MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Dr. William Dietz of the Center for Disease Control recently made a stunning statement about obesity. He believes we may be witnessing the first generation of American children with a shorter life span than their parents. Joining me in the studio to talk about efforts to address America's multi-billion dollar public crisis: Christina Economos of Tufts University, Ross Hammond with The Brookings Institution, and Barbara Linder of the National Institute of Diabetes and Digestive and Kidney Diseases.

MS. DIANE REHMI'm sure many of you will have thoughts on this issue. Feel free to call us 800-433-8850. You can join us on email to drshow@wamu.org, or join us on Facebook or Twitter. Good morning to all of you. Thank you for being here.

MR. ROSS HAMMONDGood morning, Diane.

DR. CHRISTINA ECONOMOSGood morning.

DR. BARBARA LINDERGood morning.

REHMGood to have you with us. Christina, let me start with you. First, help us to understand what it is that makes someone obese.

ECONOMOSSure. Well, the causes of obesity are extremely complex, and I think we'll get into this over the hour in terms of societal forces and the food we eat and how we move. But we should really start by talking about how many people are overweight and obese. And, right now, in the United States, two-thirds of adults and one-third of children are considered overweight or obese.

REHMAnd how do you define overweight or obese?

ECONOMOSSimply measuring your height and weight and calculating your body mass index, and...

REHMGive me an example.

ECONOMOSSure. Well, if people measure their height and weight and then go on to Centers for Disease Control website, there's a calculator. And that calculator will help them understand what their body mass index is. And there are categories that people fall into. And we want adults to have a body mass index under 25. And if their body mass index is between 25 and 30, they're considered overweight, if it's 30 or above, they're considered obese.

REHMSo let's, just off the top of our heads, take someone who is 5'3". What should that weight range be?

ECONOMOSSo for an adult, off the top of my head, that person should probably weigh between 115 and 130. It's variable for children. It's important to understand that the body mass index and the category they fall into is dependent upon their age and gender. So when you go on to Center for Disease Control website, you can also calculate this for a child and determine whether they're overweight or obese. And that's an important distinction. For adults, it is not dependent upon your age and your gender.

REHMSo if a child is 5'3"...

ECONOMOSYes?

REHMSay that young person is 17, 5'3", weighing more than 130, say weighing 150 at 5'3", then what you're saying is that that is a greater problem than it would be if that young person were, say, 45.

ECONOMOSYeah. Children are changing every day, and they're growing and developing and laying down body tissue. And we really want to make sure that we prevent overweight and obesity as a child is growing because the likelihood of them remaining overweight and obese is very high.

REHMSo tell me about the Institute of Medicine's new findings.

ECONOMOSSure. On Tuesday, a committee that I was a part of released a report called "Accelerating Progress in Obesity Prevention." We need to act now, and we need to act boldly. We have a tremendous problem on our hands in this society. It's an epidemic. And in order to accelerate progress, we reviewed 800 recommendations that have been made over the past decade, trying to encourage the prevention of obesity.

ECONOMOSAnd we narrowed it down to a group of recommendations we believe, if implemented widely, could accelerate progress and prevention. And an important point to be made about this report is that we're recommending they be implemented synergistically because we know that will amplify the impact. It's not one solution. It's a portfolio of solutions that have to be done by everyone.

REHMGive me examples.

ECONOMOSWe need to increase physical activity levels. We need to create environments where healthy foods are widely available. We need to change the messaging environment. So we're getting messages to promote the selection and consumption of healthy foods out there to all Americans and minimize the messages that promote unhealthy foods.

REHMAnd turning to you, Ross Hammond at The Brookings Institution, much of this sounds like what we've already heard. What's new here?

HAMMONDWell, I think a couple things are new here. One of the things that's new here are some new figures about just how widespread a problem this is and just how costly it is, both in public health terms and in economic terms. But I think what's also really powerful about the new report is that it encourages a systemic approach to the problem.

HAMMONDIt points out that what we do about the problem needs to be coordinated across many different sectors of our world and at many different levels, all the way from the individual up to the state and federal level. And that coordination across sectors and across levels is quite new and is, I think, a very powerful part of where this needs to head, too.

REHMAnd to you, Barbara Linder, 42 percent of Americans will be obese by 2030 as the Institute of Medicine report points out. You're talking about today's young people.

LINDERAbsolutely, that's a big problem, and it's very concerning because, since the mid- to late-1990s, we've seen the emergence of Type 2 diabetes in young people, where before this was a disease exclusively in adults.

REHMBarbara Linder, she is at the National Institutes of Health. Ross Hammond is at The Brookings Institution. Christina Economos is with Tufts University. We do invite your questions, comments, 800-433-8850. Christina and Ross, you're talking about pulling all this together. You haven't mentioned television ads.

REHMI believe you can trace the increased epidemic, as you call it, Christina, of obesity to the onslaught of television advertisement about food -- the big burgers, the big, long sandwiches, the huge emphasis on all-you-can-eat. I mean, you got so many conflicting messages out there. Who wouldn't want to eat if they were young, and who wouldn't want to eat in those proportions, Christina?

ECONOMOSWell, the report clearly points out that messaging environment is critical. And, in fact, marketing unhealthy foods to children is problematic. There have been many studies done. The evidence is strong that we need to limit the marketing of unhealthy foods to children.

REHMHow are you going to do that?

ECONOMOSWell, we've recommended that voluntary standards that have already been developed by a number of companies be strengthened and that more companies sign on to adhere to those standards.

REHMWhat would the standards entail?

ECONOMOSThe standards would entail only marketing foods to children that meet certain criteria for nutritional benefit.

REHMLike?

ECONOMOSLike minimizing saturated fat, total fat, calories, sodium, many of the nutrients we know are damaging to health. And it also would emphasize the consumption of whole grains, fruits, vegetables, low fat, non-fat dairy.

REHMBut, Ross Hammond, I'm back to the question: Do you say to McDonald's, you can't advertise a Big Mac with bacon and cheese dripping? Do you say to the pizza makers, you can't offer three for one? What do you do about how food is pushed publicly?

HAMMONDI think we need to do lots of things. I'm a firm believer that the solution -- there will not be a single solution to the obesity epidemic, just as there is not a single cause of the obesity epidemic. And I think messaging and control of messaging, the shaping of messaging and supplementing the messaging that's out there with positive messaging that encourages this selection of healthy options, as Chris alluded to earlier, is very, very important.

HAMMONDAnd that should be part of the solution. But at the same time, we need to worry about access to healthier choices and to healthier environments that people need to engage in physical activity and to make the right choices. And we need to coordinate what we're doing on messaging with what we're doing in education campaigns, with what we're doing in the way we shape our built environment and our schools. And all of that can work together. I don't think any one thing by itself is likely to solve the problem.

REHMYou know, it's interesting you used the word control because controlling the messaging from huge companies, I would think, is going to be an enormous public policy hurdle.

HAMMONDI would agree with you that it will be a public policy hurdle. But as I said, I think it's part of a coalition of activities that are needed to improve the progress we're making on this problem. I don't think it necessarily should be singled out as the only solution.

REHMAnd, Barbara, what, it seems to me, the National Institutes of Health needs to do is to point out over and over again the health problems related to obesity.

LINDERAbsolutely. And many institutes at the NIH, including my institute NIDDK, are funding a wide variety of research programs to try to understand the root cause of obesity and how obesity leads to Type 2 diabetes.

REHMAnd Type 2 diabetes has become more prevalent among young people.

LINDERAbsolutely. As I said before, it was something that we didn't see at all before the 1990s. And now, we're seeing it all the time.

REHMBarbara Linder of the National Institute of Diabetes and Digestive and Kidney Diseases, Ross Hammond of The Brookings Institution, Christina Economos of Tufts University.

REHMAnd welcome back. We're talking about dealing with the epidemic of obesity in young people and, indeed, throughout the society. But the focus becomes on those young people, who, by the year 2030, could really dominate obesity in this country, and that means young people today of the age 16, 17, 18. Christina Economos of Tufts University, the report sounds as though -- and the recommendation sounds as though you're really facing an enormous task trying to pull all this together.

REHMThe focus on physical activity, the focus on marketing, the focus on making healthy foods and beverage available, activating employers, strengthening schools, wow, how do you plan to go about doing all this?

ECONOMOSWell, the report provides a roadmap. And within the report, we lay out 20 strategies that, if adopted and taken on by multiple sectors within society, could really help move the needle on obesity. In addition to that, there is a public campaign that's being launched by HBO in conjunction with the Institute of Medicine, Centers for Disease Control, National Institutes of Health, the Dell Foundation, Kaiser.

ECONOMOSAnd that campaign is designed to engage the general public. This will take all of us to move the needle, and we hope that people will go on to website, watch the documentaries and help us incorporate the strategies laid out in this report.

REHMRoss Hammond, what do you see the cause of such a program to be?

HAMMONDI don't think anyone's done a careful estimate of what the cause of implementing all the various recommendations might be. But we know that the cause of obesity and the epidemic we're facing are just staggering for our country. We know that about 21 percent of all U.S. medical spending is now obesity-related, that that number has gone up dramatically in just the last decade and could easily go up dramatically again in the decades to come.

REHMTell me how it's related.

HAMMONDSure. Well, obesity and overweight puts you at much higher risk for many, many diseases, including diabetes, but also asthma, heart disease, arthritis, many chronic conditions. And the treatment of those conditions over a long period of time produce many -- much higher economic costs, medical spending costs, and they also lead to a much more subtle costs that come through productivity losses as people are absent from work. They have decreased productivity while at work.

HAMMONDAnd there's even costs that are somewhat hidden that we have to reengineer our infrastructure to handle much heavier populace. We have to redesign hospital beds, ambulances. We burn a whole a lot more fuel every year, many billions of dollars worth of extra fuel every year because of our heavier population. And all those things really add up to a quite substantial price tag, by some estimates $200 billion a year.

REHMAnd, Dr. Linder, talk about the challenges of treating the results of obesity after the fact as opposed to prevention.

LINDERAbsolutely. And I'd like to just clarify that when we're talking about diabetes related to obesity, we're talking about Type 2 diabetes, which is one of the two major types because Type 1 diabetes is not related to obesity. So, you know, one issue is that we just published the results of a very large study, the TODAY study, looking at how to treat young people who have diabetes.

LINDERAnd one of the disturbing findings was that the standard of care, which is the use of the drug Metformin, which is the only drug approved for use in children, had very disappointing results, that only half of the children in the study were able to achieve and sustain acceptable glucose control on a single drug, Metformin. So that speaks to what you've asked about how difficult it is to treat the Type 2 diabetes and why it's so important that we prevent this from occurring in the first place.

REHMHow does a young person feel when he or she begins to develop Type 2 diabetes?

LINDERWell, one problem is that many children, as many adults, are actually asymptomatic. They may not have any symptoms, which is why it's important for doctors to be aware of the risk factors for Type 2 diabetes, so that they can screen somebody who has those risk factors and determine if they have the Type 2 diabetes.

REHMChristina, how do you -- how to make a difference in the lives of children who may have already gotten into their habits, whose parents may be distracted because they're trying to keep food on the table, who come home late at night and say, well, let's just go get a pizza. I mean, the lifestyle we live today is actually part of what's promoting this kind of activity.

ECONOMOSThat's absolutely true, and the time trade-offs are really complicated. People are busy. They're working long hours. There's very little time spent on food preparation, which is why people are relying on convenience foods. If we reengineer our environments and make healthy foods widely available that are convenient for people, it will be a lot easier for the parents that you described to access and provide those foods for their families.

ECONOMOSAnd that requires change at multiple levels: agriculture to produce the ingredients, the food industry to formulate those foods, communities to put in food, grocery stores and food establishments that make them available, and then parents to purchase them at a competitive price.

REHMAnd, Ross, what about the role of government in this whole process?

HAMMONDI think, again, certainly, government plays a role, and there will be certain issues where making the federal government play an important role will be key to having it be sustainable over the long-term, to having it scale up to the level that's needed. But I also think it's not -- it's very important not to overlook the critical role the communities can play in making this happen. And, in fact, I think obesity is something that almost everyone in the U.S., every citizen can play a part in solving.

REHMAll right. And joining us now from his office here in Washington, D.C., is Justin Wilson. He's senior research analyst at the Center for Consumer Freedom. Thanks for joining us, sir.

MR. J. JUSTIN WILSONIt's my pleasure.

REHMI'd be interested in your reaction to this new report from the Institute of Medicine, the Weight of the Nation report. What's -- what are your thoughts?

WILSONWell, I agree with pretty much everyone, including the report that this is an issue we need to address. But I stand sort of in opposition to the idea that the government should play a role in restricting the options that consumers have. Fundamentally, what we're doing here is getting further away from personal responsibility, and, unfortunately, that's really the only proven solution to losing weight.

WILSONThe idea that, you know, personal responsibility or irresponsibility got us into this mess, but government responsibility, through a whole slew of policy seeking to reduce consumers' options basically force us into diets through various strategies is going to solve this problem, I think, is really troubling.

REHMI haven't heard anybody talking about dieting. What I've heard talked about is providing a healthier set of food choices. You don't hear it that way, Justin?

WILSONWell, recommendation two is specifically related to the government's attempts to make concerted efforts to reduce unhealthy food and beverage options. This is a water -- or a sea change in government policymaking with respect to the government's ability to tell us what we are allowed to eat. And I see it as really troubling and, frankly, very paternalistic. You know, no one seems to be questioning: At what point did it become legitimate for the government to tell us how much we're allowed to weigh?

WILSONAnd so, while I don't disagree that there are strategies that need to be happening, I think the proper role of government is to maximize people's ability to make good choices for themselves rather than using strategies to make those choices for them, which is exactly what we're looking at here. And so if they say, well, we want to make healthier options more available, well, to accomplish that, the nitty-gritty is they want to do things like zone unhealthy restaurants out of poor communities where obesity is a problem so that, I think, ostensibly, the theory is that people can't walk to them.

WILSONAlthough, those strategies have been proven to fail, or alternatively, their strategy is like levying extremely punitive taxes on certain foods so that the "healthy foods" are competitive. The trouble here is that the old axiom that you can lead a horse to water, but you can't force him to drink also stands true to the -- what people eat. If there was a market for healthier foods, grocery stores and restaurants would be providing more and more of them. And, truthfully, those options already exist.

WILSONThe issue here is that people don't buy them in a way or to the degree that the folks in the health community would want. And I think the proper role of government, instead of foisting those choices on us, 'cause it's not a choice when it's forced on us through taxation or zoning, is instead to make us want to do it for ourselves. And that's really complicated. You know, this is one of those really, very, very complicated issues, and we have found no silver bullet to address it.

REHMSure. Do you think that government has any role to play here?

WILSONAbsolutely. Absolutely. I'm reminded -- one of my favorite bits of research came out of Indiana University about a year or two ago. And they found -- they followed children and where they lived in proximity to baseball diamonds, bike paths, playgrounds, so on and so forth. And they said, for instance, just one of their many findings, that an 8-year-old child will lose 6 pounds of weight if a baseball diamond or a bike path was built within a mile of his or her home.

WILSONAnd that is the perfect example of the government doing what it does best, which is creating built environments and creating opportunities for us to do things that we enjoy, and creating situations where we're willing to take responsibility for our own health. The trouble with a lot of the policies that are contained in this report is that they take personal responsibility off the table.

WILSONThis notion that food is addictive, that we can't say no to marketing creates a new victim class. And the real problem here is that the more we let people who are overweight victimize themselves, the more we give them this as an excuse to say, you know what, I can't live in this world. There's just food around me. I'm going to give up. And that's what's happening with this rhetoric.

REHMAll right. Justin, I think Christina Economos perhaps has a comment. I wanted to ask you, Christina, about his comments regarding, for example, zoning unhealthy restaurants out of poor areas, also taxation, higher taxation on food that the government deems unacceptable for the populace.

ECONOMOSFirst of all, make no mistake. This report was based on evidence. It was a consensus committee that looked at a body of evidence that demonstrates that unhealthy foods, be them fast foods or sugar-sweetened beverages, and consumption of those at high levels are associated with obesity. So it's our responsibility to change the landscape and provide options for healthier foods that are at least equal to or perhaps greater than the options for unhealthy foods that exist right now.

ECONOMOSIt's a collective responsibility that we have as a nation. The government has a clear role to help lead the way. And every individual would not argue that they need a healthy environment to live in to execute a healthy behavior.

REHMChristina Economos of Tufts University, and you're listening to "The Diane Rehm Show." Ross Hammond.

HAMMONDYes. I just want to just add one thing to the comments that Chris made, which is I think it's really important to remember that this is not a small percentage of Americans who are facing this problem. It's not a minority. It's the majority. It's two-thirds of American adults who are overweight or obese. So this is a problem that's very widespread. That's not just a few people who have made poor choices.

HAMMONDSecondly, this is a problem that's increasingly affecting our children who have much less ability to choose their own environment. And, third, this is a problem that's very complex in its origins, both biologically and socially, and that means there's a lot of diversity. Different people become overweight or obese for different reasons. And that means that a single solution -- whether it's linked to physical activity or to messaging or to the food environment -- is unlikely to work for everyone. And we need coordinated solutions.

REHMAnd back to some of Justin's points, here's an email from Peter in Urbana, Md., who said, "Please explain how obesity in society affects average non-obese Americans. How does it impact my wallet?" Christina.

ECONOMOSWell, it's clear that health care costs have increased dramatically due to obesity, and we all share the load of that. And when we have consumption of profitable foods that are unhealthy, then we continue to have more of those proliferate the landscape.

REHMAll right. Justin, what about that? What about the health care cost shared by society as a whole?

WILSONYou know, that is not a great argument for regulating foods or trying to reduce obesity, but rather a very good argument against having a single-payer health care system, which is to say this idea that, because obesity has cost on society, we should be able to regulate it as a society. And what that really means is the non-obese being able to regulate the obese is a really good indication that what really is happening here is that we're saying anyone who leads a life that is not maximally healthy should be regulated or is grounds for government regulation.

WILSONAnd I reject that wholly. You know, I'm a white-water kayaker. I go and throw myself off waterfalls on the weekends. And it is a risky lifestyle choice that I'm making. And so the same kind of risk-taking -- whether it's driving fast, whether it's going white-water kayaking or whether it's occasionally indulging on a donut -- should all fall into the same category of leading life. You know, to a certain extent, for many Americans, life is about taking risks, whether it's a small risk or a large risk.

REHMAll right. And, Ross, I'd like to ask you about the White House and the Congress, as far as the marketing of sugar, salt and fat food marketed to children, the effects of lobbying efforts to defeat everything that the White House and some members of Congress want to see get through.

HAMMONDWell, I'm not an expert on Congress or on the White House, and I think Chris may have some perspective on this. But I do want to point out that we've now created a world in which it's estimated that one in every three children born today will develop Type 2 diabetes in their lifetime. And if that child is Latin American or African-American -- Latino-American or African-American, it's one in every two children.

REHMChristina, talk about the lobbying effort.

ECONOMOSSure. You're correct that, recently, there was an interagency working group. It was convened to develop standards that would be applied to marketing foods to children. That interagency working group presented an excellent proposal that was evidence-based consistent with the dietary guidelines. And, at this moment, it's not making progress. We need to take a strong look at that and at least apply those standards to voluntary guidelines adopted by companies and, if they don't succeed, then mandate.

REHMWhy is it not making progress?

ECONOMOSWell, there are probably a lot of reasons for that. I'm not in Washington. I wasn't at many of the meetings that occurred. But my understanding is that the food industry spoke up and felt that these standards were impossible.

REHMReuters reported that lobbying records revealed the food industries more than doubled their spending in Washington during the past three years. Justin Wilson, I want to thank you so much for joining us. Short break here. We'll be right back.

REHMAnd welcome back to our discussion on obesity. A new report tells us that one-third of U.S. adults, nearly 17 percent of the nation's children are obese, and the Institute of Medicine is putting forth a set of recommendations to address the issue. We're going to open the phones now. Let's take a call from Elkhart, Ind. Good morning, Brian. Thanks for joining us.

BRIANGood morning. I have a question about what -- the price of healthy food when people can go to, like, a fast food area and get a hamburger or whatever for a dollar. I've changed my eating habits, but my grocery bills probably went up 25 percent. And low- and middle-income people have such a hard time trying to purchase good food, so...

REHMYou're absolutely right. And that's a huge problem. Go ahead, Brian. Sorry to interrupt.

BRIANYeah. So what do you think can be done about that? And I'll take my answer off the air.

REHMAll right. Thanks.

ECONOMOSSure. Thanks for your question, Brian, and it's a really important one. And we need to make significant changes at many different levels to impact price so that consumers are able to purchase healthy foods at a competitive price with unhealthy foods, or even less. Price strategies really work.

ECONOMOSAnd so it requires a hard look at our agricultural policies to ensure that we are farming and producing foods and ingredients that ensure that wide availability of healthy foods at a lower cost. It also means that the food industry needs to work hard on reformulation and making these healthy products available at a more competitive price.

REHMAnd joining us now by phone from the Bronx, N.Y., Sylvisha Perry. She is a participant in the Berrie Diabetes Center at the Columbia University, site of the NIH TODAY study providing treatment options for Type 2 diabetes in adolescents and youth. Sylvisha, thanks for being with us.

MS. SYLVISHA PERRYHi. You're welcome.

REHMThank you. Sylvisha, tell us how old you are now and when you were diagnosed with Type 2 diabetes.

PERRYWell, I'm 21 years old now. I was diagnosed at age 15.

REHMAnd how were you diagnosed?

PERRYWell, I was on a routine checkup with my doctor, and it was just found at the routine blood work.

REHMI see. I gather you don't mind sharing your height and weight with us.

PERRYI'm 5'2", and I weigh 234.

REHMYou're 5'2". You weigh 234. How long have you struggled with obesity?

PERRYHow long have I struggled with it?

REHMYeah.

PERRYSince I was 15. It's a struggle finding out.

REHMNo. But that was the diabetes. What about your childhood, your early childhood weight and eating habits?

PERRYWell, my weight -- I've been heavy all my life, so it's been a struggle since I was born.

REHMYeah. Tell me how your life has changed your diagnosis -- since your diagnosis.

PERRYPretty much, I'm just watching what I eat. My lifestyle hasn't changed. I still go to school. I still do the same things everybody else does. I'm just aware of the things that I eat.

REHMAnd is that hard for you to lose weight and deal with diabetes?

PERRYI didn't hear you. Can you repeat that?

REHMI'm wondering about how hard it is for you to lose weight while you're dealing with diabetes.

PERRYIt's hard. My weight never -- like, it goes maybe two pounds down, eight pounds up, and it's very hard to lose weight.

REHMOK. So what kind of strategies are you learning in this study?

PERRYWell, to take your medicine regularly. They do tell you to put a message on your phone to remind you to take your medicine. If it's hard to swallow the pill, they do tell you, you know, take it with yogurt, take it with milk, something -- they just remind you to take your medicine.

REHMAnd what about the foods you eat?

PERRYThey do give us a class on how to eat healthy, a session that they have you sit down and talk with somebody to tell you the healthy food choices and the non-healthy food choices. So that was a big help for me.

REHMAnd how is -- are you making different choices now?

PERRYSometimes, yes. I'm not going to say that it's always a good -- it's always easy to make the good choice because I'm always out with friends sometimes. And it's not always healthy choices available. But, for the most part, I try to.

REHMWell, I wish you all success, Sylvisha. Thank you for joining us this morning.

PERRYYou're welcome.

REHMOK. Bye-bye. That is a tough situation. Dr. Linder, tell us about these projects around the country.

LINDERAbout the TODAY study?

REHMYes.

LINDERWell, the TODAY study was just completed. As you said, it was a study to look at the best treatment options for children with Type 2 diabetes because the only oral medication that's approved is Metformin. And we were thinking that perhaps we could get better outcomes if we had more intensive therapy by using a combination of drugs.

LINDERAnd so the study compared three groups: children who received just Metformin, people who received Metformin plus another drug called Rosiglitazone, and children who received Metformin plus an intensive lifestyle program. And the children who received the two medications did much better in terms of being able to achieve and sustain control of their glucose levels than did the children on Metformin alone. Half of the children who were receiving only Metformin were unable to achieve good glucose control.

REHMSo we're talking, on the one hand, about glucose control. We're talking, on the other hand, about a young woman who is 5'2" and weighs more than 200 pounds. How do you deal with that, Christina?

ECONOMOSWell, I do research as well, and I work in communities across the country. And I see children like this in my studies. And the discussion today is focused on prevention to some degree, but everything we're recommending will also help with treatment. You heard her say, as she's working on reducing her weight and getting her glucose in control, healthy foods are unavailable. So we can't expect to prevent and treat this condition across the country unless we transform the landscape.

REHMShe said that sometimes she loses a couple of pounds. Where is this going to go? I mean, she's only 21 years old.

ECONOMOSAnd that's why we're recommending bold and widespread changes because once someone gains weight -- and I'm sure many listeners would agree -- it's difficult to lose that weight and keep it off.

REHMAll right. Here's an email that comes from, I'm sure, a lot of people: "Is the increased popularity and use of bariatric surgery a help or hindrance to solving the obesity epidemic?" I got to say right off the bat that that costs more than $30,000. Insurance does not pay for it. How much is that going to help?

ECONOMOSWell, there is a segment of the population that is interested in going through bariatric surgery and also presents as candidates for the surgery. It's not for everyone. And we need to be clear that when people undergo this, it's a multidisciplinary approach. It's not just the surgery. There is nutritional counseling. There is psychological counseling. There is physical activity recommendations that go along with it. So it's a really big undertaking. And there's a small segment of the population that will be eligible and that will take it on and, unfortunately, that will be successful long term.

REHMAll right. To Paula in Miami, Fla. Good morning. You are on the air.

PAULAHi. Good morning, Diane.

REHMMorning.

PAULAI was calling because I was listening to this article. And I really think it's really important an issue that we're dealing with here in the U.S. And I just had an idea about maybe a way to address a piece of this issue. I mean, I know it's a lot of stuff. Now, this is, for me -- I'm sort of an in-between kind of person because I don't believe that we can blame companies altogether for the choices that we make in terms of our food. But at the same time, we can't say, you know what, they're completely unresponsible.

PAULASo what I would like to see is create, say, a tax or some sort of responsibility for companies that will help public schools pay for physical education for children. Because if you can change behaviors at a younger age and have more activity in your life and things like this, I feel that that really will help them as they grow older and become more active adults.

ECONOMOSIn this report, we're actually recommending that we take a hard look at taxing sugar-sweetened beverages, and the revenue generated from that tax would go to obesity prevention programs, exactly what the caller is recommending. We've done this with tobacco, and we can do this with a product on the market that has a strong relationship with weight gain, and those are sugar-sweetened beverages.

REHMBut here's the opposing part of this. Let's go to Dave in Stevensville, Mont. Good morning. You're on the air.

DAVEWell, good morning, Diane. Thank you. Yes. I was struck recently by an article Lewis Lapham wrote in his Lapham's Quarterly on food and his claim that -- and he's correct, of course -- that we are essentially ambulant, high-fructose corn syrup in the United States. Now, one of your previous guests was making a strong comment about personal responsibility.

DAVEAnd I concur with that. On the other hand, if the government is going to subsidize the production of corn and then the production of corn syrup, which is then added to our food supply, then it would seem to me that the government would have an equal responsibility, maybe obligation, moral responsibility to ensure that we do something about being high-fructose, ambulant people.

REHMYou've got government subsidizing fructose, corn syrup, and that lobby is making its impact on Capitol Hill. At the same time, you, Christina, are saying we've got to tax these manufacturers of these kinds of foods. You've got a battle in the making.

ECONOMOSThat's right. And we've recommended that a task force on agricultural policy in obesity prevention be created and appointed by the president to take a hard look at farm subsidies. We don't understand it completely now. We want to know whether the relationship with obesity is very strong. And if it is, we need to change the mix of crops and subsidize differently. Logic would tell us that if we're to consume five servings of fruits and vegetables per day, we need them to be available. We currently don't produce enough for everyone in this country to consume five servings.

HAMMONDOr import enough even.

ECONOMOSCorrect. So I think that we need to take this recommendation seriously and appoint this committee and take a hard look at this and perhaps make serious changes.

REHMChristine Economos of Tufts University, she is a committee member of the Institute of Medicines Committee and report which is titled, "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation." And you're listening to "The Diane Rehm Show." And now to Winston-Salem, N.C. Good morning, Susan.

SUSANGood morning, Diane. I love your show...

REHMThank you.

SUSAN...every morning. I have a concern on the opposite side of this coin. I'm the proud mother of two children, 15 and 9. Both of them are extremely athletic, working out five to seven days a week through various sports or outdoor play, that kind of thing.

SUSANBut both of my children -- who are technically considered overweight by the BMI calculator but have very little body fat. It's all muscle due to their workouts -- are both exhibiting concerns of the opposite side of this coin where they're so concerned about what they're eating and everything that they're being negatively impacted by this focus on obesity to the point to where they won't even eat the healthy foods that are provided to them because they're so concerned about that number. And these are children who are straight-A students...

REHMSure.

SUSAN...and highly academically gifted, and they're struggling with finding their identity because they're being pushed to the other direction. They're so worried about whether or not that apple is going to...

REHMOh, boy.

SUSAN...kick this over.

REHMChristina.

ECONOMOSSure. Well, I want to emphasize that BMI, which I introduced at the beginning of the program, is used on the population level and as a screening tool. But it's really important that an individual work with their health care provider and their parent to determine, as the caller stated, body fat levels, activity levels and general health. And it doesn't mean that if the BMI is slightly high that something should be done because it's muscle mass perhaps for these children and not body fat.

ECONOMOSAnd they may be perfectly healthy and developing normally. So we have to make sure that these numbers are discussed with health care providers and parents really understand them extensively because we don't want to have a backlash and have healthy kids...

REHMRight.

ECONOMOS...be afraid to eat.

REHMAll right. To Dothan, Ala. Hi there, Gary. You're our last call.

GARYThank you, Ms. Rehm. An honor and a pleasure.

REHMThanks.

GARYI was wondering what your expert thinks of the artificial sweeter aspartame which has been directly linked to causing diabetes, especially exacerbated in the young people who are drinking many sodas that are actually flavored or sweetened with this product.

REHMBarbara Linder.

LINDERI think the caller raises an important question that we don't know the answer to. We really don't know the long-term health implications of artificial sweeteners and how they relate to affects on appetite and therefore weight gain. And there does need to be a lot of research done in this area.

REHMFinally, to you, Christina, what kind of reaction are you getting from White House government officials?

ECONOMOSThe reaction to this report, overall, has been very positive. People trust that we looked at the evidence, that we're trying to advance progress and that we have made recommendations that are widespread and really require everyone in this country to take some responsibility. It is individual responsibility all the way up to societal responsibility.

ECONOMOSThis report, in no way, just points the finger at government. It calls on everyone. And I would really encourage people to go to the HBO: Weight of the Nation website which has been released in conjunction with this report and the government agencies that promote good health for us. There are action steps that everyone can take.

REHMAnd I think we have a link to that on our own website, drshow.org. I hope our listeners will go and check it out. As Christina and everyone has said, the report, in no way, exonerates personal responsibility, nor does it place all the blame on government. We've all got to be a part of this. Thank you all so much. Christina Economos, Ross Hammond, Barbara Linder. And thanks for listening. I'm Diane Rehm.

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