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Barnes and... A Conversation with Dr. David Katz

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Dr. David Katz is the director of the Prevention Research Center at Yale University, discusses obesity, weight management and healthy eating.

Transcript

HELLO AGAIN EVERYONE AND THANKS FOR JOINING US.  STATISTICS ABOUT THE EXPENSE OF OBESITY AND NONE OF THAT IS ENCOURAGING AND WE HAVE DR. KATZ AND THE HEALTH INSTITUTE AND THANK YOU FOR MAKING THIS TIME AVAILABLE.

THANK YOU.

ONE OF THE STATISTICS ABOUT OUR STATE ARKANSAS AND CAME FROM THE ROBERT WOOD FOUNDATION WELL OVER A THIRD, 35% OF ADULTS ARE CONSIDERED CLINICALLY OBESE AND ALL TOGETHER TOO MANY PROBABLY A LIKE FIGURE OF OUR YOUNGSTERS ARE LOOKING AT A LIFETIME OF OBESITY IF THE MODEL HOLDS AND THEY CONTINUE TO BE OBESE.  YOU SAY IT DOESN'T HAVE TO BE THAT WAY.

NOT ONLY THAT BUT WE REALLY CAN'T LET IT BECOME THAT WAY AND ACTUALLY THE NEWS ABOUT ARKANSAS AT THE MOMENT IS PARTICULARLY CONCERNING BECAUSE WE DID JUST GET A REPORT FROM THE ROBERT WOOD FOUNDATION AND THE TRUST OF AMERICAN HEALTH AND THEY ISSUE AN ANNUAL REPORT AND F AS IN FAT AND WE HAVE BEEN SEEING THIS BECAUSE RATES HAVE BEEN RISING AND OVER THE LAST YEAR IT SHOWS THEY HAVE PLATEAUED BUT IN ARKANSAS WE CONTINUE TO HAVE A PROBLEM AND THIS IS A PROBLEM AND IN FACT A GLOBAL PROBLEM. WE HAVE PANDEMIC OBESITY AND ALL OVER THE WORLD AND WE CAN'T LET IT EXIST AND IT'S LIKE A CANARY IN THE COAL MINE AND SAYS WHAT WILL FOLLOW AND HEART DISEASE, AND STROKE AND DEMENTIA AND THINGS WE DON'T WANT TO HAPPEN TO US OR THE PEOPLE THAT WE LOVE SO WE HAVE TO INTERVENE AND THE GOOD NEWS THERE -- THE BAD NEWS IS THE BAD NEWS, THE STATISTICAL NEWS IS BAD.  THE GOOD NEWS IS THE INCREDIBLE OPPORTUNITY BECAUSE AFTERALL WE'RE TALKING ABOUT A PROBLEM FUNDAMENTALLY THAT IS OVERWHELMING INFLUENCED BY WHAT WE EAT EVERYDAY AND GET OFF THE COACH.  IT'S NOT ROCKET SCIENCE.  IT'S THINGS THAT WE KNOW WHAT TO DO SO THE SOLUTION STARTS IT'S A PERSONAL PRIORITY AND A LEVEL AT FAMILY AND COMMUNITY AND CULTURE.  WE ALL NEED TO DECIDE IT'S TIME.  WE HAD ENOUGH AND WE NEED TO  FIX IT AND SIMILAR DECISIONS HERE IN ARKANSAS.

AND MANY OF YOUR COLLEAGUES LOOK AT THE MODEL OF DISEASE. YOU DISSENT.  IT'S NOT THAT COMPLICATED.

IN SOME WAYS IT'S MORE COMPLICATED THAN DISEASE SO THE ISSUE IS THAT THE AMERICAN MEDICAL ASSOCIATION RECOGNIZED OBESITY AS A DISEASE AND I DON'T LIKE THAT AND I DON'T LIKE THAT BECAUSE IF IT'S A DISEASE AND THOSE DRUGS AND THAT IS THE SOLUTION.  WHEN SOMETHING IS WRONG WITH THE BODY AND HAVE INFECTION WE GIVE THEM ANTIBIOTICS AND HIGH BLOOD PRESSURE AND GIVE THEM MEDICINE FOR THAT AND WE COULD DO THAT AND SOLVE THE PROBLEM BUT I DON'T THINK THEY WILL SOLVE THE PROBLEM AND I THINK THE COST IN TERMS OF SIDE EFFECTS WILL BE WAY TOO HIGH.  I THINK WE CAN MAKE OBESITY MEDICALLY LEGITIMATE WITHOUT CALLING IT A DISEASE AND I LIKE "DROWNING" AND MEANS REALLY THERE ANYTHING WRONG WITH THE BODY AND AFTER THEY DROWN THERE IS SOMETHING WRONG WITH THE BODY BUT THINK ABOUT THE RESPONSE AS A SOCIETY. WE PUT CENSORS AROUND POOLS AND LIFEGUARDS AND TEACH KIDS TO SWIM.  WE DON'T WAIT FOR THEM TO DRAWN AND FIX IT WITH A DRUG AND WITH OBESITY LET'S LET THEM GET FAT AND GIVE THE MEDICATION OPPOSED TO WE'RE DROWNING IN CALORIES AND WE CAN DO SIMILAR THINGS TO LIFEGUARDS AND FENCES AND WE CAN SAFEGUARD THE FOOD SUPPLY AND GIVE THEM INFORMATION ABOUT NUTRITIONAL QUALITY.  WE CAN MAKE IT POSSIBLE TO PUT ACTIVITY INTO THEIR DAILY ROUTINE AND TEACH THE KIDS TO BE FOOD LITERATE LIKE WE TEACH THEM TO SWIM AND ULTIMATELY WE CAN TEACH PEOPLE UNTIL WE CHANGE IT TO SWIMO SO NOT THAT MANY DROWN AND THE HUMAN BODY HASN'T CHANGED IN THE HALF SNCH AND THAT'S THE TIME SPAN THAT WE WENT TO EPIDEMIC OBESITY.

A FELLOW CLINICIAN OF YOURS AND ACCEPTING IT ONLY FOR THE PURPOSES OF THE DARWINIAN MODEL OF EVOLUTION TOOK FISH 2 BILLION YEARS -- WHATEVER TO ACQUIRE LEGS BUT YOU LOOK AT A PICTURE OF MEN AND WOMEN AT A BASEBALL GAME IN THE 1950'S AND NOW AND THERE IS A STARK DIFFERENCE IN THEIR PHYSIQUES.

THERE CERTAINLY IS AND AGAIN THAT TELLS US SOMETHING.  GENES CHANGE SLOWLY AND AGAIN WHETHER WE'RE TALKING ABOUT OBESITY AS A DISEASE OR THINKING WHERE DOES THE PROBLEM RESIDE AND THIS IS CLEARLY A CASE WHERE WE ARE VULNERABLE TO OBESITY JUST LIKE WE'RE ALL VULNERABLE TO DROWNING, AND WHAT WILL DETERMINE WHETHER OR NOT WE GET THERE FROM THERE IS THE ENVIRONMENT.  IF IT EXPLOITS OUR VULNERABILITY WE WILL GET FAT AND SICK.  IF IT DEFENDS US FROM THE VULNERABLE ITD NOT MANY WILL GET FAT AND SICK.  WHAT WAS DIFFERENT BACK THEN WASN'T THE MEN AND WOMEN AND IT WAS THE SAME BUT NOW IT'S THE PORTION SIZE AND THE AVERAGE FOOD IN THE SUPERMARKET SOLD ABOUT 15,000 PRODUCTS AND IN TODAY SELLS ABOUT 50,000 PRODUCTS.  WELL, WE DON'T HAVE 35,000 NEW FRUITS AND VEGETABLES, DO WE?  SO MOST OF THE STUFF IS PROCESSED FOODS AND BAGS AND CANS AND THAT MEANS MORE MARKETS OF PROCESSED FOOD TO GET IT AND I BET YOU CAN'T EAT ONE SO WE'RE OVER EATING ALL OF THE WRONG STUFF AND PROPELS US TOWARD OBESITY AND THESE THINGS AND 50 YEARS AGO NO CELL PHONES AND NO INTERNET AND IT'S REVOLUTIONIZED OUR LIFE AND THE ONLY PHYSICAL ACTIVITY THAT WE NEED TO GET THROUGH THE DAY IS THE THUMB AND THAT'S A BIG TRANSFORMATION.

BY ENVIRONMENT I GATHER YOU MEAN THE OVERALL.

IT'S BOTH AND OVER RECENT DECADES WE EMPHASIZED DRIVE-THRUS AND DESIGNED SUBURB AN NEIGHBORHOODS THE ONLY WAY TO GET ANYWHERE IS IN A CAR. THINGS ARE TOO SPREAD OUT.  WE DESIGNED NEIGHBORHOODS THAT DON'T EVEN HAVE SIDEWALKS AND WE DESIGNED BUILDING AFTER BUILDING THAT THE ELEVATOR IS EASY TO FIND AND PLAYS MUSIC AND THE STAIR WELL IS HARD TO FIND AND SMELLS BAD.  WE ENGINEERED PHYSICAL INACTIVITY INTO THE ROUTINE AND THEN THERE IS THE CULTURE, AND A CULTURE THAT THINKS ALL YOU CAN GET BUFFET IS A BARGIN AND I TRAVEL THE LANDS AND REACH OUT WITH PEOPLE WITH COMMON SENSE AND YES YOU'RE GETTING EXTRA FOOD BUT YOU WILL GET FAT YOU DON'T NEED ALL THE CALORIES.  WHERE IS THE BARGAIN IN THIS?  WE'RE A CULTURE THAT FEEDS OUR KIDS JUNK FOOD AND IT'S CUTE AND INNOCENT AND LOOK AT THAT KID ENJOYING THE GLOW IN THE DARK FOOD.  AND HOW DID IT BECOME OKAY TO BUILD THE THING WE CARE MOST ABOUT OUT JUNK AND YES IT'S A ENVIRONMENTAL PROBLEM.  IT'S A CULTURAL PROBLEM.  BOTH OF THESE CAN BE CHANGED AND THAT BEGINS WITH A PASSION FOR MAKING THE CHANGES.

I SPENT MY TEEN YEARS AT POND LOVE AND I RECALL VIVIDLY THERE WERE DINERS BUT I CAN RECALL VIVIDLY WHEN THE FIRST FAST FOOD OPENED.  IT WAS THE GOLDEN ARCHES AND THROUGH THERE NOW AND THERE ARE 60.

IT'S CLEARLY A PROBLEM.

AND I STILL LOVE THEM ALL IN MY DEFENSE.

THAT'S THE IMPORTANT ISSUE STEVE AND IT'S NOT JUST ON THE SUPPLY SIDE.  IT'S COLLUSION. THE INTERESTING THING ABOUT HUMAN BEINGS WE ARE ALL THE SAME AND CAME IN VARIATIONS AND NO CULTURE HAS BEEN IMPERVIOUS TO THE GOLDEN ARCHES AND THE JAPANESE OR THE CHINESE WILL REJECT IT AND EVERYBODY LOVES SALT AND FAT AND GIVEN THE OPPORTUNITY TO EAT THE FLIES EVERYBODY LOVES THEM AND WE HAVE TAKEN ADVANTAGE OF THE PRIMORDIAL TASTE PREFERENCES AND WE TAKE SALT AND FAT BECAUSE IT'S HARD TO GET IN NATURE AND SO THE FOOD SUPPLY SATISFIED THE DEMAND BUT THEY UPPED THE ANTE. NOW WE WILL GIVE YOU MORE SALT, FAT AND SUGAR AND DEMAND WANTED MORE AND SUPPLY WANTED MORE AND ET CETERA AND LOOK AT WHY WE ARE AND WE CAN'T JUST BLAME THE SUPPLY SIDE AND TRYING TO KEEP THEM SATISFIED AND WE LIKE IT BECAUSE THAT'S WHAT THEY HAVE BEEN FEEDING US FOR DECADES.

LET'S TAKE THE DUNNETTIC ANGLE.  I KNOW YOU HEAR IT FREQUENTLY AND OTHER PHYSICIANS TELL ME THE SAME THING "I MAYBE OVER WEIGHT BUT MY MOTHER OR FATHER WAS BIG.  IT'S MY GENES".

THERE IS DEFINITELY A GENETIC COMPONENT TO OBESITY BUT I WOULD ARGUE BEING HUMAN MAKES YOU GENNETICALLY THAT WAY AND YOU MAKE BODY FAT AND HOW COME HUMAN BODIES ARE AVAILABLE OF MAKING FAT AND WHAT WE'RE DOING IS TAKE THE CALORIES AND PUT THEM IN STORAGE AND IT MAYBE A RAINEY DAY AND YOU WANT TO CARRY THEM WITH YOU IT'S A BELL CURVE AND WE'RE NOT ALL THE SAME STRENGTH OR SPEED AND WE DON'T MAKE FAT AS READILY EITHER AND WE ARE GENERALLY AVAILABLE AND MY ARGUMENT ABOUT THE BASICS OF THIS IS WE ALL HAD THE SAME GENES 50 YEARS AGO AND LITTLE OBESITY AND IF YOUR FAMILY IS VULNERABLE IT'S HARDER, NO QUESTION AND I SEE THIS WITH MY PATIENTS AND I BUY INTO THAT BUT MOST ARE OVER WEIGHT OR OBESE AND THE GENES HAVEN'T CHANGED. THE PROBLEM IS THE STUFF THAT CHANGED AND THAT'S ALL AROUND.

SO THE GENETICALLY PREDISPOSED -- IT'S NOT DOOMED.

EXACTLY.

NOT DESTINY.

NO IT'S NOT AND NOT ONLY LIFESTYLE CAN CHANGE OUR MEDICAL FATE WE HAVE EVIDENCE THAT THE WAY WE EAT AND PHYSICAL ACTIVITY AND AVOIDING TOXINS LIKE TOBACCO THAT CAN CHANGE GENE EXPRESSION. WE OFTEN GET BOGGED DOWN IN THE NATURE /NURTURE DEBATE AND THE QUESTIONS RAISE WHICH IS MORE AND PLAY THE HAND I AM DEALT OR WHAT?  AND WE CALL IT GENETICS NOW AND WE CAN NURTURE NATURE AND WE HAVE STUDIES THAT SHOW IF YOU IMPROVE YOUR DIET, AVOID TOBACCO, LOSE WEIGHT, GENE EXPRESSION CHANGES AND SO YOU TURN OFF GENES THAT GIVE YOU CHRONIC DISEASES AND YOU TURN ON GOOD GENES AND WE CAN INFLUENCE OUR OWN BEHAVIOR AND THEN THE BEHAVIOR OF OUR GENES.

IT SEEMS LIKE THE QUICKEST WAY TO GET RICH IS WRITE A DIET BOOK AND THEY [INAUDIBLE]

YEAH.

AND FEEL FREE TO CRITIQUE THAT APPROACH BUT NEED IT BE THAT COMPLICATED AND YOU EAT WALNUTS FOR BREAKFAST OR WHATEVER.

WALNUTS  ARE GOOD AND ACTUALLY NOT, AND HAVE A BOOK CALLED "DISEASE PROOF"  COMING OUT AND ONE OF THE CHALLENGES AND IT'S A GOOD BOOK AND IT'S HONEST AND SAYS THERE IS NO SILVER BULLET AND YOU CAN'T EAT CUM QUARTS ON A TUESDAY AND DURING THE REST OF THE WEEK YOU'RE FINE AND DESPERATION BREEDS GULL BILLITY.  PEOPLE KNOW WHAT IT TAKES TO LOSE WEIGHT AND EAT WELL AND BE PHYSICALLY ACTIVE AND IT WORKS AND YOU NEED TO DO IT EVERYDAY AND IN AN ENVIRONMENT LIKE THIS IT'S REALLY HARD AND YOU KIND OF FEEL LIKE THE ODD MAN OUT.  IF YOU TAKE THE STAIRS AND EVERYBODY ELSE TAKES THE ELEVATOR YOU'RE LEFT OUT.  YOU WATCH TV AND SEE THE COMMERCIALS FOR ALL THIS FOOD AND YOU SEE SOMEONE ON THE SCREEN FIT AND HEALTH AND HE ENJOYING IT AND IF I CAN'T HAVE IT I'M LEFT OUT SO YOU FEEL THAT WAY, SO EVERYBODY FEELS LIKE THEY'RE SUFFERING AND THEY WANT TO FIX THAT WITH MAGIC AND THAT BECOMES IRRESISTIBLE TO PEOPLE SELLING THE SNAKE OIL TO MAKE SOME BUCKS AND YOU'RE RIGHT YOU GET FAD DIET BOOK ONE AFTER ANOTHER AND SOME ARE GOOD AND SOME ARE EXPLOITING THE PUBLIC AND WHY IS THE PUBLIC BELIEVING THIS IN THE FIRST SENSE?  AND I BELIEVE MOST HAVE COMMON SENSE. TELL ME SOMETHING TOO GOOD TO BE TRUE AND I WILL BELIEVE IT ANYWAY AND WHERE THE BASIC AMERICAN IS AND I DON'T LIKE THE TRUTH AND TELL ME SOMETHING EASY AND I WILL GIVE IT A SHOT. LOOK WHERE IT'S GOTTEN US?  THERE HAVE BEEN BOOKS FOR DECADES AND WE HAVE BEEN GETTING FATTER AND IT'S NOT THAT COMPLICATED. IT'S THE WRONG SOLUTION.  WE NEED TO FOCUS ON EATING WELL, BEING ACTIVE AND FOR THE ENTIRE APPROACH AND SHARING WITH OUR FAMILIES AND STEVE I THINK THE GOOD NEWS IS FRANKLY WHEN YOU LOOK AT THE LONG-TERM YOU CAN LOVE FOOD THAT LOVES YOU BACK. THINK ABOUT THE MEDITERRANEAN DIET.  THAT'S NOT A FAD DIET AND YET IT'S ONE OF THE HEALTHIEST DIET.  WE DON'T NEED TO CHOOSE BETWEEN THE PLEASURE OF GOOD FOOD AND HEALTH BUT WE NEED THE RIGHT PERSPECTIVE.

IT NEED NOT BE THE CHOICE ALWAYS BETWEEN A CHEESE BURGER AND A BANANA.

NO BUT THINK OF A HEALTHIER BURGER AND A TURKEY BURGER OR WHOLE GRAIN BUN OR LETTUCE AND TOMATO AND ALL THESE LITTLE ADJUSTMENTS.  WE START THINKING HOW DO I LOVE FOOD THAT LOVES ME BACK?  HOW I DO PRESERVE THE CHOICES THAT I LIKE TO MAKE AND MAKE THEM BETTER?  SO MUCH OF MY WORK IS FOCUSED ON THAT AND PROGRAMMING FOR SCHOOL CHILDREN, PROGRAMMING IN SUPERMARKETS, HELPING PEOPLE TRADE UP.  YOU WANT CHIPS EAT CHIPS BUT CHOOSE BETTER ONES.  YOU WANT PASTA SAUCE BUT PICK BETTER SAUCE. PICK A BETTER SALAD DRESSINGS AND IF YOU DO THESE THINGS IT ADDS UP WITH THE FOOD SUPPLY SO EACH BETTER CHOICE MEANS GRAM AFTER GRAM OF SUGAR AND MILLIGRAM OF SALT AND YOU'RE ADDING FIBER AND MINERALS AND ANTIOXIDANTS AND REDUCING THE NUMBER OF CALORIES TO BE FULL AND YEAH MAYBE THE CHEESE BURGER IS NOT A GOOD IDEA AND MAYBE YOU WILL HAVE ONE OCCASIONAL BUT IN GENERAL IF WE USE THE RIGHT INGREDIENTS WE CAN HAVE THE CAKE AND EAT IT TOO AND WE ARE SUPPORTING IT BACK AND HEALTHY PEOPLE HAVE MORE FUN.  THE REASON TO CARE ABOUT THIS IS NOT BECAUSE A GUY LIKE ME WITH AN MD AFTER HIS NAME TELLS YOU SHOULD AND IT'S FUN.  HEALTH IS FOR LIVING AND AT THE END OF THE DAY IT'S ALL BETTER IF YOU'RE HEALTHY AND THIS IS A KEY PART OF THE FORMULA.

PARENTS WILL LOOK AT -- YOU ADVISE THAT A LOT OF PARENTS DON'T KNOW.  I MEAN THEY'RE WELL INTENTIONED.  THEY'RE  EDUCATED AND THEY'RE NOT FAT BUT THEY'RE HEADING IN THAT DIRECTION PLAINLY.

ONE OF THE PROBLEMS IS WE GAUGE THINGS ON RELATIVE SCALES. EVERYTHING IS RELATIVE.  SO WHAT IS FAT?  IN A SOCIETY WHERE EVERYBODY IS LEAN AND YOUR CHILD IS NOT YOU WOULD PROBABLY NOTICE.  IN A SOCIETY WHERE SO MANY KIDS ARE HEAVY AND YOUR CHILD IS A BIT HEAVY TOO THEY LOOK FINE BECAUSE THEY LOOK LIKE EVERYONE ELSE.  THE OTHER THING IS AND THIS IS TRUE FOR PARENTS AND DOCTORS.  NOBODY LIKES TO HEAR JUST THE PROBLEM WITHOUT A SOLUTION.  IF PARENTS FEEL I DON'T KNOW HOW TO IT SO IF I ADMIT MY CHILD IS OVER WEIGHT I DON'T HAVE A PROBLEM AND NO SOLUTION AND THERE IS A BIT OF DENIAL GOING ON SO WE TELL OURSELVES WHITE LIES MAKING THE PROBLEM GO AWAY AND MOST PEOPLE AREN'T EMPOWERED TO DEAL WITH THE PROBLEM.  WE CAN DEAL WITH THAT.  AND YOU LOOK AROUND AND COMPARED TO EVERYONE ELSE I LOOK OKAY AND UNFORTUNATELY EVERYONE ELSE IS HEAVY TOO.

WHEN YOU HEAR A PARENT SAY OF A ADOLESCENT OR YOUNGER AND MAYBE OVER WEIGHT BY THE CLINICAL MEASURE, "OH THAT'S JUST BABY FAT". WHAT'S YOUR REACTION?

WE HAVE EVIDENCE THAT OVER WEIGHT IN CHILDHOOD GOES INTO ADULTHOOD AND INCREASES THE LIFETIME STRUGGLED WITH YOUR WEIGHT AND IN TURN RAISES RISK FOR ALL OF THE CHRONIC DISEASES THAT WE WANT TO AVOID, HEART DISEASE, CANCER, STROKE, ALL THE BAD STUFF SO WE NEED TO BE THINKING OF THIS IN TERMS OF WHAT DO WE WANT TO GIVE OUR KIDS.  YOU THINK ABOUT PARENTS THAT LOVE THEIR KIDS AND GIVE THEM A GOOD LIFE AND PUT MONEY ASIDE AND ALL OF THE THINGS THAT WE DO AND WE CAN BEQUEATH A FUTURE THAT THEY'RE VULNERABLE DEALING WITH THEIR WEIGHT AND SUSCEPTIBLE TO CHRONIC DISEASE OR THE OPPOSITE AND WE ENCOURAGE THE BABY FAT BECAUSE OF THE CULTURE.  IT'S OKAY.  LET HIM HAVE ANOTHER COOKIE.  WHAT WE NEED TO DO IS ACTUALLY UPDATE THE LOVE.  PROTECTING THE HEALTH OF OUR CHILDREN IS ONE OF THE BEST WAYS TO SHOW THEM.  IT'S THE GIFT YOU GIVE YOUR KID MORE YEARS WHAT GIFT COULD RIVAL THAT SO AGAIN IT'S A CULTURAL ORIENTATION.  WE TEND TO BE DISMISSIVE ABOUT EXTRA WEIGHT BECAUSE WE DON'T WANT TO MAKE A PROBLEM BUT IT BUT IT'S THE FUTURE AND FATE OF OUR CHILDREN THAT LAYS IN THE BALANCE WE'RE. WE NEED TO TAKE THIS MORE SERIOUSLY BUT NEED A SOLUTION TO THE PROBLEM.  I THINK PARENTS WILL ADMIT THERE IS A CAUSE FOR WORRY WHEN THEY HAVE AN EFFECTIVE RESPONSE.

WITH THIS AF LARGE OF OBESITY AND YOU SAID WE HAVE TO INTERVENE, WHO?  SOCIETY AS A WHOLE.

WE ALL HAVE SKIN IN THE GAME SO EVERYBODY.  WHEN I TALK ABOUT PROGRAMMING I POINT THE FINGER AT MYSELF SO MY JOB AS A MEDICAL SPECIALIST DEVELOP PROGRAMS TO GETS YOU THERE SO WE HAVE A FOOD LITERACY PROGRAM IN SCHOOLS ALL AROUND THE WORLD.  MAGNETS FOR THE FRIDGE FOR THE PARENTS AND KIDS TO IDENTIFY MORE FOODS AND AGAIN THE SHORTER THE LIST THE BETTER.  IT'S EFFECTIVE.  WE DEVELOPED A NUTRITIONAL GUIDANCE SYSTEM AND PUT IT INTO 1700 MARKETS IN THE COUNTRY AND HAS A VALLEY FOR THE FOOD AND GOES RIGHT NEXT TO THE PRICE ON THE SHELF TAG AND THE IDEA IS YOU NEED TO CARE.  I CAN'T DO THAT JOB FOR YOU.  I CAN GIVE YOU REASONS BUT YOU'RE THE BOSS AND YOU HAVE TO CARE ABOUT THE HEALTH OF YOU AND YOUR CHILDREN AND YOU CARE BUT I AM CONFEWED AND DON'T KNOW WHICH BREAD TO BUY AND THAT'S MY JOB AND WHICH ONE IS THE NUTRITIONAL BREAD AND THE SUPERMARKETS EXECUTIVES NEED TO AGREE TO PUT THAT INTO THE STORES AND MAYBE THERE NEEDS TO BE A FINANCIAL INCENTIVE AND IT ACTUALLY COSTS YOU LESS AND MAYBE WE NEED TO GET THE FEDERAL GOVERNMENT INVOLVE AND WE WOULD LIKE TO DO THAT FOR PEOPLE IN THE SNAP PROGRAM AND GUIDE THEM TO MORE NUTRITIOUS FOOD AND PROVIDE A FINANCIAL INCENTIVE AND THE LESS IT COSTS SO WHO NEEDS TO GET INVOLVED? EVERYBODY.  WE ALL CREATED THE PROBLEM.  WE ALL NEED TO CREATE THE SOLUTION AND IMPLEMENT IT BUT IT'S A DIFFERENT TASK. THERE IS A DIVISION OF LABOR. I EXPECT MY PATIENTS TO USE THE INFORMATION I DEVELOP AND I EXPECT PEOPLE IN PUBLIC HEALTH AND MEDICINE AND DEVELOP THE TOOLS AND SHOW YOU HOW TO USE THEM AND WHAT YOU DO WITH THEM DEPENDS ON YOU.

ONE OF THE MOST BASIC INTERVENTIONS WOULD BE THE BODY MASS INDEX TESTING OR EXAMINATION OF YOUNGSTERS IN SCHOOL.  IT REMAINS IN ARKANSAS TO THIS DAY HIGHLY CONTROVERSIAL.  IT'S NANNY STATE.  YOU'RE TREADING ON PARENTAL TUMP AND WHAT IS YOUR RESPONSE?

WE JUST GRAVITATE TO THE POLLS AND YOU'RE LEFT, RIGHT, CONSERVATIVE OR LIBERALS AND THE LIBERALS SUPPOSEDLY SUPPORT ALL OF THE INTERVENTIONS AND THE CONSERVATIVES DON'T AND THE GOVERNMENT IS NOT TELLING US WHAT TO DO AND IT'S CLEARLY IN THE MIDDLE.  I DON'T WANT TO ASK IF I TAKE MY KIDS OUT FOR ICE CREAM IF THERE IS MERCURY IN IT AND THERE HAS TO BE STANDARDS THERE IS A ROLE FOR REGULATION AND I DON'T WANT THEM TELLING ME WHAT TO HAVE FOR BREAKFAST BUT IF THEY REQUIRE CALORIE COUNTS IT'S NOT TELLING ME WHAT TO EAT AND I STILL GET TO CHOOSE AND I THINK THERE IS MIDDLE GROUND AND I THINK WE NEED REGULATION TO CONSTRAIN THE EXPRESSES AND ABUSES OF THE INDUSTRY BUT I THINK WE CAN ALSO ACHIEVE A LOT BY EMPOWERING THE DEMAND SIDE.  IF EVERYONE HAS INTELLIGENCE AND INFORMATION ABOUT NUTRITION THEY CAN SHOP ACCORDINGLY.  IF THE MORE NUTRITIOUS THINGS ARE ACCESSIBLE AND AFFORDABLE WE CAN DO THAT. IF WE HAVE ACTIVITY IN THE SCHOOL DAY AND WORKDAY EVERYONE CAN GET THROUGH ACCORDINGLY SO WE NEED TO ENGINEER SOLUTIONS INTO THE FABRIC OF THE DAY. SOMETIMES THAT INVOLVES GOVERNMENT.  SOMETIMES IT'S A PRIVATE SECTOR ENTERPRISE BUT WE PRESERVE THE POWER OF THE CHOICE WITH THE INDIVIDUAL AND I THINK OF THE NEW VALUE SYSTEM AND THE HIGHER THE NUMBER THE MORE NUTRITIOUS.  JUST LIKE GPS.  IT ONLY TELLS YOU HOW TO GET THERE SO WE NEED TO ABANDON THIS IT'S EXTREME TO THIS EXTREME, ALL OF THE POLARIZING RHETORIC.  LET'S LOOK FOR COMMON GROUND AND SOLUTIONS AND OFTEN LIE ON NEGLECTED MIDDLE PATH THAT WE DON'T WANT TO TALK WITH AND THAT IS A PROBLEM WITH OUR CULTURE AT LARGE.

DR. KATZ THANK YOU FOR YOUR TIME.

THANK YOU FOR HAVING ME.

AND THANK YOU TO THE CLINTON SCHOOL FOR THE USE OF THEIR FACILITIES AND AGAIN THANK YOU DR. KATZ.  WE WILL SEE YOU NEXT TIME.

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