the short term because you're cutting your calories. So you can do that with cabbage soup, molasses, chicken tenders. If you cut your calories back, you're going to lose weight. But the diets can be very unsafe. But they also tend to not work in the long term, because people can't stay on them very well."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. Americans are getting fat. One-third of Americans today are obese, and another third are overweight. Nearly one-third of our children are obese. The dramatic growth of obesity in the U.S. is the subject of a new HBO documentary series called "The Weight of the Nation," made in conjunction with the National Institutes of Health and other leading health organizations. It will be shown tonight and tomorrow night.

The extra weight we carry has serious health impacts, including increased heart disease, diabetes, kidney disease and even cancer, and it's expensive. Obesity-related health care costs nearly $150 billion a year, half of that borne by the public in Medicare and Medicaid costs.

Our guest is one of the experts who appears in the series, Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale. He spoke with FRESH AIR contributor Dave Davies. They began with a clip from the HBO series featuring a 27-year-old woman who is five foot five and weighed 341 pounds when she said this.

(SOUNDBITE OF TELEVISION PROGRAM, "THE WEIGHT OF THE NATION")

UNIDENTIFIED WOMAN #1: I've been told, you know, numerous times there's guys that like big girls. I don't want a guy that likes a big girl. I just want a guy that likes me. I don't want a chubby chaser. My relationship with food has very different dimensions. Food can be my best friend. Food can be my boyfriend at the moment. Food can be a vacation to the beach when I can't afford to go.

DAVE DAVIES, BYLINE: Well, Kelly Brownell, welcome to FRESH AIR. We've just heard from one of many people who are in this documentary, this series of documentaries, who speak very candidly about their struggles with obesity. What do you think it adds to this presentation to hear these folks describes their lives?

KELLY BROWNELL: Usually when obesity is discussed in the media, you hear statistics about how many people have a problem, what the health care costs are, what the medical complications of the problem might be. But very rarely do you hear the human stories. And this was one of them that I find very touching.

There are medical consequences of obesity, but there are also psychological, social ones, financial ones for that matter, that really bear down on people and can really make their lives very, very unhappy. And so part of the issue in dealing with obesity as a national problem is trying to prevent it so it doesn't happen in the first place, trying to help the people who have it, but also making the environment more accepting and welcoming to obese people, trying to get rid of the bias and stigma aimed at them.

DAVIES: You know, what's interesting is that when we decided we would review this as an interview possibility, I was thinking, well, this is a big issue for America, but I kind of know about it. And what I discovered when I watched the four parts of the documentary is there's a lot I didn't know, that's new to me. So let's cover some of this ground.

Broadly speaking, how big is this problem for America?

BROWNELL: The problem is big and growing. Right now, two-thirds of American adults are overweight or obese, and one-third of American children. And the numbers in children are particularly alarming because they seem to be growing, and those children tend to track into their adult life with weight problems in those years, as well.

And as a consequence, we have this alarming statistic that this might be the first generation of children in the nation's history expected to lead shorter lives than their parents did. And so obesity and the physical inactivity that are driving it are having a very damaging set of consequences to this current generation of children.

DAVIES: So when did the obesity problem really blossom in America, and what's changed? What's been driving it?

BROWNELL: Rates of obesity began to increase significantly in the 1970s but really went through the roof in the '80s and the '90s. In fact, at first glance it's simple to explain. People are eating more, and they're exercising less. But beyond that, it gets to be pretty complicated because there are a lot of ways people are doing those two things.

People are more and more sedentary because of energy-saving devices. When I was a boy, and you wanted to lower the window in your automobile, you had to roll a crank, and now it's just a button. Electric toothbrushes, electric garage door openers, on and on and on, ways that people save energy. Plus physical activity is being subtracted out of the school life. More and more jobs are sedentary.

People may send an email message rather than getting up and walking two offices away to talk to a co-worker. So that part of the equation is deteriorating. Now that's how many calories people are burning through physical activity.

And the food environment is deteriorating in such profound ways. Serving sizes are multiples of what they used to be. There are things like value meals that encourage people to buy a lot of food at the same time. You go to the movie theater, and you can get, you know, a bucket-sized popcorn for only an additional quarter or whatever it is.

Foods are priced in a way that's the reverse of what it should be. Because of subsidies to the agriculture industry, you have the government helping to buy things like high fructose corn syrup and helping to buy the raw ingredients for salty snack foods, and sweetened desserts and the like.

So there are a number of reasons that converge to form this fundamental reality that people are eating more and exercising less, but it's such a powerful force that it really spiraled in the out-of-control obesity rates in the United States, and increasingly, countries in every corner of the world.

DAVIES: What are some of the health consequences of all this extra weight people are carrying?

BROWNELL: There are a whole cascade of medical consequences from obesity. The most well-known is diabetes, which takes a terrible toll on human health and well-being. But heart disease is also a consequence of obesity. Cancer, a certain number of cancers are affected by obesity.

And then you have a number of problems like sleep apnea, gout and a variety of other arthritic problems that are affected by body weight. So stated simply, every organ system in the body is affected by the excess weight.

DAVIES: Now, we know, and the documentary makes the point, that obesity, that being overweight is a function of both genetics and the environment. And, you know, the genetics of the human race I don't think have changed significantly since the 1980s. But something has obviously changed a lot in our environment. What are some of the big things that have driven the increase in obesity?

BROWNELL: Genetics may help explain why one person has more of a problem than another might, given the same environment, but it's clearly the environment that's driving this problem. And we could count 100 ways or more that the environment has changed, in ways that I call toxic. Serving sizes have increased.

What used to be the large fry at McDonalds is now the small serving of fries. A muffin used to be smaller than a baseball; now it can be as big as a softball. And this gets multiplied by many products in the food system. Marketing of unhealthy foods is out of control completely. The industry is doing a very poor job of policing itself in that respect. And kids are targeted in a predatory way by the industry.

You have institutions like schools colluding in the sales of unhealthy foods in order to make money. These are just a series - examples of things that are going on out there in the environment.

DAVIES: You've described the ads that are aimed at kids as powerful, pernicious and predatory. Does advertising work on kids in a different way than the rest of us?

BROWNELL: Certainly children are heavily affected by the marketing, or else the companies wouldn't spend so much money doing it. As an example of how much marketing there is, the Robert Wood Johnson Foundation is now, by far, the largest funder of work in this country on childhood obesity. They're spending $100 million a year on the problem. The food industry spends that amount every year by January 4th, just marketing just junk food just to children.

So there's a huge amount of it, and it's predatory in the sense that it escapes our ability to detect we're being marketed to. So product placements, social media like Facebook, the Internet, not to mention television of course, are just filled with marketing messages for food, and nearly all of it is for unhealthy food.

So if the food companies were setting out to make American children as obese as possible, you couldn't do it any better than they do with their current marketing practices.

DAVIES: You mentioned that food companies are now trying to reach kids in online promotions. What kind of promotions? How does that work?

BROWNELL: There are a number of ways that food advertisers are trying to capture children beyond the old-fashioned television advertisements. So the internet is an example, and one example of that for very young children is something called advergaming, where a cereal company or a soda company will have a website, a fast food company, where the kids will go in to play games.

And they're very engaging games. Kids can go on and play for a long period of time, but it's all branded. It's all about the products, and it's all about the brand image of those products that the companies are trying to sell.

And those are very pernicious forms of marketing because a lot of times parents aren't watching when their kids are exposed to that, or parents may not recognize it as a negative force. And it costs very little for the companies to put together these websites and maintain them over time. So it's a very cost-effective way in getting at our children.

DAVIES: Now what about the argument that, you know, you don't want the government being nannies, that, you know, manufacturers do have a First Amendment right to promote their products?

BROWNELL: The issue of a nanny state and the food police and other things used by the industry to try to fight off government intervention are common now. As a country, we sometimes believe that health-related issues reach a certain point of importance where we believe government has a role.

For example, we could teach people to drive at the speed limit and be safe and not fall asleep at the wheel, or we can put airbags in cars. We could hope people brush and floss, or we can put fluoride in the water. We could hope that parents get their children immunized before they go to school, or we can just require it.

So the question is whether obesity has reached a certain level of crisis, like we felt we reached with tobacco, where government needs to step in and take a role because the price we all pay is simply too high. I obviously believe we're there, and I think more and more, the country is believing that, and that's why we're doing things like kicking the junk food out of schools.

People are getting mad at the food companies for marketing to children. We have cities like Boston and Cleveland where the mayors have talked about or implemented rules for getting rid of sugared beverages on municipal properties. One thing after another like this suggests that the country believes that obesity is serious enough where government has an active role to play.

DAVIES: We're speaking with Kelly Brownell. He is the director of the Rudd Center for Food Policy and Obesity and one of the experts in the new HBO documentary series "The Weight of the Nation." We'll talk more after a break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

DAVIES: If you're just joining us, our guest is Dr. Kelly Brownell. He is director of the Rudd Center for Food Policy and obesity and one of the experts cited in a new HBO documentary series about obesity. It's called "The Weight of the Nation.

I want to listen to another clip from the documentary series. This is from a corner neighborhood store in West Philadelphia, where Mayor Michael Nutter is taking a tour. He has some health officials with him. And they're talking to the guy who runs the store, his name is Herman Strother(ph), about foods that people eat. And he's just mentioned that kids there can buy 25-cent bags of chips, which is kind of unusual. And one of the people who is with the mayor asks him a question.

(SOUNDBITE OF TELEVISION PROGRAM, "THE WEIGHT OF THE NATION")

UNIDENTIFIED WOMAN #1: Is there anything that you're able to sell that's on the healthier side, that competes, price-wise, with this?

HERMAN STROTHER: Not at all. For 25 cents? Nothing. Kids, they know no vegetable or fruits. You know, they may know apples and oranges, but, I mean, I had a kid the other day, I was eating in here, and he asked me what that was. I was eating broccoli, fresh broccoli, you know, raw broccoli, dipping it. And he asked me what it was.

Some of the kids are raised on this stuff. You know, every day, it's morning time, they come in, two bags of chips, soda, candy. You know, this is a big part of these kids' diet.

DAVIES: And that's from the documentary "The Weight of the Nation." We're speaking with one of the experts quoted in it. That's Kelly Brownell. He is the director of the Rudd Center for Food Policy and Obesity.

This is a bigger problem in a lot of low-income communities, isn't it?

BROWNELL: The HBO films do a very nice job of pointing out what are some of the environmental circumstances helping drive the obesity problem. And they do an especially nice job with this particular concept, which is what people call food deserts, and that is there are places, especially in poor areas of cities, where individuals simply don't have access to healthy foods.

You get corner markets, bodegas, fast food restaurants, and those may become the only opportunities to buy food, and even when those places might carry healthier opens, like they might have a few fresh fruits and vegetables, they tend to cost more than other people might pay in the suburbs.

So even if people in those living circumstances wish to eat a healthy diet, it becomes hard to do it. And that's one of the things where government can play an active role, creating incentives for large supermarkets to open in those areas, farmers markets in the inner cities and the like. And those food access issues are being addressed in a lot of places, most noteworthy, in Philadelphia.

DAVIES: Now, the documentary talks about some particular problems. Soda is a huge issue for kids, isn't it, soda and sugar-sweetened beverages?

BROWNELL: Sugar-sweetened beverages is a major problem for a lot of reasons. First, they're the single greatest source of added sugar in the American diet. They're completely empty calories, that is they have no nutrition at all. If you eat a Cheeto or a Twinkie, you're getting at least a little nutrition, but these have none.

They're very heavily marketed, and one fact that most people don't realize is that the body doesn't seem to recognize calories very well when they get consumed in liquids, so you don't realize you're as full as you really should and that you've consumed as many calories as you have. And so the body doesn't shut off the consumption of these calories as quickly as it might.

And therefore these beverages have become public enemy number one in a number of places around the country, with policies like getting rid of them in schools, not allowing them to be sold in public venues like public parks and things. And then the most radical proposal, but one that's getting traction in a number of places around the country, is the idea of a tax on sugared beverages, which we've been working on for about 20 years.

This is a highly appealing public health approach because a tax - and we propose a penny per ounce on any beverage with added sugar - would drive down consumption enough to deliver considerable public health benefits, save the public money because it would reduce disease levels, and they could raise a lot of money.

They could be used for things like nutrition or health programs or other important things that government needs to do.

DAVIES: Is this in effect in cities?

BROWNELL: There are a number of cities and states that have small taxes. No place has passed a large enough tax, really, to affect consumption. Philadelphia came within one vote in its city council of passing a tax, and a number of other places around the country are considering it.

Such taxes do exist outside the U.S. in several countries.

DAVIES: You know, it's interesting because I don't think school boards or school administrators, you know, are interested in promoting obesity or undermining kids' health. What are some of the pressures that have made school lunchrooms so unhealthy over the years?

BROWNELL: Well, the food companies have been very creative in exploiting the school environment. For many years, they've stepped in, and they've been giving schools money to have vending machines in the schools, or they'll say, well, we'll put a scoreboard on your football field, but of course it has to have the Coke logo on it. And they'll do things like this.

And as the public funding for schools has been cut back over the years, this type of outside income looks more and more appealing to schools, and in some cases they become dependent on it. But it really is a bargain with the devil because you might be making a little bit of money, surprisingly little in many cases but making money nonetheless, but you're selling away the health of the children.

School officials are beginning to realize that the food that they serve in the school is important in the health and well-being of these children but also how they perform in school. And so that's why you see school systems all over the country taking action to create tougher nutrition rules not only in the classroom but what goes on with fundraisers, for example, whether teachers can use candy to teach kids to count, sugared cereals to teach kids to count and for rewards in the classroom.

So a lot of these positive changes are occurring, and when they do occur, the school seems to get by just fine.

DAVIES: I want to just kind of paint a little bit of a picture, for people, of what some of the issues are in school lunches. When I was a kid - I mean, I remember when I didn't bring my lunch, and I bought a lunch at school. It - we'd move down a cafeteria line, and I would get served some kind of food, green beans with some milk, whatever, with some kind of something, some fish, some meat.

And in the documentary, it says that a lot of school lunchrooms now are more like food courts. Are they trying to compete with other food options?

BROWNELL: Boy, you stated it exactly. In some cases, in fact a lot of places, you'll find fast food restaurants right outside of the school grounds. And of course that occurs very intentionally. And the schools want kids in the school, both to keep them there, where they feel that they're safer, but also they want whatever income can be generated from that. And some schools have gone to the extreme to create their own version of fast food in the schools, some cases by just serving it themselves or other cases by actually having fast food franchises in the schools.

And it's just a terrible, terrible idea to be doing this. And what needs to happen is that cities need to enact zoning laws that don't permit these sort of restaurants within a certain radius of a school, and therefore kids won't be inclined to go out and get those kind of foods.

And then they'll rely on what's served in the schools, and if that's healthy, kids will eat healthier. And research shows, by the way, that kids don't make up for it by eating more junk when they get home. If they eat better at school, they tend to have a better diet overall.

DAVIES: We're seeing more kids with diabetes, right. What are the consequences of that?

BROWNELL: What's now called type 2 diabetes used to be called adult onset diabetes. But now since kids are having this problem, we've had to change the name of the disease. So now you're getting kids younger than age 10 who are having this type of diabetes, and all driven by poor diet, physical inactivity and obesity, for the most part.

And this leads to some very negative consequences. So as these children get into their 20s or 30s, they could need coronary bypass surgery. They could lose their eyesight because of the diabetic complications. They could lose limbs to amputation. And we never thought we would approach this point as a country, but we really have.

And you have to ask: What in the world is our country doing if we're letting this type of thing happen?

DAVIES: I think it was Dr. Francis Collins(ph) who said, if your kids were doing something that threatened them with a brain disease, you would act. This is every bit as serious.

BROWNELL: Well, part of the bias and stigma aimed at overweight people floats down to overweight children, and they get blamed, or their parents get blamed, for the problem rather than thinking that something really ought to be done to protect them.

And all that does is lets them continue to be prey to the food industry that's preying on them in all sorts of negative ways, and sort of dooms them to a life of heavy rates of disease, disability and premature death.

GROSS: Kelly Brownell is the director of the Rudd Center for Food Policy and Obesity at Yale. He'll continue his interview with FRESH AIR contributor Dave Davies in the second half of the show. Brownell is one of the experts featured in the HBO documentary series "The Weight of the Nation." I'm Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to the interview that FRESH AIR contributor Dave Davies recorded about the obesity epidemic with Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale. He's one of the experts featured in the HBO series "The Weight of the Nation," which will be shown tonight and tomorrow night.

When we left off, they were talking about factors that contribute to the increasing levels of obesity among children.

DAVIES: One of the other causes of childhood obesity that's dealt with, is the fact that our kids just don't get out and play as much as they used to. I was surprised to hear in one of the documentary episodes that P.E. is kind of disappearing in public schools.

BROWNELL: There's been so much pressure on schools to get standardized test scores up than anything that might compete with time in the classroom has gone by the wayside and physical education is one of those things. And so now there's only one state in the United States that has requirements for physical activity in the classroom - daily requirements. Most all other states don't and a lot of localities don't as well.

Now the problem with that is it contributes to the obesity issue, but it also hurts learning because kids just aren't as alert if they're - than they would be if they are physically fit. So more and more school systems are beginning to design ways to add physical education back into their curriculum, because they think they just can't afford not to do it.

DAVIES: What are the kind of regulations that you think would be effective? I mean you can't tell somebody how big a box of cereal they can sell, can you? I mean how do you get a handle on this?

BROWNELL: Government might have more authority in this realm than you may think. It's possible that government could say that food can only be served in certain portions because people overeat when they are given larger portions. But that's not where I would start. I would start really on two planes. One would be changing the fundamental prices of foods so that junk food costs more and healthy food costs less. And the way to do that would be to put a tax on junk food, use the revenue to subsidize fruits and vegetables. That would be of special benefit to the poor but would help everybody in the population.

And the second thing I would take on would be the blight of food marketing and crack down on the company's ability to market unhealthy foods to children. But there are so many other things that can be done as well - having to do with schools, with the way communities are designed by offering people opportunities to be physically fit in their day-to-day life. There are probably 100 things that one might do, but to set priorities I would work on the cost of food and the marketing of it.

DAVIES: So tax the bad food and let that subsidize a good food, right?

BROWNELL: Well, the precedent for that is tobacco, of course. The decline in cigarette smoking in the U.S. in the last century was the greatest public health victory of that century, and millions and millions of lives were saved in the U.S. Now the tobacco companies have just taken their business to the developing world, so they're making more money than ever, but at least in the U.S. that we've scored some victories.

And the part of the initiative against tobacco that was most effective were the high taxes on cigarettes. So that would seem to apply to food. So for example, the one penny per ounce tax on sugared beverages that has been proposed and considered in various places around the country would be expected to decrease consumption of those beverages somewhere around 20 percent. That would decrease health care costs, raise a lot of revenue and some of that revenue might get used to subsidize fruits and vegetables, and then everybody would benefit from that.

DAVIES: Well, the series also deals with the what adults are doing to try and beat this problem. And there's - we're going to listen to a little, interesting montage about some of the diet folks have tried. Let's listen.

(SOUNDBITE OF HBO DOCUMENTARY SERIES, "THE WEIGHT OF THE NATION")

(SOUNDBITE OF MUSIC)

UNIDENTIFIED WOMAN #2: I have tried all sorts of diets. Can I name them. Nutrisystem...

UNIDENTIFIED MAN #1: Nutrisystem, South Beach diet.

UNIDENTIFIED MAN #2: The South Beach diet was probably my most successful one.

UNIDENTIFIED WOMAN #2: Cabbage soup diet.

UNIDENTIFIED MAN #1: Seven day diet where you're pretty much just drinking cabbage soup.

UNIDENTIFIED WOMAN #3: The Atkins diet.

UNIDENTIFIED WOMAN #2: Atkins diet.

UNIDENTIFIED WOMAN #4: Atkins.

UNIDENTIFIED WOMAN #5: Atkins.

UNIDENTIFIED PEOPLE: The Atkins diet.

UNIDENTIFIED WOMAN #2: The healthy fats. The low-fats. The non-fats.

UNIDENTIFIED WOMAN #3: The low-carb. All I ate more chicken tenders and chicken wings...

UNIDENTIFIED WOMAN #4: The Masters cleanses.

UNIDENTIFIED WOMAN #5: Cleanses, lemonade and cayenne pepper and maple syrup mixture that Beyonce did, so I can get skinny like Beyonce, and that didn't work for me.

UNIDENTIFIED PEOPLE: Weight Watchers.

UNIDENTIFIED WOMAN #4: Everything. Except for the non-practical ones. I don't like the cookie diet. That's just stupid.

UNIDENTIFIED WOMAN #2: And you're paying up thousands of dollars and nothing ever works. You might lose a few pounds but nothing sticks, nothing's right.

DAVIES: And some dieting programs from the HBO documentary series "The Weight of the Nation." One of the experts there is our guest Kelly Brownell, director of the Rudd Center for Food Policy and Obesity.

Kelly Brownell, are there any popular diving programs you think or sound?

BROWNELL: Well, some of them are sound but the results of them are pretty terrible, for the most part. The beauty of the diet industry is that they keep promising miracles. There's very little regulation on about what they can promise people. And since none of the programs really work very well, then you have this growing clientele of people that want to try one program or another after another in hopes that something might finally work. Now there's this funny paradox that nearly every diet works and no diet works at the same time.

It works like this - that the diet may be effective in the short term because you're cutting your calories, so you can do that with cabbage soup, molasses or whatever you happen to do - chicken tenders, for that matter. If you cut your calories back you're going to lose weight. But the diets can be very unsafe, if you just eat some crazy food over and over again. But they also tend not to work in the long run because people can't stay on them very well. And that's what treatment of obesity is such a difficult enterprise, even in world-class programs that provide wonderful sound and scientifically tested help, the long-term weight-loss is for people who tend not to be very impressive. And that's the reason that this problem should really be prevented because it's so hard to treat once it exists.

DAVIES: So what principles work for folks?

BROWNELL: Well, what works the best is sort of the old advice. I remember back when I was growing up people would talk about the four food groups. Well, that's morphed into a food guide pyramid and now a plate and things like that. But the same old advice is pretty true. If you eat a reasonable amount of a mix of healthy foods, you're going to do fine. There are some low hanging fruit, for example, if you stop drinking sugar sweetened beverages some people can whack out a lot of calories from their diet, just like that. Alcohol could be in that same category. Stop eating fast food can be a really good thing.

But the diets that tend to work the best over the long term are when people make reasonable changes that they can live with. So instead of going on some special diet, eat what you know are healthy foods in reasonable amounts. Try to get as much physical activity as you can and to just stick to it over the long term.

DAVIES: You know, we were talking before we went on tape that you have been at this a long time. I happen to know a woman who was a research assistant for you back in the 1970s. So you've worked in this area at a time when obesity has really grown. I'm wondering what your observation is about seeing this problem grow and develop and change in different ways.

BROWNELL: Well, when I first started my career, which happened to be at the University of Pennsylvania, I was doing treatment studies to try to help people lose weight. But that got very frustrating and I found the results were so discouraging that I gave up on treatment and started to think, instead, about policy changes and prevention. And when I moved to Yale University, that has really been the focus of our work. And now that the country is beginning to think about this in that way, I think we're going to see significant improvements.

And again, we can use cigarette smoking as an example. When we first started just yelling at people and telling them they should stop smoking, that didn't work because the companies were convincing people that it was glamorous to smoke, and it was a very hard thing to change because it was addictive. But once government got involved and started establishing policies, like not letting people smoke in public places and high taxes and the like, then things really started to turn around. And I believe we're at that same point today, with the obesity problem - where now government is taking an active role, people are considering doing things to make the environment healthier, and that's what will lead to better eating, more physical activity and lower weights and those things are very encouraging trends.

DAVIES: So the 30-year-old who has had a weight problem all his or her life, is just going to have a hard time of it. But if you can change the environment so the kids don't grow up that way in the future - 30-year-olds don't have it - that's where we need to be headed.

BROWNELL: Well, it would be hard for that 30-year-old to lose weight, but not impossible, some people do and aren't able to keep it off, so by all means people should try. But we owe to people as a nation to make the environment safer and healthier and create it in a way where healthy choices become easier. So instead of driving down the road past 15 fast food places, why can't those places have reasonable foods at low cost, but have healthy choices?

When kids go to school it should be a safe nutrition environment. When you turn on the television you shouldn't be blitzed with advertisements for unhealthy foods. There are lots of things that could be done to make the environment healthier.

DAVIES: Kelly Brownell, it's been really interesting. Thanks so much.

BROWNELL: Thank you.

GROSS: Kelly Brownell is the director of the Rudd Center for Food Policy and Obesity at Yale. He spoke with FRESH AIR contributor Dave Davies. The HBO documentary "The Weight of the Nation," will be shown tonight and tomorrow night and will stream free of charge, along with other video material at HBO.com.

Coming up, we listen back to an interview of you with combat photographer Horst Faas. He died last week at the age of 79. This is FRESH AIR.

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