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I would like to talk to you right now
about perhaps the most over-used

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and misunderstood word
in the English language: "freedom."

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Freedom has two parts: freedom from -
freedom from oppression,

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freedom from search and seizure;
and freedom to - freedom to choose.

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But freedom to choose has some
caveats, has some provisos.

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The one we ascribe
is called "personal responsibility",

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and that's an ideology.

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And there are some basic principles

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that we ascribe
to personal responsibility,

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that is, we have to have knowledge.

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The five-year old who accidentally
shoots his brother is not guilty,

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because he didn't have the knowledge.

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Access.

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We have 57,000 people being thrown off
voting rolls right now in America

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because of redistricting;
they don't have access.

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They can't have personal
responsibility to vote.

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And finally, affordability.

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You have to be able to afford your choice,

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and society has to be able
to afford your choice.

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An example: In California we've just
released 100,000 inmates

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who are drug addicts.

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We said, "Drug addicts
have to be locked up."

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You know what?

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We can't afford it.

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So, these are all caveats
to personal responsibility.

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And then the last one,
really important,

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is that your actions
can't hurt anyone else,

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because if they do,
then that's breaking the law.

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Well, the fact is,
we've got a healthcare crisis,

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and it's a big one.

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In fact, Medicare will be broke
by the year 2026.

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We do not have the money
to keep doing what we've been doing.

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And this healthcare crisis
is not due to physician reimbursements,

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it is not due to hospital charges,

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it is not due to infrastructure,
or administration.

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This healthcare crisis is due
to chronic metabolic disease.

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That's where the money's going.

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$245 billion dollars last year
in America for diabetes.

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$200 billion for dementia,
another chronic disease.

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And Obamacare promises us
that we're going to be able

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to put 32 million sick
people on the rolls,

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and we're going to to do it
by providing preventative services.

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Well, guess what?

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There are no preventative services
for these chronic metabolic diseases.

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They don't exist.

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The only thing that works is prevention,
and we don't have a prevention.

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So, what does this mean?

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This means that we're screwed.

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(Laughter)

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The fact is, that we cannot afford this.

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Where is this coming from?

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It's coming from this thing
called the obesity epidemic, right?

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Everyone says, "If only these people
could just eat less and exercise more,

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we would solve this problem;
it's their fault."

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That's where this comes from.

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You know, we have these things
called the seven deadly sins.

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We have absolved all five
of the other sins.

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We've absolved jealousy,
greed, wrath, pride, and lust.

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In fact, we have TV shows
that extort them.

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The only two that we have not
been able to get rid of,

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the only two that still stand
are gluttony and sloth.

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It's your fault.

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Well, you know what?

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I'm a pediatrician,
and I take care of kids.

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I have a hard time ascribing
personal responsibility to their obesity.

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In fact, we have an epidemic
of obese newborns.

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Obese newborns.

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Now, you want to assign them
personal responsibility?

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I take care of kids with brain tumors.

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You can see right here this arrow
pointing to a goombah

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sitting right in the middle
of this patient's energy balance pathway.

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A brain tumor that is causing
massive obesity.

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Let me tell you about
two of those patients.

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Here's a patient that I took care
of many years ago.

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She had a brain tumor,
and she gained 150 pounds.

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You can see her here
right now at 220 pounds.

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And we put her on an experimental
medication to lower her insulin level.

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Remember, insulin is the diabetes hormone,
it's also energy storage hormone.

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It's the hormone that tells your fat cells
to take up extra energy.

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There is no weight gain without insulin.

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And we knew that these patients
had very high insulin levels.

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So we gave her a drug to drop her insulin
in an experimental fashion.

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A week later, the mother called me up,
the kid hadn't lost any weight yet,

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and she says, "Doctor Lustig,
something's going on here."

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I go, "How do you mean?"

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"Well, we would go to Taco Bell,

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and she would eat five tacos
and an Enchirito,

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and she'd still be hungry.

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We just went to Taco Bell

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and she only ate two tacos,
and she was full.

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And she just vacuumed the house!"

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(Laughter)

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I go, "Really? Isn't that interesting."

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In fact, we did this many times,
and the exact same thing happened.

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And here she is, one year later
having lost 48 pounds,

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and feeling much better
about herself, as you can imagine.

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The next patient I'm going to show you
isn't even my patient.

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This is a beautiful 13 year old girl
who lives in Hawaii.

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Notice the lily in her hair.

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And one month after this picture
was taken, she was in a car accident,

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and she stroked her hypothalamus,

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that area of the brain where
that tumor was for the other patient.

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And this is her, one year later.

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Now, does anyone really want to tell me
that this is personal responsibility?

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That this was this young girl's fault?

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Well, I was giving grand rounds
at Kaiser, Honolulu,

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and they said maybe we should
put this girl on this same drug.

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And there I am with her.

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And her mother said,
"Yes, go ahead and try."

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And here she is one and a half years later
at her high school graduation.

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Now, does anybody really
want to make the argument

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that this is this kid's fault?

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I have a hard time with that.

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In fact, what we learned
from these experiments

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is that the behavior
is secondary to the biochemistry.

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When you fix the biochemistry,
the behavior improves,

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and we've seen it now in adults as well.

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So, everyone says
the behavior's the problem.

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No, it isn't.

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The biochemistry
underlying is the problem.

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Well, so now you say to me,

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"What about the rest of us?


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We don't have brain tumors."

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Well, in fact,
it's the exact same problem.

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Nothing's different.

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All of us now have insulin levels
three times higher than we used to.

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and the question, of course,
is where did that come from?

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Who in the audience has diabetes?

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Anybody?

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Must be a few of you, because 
diabetes is pretty big problem here.

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Here's the problem:
seven out of eight of you,

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seven out of eight people with diabetes

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don't even know they have it.

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You are blind to diabetes,
until you become blind from diabetes.

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So you don't even know
you have a problem yet.

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So here's the way to look at this.

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Here is the American population;
30% obese, 70% normal weight.

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The standard mantra is,

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"It's the obese people's fault because
80% of those obese people are sick."

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They have type 2 diabetes;
they have hyperlipidemia;

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they have cardiovascular disease;
they have hypertension;

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they have cancer; they have dementia;

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and they are breaking the bank.

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Those 80%, those 57 million people,

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if we could just get them to diet
and exercise, we could solve this problem.

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That's the standard mantra;

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this is incorrect.

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Because 20% of those obese people
are actually metabolically healthy.

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They will live a completely normal life,
die at completely normal age,

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not cost the tax payer a dime. 


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They're just that.

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Conversely, up to 40%
of the normal weight population

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have the exact same diseases.

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They get type 2 diabetes, hypertension,
dyslipidemia, cardiovascular disease.

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And you know what?

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They don't know they have a problem.

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When you add them up,
it's more than half the US population.

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In other words,
this is a public health crisis.

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Here is an example of how that works.

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Here are two people of equal weight;
one's healthy, one is sick.

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Want to take a guess
which one the sick one is?

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Can you tell?

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I can tell.

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The one in the bottom is sick; why?

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The guy on the top,
he's just got big love handles.

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The guy in the bottom has got fat
all around his organs,

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and that is what's making him sick.

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And this is called TOFI; T,O, F, I.


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Thin on the outside, fat on the inside.

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I venture to guess there's a few
TOFIs in the room right now,

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and you think you are just fine,
and you are not.

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So lets talk about the last public
health crisis that we experienced.

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HIV; remember HIV?


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1979; Patient Zero.

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1981; the term "AIDS" got coined.

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1986, Everett Koop said,
"You know, we've got a problem."

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When did HIV become
a public health crisis?

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1991.

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Why?

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Because Magic Johnson got HIV.

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And everybody said, "Holy ____,
this could happen to me."

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This really is something
where everyone is at risk.

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Because it's not a behavior,
it's an exposure.

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So the question is,
how do we resolve this?

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Well, here's the problem;
it's on this slide, right here.

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This is Coca Cola's "beating obesity"
campaign, "Coming Together."

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"Beating obesity will take
action by all of us,

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based on one simple common sense fact:

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All calories count, no matter
where they come from,

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including Coca-Cola,
and everything else with calories."

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A calorie is a calorie, and you can get
your calories from carrots,

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or you can get your calories
from cheesecake,

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or from Coca Cola,

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or anything else
with a "C" for that matter.

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It doesn't matter where
the calories come from,

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it's, "a calorie is a calorie",
that's what they say.

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Well, you know what?


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I don't believe in common sense.

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I believe in data.

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And the data say something else entirely.

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What the data say is some calories
cause disease more than others,

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because different calories
are metabolized differently,

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because a calorie is not a calorie.

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And when you believe that a calorie
is not a calorie, a whole world opens up,

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and actually, how to fix this problem
becomes very clear.

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This is because of our new diet.

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It is 40 years old now.
It is called "the Western diet",

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it is called "the industrial global diet",

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and it is basically
the processed food diet.

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And everyone of you
is eating it all the time,

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whether you like it or not.

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There are eight things wrong,


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not one, but eight things wrong
with processed food, and here they are.

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Three thing too little,
five things too much.

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Not enough fiber, not enough
omega-3 fatty acids,

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which you get from wild fish 
not farmed fish,

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not enough micro-nutrients,
all the vitamins and minerals.

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In addition, too much trans-fats,
but we know that they're coming down,

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branched-chain amino acids;

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they're amino acids you get
in corn-fed beef, chicken and fish,

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omega-6 fatty acids in seed oils,
alcohol, and finally, the big kahuna,

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the one that blows all the other
seven out of the water, sugar.

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Sugar, okay?

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We're going to talk about that
for the rest of the time.

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Does sugar cause diabetes?

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Everyone says, "Well, yeah,
but it's because of the calories."

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"Sugars are empty calories,"
that's the mantra.

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It is not; this is absolutely not true.

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Sugars are "toxic calories".

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In fact, studies from Europe show
that if you consume one soda per day,

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your risk for diabetes goes up 29%,
irrespective of the calories,

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irrespective of your weight,
irrespective of anything else you eat.

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We've shown that for every
150 calories the world consumes,

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diabetes prevalence goes up
a total of 0.1%, which is nothing.

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But if those 150 calories happen to be
a can of soda, diabetes goes up 11 fold.

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1.1%, and we're not consuming
one can of soda,

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we're consuming two and a half.

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So 29% of all the diabetes in the world


239
00:13:11,146 --> 00:13:14,926
is due to sugar, and sugar alone.

240
00:13:14,926 --> 00:13:19,212
This study actually satisfies
both the scientific and legal criteria

241
00:13:19,212 --> 00:13:20,758
for proximate cause.

242
00:13:20,758 --> 00:13:24,488
You have to be able to show
that something causes something else

243
00:13:24,488 --> 00:13:26,263
before you can do something about it.

244
00:13:26,263 --> 00:13:28,654
Well, we've proven it; we've shown it.

245
00:13:29,684 --> 00:13:31,954
It's shown here as well; same thing.

246
00:13:31,954 --> 00:13:36,220
Now, the question is,
why does this happen?

247
00:13:36,220 --> 00:13:40,240
Number one: sugar causes
liver fat accumulation.

248
00:13:40,240 --> 00:13:42,780
All that fat around the organs
that I just showed you?

249
00:13:42,780 --> 00:13:45,098
For sure, that's what that did.

250
00:13:45,098 --> 00:13:48,958
And that's not love-handle fat,
that's inside you.

251
00:13:48,958 --> 00:13:51,838
Number two: sugar's addictive.

252
00:13:51,838 --> 00:13:54,989
Weakly so, but it's everywhere,
it's like alcohol.

253
00:13:54,989 --> 00:13:57,239
And about 20% of people
are addicted to alcohol,

254
00:13:57,239 --> 00:13:59,059
probably about the same for sugar.

255
00:13:59,059 --> 00:14:01,007
So you can't stop.

256
00:14:01,007 --> 00:14:04,102
So this slide over here shows
the prevalence of diabetes

257
00:14:04,102 --> 00:14:07,235
worldwide as we speak right now.

258
00:14:07,235 --> 00:14:08,475
Who's worst?

259
00:14:09,215 --> 00:14:14,129
Saudi Arabia, Kuwait,
UAE, Qatar, and Malaysia.

260
00:14:14,469 --> 00:14:15,729
The worst.

261
00:14:15,729 --> 00:14:17,289
Why them?

262
00:14:17,969 --> 00:14:19,569
No alcohol.

263
00:14:20,049 --> 00:14:23,349
But they've got soft drinks
like they're going out of style.

264
00:14:23,362 --> 00:14:27,844
Because it's hot, and the water
supply's a question mark,

265
00:14:27,844 --> 00:14:30,667
and no alcohol.

266
00:14:30,667 --> 00:14:31,667
(Laughter)

267
00:14:31,667 --> 00:14:33,517
This is their reward.

268
00:14:34,487 --> 00:14:36,970
But you know what,
I'd rather have alcohol.

269
00:14:36,970 --> 00:14:40,866
Because you can only drink yourself
under the table once a day.

270
00:14:40,866 --> 00:14:43,976
(Laughter)

271
00:14:46,666 --> 00:14:51,028
But for soft drinks; all day, all night.

272
00:14:51,028 --> 00:14:54,278
Sugar in the morning, sugar
in the evening, sugar at supper time.

273
00:14:54,278 --> 00:14:55,941
That's what we're seeing.

274
00:14:55,941 --> 00:15:00,319
So, we've been overdosed.

275
00:15:00,319 --> 00:15:02,549
The American Heart Association says

276
00:15:02,549 --> 00:15:06,663
we should be consuming
six to nine teaspoons of sugar per day;

277
00:15:06,663 --> 00:15:08,793
we are up to 22.

278
00:15:08,793 --> 00:15:15,402
And 80% of foods that are available
in the American grocery store today

279
00:15:15,402 --> 00:15:16,952
are spiked with added sugar.

280
00:15:16,952 --> 00:15:20,950
And that's for the food industry's
purposes, not for yours.

281
00:15:20,950 --> 00:15:23,624
So, no access.

282
00:15:23,624 --> 00:15:26,834
You don't have access
because it doesn't exist.

283
00:15:26,834 --> 00:15:29,166
Real food is hard to find.

284
00:15:29,166 --> 00:15:30,736
Number two:

285
00:15:30,736 --> 00:15:33,776
How about that there are 56
names for sugar,

286
00:15:33,776 --> 00:15:35,876
so you don't even know
what you're consuming.

287
00:15:35,876 --> 00:15:37,858
And here there are.

288
00:15:37,858 --> 00:15:39,601
No knowledge.

289
00:15:39,601 --> 00:15:40,711
And how about this?

290
00:15:40,711 --> 00:15:43,041
Everybody knows what
a "Nutrition Facts" label is.

291
00:15:43,041 --> 00:15:45,609
There's a number
over there in the purple.

292
00:15:45,609 --> 00:15:48,659
It's called the "Dietary Value".

293
00:15:48,659 --> 00:15:51,141
Notice, there's none for sugar,
and that's on purpose

294
00:15:51,141 --> 00:15:53,947
because they don't want you to know
how much is too much.

295
00:15:54,687 --> 00:15:56,737
So, no knowledge.

296
00:15:56,737 --> 00:15:59,791
How about the National
School Lunch Program?

297
00:16:00,761 --> 00:16:02,761
Six cents extra.

298
00:16:03,581 --> 00:16:06,397
Six cents, Michelle Obama
got out of Congress.

299
00:16:06,397 --> 00:16:08,577
That's not even enough for two grapes.

300
00:16:08,577 --> 00:16:12,496
And, if you are eating school breakfast,

301
00:16:12,496 --> 00:16:15,246
you're getting Fruit Loops
and a glass of orange juice.

302
00:16:15,246 --> 00:16:20,105
That's 11 teaspoons of sugar;
you're already over your limit.

303
00:16:20,105 --> 00:16:22,366
You want to know why we have a problem?

304
00:16:22,366 --> 00:16:24,456
This is why we have a problem.

305
00:16:24,966 --> 00:16:27,012
So everyone says, "Education!"

306
00:16:27,012 --> 00:16:31,002
"Educate the public, educate
the populace, tell them what's going on!"

307
00:16:31,022 --> 00:16:34,779
Except for one thing: education hasn't
worked for any other substance of abuse.

308
00:16:35,509 --> 00:16:39,147
Did Nancy Reagan's "Just Say No" work?

309
00:16:39,147 --> 00:16:40,797
(Laughter)

310
00:16:40,797 --> 00:16:42,406
Really?

311
00:16:42,406 --> 00:16:43,606
(Laughter)

312
00:16:43,606 --> 00:16:45,712
And you know what?

313
00:16:45,712 --> 00:16:50,448
I can prove that it doesn't work
because here is the stock prices

314
00:16:50,448 --> 00:16:54,234
against the S&P 500
for McDonald's, Coke, and Pepsi,

315
00:16:54,234 --> 00:16:57,559
and look at what happened
at the economic downturn in 2008.

316
00:16:57,559 --> 00:16:59,751
They did very well, thank you.

317
00:16:59,751 --> 00:17:03,271
In fact, if you want make money,
invest in a food company.

318
00:17:03,841 --> 00:17:06,546
So, where does that leave us?

319
00:17:06,546 --> 00:17:10,796
It leaves us with this question
of freedom and personal responsibility.

320
00:17:10,796 --> 00:17:13,694
What does personal
responsibility really mean?

321
00:17:13,694 --> 00:17:19,274
Well, if the information is kept secret
and you don't have knowledge,

322
00:17:19,274 --> 00:17:23,285
if your access is limited
because you can't even find it,

323
00:17:23,285 --> 00:17:25,805
and if society can't afford it,

324
00:17:25,805 --> 00:17:30,790
and we can't even give our kids
something healthy to eat,

325
00:17:30,790 --> 00:17:33,153
is it really personal responsibility?

326
00:17:33,153 --> 00:17:38,633
And lastly, if your decision
to drink a soda

327
00:17:38,633 --> 00:17:42,424
lands you in the emergency room,
and costs me dollars,

328
00:17:42,424 --> 00:17:46,021
and if your decision to be fat and sick

329
00:17:46,021 --> 00:17:50,351
costs your employer $2750

330
00:17:50,351 --> 00:17:54,366
per employee, whether you're obese or not,
you know what that is?

331
00:17:54,366 --> 00:17:57,216
That's not called freedom,
that's called anarchy.

332
00:17:57,226 --> 00:17:58,672
That's what we've got.

333
00:17:58,672 --> 00:18:03,895
So the libertarians say, "Wait a second;
don't tell me what to eat!"

334
00:18:03,895 --> 00:18:06,898
Well, you know what?
You've already been told what to eat.

335
00:18:06,898 --> 00:18:09,128
Where were you for the last 40 years

336
00:18:09,128 --> 00:18:12,709
as your food supply was being
changed under your nose.

337
00:18:12,709 --> 00:18:14,849
Were you protesting then?

338
00:18:14,849 --> 00:18:17,971
The libertarians say,
"Get government out of my kitchen!"

339
00:18:17,971 --> 00:18:20,931
You know, I don't want
government in my kitchen either,

340
00:18:20,931 --> 00:18:25,349
unless there's somebody
more dangerous already there.

341
00:18:27,789 --> 00:18:32,735
So the real question is, who the hell
do you want in your kitchen?

342
00:18:32,735 --> 00:18:37,342
The government, who will take
your freedom and your wallet?

343
00:18:37,342 --> 00:18:38,847
Or the food industry,

344
00:18:38,847 --> 00:18:43,407
whose already taken your freedom,
your wallet, and your health?

345
00:18:43,407 --> 00:18:45,069
That's your only choice.

346
00:18:45,499 --> 00:18:48,079
Now, having said all this,

347
00:18:49,249 --> 00:18:52,979
the food industry
is composed of a lot of people,

348
00:18:52,979 --> 00:18:54,027
and you know what?

349
00:18:54,027 --> 00:18:56,306
They really want
to do the right thing, they do.

350
00:18:56,306 --> 00:18:59,425
Individually, they would actually
like to do the right thing.

351
00:18:59,425 --> 00:19:03,363
And I have met with these people,
and they are actually very nice people,

352
00:19:03,363 --> 00:19:06,674
but, they work for a food company.

353
00:19:07,834 --> 00:19:11,474
and contrary to what
the Supreme Court says,

354
00:19:11,474 --> 00:19:13,841
corporations are not people.

355
00:19:14,481 --> 00:19:18,721
Because corporations have a fiduciary
responsibility to their stockholders,

356
00:19:18,721 --> 00:19:20,259
and people don't.

357
00:19:20,869 --> 00:19:26,904
Corporations get three month profit
cycles, and Wall Street earning reports.

358
00:19:26,904 --> 00:19:29,194
And they have to make those reports.

359
00:19:29,194 --> 00:19:32,744
So I've met with the food industry,
and I will tell you about one story,

360
00:19:32,744 --> 00:19:36,113
which will remain nameless,

361
00:19:36,113 --> 00:19:40,468
They told me very straight out,
ten scientists, ten corporate executives,

362
00:19:40,468 --> 00:19:42,558
they said, "You know, we can change.

363
00:19:42,558 --> 00:19:43,588
We've changed before.

364
00:19:43,588 --> 00:19:46,440
we had to change back in the 80s
when we went low fat,

365
00:19:47,350 --> 00:19:50,330
with two provisos;

366
00:19:50,350 --> 00:19:54,320
we wont go it alone,
and we can't lose money."

367
00:19:55,530 --> 00:19:57,748
Those are two non-starters today.

368
00:19:57,748 --> 00:19:59,288
So what does that mean?

369
00:19:59,288 --> 00:20:01,678
That means that they
have to be told what to do,

370
00:20:01,678 --> 00:20:03,688
and they have to do it
all at the same time

371
00:20:03,688 --> 00:20:05,898
so that there's no
competitive disadvantage.

372
00:20:05,898 --> 00:20:07,548
What does that mean?

373
00:20:07,548 --> 00:20:09,714
That means government.

374
00:20:10,254 --> 00:20:13,162
But governments are complicit
and complacent.

375
00:20:13,162 --> 00:20:14,921
They're getting paid off.

376
00:20:14,921 --> 00:20:17,891
Over half of Congress takes money
from the food industry.

377
00:20:17,891 --> 00:20:20,945
And 6% of our exports are food.

378
00:20:20,945 --> 00:20:24,085
What do you think what happen
if all of a sudden we told the world,

379
00:20:24,085 --> 00:20:25,995
"You know, all that shit we put in food?

380
00:20:25,995 --> 00:20:28,088
It really isn't so good for you."

381
00:20:29,064 --> 00:20:32,631
What happened when that one downer cow
went from Canada to Washington state?

382
00:20:32,631 --> 00:20:36,630
That was at the end of meat sales
to Britain and South Korea for two years.

383
00:20:36,870 --> 00:20:39,870
So, they're on the other side.

384
00:20:40,950 --> 00:20:45,974
But we've got a crisis,
because we will not have healthcare.

385
00:20:47,734 --> 00:20:51,284
Here is a report that just came out
from an investment bank,

386
00:20:51,284 --> 00:20:53,546
an international investment
bank, Credit Suisse,

387
00:20:53,546 --> 00:20:59,862
called Sugar Consumption at a Crossroads,
and this is a direct quote from this tome:

388
00:20:59,862 --> 00:21:05,439
"We believe higher taxation on sugary food
and drinks would be the best option

389
00:21:05,439 --> 00:21:07,599
to reduce intake and fund
the healthcare costs

390
00:21:07,599 --> 00:21:09,517
associated with diabetes and obesity."

391
00:21:09,517 --> 00:21:13,562
An investment bank
is calling for taxation.

392
00:21:13,562 --> 00:21:17,802
That's how big and bad
this problem has gotten.

393
00:21:20,982 --> 00:21:26,603
I believe food should
confer wellness, not illness,

394
00:21:26,603 --> 00:21:27,823
and it used to.

395
00:21:27,823 --> 00:21:28,823
But you know what?


396
00:21:28,823 --> 00:21:30,907
This is a public health crisis,

397
00:21:30,907 --> 00:21:35,607
and you cannot solve public health
crisis one person at a time.

398
00:21:35,607 --> 00:21:41,494
Here is a list of diseases that were all
personal responsibility issues,

399
00:21:41,494 --> 00:21:45,168
except for the sheer gravity
of each of them,

400
00:21:45,168 --> 00:21:47,898
became a public health crisis.

401
00:21:47,898 --> 00:21:51,976
Why don't we add sugar to the list?

402
00:21:53,586 --> 00:21:56,891
Personal responsibility isn't ideology.

403
00:21:56,891 --> 00:22:00,845
It's the elephant in the kitchen,
and we can't afford it.

404
00:22:01,405 --> 00:22:05,342
What we need is a policy
based in biology.

405
00:22:05,342 --> 00:22:06,892
And it's got a name.

406
00:22:06,892 --> 00:22:08,843
It's called real food.

407
00:22:09,573 --> 00:22:11,633
And the only way we can solve this

408
00:22:11,633 --> 00:22:14,583
is by kicking that elephant
out of the kitchen.

409
00:22:14,583 --> 00:22:15,841
Thank you.

410
00:22:15,841 --> 00:22:17,551
(Applause)