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A Surgeon General’s Opinion: Obesity Is America’s #1 Health Concern

In my quest to bring the best possible health advice to the Revolution Health community I am actively pursuing interviews with credible sources. At the top of the list is America’s #1 doctor, the Surgeon General. I recently had the opportunity to sit down with Vice Admiral Richard H. Carmona, M.D., who served as Surgeon General from August 2002 to August 2006. He addressed a range of health issues facing Americans today. I am posting the interview in segments; the following post is part of that series.

Dr. Val: Obesity rates continue to rise each year. Does obesity lie at the core of the chronic disease crisis and if so, what can America do to reverse this trend?

Dr. Carmona: Obesity is absolutely at the core of the chronic disease crisis. When we look at the relationship of obesity to other diseases that plague society today (such as asthma, cancer, cardiovascular disease, and diabetes) obesity increases the incidence of each of them, and can even accelerate some of them. Losing weight is not about trying to emulate models in fashion magazines, it’s about being healthy.

If we could only address one major public health issue as a nation, I would focus on the obesity crisis. Weight loss could have the greatest impact in decreasing the chronic disease burden in America.

Dr. Val: So what can we do about obesity?

Dr. Carmona: That question is simple on the surface but incredibly complex when you begin to analyze it carefully. First of all we have to identify the variables that contribute to this problem, because it’s a multi-factorial issue. The socio-economic determinants of heath are inextricable from the health status of individuals and communities. That means that if you’re poor and have less education, you’re going to experience health disparities. You can’t afford to buy healthy food, you don’t live in a neighborhood where you can walk at night and get exercise, and so on. So understanding all the determinants of health to address obesity is important.

Let me describe just one significant variable contributing to the obesity epidemic: the sedentary lifestyles of children. Thirty years ago it was commonly believed that physical education in school was not important, because kids played during all the hours that they are out of school. Parents reasoned: ‘Why should I pay a teacher to have my kids play ball at recess? I’d rather have her teach them math and science.’ So there was a sweeping trend to discontinue physical education at school. Now, however, kids spend too much time on playstations rather than on play grounds – or they watch over 4 hours of TV a day. They’re sedentary at school and at home.

Other variables that influence obesity rates in kids include the accessibility to fast food, the increased rate of single parenthood, and the change in cultural traditions around meal time. For wealthier families, easy access to large volumes of food of every possible kind can create an environment where people overeat.

The solution to the obesity crisis is not “one-size fits all.” The approach to obesity must be tailored to the cultural and socio-economic sensitivities of the sub-population that you’re trying to reach.

Ultimately we need to change behavior – walk a little more, eat a little less, buy some healthy foods. But targeted interventions must be culturally sensitive and socio-economically relevant. For example, the government is funding programs to make healthy foods more accessible to underserved areas, and physical activity programs are being reinstated in schools. But the effects of these programs are not going to be seen for many years because it takes time for the culture to catch up. Also, the approach must be comprehensive. If we were able to get all of our children enrolled in a daily game of baseball (to increase their physical activity), that would not solve the problem of fast food and video games.

There needs to be a community approach, so that no matter where the child turns they’re getting positive reinforcement of healthy behaviors. That’s part of what I’m doing with the national non-profit health organization that I’m president of now – Canyon Ranch Institute.


The Surgeon General series: see what else Dr. Carmona has to say about…

Cost Savings Associated with Preventive Health

Consumer Directed Healthcare and Health Literacy

Complementary and Alternative Medicine

Preventing Chronic DiseaseThis post originally appeared on Dr. Val’s blog at

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5 Responses to “A Surgeon General’s Opinion: Obesity Is America’s #1 Health Concern”

  1. Jon says:

    Great post, Val, and I love this series with the former Surgeon General. I have never heard the obesity problem described as it is here. It’s very insightful.

    Anyone else who enjoyed readying: Digg this post


  2. Anonymous says:

    The only thing in this that is true is that children being more sedentary has been a factor in some cases of children weighing more on average than have children in past years. However, there are so many differences in what and who was measured and how lifestyles have changed over the years, that even this is a tenuous connection. The rest of this is pure cultural bias and the dogma du jour.

    Where are the studies that obesity, per se, causes death? The last time some health “authority” made the pronouncement that obesity cause X number of premature deaths, they were forced to retract their alarmist statements. Funny, how these alarms are always spread far and wide, but the correction is whispered quietly and not really heard. What about the fact that the constantly changing definitions of obesity and some other conditions, such as what contstitutes abnormal blood sugar levels, automatically pushes more and more people into these categories?

    There is no proof that losing weight significantly affects a person’s mortality. It may change certain markers established by the medical profession as indicators for health, but it does not lengthen life. There is an association between obesity and certain conditons, but that is not proof that obesity causes them. What if it turns out that the condition causes the obesity? What if it is a matter of increasing weight being associated with increasing age, because we know that aging is the #1 risk factor for many diseases?

    A guy won the Nobel Prize for showing that there is a critical mass of belief. That is, that after a certain percentage of the populace believes something to be true, the idea becomes established as orthodoxy. Proof is not required. This is just as true in medicine as it is anywhere else, and doctors, in spite of their scientific background and intelligence, are not immune to this phenomena. 

    What I would like to see on this issue and many others is complete objectivity. If people would stop their obsession with the notion that obesity is the modern equivalent of the black plague, then perhaps we could find some real answers. Ironically, the one truly established ill effect of being overweight (whatever that exactly means) especially in children, is the psychogical distress caused by social ostracism. Having the medical profession running around like Chicken Little saying we have to do something about this “crisis” only adds to the pain of parents and children who are deemed by society to be somehow defective due to their appearance.

    Finally, when someone says “there needs to be a community approach”, I start envisioning fat gulags for hapless chidlren who, mainly doomed by genetics, weigh more than what society says they ought to weigh. Oh yeah, and hold onto your wallet. Can lawmakers be far behind eager to throw money at the problem?

    Yes, there are kids who are suffering from diseases that coexist with weight gain, but where is the proof that any sort of intervention makes a lasting difference on weight? Where is the proof that losing weight actually improves their health or life? What if the weight loss causes other health problems, mental or physical? Where is the proof that weight loss can be sustained by most people permanently?

    Why do I have the feeling that many of the doctors engaged in this crusade never had a weight issue in their lives? I sometimes wonder what would happen if that magic pill was invented that would allow everyone to be slender, then what would slim people do when they were deprived of their sense of moral superiority over those not as fortunate in their “choice” of ancestors?

    It is time for truth and scientific objectivity. Just as in the recent case where statins were shown not to affect what really matters when it comes to heart disease, we need to look at all medical issues minus our prejudices. And whenever someone starts talking in terms of epidemics without germs or crusades against the latest societal boogie man or yelling “We have to do something!”,then I know that objectivity flew out the window.

    BTW, there is NO proven association between the availability and consumption of fast food and obesity in children. Zip, zero, nada. If you want to say, “I don’t like the idea of kids eating fast food.”, I can accept that. But that is merely an opinion; not  a fact. If you have some proof that consumption of fast food causes overweight (again, whatever that means exactly), I would like to see it.

  3. PearlsAndDreams says:

    My only issue here is … if he is going to latch obesity to chronic illness, then diseases that are chronic and not related to obesity but genetic …autoimmune, muscular dystrophys, CF, and a the like …need to have a whole new classification … OR … diseases that are related to obesity like diabetes, heart disease, osteorthristis etc … need to not be called CHRONIC illnesses (because, they have more preventative, treatments more ability to resolve than the autoimmune, CF etc)

    There is a vast difference in lupus/rhematoid arthritis type arthritis and osteo arthritis ..both in cause and effect … yet they are both called Chronic Disease.

    When someone like the Surgeon General says “Chronic Diseases could be prevented” people, like my father, or sister for that matter, who choose to stay uneducated, think “well, you could get better if you would only ….”

    They don’t see the distinction between diabetes and lupus … because they are both chronic illnesses. Even though the SG qualified ‘most’ and said what he sees as chronic illnesses that could be …

    it still is a ‘sticky wicket’ for those of us dealing with these autoimmune diseases and other illnesses that are genetic in nature, rather than lifestyle.

  4. Anonymous says:

    hello mam…my weight is increasing just after taking water also…i have joined gym for it.also joined yoga gave me some benefit.Even i went for body therapy.but if i gat careless for even for one day…my weight increases for about 1 kg….pls help me…as i m need for it….n don’t wana grow with fat n obesity.

  5. jyotinavi says:

    hello mam…my weight is increasing just after taking water also…i have joined gym for it.also joined yoga gave me some benefit.Even i went for body therapy.but if i gat careless for even for one day…my weight increases for about 1 kg….pls help me…as i m need for it….n don’t wana grow with fat n obesity.

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