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How Did the Nation Get So Fat?

In conjunction with the HBO documentary “Weight of the Nation,” WebMD is examining some of the issues surrounding the nation’s obesity crisis. In this piece, WebMD Senior Writer Dan DeNoon talks to CDC Director Tom Frieden, who appears in the documentary series. A third of Americans are currently obese, and that number is expected to rise to 42% by 2030.

Question: What caused the obesity crisis?

Frieden: Nobody could have predicted that obesity would get as bad as it is. Today, if you go with the flow you will end up overweight or obese — as two thirds of Americans do.

We are not certain what caused it. In the simplest terms, I believe, it is more about eating more than about getting less physical activity. We eat about 250 calories more a day today than we did 20 years ago. That is a reflection of everything from the availability of food, the decreasing cost of some very unhealthy foods, to the increasing portion size. It is a very different food environment now than the food environment we evolved to suit.

We did engineer most physical activity out of most of our lives. From car culture, to less leisure and more screen time — not just TV but also computers and handheld devices — we have become more sedentary.

Half as many kids walk to school as used to. And on any given day, more than a third of kids and adolescents eat fast food. That wasn’t the case when we were growing up.

I don’t think we can turn back the clock on changes in our society that reflect our increasing desire for convenience, whether in food or in transportation. Whatever caused us to become so obese, it is a serious problem. Obesity leads directly not only to diabetes, but to cancer, stroke, heart attack, and depression.

Question: The HBO series also points to much of the progress that has been made in fighting obesity. What steps can we take?

Frieden: What someone does to be healthy or not is their responsibility. But we as a society have a responsibility to do things that will help them when they make those decisions to be healthier.

• For yourself and your family, figure out things you enjoy doing that are physically active. Play ball with kids, or bike, or take walk in the evening with your spouse. If it is a chore, it is going to be hard to keep up for years and years. Being physically active is really important.

• You don’t want to be on a diet you see as a punishment. You want to seek out foods you enjoy that are healthy. Think about moderation in foods that are less healthy, and heavy up on fruits and veggies that are healthy.

• If you have to snack, snack on stuff that is healthy, whether celery or red peppers or Wheat Chex. And when you drink, don’t forget to always have a glass of water, too, that will fill you up with something that is less sweet and tastes good.

• On the community level there are a lot of things we can do. We want to make sure kids walk or bike to school healthily. We want to make sure phys ed classes are better than they are. In studies of physical education classes, kids are active only a third of the time. They should be active from the time they walk in the door until they leave. We can do this without spending a penny.

• People around the country are figuring out ways to create and to use parks. Parks are good not only for health but for safety and social cohesion.

• In work places, employers are recognizing that it’s good for people to get active. If health insurance is major cost, let’s figure out ways to get employees active. It is something that will promote productivity.

• Health-care providers can promote everything from breast feeding to counseling patients.

• Child care is another area where we have seen tremendous progress. We’ve begun to make sure kids get active and not stuck in front of a TV.

Question: While we were doing this interview, you said you had eaten a piece of cheesecake that morning. How do you stay fit?

Frieden: I have been steeped in these issues for years. But in my own life I really try to build in physical activity. If I can’t get to the gym I walk up the stairs. I’m on the 12th floor. I do weigh myself regularly. And if it’s creeping up there I know I need to do some course correction, maybe cut down on portion size for a while.

I had some cheesecake this morning because I was doing well. You don’t have to give up things you love. Just make sure you get healthy things as well.

Photo: Courtesy of HBO

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