Fit: Up to Bat to Fight Fat

THE BIGGEST THREAT to America, according to former surgeon general Richard Carmona, pictured right, is our waistlines. As our nation's girth grows, so do the medical bills for preventable diseases. But what can be done to slim down society? Carmona swung by George Washington University last week to speak on behalf of the STOP Obesity Alliance and stayed to answer questions about America's portly problem.

» EXPRESS: In your view, what kinds of programs are successful?
» CARMONA: How do you define success? If you take an obese person who wants to lose weight, that amount will be very different from what a physician wants. He says, "I want to look like that guy in the Speedo." But as doctors, our first priority is getting rid of risk factors.

» EXPRESS: But aren't good looks more persuasive than good health for most people?
» CARMONA: One size doesn't fit all. If you're speaking to a young lady who's overweight, for her, it's an image issue, even if I'm worried about her having a heart attack in 20 years. For a parent, it's: Do you want to be able to play ball with your son?

» EXPRESS: What are the political difficulties in making obesity a government priority?
» CARMONA: It's hard to get traction because obesity isn't sexy. When I was working in critical care, everyone wanted to know about the next gunshot wound. But where are the cameras when you immunize 10,000 children? "ER" is so popular, but where are the public health television shows? The government has to be aware of this issue being a major health challenge with national security and work force implications.

» EXPRESS: How much can the government regulate obesity, like with the trans-fats ban in New York?
» CARMONA: My sense is that I wouldn't like to live in a nation that's going to regulate my behaviors. Empower me, change the culture. Smoking is now socially ostracized. If you walk into a smoke-free zone with a cigarette, everyone's going to look at you like you have three heads.

» EXPRESS: What can the public health community learn from smoking when dealing with obesity?
» CARMONA: Smoking is still the number one cause of preventable death, but certain groups are smoking less — it's one out of five adults nationally. And smoking isn't cool anymore. There used to be Joe Camel, and all of the TV and movie heroes smoked. To make it uncool took decades. But it's illustrative that we have to create the same environment around obesity.

» EXPRESS: But people know obesity is bad. No one wants to look fat, and no one wants to be unhealthy. How do you go beyond those messages?
» CARMONA: People hear, but they're not listening. People who can't fit into their pants think, "It's OK. I can still walk." It's still an epidemic, and it's a growing concern. We're hoping over time to resonate with the public. A lot of diabetes goes away when people lose weight. Quality of life goes up.

» EXPRESS: What do you think of reality TV's take on obesity — "The Biggest Loser," "Fat March," etc.?
» CARMONA: I'm a little ambivalent about it. It's good we're putting this issue out there. But if it's purely for entertainment, it's an embarrassment. If, however, people watching these shows start to model the behavior they see, it's a vehicle for health literacy.

Photo courtesy STOP Obesity Alliance