January 2010 Issue

A Unique Perspective: Dr. David Katz’s Take on Reversing Obesity in America
By Sharon Palmer, RD
Today’s Dietitian
Vol. 12 No. 1 P. 28

Catch up with what a true nutrition visionary is proposing to solve the nation’s weight crisis in this special Today’s Dietitian interview.

Imagine a nutrition conference session so rousing the packed audience erupts into a standing ovation. A speaker who is so passionate about stopping obesity in its tracks, you feel a bit ashamed for not doing more yourself. 

If you’ve been lucky enough to hear David L. Katz, MD, MPH, FACPM, FACP, speak, then you know exactly what I’m talking about. Katz is on a mission to put the brakes on obesity in America. Sure, a lot of nutrition authorities talk about reversing obesity. But when Katz speaks about it, you truly believe it’s possible. After all, he’s spent his career taking on the biggest challenge in modern healthcare.

Katz, cofounder and director of the Yale-Griffin Prevention Research Center, has garnered numerous awards for his work and has earned himself a spot in the top echelon of nutrition experts, regularly contributing to publications such as The New York Times; O, the Oprah Magazine; and Prevention. He makes routine appearances on television and has published more than 100 scientific papers and 12 books on nutrition and health. In addition, Katz has his hand in many remarkable nutrition projects, including the Overall Nutritional Quality Index used in the NuVal nutrition guidance program in supermarkets, the school nutrition education program Nutrition Detectives, and the school fitness program ABC for Fitness. His research foundation, Turn the Tide Foundation, Inc, is dedicated to advancing practical, real-world strategies for empowering American families to fight obesity.

Clearly, Katz is determined to turn the tide of obesity in this country. But with Americans’ weight continuing to spiral out of control, what will it take to reverse the trends? Today’s Dietitian sat down with Katz to discover his perspective on tackling obesity and followed up with him during a special Q & A, wherein he revealed how dietitians can play a part in the solution.

A Big Problem Needs a Big Solution
You know the statistics: Some 65% to 85% of U.S. adults are overweight or obese. The health consequences of this pandemic are grave and include an increased risk for a laundry list of conditions, such as heart disease, diabetes, hypertension, certain cancers, and psychological disorders. What’s even more disconcerting is what’s happening to our nation’s children: Sixteen percent of kids aged 6 to 19 are overweight, and health experts believe they will face some of the same health conditions overweight adults experience. We’ve been aware of this problem for a while, but despite all of the hoopla and media coverage, the country’s weight problem continues.

What’s so special about Katz’s take on fixing obesity? Instead of sweating the little stuff such as carbs vs. protein, he looks at the big picture. Katz believes obesity is simple: People gain weight when calories in exceed calories out. Despite all of the posturing over what has led to our overweight society, it boils down to a simple truth about humankind: People get fat when circumstances allow it to occur.

Our ancestors lived in a world that was scarce in calories. They generally ran after what they wanted to eat and away from what wanted to eat them. Humans adapted to withstand exertion and the threat of starvation; thus, they have no natural defense against excess calories or the lure of the couch. 

Today, we have more delicious calories available than ever before and more technology to do what our muscles used to do. Thanks to radical changes in our environment, our natural traits have put us at risk for obesity. Placing humans in this modern setting of fast-food restaurants, vending machines, elevators, and video games is like dropping a polar bear into the Sahara Desert, according to Katz. We are no more adapted to the modern world than the polar bear is to the desert. Just as polar bears would overheat in the Sahara Desert, we overeat in a sea of calories in the modern world.

One thing that hasn’t helped to curb obesity is the rise in many popular diets, according to Katz. When health experts backed the benefits of fat restriction, it served as the impetus for the food industry to create low-fat junk foods that seemed to make the nation even fatter. This opened the doors to the low-carb craze, with its own set of refined, processed junk foods.

Eating well for sustainable health and weight control never has been and never will be about deciding which of only three main nutrient classes (carbs, protein, and fat) to abandon, says Katz. Instead of focusing on how to make a healthful weight-controlling diet more accessible to all, we have continued to debate the merits of different diets. Yet, the facts about the proper dietary intake for optimal health are right there in the open. Diets rich in fruits, vegetables, and whole grains, restricted in animal fats and trans fat from processed foods, limited in refined starches and sugar, providing protein principally from lean sources, and offering fat principally from monounsaturated and polyunsaturated oils are linked to good health. In addition, the role of physical activity in weight loss is quite convincing.

The bottom line in the challenge of obesity control is not about what; it is about how. Katz poses the big question: How can we enable an increasingly overweight population to resist the “obesogenic” forces conspiring against it?

Katz proposes a few solutions. One is to reengineer the modern environment so that it does not promote obesity. The second is to better utilize human intelligence and resourcefulness and empower individuals and families with the skills and strategies necessary to resist the obesogenic elements of the modern landscape. Factors that promote obesity in our environment are everywhere—from the tasty concoctions of fat, sugar, and salt that food technologists develop to tempt our taste buds to the lack of physical education in schools.

Epidemic obesity is the consequence of a flood tide of obesogenic factors that make an abundance of calories available while reducing our physical activity. To hold back these flood waters requires a complete dam; one sandbag will not make a difference. To hold back the flood, Katz advocates for a comprehensive system of reforms in knowledge, behavior, policies, and the environment. What about physical activity in the classroom every day instead of Ritalin, insurance companies that reimburse weight management counseling, physical activity as part of the workday, food labels for dummies, sidewalks in every neighborhood, engineering time to prepare food at home, stairs vs. the elevator as a social norm, the elimination of the junk food category in the food supply, subsidizing fresh fruits and vegetables, truth in advertising and controls on food marketing, and educating families about good nutrition and physical activity? What a wonderful, wonderful world that would be.

A Q & A With David Katz

TD: Why has our modern healthcare system failed to treat obesity effectively?
DK: It’s not a criticism to point out that neither the healthcare system in general nor dietitians specifically are well positioned to fix this problem. The healthcare system is really about “disease care” and, even when it works optimally, will have relatively little to do with building health. It’s about fixing what’s broken.

Many of the chronic diseases that plague our society are propagated by obesity. We need to look at the origins of these problems. They are not in clinics or hospitals; they are in supermarkets, schools, living rooms, and neighborhoods. The foundation of health is where people work, live, love, and play. We need to build health promotion in these settings. Where are the places that people make decisions every day? How do we build policy and tools so that making a good choice is the default? I am cautiously optimistic that we can fix obesity.

Physicians and dietitians are absolutely an important part of the solution. They can offer good counseling and resources, but if people have an environment of no physical activity in schools or the worksite, have a hectic schedule, and can’t navigate past what Madison Avenue puts on food packages—you can give people good advice, but they can’t use it.

TD: In what way have dietitians failed to become a voice in reversing obesity?
DK: Dietitians are much in need, partly because eating well is not the norm and takes special knowledge and effort. If we really want people to eat well, we need to make eating well lie along the path of least resistance in our society. Dietitians can have a hand in this, but it’s not what they conventionally do. By and large, they are not trained to influence the legislation process. They haven’t learned to be a formidable advisory to schools or to found wellness committees or to lead a group of citizens for change. 

What’s called for goes way beyond the clinical model. The benefits can be enormous when you go beyond personal diet counseling to solve problems at the environmental and community level. Dietitians need a skill set to do that. For example, you can spend the rest of your career on individual advice on nutrition, but you can still fail when Madison Avenue snatches the attention away. A different solution is needed now, and a certain amount is played out on a macro level with environment and policy change.

TD: Do you think dietitians focus too much attention on nutrition science in weight loss, such as macronutrient composition, rather than commonsense approaches to weight loss?
DK: Yes, it’s a problem in dietetics, which is focused on particular nutrients instead of foods. Michael Pollan said it right: “Eat food, not too much, mostly plants.” Dietitians can feed into the problem when they focus on nutrients rather than food. The food industry can exploit that, so they can use the low-fat diet to create [low-fat junk food] or the low-carb diet to create low-carb junk food. When you focus on food in a more holistic way, it closes down the opportunities for misdirection. Dietitians should stop trying to offer diet guidance one nutrient at a time but instead talk about the healthfulness of foods in a holistic way.

TD: How can dietitians work to change the modern environment that favors obesity?
DK: There are practical changes that dietitians could propagate. For example, I’m doing a makeover for O Magazine for a woman and her family and I found that in this case, the major stumbling block for her is her kids. No man is an island, and no woman is either. Don’t focus on the individual, but look at the family. In diet counseling, there is too little attention on the family.

I devised a program, Nutrition Detectives, that makes kids part of the solution and lets kids advocate for health in the family. We are seeing significant improvement in parents and kids with this program. It goes home with kids and changes their attitudes. It teaches kids why they should care and how they can get involved. They become their mom and dad’s ally. Dietitians can quickly add this to their counseling, as it’s available online.

Dietitians should take advantage of the programs for families that are out there. Healthfinder.gov is a Web portal with links to other Web sites that have been checked out by nutrition authorities. There is a lot of information out there to help people. When you are giving good advice, kids have diet tools, there is good programming, the worksite encourages people to eat well, and we cultivate the will of the individual; we pave the way everywhere to spend a lifetime in a better environment. When everyone is on your side, it gets easier.

Every dietitian with a kid in school should make a presence in the school wellness committee. Kids are getting adult-onset diabetes; the dietitian should be clamoring for better nutrition and physical activity every day in schools. Why not agitate the local chamber of commerce to meet with businesses to make sure good nutrition and physical activity are available? Look past the individual; it’s not enough.

People need to put their feet and forks to good use. If you are health conscious, the world is inhospitable to you. Turn an environment that is inhospitable for health into one that is hospitable. We all have to be public health advocates. There is some element of volunteerism in this, but there is potential money to fund these programs. I’ve been talking to insurance executives about improving health and sponsoring school wellness programs. They are going to have to pay these kids’ medical bills, and it costs less money to pay earlier in school with physical activity and better nutrition. It’s connecting the dots. Nutrition Detectives and ABC for Fitness are free, which is why they are used in thousands of schools. Put your effort where your mouth is. Be civic minded and get involved.

TD: How can dietitians help empower people to fight obesity?
DK: The issue is skill power. If you’re going to eat well, you have to be able to reliably identify more nutritious foods that you can afford to eat and you have to know how to prepare them. What is the skill set people need to eat well? We talk a lot about willpower but not skill set. That’s a good job for the American Dietetic Association—to determine what the basic skill set is for someone to get the job done and then how to give it to everyone. In my work, I’m looking for shortcuts to get past the hype, so we created a guidance system called NuVal to help people identify more nutritious foods. For example, dietitians can teach people how to create more nutritious menus, to make better food choices, and how to put foods together. A shortcut could be supermarkets that feature all of the ingredients clustered together to make a nutritious family meal in half an hour. What role can the dietitian play in this?

The issue is empowerment—you give people the power to leave will out of it. They need skills like knowledge about nutrition, how to read nutrition labels, and how to put it together in the kitchen. These skills are actually a big list. If you don’t address all of them on the list, then you are halfway to nowhere. You need to think of it that way. Some changes are easily taught and others are a change in the environment.

TD: How can dietitians motivate people who don’t seem to want to change?
DK: I think the word is getting out more and more and that people understand. They are appalled, especially about obesity in children. More and more people appreciate how acute the problem is. Children are getting adult-onset diseases; we are going to see heart disease in teenagers if we don’t get our act together. The costs of obesity will completely destroy our economy. People understand how much good can be done by living well. We live in a very medicalized society treated by “big pharma” and “big health,” but what people eat is far more powerful than pharmaceuticals and surgery. People give a lot of power to the health profession, but the physician’s role in health is vastly smaller than if you live well.

People are in the driver’s seat for health. No. 1 is cultivating the will, and No. 2 is cultivating the way. People need to put their feet and forks to better use every day. Start there—I’ve heard it, I believe it, I am impassioned, I have a will, now here it is. If you cultivate the will and pave the way, I think we can do it.

To learn more about Katz’s work, visit www.davidkatzmd.com. And to view the full text of Dr. Katz’s poem Back to Our Nutrition Future (also known as Polar Bears in the Sahara), click here.

— Sharon Palmer, RD, is a contributing editor at Today’s Dietitian and a freelance food and nutrition writer in southern California.