The Weight of the Nation: Part 1 - Consequences (HBO Docs)

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To win, we have to lose. The four-part HBO Documentary Films series, The Weight of The Nation explores the obesity epidemic in America.

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The Weight of the Nation: Part 1 - Consequences (HBO Docs)
http://www.youtube.com/watch?v=-pEkCbqN4uo

This Georgia is heavy as I was.

It's called acanthosis.

18 plus percent of our children right now are obese.

How bad are you?

About 280.

If you go with the flow in the America today

you will end up overweight or obese

as two thirds of Americans do.

I don't want to be fat for the rest of my life.

I've got diabetes.

Sleep apnea.

High blood pressure.

I get dizzy when I get up.

Everything is hurting now.

You don't crave broccoli

and our generation has grown up craving a Big Mac.

We have built a cheap food model

and that's the one we're dealing with right now.

It is so hard to combat against what

the TV is telling you to buy your kids.

The kind of food that we eat is the kind that's most profitable.

Local and regional foods taste better.

The weight of the nation is out of control

but we can fix that.

How do you like the market?

Market mean everything for this neighborhood.

We have got to come together as a country

and really make this a priority.

As long as we stick together, that's what it's about.

It is not only health,

but it's about survival and well-being of

the United States as a nation.

The reason we have government in the first place is

to solve problems collectively that we can't solve individually.

If we don't now take this as a really serious, urgent national priority

we are, all of us, individually and as a nation,

gonna pay a really serious price.

I weighed 99 pounds when my husband and I got married 30 years ago.

Then you start having a family and

after my second child, it was like poofiness.

My grandmother, my mother, my sister and myself would have got,

it's been the same story.

It is not easy to take weight off

and that's liposuction, patches, pills, fad diets,

counting carbs, counting calories, I have tried it all.

And I've asked my husband "Let's be honest, dear, am I that big?"

And when he doesn't answer me I think

"Oh my God, what has happened to me?"

You know or if he says

"No way" then I feel better about myself, you know,

but once he don't answer I know, I'm that big and it's

like a slap in the face, wake up, you know, do something.

You try and it doesn't and you lose hope then.

Bogalusa is just like any town throughout the Southeast of United States.

And there's some variations.

You get rural in Northern Mississippi.

It's really a lot of poverty and so forth and it

partly relates to the industry and the agriculture.

But we are just like any old country town.

It's strawberries and cheese and...

No, it's strawberry jello

and it's got bananas, and pineapple, and you

would not believe how good it is. Get your plates,

start eating. This is Lousiana cooking, this is Lousiana

at its' best. Where's the shrimp pasta?

You get tired of the diet that's not gonna work

and then you fall off the wagon so to speak and

you know then you really pig out some you are not supposed to have

You know? You get tired of that feeling of failure.

If you don't fry it, you grill it. If you don't grill it,

you boil it.

That's the way we eat down here.

Good morning!

Hello.

Hi, what's the name?

Cindy and Gary Roach.

Cindy, you're gonna be first. Gary is gonna be second.

And just have a sit.

When did you start to coming to the heart study?

We were in Grammar school.

Grammar school?

Both of us.

I would say about the third... fourth, fifth grade.

Kathy Pigott.

Kathy, when did you started to come through screening?

I came to start a heart study... my first year was in 1973. I was in kindergarten.

The Bogalusa heart study is a landmark investigation of

the genesis of cardiovascular disease, from childhood quite through adulthood

and many of us, as we came up through our biomedical sciences

in undergraduate university,

we learned about the Bogalusa heart study.

The main focus is on cardiovascular disease and

the pathogenesis of disease over time really starting in childhood.

In the Bogalusa heart study

we are looking at risk factors in children.

Since we want to look at the early natural history

it is obvious that we oughta look at the early onset of these diseases.

The major effect of the Bogalusa heart study

is the biannual general examination of all school children in Bogalusa.

I can remember being very excited.

When they used come to the school they used to come,

it was a big while trailer

and that's where they did all of your work.

And back then I was just happy because

we were getting out of class.

When I got the heart study, the intention was to look at risk factors,

just like framingham, but to do it in children.

What I need is a list of the people that you don't have any kind of record on.

Some of them we have because we knew the cause,

we just didn't have the death certificate.

So you have exhausted all the data from the coroner's office.

Yes, sir, we have.

After we have been in the study 5 or 6 years,

we clearly established that heart disease began in childhood.

What clenched our information was doing an autopsy study.

560 deaths since 1972.

When we'd begun to see lesions in kids it really jelled the fact that

looking at risk factors clinically in life and here looking at the actual vascular

disease in death, and having a strong correlation.

Highly significant relationship.

Fair and straight.

Take a breath.

Our children are now 50 years old,

and we have a 30, 35 year history on them.

It's the only study like that in the world

that has long term black and white population.

The obesity that we are seeing in very damaging to the cardiovascular system.

I just found out that I have high blood pressure,

and they said that I was on the boardline with maybe on diabetes,

so my doctor told me to do, to go brown

so no more white rice or potatoes or white bread.

So we've gone to like wheat pasta, wheat bread, that type of thing.

What did you get for the subscapular?

132.9.

133.

Obesity is not just fat cells sitting there

but the particularly the central fat, the abdominal fat,

the android deposition, the male deposition of fat.

The waist measurement.

This is to measure the abdomen.

But it's the obesity which is the major driving force for

incident resistance. Incident resistance and obesity are the

driving force for hypertension, diabetes.

The blood pressure was 140 over... Is high.

If you lost 20 pounds it might go to normal.

Well I am working on that.
But you are beyond submaterson.***

I'll go back and see a doctor.

God's good.

I found out through heart study I had high

blood pressure and I can take that to the doctor.

My grandmother had a heart attack, both my

grandmothers. I'm sorry. But I know going through

heart study that if something is wrong, it's gonna be

caught early on and maybe I'll be here to see my

grandkids grow up. I've got to learn to eat the right

things at the right times. And I'm gonna try. I'm gonna

give it a shot. And come back and you'll all see maybe

a new me.

Life is really hard for people who are obese. And by hard

I mean both the social consequences of that and the health

consequences of that. Right down to the fact that those

who are very obese are not gonna live as long as others.

What makes me frustrated bordering on angry is that

this is preventable. It's not, this is not one of those unfortunate

acts of nature that we just have to accept as reality. This

is not the product of a tsunami.

The weight of the nation is not healthy and to get it

healthy we're all going to have to do our part. All of us

have to be part of the solution to reduce obesity in this

country. Otherwise, we are going to be faced with deadly

increasing healthcare costs and the lives that are lost from

cancer, heart disease, diabetes, and other problems.

How many people in this society are able to maintain

a healthy weight? One third or less. Something's

wrong with this picture. Levels of obesity in the United

States have increased in alarming ways. In the 1980s

the Centers for Disease Control began putting together

a map showing levels of obesity state by state and then

they went through the years and every time a state changes

colors, it's suggesting increasing levels of obesity.

When you look at the rates of adult obesity from 1960

until 2008, you can see that the rates were moderate

and relatively consistent over time but then starting

in the 1980s we saw a rapid increase resulting in the

current level which is fully over a third of adult men

and women in the United States are obese. But it's

the morbid obesity where we've seen the most striking

increase from 1988 until 2008.

We have childhood obesity at levels where people aren't

denying it anymore. So it is a teachable moment. When

it was only adults or only people in less valued groups you

could put it aside. It's those people. But when it's children

you can get a conversation going. People who are poor tend

to have higher rates of obesity. So if you look back in the

late 1980s and early 1990s, there's a linear relationship between

poverty and obesity. But if you look more recently from 2005

to 2008, everybody's rates have gone up and being wealthier

is not nearly as protective against obesity as it used to be.

There is some regional variation but it's all different degrees

of terrible. The levels are so high everywhere that every

state has to pay attention to this issue. The healthcare costs

not to mention the human burden are very high in every corner

of this country and increasingly every corner of the world.

Obesity is an enormously complex problem with inputs from

several places. Genetics is one. We know that about 60-70%

of the risks of obesity are heritable ones.

When it comes to obesity for the vast majority of people,

there's no one gene that makes a difference. There's many,

many genes. Dozens perhaps hundreds. Each in which has

a small effect on the obesity in the population but which add

up to a susceptibility when exposed to this environment

that we live in for getting more overweight or not.

There are a large number of genes that have been

identified in humans that do play a role in the control of

body weight. And very interestingly the majority of these

genes are genes that influence food intake.

Obesity is a classic example of what we call a gene

bi-environment interaction. Any individuals body weight

in most instances is a result of the interaction of their

genetic makeup with the environment that they happen

to be living in.

There's no doubt that genetics, the DNA that we inherit

from our parents affects how much we weigh. There's

also no doubt that the environment we live in affects

how much we weigh. There's no nature versus nature.

There's nature and nurture.

Both nature by that we mean genes and nurture we mean

experience affect each other and they're inextricably intertwined.

Is there a genetic predisposition to obesity? Absolutely. Is

obesity caused by environment and behavior? Absolutely.

I've been interested in obesity for a long time. We're now

responsible for a city of 8.3 million people. Every one of

those people I consider to be my patient as a doctor.

And of all the health problems I deal with, this is the one

problem that's getting worse. Obesity and diabetes.

This shows the diabetes and obesity in the South

Bronx here.

The lowest income country in New York state, very high.

Prevalence of obesity, very high rates of diabetes.

Just a short distance away here, Manhattan, we have

Bere side where it's the highest income neighborhood in

the city. We have a very low prevalence of obesity, very

low prevalence of diabetes. Obesity is driving the epidemic

of diabetes.

In the darkest areas on this map, close to 90% of adults

are overweight or obese.

You do have to really start connecting some of these dots.

You know 57% of the kids in Philadelphia are overweight or

obese.

We already know, based on the information from the

Center of Disease Control and many others that for

kids living in these neighborhoods, many of them will

die before their parents.

A child born in 2000 has a 1/3 lifetime chance of having

diabetes. If that child is African American or Latino, it's

one in two.

The red spots are where the highest rates of poverty are.

In this area, almost one out of every three children is

considered to be overweight or obese and this is an

area as you were saying with poverty, the average household

income is less than $25,000 for a family of four.

If you look at the state of Tennessee in Nashville, it is

a crisis level here. I mean we rank at the bottom.

If we don't take on strategies that affect how the low

income communities is dealing with the obesity epidemic

we're gonna see this phenomenon across our society

and in a relatively short period of time.

We're pretty much in downtown Bogalusa right now

which I'm sure was really nice back in the 60's or

70's. And up here on the left is the lumber mill.

The smell of the lumber mill kind of permeates this

whole place and that's one of the lingering memories.

I think a really important question is when we look at

the levels of overweight and obesity we're seeing

in Bogalusa in 50% of kids being overweight or obese

is Bogalusa unusual? Or if we looked at other places

like this around the country would we be seeing simliar

levels of overweight and obesity. You know? Is Bogalusa

special or do we just happen to have 35 years of data

on it?

In the 1970's 5% of children were overweight and obese.

Today that's over 30%. So we've seen just dramatic increases

in a very short period of time. So our biologies changed quite

rapidly within a very short time frame on the evolutionary time scale.

And the Centers for Disease Control and Prevention have

produced these maps and this area around the lower

Mississippi delta encompassing Arkansas, Mississippi,

Louisiana historically has the highest level of obesity and

is kind of at the forefront of the obesity epidemic in

the United States.

I've been here 10 years and I have seen a drastic change

in obesity and I've seen a change in the blood pressures.

It's definitely going up.

Their blood pressure should not be that high. Actually

it should never be over 120/80. So this is a kid that we'll

watch. We'll monitor his pressure, we will probably do

lab work on him, get an EKG, make sure everything with

his hearts okay, send him to cardiology. If that comes back

clean we may send him to see a kidney specialist to make

sure there's nothing going on with the kidneys because

that can sometimes cause blood pressures to go up. So

this will be a kid that we watch and we follow.

We have to address it now. These are gonna be our patients

that are on dialysis in their 30's if we don't do something now.

They're our future.

They need us. They need us to care and we do.

We as pediatricians never had to worry about learning

a lot about hypertension. That was a specialist disease.

We send the occasional one to the cardiologist. But now

there'll be many, many times that I'll be facing children

with increased blood pressure.

I think the results that we're showing in Bogalusa may

be a reflective as to where the country is going. The

blue line is the national data and the red line shows the

Bogalusa. By the mid 1980's, Bogalusa really began out

stripping the pace of the rest of the country.

We don't really see ethnic disparities. We see that both

African American and white children have comparable

levels of overweight and obesity.

This is it. This is what the kids have. The swings are broken

down. There's no basketball court for them to play on.

And I mean what does a parent do? You know what voice

do they have as demanding safer play spaces for their kids?

And this is actually, we're in a part of town with higher poverty

rates and the density of kids is actually one of the higher

areas in Bogalusa. I guess you know we as communities

need to realize that these futures of our environment have

health consequences and have consequences for the obesity

epidemic.

It has to be a complete community, entire society approach to

reducing this complex problem.

Not only is the prevalence of overweight and obesity

going up. In other words, more and more children are classified

as overweight or obese but within that category those children

are becoming heavier and heavier. Around the world, obesity

rates continue to climb. So I don't think we've reached the

maximum yet.

One of the most important ways we've learned about

cardiovascular health and what a normal heart and vessel

system looks like as well as how disease process develops

across the lifespan of the cardiovascular system is by

studying tissue from autopsy specimens in people who have

died for completely different reasons but also in people

who have died related to cardiovascular causes.

Weight that's present in young adult hood and weight that is

gained from young adulthood to middle age has tremendous

consequences. So we really think of this as a perfect storm.

A hurricane of consequences that drive cardiovascular risk.

And what we have in this case, this is a heart from a 26

year old woman of normal size, height, and weight who died

of a non-cardiac cause or her cardiovascular systems entirely

normal. Now in contrast we have a heart from another

individual in this case a male who's in his 50s who weighed

500 pounds and he was 5' 9" in height. His BMI was calculated

to be 70. Over 30 is obese.

It's really dramatically different from the normal heart.

You can see here there's a lot of fat. The cavity is a little

bit small and the wall thickness is extreme. It's more than

a centimeter and a half.

So this heart had to do a lot more, vigorous pumping to

push around a larger amount of blood volume and also

is pumping into a thicker, stiffer arteriole bed so it had

to beef up the muscle in order to compensate for that.

So this is hypertrophy.

Pretty quickly that heart muscle that thickens so dramatically

can actually start to weaken. So the cells go through changes

they pass a sort of tipping point where they then become

weaker and the heart over all starts to dilate or enlarge and

that ultimately can lead to heart failure.

So right here we see the thickened wall at a very small

cavity but this individual died of a heart attack. The contrast

here is a woman who has thickened walls as well but she

didn't have a heart attack and over time those thickened

walls got weaker and weaker and the heart got bigger

and bigger and dilated to the point where she has this

big, baggy ineffective pump.

Now the hearts a muscle like any other muscle in your

body with one important difference. It never gets to rest.

So the heart is particularly dependent on its' continuous

blood supply and if that blood supply gets interrupted such

as in a heart attack, there's damage to the heart muscle

that starts to occur within seconds to minutes.

And so in the end with the patient's death, the pathologist

sees. This is a 71 year old woman who weighed about

260 pounds. You can see here that it's enlarged. It also

has a fair amount of fat on the epicardio surface of the heart.

This patient has had a bypass operation because you can see

the bypass grafts laying on the surface of the heart.

So this woman as a result of her obesity developed

atherosclerosis and required coronary artery bypass

and that's the graft that you see here that was done

sometime before her death.

You can imagine as a plaque forms in an artery, it will

affect the dynamics of that artery. Normally an artery is

composed of smooth muscle cells that actually expand

to accept the blood when the heart is pumping and then

contract to push it forward to the rest of the tissue that's

down stream. Over time when plaque start to build up,

there's more ingrowth of tissue and severe limitation

to blood flow and that may cause symptoms like angina

or chest pain when someone is exerting themselves. So

when a plaque forms, that plaque may gradually enlarge

over time and if too much blood clot forms it completely

blocks the artery. Once that happens, almost instantaneously

the heart muscle cells down stream will start to die.

Now the blue vessels that you see are actually veins which

are bringing blood back to the heart and that red vessels

coming out are arteries. This is the aorta which carries

oxygenated, fresh blood to the rest of the body tissues.

This is our aorta from our 26 year old. She has a normal

heart and a relatively normal aorta. But if we look very

closely, you see a little bit of yellow raised lesion here,

here, here. Fatty streaks are among the earliest lesions and

they occur in children between the ages of 5 and 10 we think

this process begins.

Those early life experiences, the development of obesity

and overweight at a very young age we know has major

consequences much earlier than we should see for the

arteries in particular.

This is an aorta from our 71 year old woman and you can

see that this is a lot more complicated. The surface is very

rough and in fact this aorta is crunchy. It's calcified. It's

hard, it's stiff. And some of these lesions, these plaques

have ruptured exposing the lipid to the blood stream and

when you see this kind of disease in the aorta, you know

it's present in other vessels as well.

So ideal cardiovascular health is really defined by

7 factors in health behaviors and they include having

optimal levels of total cholesterol, a normal blood

pressure, not having diabetes, having a lean body mass

index meaning you're not obese or overweight, not

being a smoker, participating in recommended levels

of physical activity as well as pursuing a healthy diet.

Unfortunately at present in the United States, less than

1% of individuals actually meet the definition for all 7 of

these criteria or ideal cardiovascular health.

Last February I was training for the country music

half marathon. I had reached 10 miles and I was gonna

do 12 that day and I started to feel really nauseous and

light headed and my legs started to fail and it was a

heart attack. This is me on my wedding day. I'm at my

heaviest. You can see by the look in my eye how I feel.

I remember feeling ashamed. I weighed 400 pounds.

I've lost 100+ pounds since this day.

I play a very wind driven instrument. It's a very physical

instrument and I notice changes in my playing. My

weight affected my musicianship. You know how people

say they look at a photograph of the way they were and

they say I never want to go back to being that guy. I

don't believe that. I think I am that guy but I'm taking care

of that guy now.

You can change even if you weigh 400 pounds. You can

change. It boils down to a decision and saying this is what

will happen. It's not a matter of saying I want to or I would

like to. It is what will be. And that kind of decision, that kind

of fortitude changes things.

Individual with the abdominally preponderant fat if you

will is at higher risk for the complications of obesity meaning

diabetes, high blood pressure, heart attack than an

individual who has fat stored elsewhere.

There are health consequences associated with fat that

positions specifically within the belly. We now know that

there are hormones that are released from these fat

cells that then could interact for example with your heart

or with your pancreas and they may become detrimental.

This person as you can see where weight is body fat as a

thick rim of fat underneath their skin called subcutaneous

fat. This person also has a lot of fat inside of their abdomen

as you can see all of these white blotches here inside the belly.

Almost every organ system in the body is adversely affected

by having access body fat. And this is access body fat underneath

you skin, access body fat inside your abdomen, and access fat

inside of other organs like liver tissue and muscle tissue and

heart tissue affects the function of those organs.

All of us have fat inside our tummy. We have to have a little

bit because we actually mobilize that fat every night when

we're fasting while we're asleep. That's the fat that

is metabolized and turned into the fuel supplied to keep our

brain happy while we're asleep until we have our breakfast.

Evolutionarily men and women have been programmed to

deposit fat into two different fat depos. We have the

visceral depo which is this depo of fat that's located inside

the abdominal wall. It's the first fat depo that is readily

mobilizable and it's burned up very, very quickly and so

men who needed to go out and actually find the game or

the bear or the food for the family, they needed to be

able to have a calorie substrate that was able to burn

really, really quickly to provide them some energy.

Women on the other hand, we fight against losing

weight in our hips and thighs. And the reason we're

programmed that way is that we rely on the calories

in our hips and thighs evolutionarily to provide us

with calories for breastfeeding or to help sustain a potential

famine while we're pregnant.

Now that's all in evolutionary terms. In the modern

world of course we're all living with excess energy supplies

and if we're both males and females store that fat inside

the abdomen, inside their muscle, inside their liver, and

under the skin.

And all of a sudden the system which was elegantly designed

now no longer is necessarily advantageous for these days.

I work in a department of surgery where we do liver transplants

and we're finding this very scary finding over the last decade

that the reasons we do liver transplant are changing. Used

to be hepatitis was the reason we did liver transplants but

increasingly a form of cirrhosis where the liver gets really

stiff, stiff called cryptogenic cirrhosis has been the reason

we're doing more and more liver transplants.

This is a lot of fat to get past. Looks like you've done a good

job at sweeping it over. That's not what a normal liver looks

like. See how pale and pink it is? It looks like injected with

fat. It's normally much redder and it doesn't have all these

fat globules in it. This is called fatty liver and it's also very

thick and hard to move around.

So what's cryptogenic cirrhosis? Turns out that's a bad

term that defines people who have stiff diseased livers

for reasons that we don't fully understand except it turns

out that almost all of those people have a very severe form

of obesity and they have a form of liver change related to

obesity where fat literally get stuck between the cells of

the liver, causes inflammation, causes stiffness, liver disease

and it may be the leading reason why in America in the next

decades we're doing liver transplants.

13% of all children who die in autopsy studies have non-alcoholic

fatty liver disease and 38% of obese children. This is a disease

we never saw before. It didn't exist before. In adults or children.

And now 38% of obese kids have it.

The liver is a critical organ in our body because of the important

functions that it serves and now we're realizing that the liver

is very important in the metabolic problems that are associated

with obesity. This has been a particular interest for us because

we really are recognizing more and more the liver's central

role in causing or being involved at least in a metabolic

complications of obesity which lead to serious long term

outcomes like diabetes, high blood fats and blood lipids,

and eventually heart disease and death.

I've battled my weight my entire life. I've never been a

person that had an easy time with weight from when I was

about 18 years old on up. About a year ago I was a little

over 200 pounds. Following the weight gain portion

of this study, all of my vital statistics changed. My

cholesterol went up from somewhere in the normal range

to like 250 or 260. My triglycerides went up. My fat when

they measured my fat went up about 10% I think.

Being a person that basically yo-yoed, I really wanted to

have some answers as to what it really means and is

it okay to stay obese? As I found out from the study it

isn't okay. It didn't work out well for me, my body, or

my mind.

We're gonna do a whole body scan on you. Measure for

body fat, takes about 10 minutes. I just need you to hold

real still.

This liver as you can see here, a brown organ in the center of

our body is a metabolic work horse. It's a four pound organ

that has extraordinary metabolic functions. It makes a large

number of proteins that are secreted throughout the body.

It also makes fats that are secreted throughout the body and

also makes sugar to keep our blood sugars at a normal

level and prevent hypoglycemia and fainting when we don't

have food and if you take two obese people who are the

same body size, same amount of body fat and one of them

has a lot of fat in their liver and the other has normal amount

of fat in the liver, the one with the high liver fat will have

all the metabolic abnormalities that are associated with

cardiovascular disease risk; whereas, the person with the

normal liver fat will be relatively healthy and

metabolically normal.

So what we will be doing today is we will be infusing

some molecules. We will use these molecules in order

for us to understand how well your body metabolizes

fats. We want to understand and see, try to understand

what is the mechanism that causes this increase in fat

in your blood stream.

They've asked us to use one of 5 fast food restaurants:

McDonald's, Burger King, Kentucky Fried Chicken, Taco

Bell, or Pizza Hut. So and the idea is to add 1,000

calories a day to my daily normal diet. So that I gain

weight over the course of about 6-8 weeks.

Many studies that have looked at obesity have really

evaluated effective weight loss in obese people because

that's what we're trying to get obese people to do and

we know a lot about the metabolic effects of losing weight.

Much fewer studies have actually looked at what

is the effect of weight gain in obese people? And that

actually occurs much more frequently in our population

than is weight loss. So we decided to do a study that

we really evaluate in a rigorous way, well-defined way,

well-controlled way. What is the effect of gaining 5%

body weight in people who are already obese on their

metabolic function?

It's a hand tossed pepperoni pizza. Those of us that have

on occasion eaten an entire pizza. Each piece has 340 calories

and 14 grams of fat. Beat burrito for 550 calories. There's a lot

of calories for a small amount of food. I'm a volume

eater so I could probably polish this off for lunch and still

be hungry. I keep these diaries. Shows everything we eat.

I did the diary for about a month before we started the

overfeeding so that they would know about how many

calories I took in on a normal basis every day and then

they added 1,000 calories to that. I'm gonna pick up

I guess maybe...

An extra crispy chicken breast is 500 calories and 33 grams

of fat. It's a great piece of chicken, I'll admit that. They

serve it with the little biscuits. One biscuit at 180

calories and 8 grams of fat. Now that I'm aware the

fact that it's 33 grams of fat, I don't think I would be

as eager to grab the chicken.

You increased your LDL cholesterol, the bad cholesterol,

by 14% and you increased your triglycerides by 33%

after gaining this 5% of body weight over such a short

period of time. Your liver fat went from 3.9% up to 10.2%

and you can see this peak much higher. That's 160%

increase in liver fat content. This is 5 pounds of fat and

you literally gained 10 pounds of fat. So you actually gained

2 of those fat models by that small 5% weight gain which

you did over really a period of a couple months.

Pretty disgusting.

Body fat is not an inert dead tissue. It's alive, acting tissue.

It's not just the volume but this tissue has metabolic function

that can cause harm. Now the good news is that the smallest

amount of weight loss is needed to improve your health. A

5% or 10% weight loss can have significant benefits on your

metabolic health. These are microscopic pictures of a liver

from a lean man, an extremely obese man, before and after

massive weight loss. You can see in this lean person that the

liver cells are pink and very tightly packed; whereas, in this

very obese person there's a lot of white open circles which

consist of fat inside of those liver cells. Almost half of this

person's liver is comprised of fat. But once this obese person

loses weight, their liver has returned completely to a normal

architecture.

About 30% of adults in the United States have fatty liver disease.

So this is not a simple issue. This is a very complicated problem

that involves a large number of people in the United States.

We know that when we begin the weight loss process, you'll

very, very rapidly reduce the fat content of your liver. In fact,

we found that 48 hours of calorie restriction causes a 25%

reduction in liver fat content.

Following the study when you start the weight loss program,

Doctor Klein's office worked with me and we charted everything

I ate and we talked about it and we got into a plan of eating

mostly lean meats, fruits and vegetables, and whole grains

and as soon as I started doing that, the weight started coming

off and all of my statistics went back to where they were

when I started. I didn't want another hamburger. I didn't

want another piece of fried chicken. I didn't want another cookie.

I didn't want any of it. I found out that with only a 5% weight gain,

a person who has a genetically healthy disposition is at risk

also. So even though I considered myself always to be a normal

person and never that much over weight and never that unhealthy,

going through all of this taught me that it's almost like you're

at the line waiting to go over the edge.

This is a serious medical problem that we need to address because

this excess fat in the liver is driving a lot of these abnormalities

that are associated with obesity. Not just in adults but also in our

children.

What obesity has done as it's moved in this wave through the

population is to create right behind it a wave of chronic disease.

Obesity causes an enormous number of health problems. There's

hardly any part of your body that it doesn't harm. It increases

your risk of cancer. It increases your risk of joint problems.

Our bodies were not designed to carry 2x our body size. So

there's consequences.

Arthropathy, that's a fancy way of saying joints that hurt. And

joints that hurt, hurt more when you carry too much weight around.

Obesity negatively affects the function of the human brain.

The higher the problem with obesity, the less the activity

of areas of that brain that are extremely important for

cognitive operations.

The list goes on and on and on. Gall bladder disease, liver

disease.

People individually with obesity are much more likely to

have diabetes and diabetes they may have foot infections

that fester and don't heal and so requires amputations

and may develop blindness and may develop kidney failure

which leaves them tethered to a dialysis machine for the

rest of their lives.

What is this doing to ourselves as a nation? This is really

having an enormous implications.

Diabetes follows obesity as night follows day.

I always thought when they talked about someone being

overweight and that caused this and then it caused that,

I thought they meant being huge. Well, we weren't huge

but we were overweight. And it just takes a little bit of

overweight to hurt the heart, to start the diabetes, to

lose a toe, then to have to have bypasses in the leg and

trying to save it and then losing a foot.

He's found out just how much he can do and what

he can't do.

Diabetes just means high blood sugar. Type 1 diabetes

means you don't have enough insulin to run your body's

functions.

Type 2 diabetes says I have plenty of insulin, but it's not

working well at the level of the cell. So the level of insulins

high but the ability to clear sugar into say fat is lost.

Therefore, the blood sugar rises. Makes you sick.

We understand much better than we have in the past

what are the risk factors for developing type 2 diabetes.

The one that everyone is most acquainted with of course

is obesity. Increasing weight and it doesn't have to be that

you become obese. It can be even at lower levels of

weight when you go from being 2% overweight to 5%.

That increases your risk substantially.

You were in football and then you were to Boston college.

This is my Boston college graduation picture and I've put a little

bit of weight on there.

This was 30 years ago. So you were just about 42, 43 in that picture.

This probably shows as heavy as I was. You can see it in my face.

And it seems like I mean as we get older and we gain 3 pounds,

well that's not very much and we think we don't have to worry

about it but at the end of ten years, 3 pounds a year is 30 pounds

and that's huge.

Somehow obesity especially in the abdominal area makes you

resistant to your own insulin. So what happens? Your pancreas

is now really trying to keep up, trying to make more in order

to keep your blood glucose from rising too high. Ultimately,

it gets exhausted and the cells that are making the insulin

are now themselves sick because of being overstimulated

and then diabetes ensues.

If you look at a study called the nurse's health study in which

they took nurses back more than 20 years ago, asked them

how much they weighed and if they didn't have diabetes at

that point, they then followed them over something like

15 years and for those nurses who had a high BMI, body

mass index, which was in the obese category they had a risk

that was between 50 and 100x higher than women who

were thinner at that time.

We could've eaten better and we could've done a lot of things

better if we knew what it was leading to, to diabetes.

You don't have to have steak and roast beef and all those

things that we used to like. We don't have anymore. Fish

is wonderful. Chicken is wonderful. And that's pretty much

where we stand today.

So you got some early cataracts that make it a little bit

difficult for me to see absolutely clearly in there.

Diabetes affects the vessels and it affects the vessel

supplying the eye, the vessel supplying the kidney,

maybe the vessel supplying the nervous system. Those

are the small vessels and then it also affects those

medium sized vessels that supply circulation to the heart,

to the brain, and to the legs. So the periphery.

Now let's get to where the action has been. I'm gonna

take a look at the foot and this is where the problem has

been on the bottom of the foot here right?

Peripheral nervous system is what gives you sensation so

people with diabetes who suffer from peripheral

neuropathy means that they don't feel their toes as well.

They don't have the same sensation to light touch or

temperature and their feet therefore are very vulnerable

to various kinds of trauma.

You don't realize all that can go wrong when you are

a diabetic. In 2010, January actually it was New Year's

weekend and he woke up about 3 in the morning and

his foot had mushroomed to twice its' size. We called

his primary care doctor and he said get in immediately.

I'll have the vascular team set up. Which he did in the

emergency room they took a look at his foot and said,

if it's between your life and your foot, your foot goes.

I want to take a look at the stump. Can you get that off okay?

That slips right out. Okay. And that's one of the problems is

that with a diabetic foot because the circulation is reduced

the bacteria kind of get their way in, it looks like an innocent

little infection. Not unlike sometimes what this looks like...

There is this risk that we know of that 50% of people with

an amputation on one side will get an amputation on the

other side within about 5 years or so.

In the U.S. at this point in time, there are approximately 24

million people with type 2 diabetes. Of that group, there're

about 5 million of 6 million who haven't been diagnosed

and we know that from having done screening programs

where we pick up cases of diabetes where the people didn't

know it so something on the order of 19 million or so

with diagnosed type 2 diabetes and another 5 million

or so with undiagnosed diabetes.

This has slowed us down but what's not gonna keep us

slowed down.

I think we have to work at it every day or else I think you

have a tendency to just die. And I mean we got grandchildren,

we both have grandchildren we want to see and things like that.

Too much in life that's important to us just to give up.

You forgot our wedding picture.

This was 1968.

Happy Anniversary in June.

Among the health issues that are confronting this

country and now increasingly the world, this could

be the number 1 issue both in terms of human misery

the severity of the disorders that are consequent to it

and the cost of this enormous problem which is only

gonna get bigger.

We're living in somewhat of a damaged control mode where

we're waiting for people to get sick, hospitalized, diabetes,

stroke, cardiovascular disease, cancer and then we're

investing enormous amount of money in trying to mitigate

the chronic disease state. That's a huge drag on our economy.

Someone who's obese costs on average more than $1,400

to care for more than someone who's not obese. Someone

with diabetes costs on average $6,600 more to care for

per year than someone without diabetes. Collectively,

obesity costs about $150 billion a year.

Out of that almost $150 billion a year, about half those

costs are paid for by public funds, Medicaid and Medicare.

If you look at the skyrocketing healthcare costs in the

United States which we don't have solutions for. Whatever

competitive position that we have in the world will only

be weakened by this overweight problem that we have.

We're going to have a productivity crisis. We're going to

have an employer-employee crisis. We're going to have

people say I'm not sure that I'm going to manage my

bottom line business system if I don't have fit employees.

One of the things businesses are doing is increasing

the premiums for obese individuals and even North

Carolina state employees if they're obese now pay

higher rates. Alabama employees pay higher rates

if they're obese. Private sector firms are doing similiar

things but in fact some are saying you know what

it's just too expensive and they're moving their sites

to India or China for cheaper labor and basically offloading

the cost entirely.

What type of nation can live without a work force that

is healthy? So what diabetes and obesity is doing to this

nation is crippling the workforce. But beyond that crippling

the families and the individuals and the communities.

27% of young people trying to get into the military cannot

get in because they weigh too much.

That affects the productivity in the military but think about

that affect for police forces and fire departments and

work places around the rest of the country.

What is this doing to ourselves as a nation? This is

really have an enormous implications.

I gained about 150 pounds. I don't want to live

like this anymore.

If I set my mind to it, I can do almost anything. Why

can't I solve this problem?

What can I do about it?

I need to find something that works for me.

When it comes to fighting obesity, what is the

best thing that I can do for me and my family?

Soda and other sugary drinks are the number

one source of calories in our diet.

It's really not just about what we're eating. But it's

about what is eating you.

You can separate out environmental factors from

genetic factors.

People who are overweight or obese and people

who already have diabetes doesn't mean that the

game is up.

We've got to start somewhere.

Physical activity really is the wonder drug.

It's a lot of hard work but it's worth it.

The pay off is huge. I'm just an ordinary person

who does a whole bunch very, very tiny ordinary

things that together are extraordinary.