JIM GLASSMAN:
(MUSIC) Welcome to Ideas In Action, a television series about ideas and their consequences.  I'm Jim Glassman.  This week, obesity in America.  It's no secret that Americans are fatter than ever.  It's an issue getting a lot of attention in Washington these days.  But what role should government play in trying to help people slim down?  Joining me to discuss this topic are Dr. Scott Kahan, co-director of George Washington University's Weight Management Program and faculty member of the Johns Hopkins School of Public Health.  Justin Wilson.  He's a Senior Research Analyst at the Center for Consumer Freedom where he focuses on food and consumer issues.  And Penny Lee, Executive Director, The Campaign to End Obesity, a group that advocates for federal policies to reverse the growth in obesity, and to promote healthy lifestyles.  The topic this week:  Responding to America's obesity crisis.  This is Ideas In Action.
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JIM GLASSMAN:
60 million Americans including more than a third of all adults are now considered obese.  Obesity has been linked to Type 2 diabetes, high blood pressure, heart disease, stroke and depression.  The cost of annual medical care for an obese person is 42 percent higher than for someone who is not obese, driving up the cost of health insurance.

But how should we beat obesity?  Should it be classified as a disease, and should the government mandate that insurance companies cover the cost of weight loss programs?  Should consumers pay a tax on food and drink that the government believes contribute to their growing waistlines?  In short, what is the role of government in confronting the obesity epidemic?  Penny, why is it that the obesity epidemic seems to be growing?
PENNY LEE:
Well, we have had for many years now, unfortunately, an energy imbalance.  We have considered-- we have continued to take more energy in, and not expelling enough energy out.  A lot of it has to do to our environments-- some of it is our own habits.  We have seen progressively year after year, a more sedentary lifestyle.  We have seen in American culture that, you know, we love-- having grown up-- or having spent some time in Texas, we love the super-size.

We love having as much as we can eat, to do as much as we can.  The bigger, the better.  But unfortunately, as we all know, we can't have everything, and we can't have it all the time.  And so we can't continue just to take and-- intake and intake without expelling some of that energy.  So, for the most part, in the simplistic-- way, our energy is out of balance right now.
JIM GLASSMAN:
So by energy meaning calories?
PENNY LEE:
Calories in.  We're taking too much in, and we're not expelling too-- enough out right now.
JIM GLASSMAN:
Justin, how concerned are you about this?  Do you think that-- obesity is a personal lifestyle or is it something that the government ought to be concerned about?
JUSTIN WILSON:
Well, there's two different takes about what is causing obesity.  One side believes it's a toxic food environment, to quote one of the primary researchers on this.  This notion that we can't seem to survive in this environment of food.  And the other side says that it's changes in the way we're responding to the environment.  The, sort of, lack of personal responsibility given the changes around this.

I think it's an interesting way of thinking about obesity as, sort of-- a result of civilization.  You know, we have gone from being hunters and gatherers.  Or, you know-- Middle Age serfs to being what we are now-- sitting behind a computer desk and just typing away in a relatively short period of time.  And it's gotten to the point where, I think, we are not responding to our environment, and we're not really taking personal responsibility for ourselves.  Because, really and truly, that is the only reason why we're putting on weight.
JIM GLASSMAN:
But it's costing all of us when somebody else is obese.  So shouldn't it be something that the government should worry about?
JUSTIN WILSON:
Well, I think you've made a fantastic argument against any kind of single pair health care program.  But I also think that you've opened the door to a question that most Americans are not really interesting in answering, which is:  Should I be for-- you know, can-- should anything be allowed to be regulated if it's-- you know, has a so-called cost on our neighbor?

I mean, the sort of policies that fit under that rubric of policymaking are really troubling.  You know, we can start with obesity.  But we can move to padded sidewalks and speed limits of five miles an hour.  And, you know, obviously this is a little bit absurd.  But it's a slippery slope that I think has got legitimacy.
JIM GLASSMAN:
Now Scott, you think that obesity or fighting obesity ought to be a top national priority?
DR. SCOTT KAHAN:
Should be one of them.  Certainly.
JIM GLASSMAN:
And why is that?
DR. SCOTT KAHAN:
Well, obesity is the major epidemic of the 21st century so far.
JIM GLASSMAN:
Is obesity an epidemic or are the diseases that are the result of obesity the epidemic?
DR. SCOTT KAHAN:
Both-- certainly obesity causes a number of chronic diseases that ultimately can cause premature death-- disability and so forth.  But obesity itself, I believe, is a disease and-- should be classified as such.
JIM GLASSMAN:
So let me ask the same question I asked Penny.  Why is that people are-- are much fatter?  I mean, she says it's because we take in too many calories, and we don't exercise.  But-- but why-- why do we take in more calories, and why don't we exercise?
DR. SCOTT KAHAN:
And that's exactly the point.  So there's many drivers of why we eat, why we exercise or move-- of all of our behaviors.  And many of-- our behaviors are being strongly driven by the environment that we live in.
JIM GLASSMAN:
So is there a legislative fix for this?
PENNY LEE:
Well, I mean, there are many different things that we can do to improve.  We can-- you know, it used to be that, you know, back in your-- my father's day or grandfather's day for that matter, you know, people-- walked to school every day.  Or there was a safe environment in which they could.  Now you don't have that anymore.  You load up on buses.  You load up on-- your parents take you in.  So-- there's transportation environments that-- yes, legislative we can do.  We can make safe routes to school.  We can make, you know, things-- easier and safer ways in which people can engage or kids can engage in-- in playgrounds--
JIM GLASSMAN:
But you wouldn't say--
PENNY LEE:
--At school.
JIM GLASSMAN:
--That-- that kids shouldn't take a bus to school--
PENNY LEE:
Oh no.  No, no--
JIM GLASSMAN:
--Or that the government should say--
PENNY LEE:
--No.  No--a--
JIM GLASSMAN:
--"No more buses?"
PENNY LEE:
--No that's not what I'm saying.  I'm just saying they should have an alternative, though.  If there were ways in which, you know, you can move safely.  Right now, there's some places you-- you can't.  So legislatively, there's transportation things that we can do.  There's-- things in as far as nutritional standards that we can increase.

We can make it easier so parents know what actually is in the products that are in their foods.  We can make labeling on our food products more accessible, more easier to read, more-- better to understand so they can educate them.  You know, right now, you know, back in the 1950s, one hamburger was around 1.5 ounces.  We now celebrate the 12-ounce burger or the 15-ounce burger, for that matter.  You know, people don't understand what--
JIM GLASSMAN:
What-- a five-- that's a tenth of a pound?  A tenth-pounder?
PENNY LEE:
In the 19's 50 (?), your average hamburger was 1.5 ounces.
JIM GLASSMAN:
So--
PENNY LEE:
And so there's different things.  So we need to educate, and that's what legislative we can do.  There's certain things.  Again, in transportation, in the nutritional field, in the health care field, that we can educate people, and-- and make it better for them.
JIM GLASSMAN:
But-- it's hard for me to believe, you know, ask Justin this question.  It's hard to believe that people don't know that eating pizza or eating ice cream or eating, you know, or drinking lots of soft drinks makes them fatter.  They don't think it makes them thinner?
JUSTIN WILSON:
I don't think that there's a lack of education on what it takes to lose weight.  I think there's a lack of will.  I think there's a lot of people who are putting on weight.  And they say, "You know what?  The-- the tradeoffs are not worth it.  I'm willing to make this decision."  And I think, you know, it doesn't take a Ph.D. in nutrition to understand what it means to be on a diet, and how to keep the weight off.

And everyone recognizes it's eating fewer calories, and getting more exercise.  But what frustrates me about the discussions that are going on in the government is that we're losing track of this notion that people should be able to make the decision for themselves-- you know?  People are advancing this argument.  "Well, we're all paying the cost of obesity, so we should all be able to regulate each other, into a thinner nation."

All of the policies that have been proposed or implemented so far have failed.  And it's not me saying that.  That's Kelly Brownell from Yale University.  And it becomes frustrating that the response instead is:  We need, you know, not to rethink it, and readdress personal responsibility, but we just want more government-- intrusion into what I think is the private health sphere.  This notion of, you know, what two consenting adults eat in their kitchen is their business is being lost as we walk down the road of more and more government intervention.
JIM GLASSMAN:
Is it true that lots of people, including physicians, don't understand the basics of nutrition?
DR. SCOTT KAHAN:
Yeah.  And why should they?  They're not taught it.  Physicians aren't taught about nutrition in medical school.  I mean, I literally did not get even one hour of nutrition training during my four years in medical school-- it's hard to believe.  On top of that, as much as it seems likely that most people out there, most lay people out there learn about nutrition, know about nutrition, it has not been my-- my experience.  I have many patients that come into my office.  They're doctors.  They're lawyers.  They are accountants.  They're very well educated people.  They have tons of willpower in every area in their lives.  They come in, and they don't know the basics of nutrition.
JIM GLASSMAN:
So what don't they know?  Give us a fact that you-- you would-- people would really be surprised to learn about nutrition?
DR. SCOTT KAHAN:
Well-- well-- I-- I had a patient that came in-- not too long ago.  He's a lawyer.  Very smart guy.  He comes in-- very much-- dejected about where he is in terms of his weight.  And before he left my office after the initial-- interview, he said, "So what should I eat tonight for dinner?  You know, usually I have pizza.  Is that healthy?  Should I eat that?  I don't know.  Should I have a salad?"  So, you know, some of these things, they seem inevitable.  But we don't learn this stuff.  Do we--
JUSTIN WILSON:
I mean-- I mean-- I think--
DR. SCOTT KAHAN:
--Ever teach this stuff in school?
JIM GLASSMAN:
Justin?
JUSTIN WILSON:
First of all, yes.  There's ever-- every state in the country requires health education.  And-- pretty much every standard health education does require that.  Now I-- I think that when it comes to talking about obesity, we need to talk about health classes.  We need to talk physical education classes.  We need to talk about, believe it or not, home EC classes.

Why don't Americans learn to start cooking again?  And at the same time, the idea that someone doesn't know the difference-- you know, I always say a banana and a banana split is, sort of, beyond me.  And at that point, I recognize that, "Well, they say they want to lose weight."  If they are saying, "Well, I just don't know."  It's-- it's an excuse, which is also why it's so troubling that we're trying to redefine obesity as a disease.  You know, it becomes so easy for people to, then, just say, "I'm sick.  I need help, and I can't do this on my own."  To become dejected.  Because in the end--
PENNY LEE:
They do need help.  But they do need help.  I mean--
JUSTIN WILSON:
But I--
PENNY LEE:
--If someone is-- is suffering and struggling with obesity, they need help.  And they need-- preventive and-- and treatment for it.  You can't just say, "Oh sorry, you're on your own."  I mean, that-- that hasn't worked.  So things do need to be addressed in prevention and treatment--
JIM GLASSMAN:
Let me ask--
PENNY LEE:
--Do need to take place.
JIM GLASSMAN:
--Scott about that.  About do you-- provide counseling to people both psychological and informational?
DR. SCOTT KAHAN:
We provide nutrition information.  We provide psychological counseling.  We provide group counseling.  We provide medical treatment.  We-- we try to provide as much as possible comprehensively-- to help people manage that.  At the same time, it's expensive.  I mean, we have a number of doctors and Ph.D. psychologists and dieticians on staff.

And it's an incredibly expensive intervention that very few people can afford.  We have, you know, 100 million people out there that are obese and overweight.  Well, actually much more-- and-- the tiniest fraction of that, far less than one percent, can afford an intensive intervention like what we give.
JIM GLASSMAN:
Well-- let's talk about legislative interventions.  What-- what do you favor?  I mean-- would it be a good idea to have-- a big tax on soft drinks, for example?  Or on pizza or on ice cream?
PENNY LEE:
I-- we have-- I am not for the taxation of-- as it, what they would call, sugar-sweetened beverages.  I mean, we still don't know exactly if the companies were just going to diversify their-- their cost, and spread it down to the consumers, whether or not it has a regenerative-- or-- an impact on lower-incomes.  You will also have-- cases where you have chocolate milk-- you know-- strawberry milk that actually has higher sugar contents than actually-- a can of Coca-Cola.  So there's still, I think, some more research that needs to be done on--
JIM GLASSMAN:
So what-- what--
PENNY LEE:
--Exactly what--
JIM GLASSMAN:
--Can be done?
PENNY LEE:
What can be done?  I mean, for-- first of all, I mean-- I think that we need to have BMI as a vital sign.
JIM GLASSMAN:
BMI is--
PENNY LEE:
BMI is your-- is--
JIM GLASSMAN:
--Body mass index.
PENNY LEE:
--Body-- body mass index.  To be able-- so people know.  I mean, right now, you know what a bad-- cholesterol level is.  You know what your heartbeat should be.  We should make BMI a vital--
JIM GLASSMAN:
Do you know your BMI?
PENNY LEE:
I do, actually.  (LAUGH) I'm not going to say it here on air, but yes I do know what it is.  And there's-- there's standards.  And so people are aware if they're getting close to a number, that they should, maybe, you know, adjust their lifestyle.  They either exercise more or eat less, so that we know.  We can see, especially with kids, this is where it's really important to make sure that they know, kind of, where they stand, so that they can be in some corrective treatments early, so it doesn't progress into some of the later diseases that we've seen.
JIM GLASSMAN:
What-- what about menus?  Should there be a requirement that all menus-- have the caloric content or the fat content of dishes?
JUSTIN WILSON:
I think it's an interesting question.  But--
JIM GLASSMAN:
That's why I--
JUSTIN WILSON:
--Well, no--
JIM GLASSMAN:
--Asked it.
JUSTIN WILSON:
--Of course.  (LAUGHTER) Of course.  Because it's-- it's unclear if it actually accomplishes anything.  People say they want information, and I'm the personal responsibility guy here.  And I think people should be able to make informed choices.  But in terms of its actual ability to reduce obesity, and so far the results have been mixed.  And those that seem to have had some, in fact, it's been relatively minor.

I think, to a certain extent, there needs to be flexibility.  'Cause there's operational difficulties for restaurants.  I've been to some restaurants in New York where, I mean-- it looks like an Excel spreadsheet, (LAUGH) trying to figure out between the calorie counts and the price.  And in Philadelphia, they want to have calories and salt.  They want to have trans fats and grams of-- saturated fat.
DR. SCOTT KAHAN:
Actually that's just on the menu, not on the menu board.  So it's--
PENNY LEE:
Right.
DR. SCOTT KAHAN:
--Much-- it's easy enough--
JUSTIN WILSON:
Well, just in Philadelphia.
DR. SCOTT KAHAN:
--To discern-- right.
JIM GLASSMAN:
And you're-- you're-- you're in favor of-- of that--
DR. SCOTT KAHAN:
I am very much for--
JIM GLASSMAN:
--Of a rule--
DR. SCOTT KAHAN:
--A number of reasons.  First-- first of all, we talk about personal responsibility-- but we have to help people be responsible.  If they don't know about how many calories are in things, if they never learned about-- nutrition in school, they're not going to be able to make-- personal decisions.

So I think having them on menu boards or on menus-- is certainly effective.  I would also say that there's been a number of studies in this, and the studies are very, very, very positive.  There has been one or two that haven't been all that positive, but that's the way it is with studying any--
JUSTIN WILSON:
Well, I mean, yeah--
DR. SCOTT KAHAN:
--Any--
JUSTIN WILSON:
--Right.  If you look at all of the studies in totality, there has been, what, two or three that have said that it's had small changes, and two or three that have said it has not--
DR. SCOTT KAHAN:
There have been seven or eight--
JUSTIN WILSON:
--Had changes.
DR. SCOTT KAHAN:
--That have showed-- small changes.  And--
JUSTIN WILSON:
Oh, I'm talking about the--
DR. SCOTT KAHAN:
--There have been one or two that--
JUSTIN WILSON:
--Ones looking at New York.
DR. SCOTT KAHAN:
--Hasn't been.
JUSTIN WILSON:
So.
DR. SCOTT KAHAN:
New York and elsewhere.
JIM GLASSMAN:
Aren't the people who are looking at these calorie numbers people of, let's say, high socio-economic status and education, really aren't the major problem as far as obesity is concerned?
DR. SCOTT KAHAN:
Obesity doesn't discriminate, okay?  It's--
JIM GLASSMAN:
Well, but-- but--
DR. SCOTT KAHAN:
--it's--
JIM GLASSMAN:
--Does-- it certainly skews to lower-- socio-economic status?
DR. SCOTT KAHAN:
Yes, they're slightly higher, but it's across the population.  And not everybody's going to look at the calories on the menu boards, and not everybody's going to make decisions based on that.  But many people will.  Many of them are high socio-economic-- in high socio-economic groups.  Many of them are in low-- socio-economic groups.  But it's information.
JUSTIN WILSON:
But it's only information at chain restaurants.  You know, one of the--
DR. SCOTT KAHAN:
Right.
JUSTIN WILSON:
--Complications--
PENNY LEE:
For right now.
JUSTIN WILSON:
--Is that the number of restaurant-- well, even in the federal bill, it's only at places that have 20 locations or more.  In New York City, we're talking about less than about five percent of the restaurants that are actually displaying this.  And when you talk about it for, you know, racial and ethnic disparities-- a lot of the smaller ethnic places don't have any kind of information whatsoever.  And-- and so, you know, we should calibrate our expectations with policies like this.  Because all we've seen so far is a small reduction in the number of calories, but we have no idea.  But--
JIM GLASSMAN:
So-- so what-- what do you propose, Justin-- if-- if anything?  Do you think that-- do you think obesity is just simply a lifestyle choice?  I mean, there are organizations-- that-- that talk about how, you know, fat is beautiful, and-- and stop bugging us about being fat?
JUSTIN WILSON:
I think it's--
JIM GLASSMAN:
Do you--
JUSTIN WILSON:
--It's a personal--
JIM GLASSMAN:
--Do you believe that?
JUSTIN WILSON:
--Choice.  Absolutely.  It's a personal choice.  And for those people who-- who, I guess-- because choice is a little bit complicated, right?  Some people say they want to lose weight, but that they're not willing to make the tradeoffs.  'Cause there-- every single person.  There's a spectrum.  Someone who is maximally healthy.

I-- I actually, personally, fit into that category.  I was at the gymnasium this morning-- and then those who are maximally-- maximize the taste in food, right?  And we all fit on this spectrum.  Some people say, "I would rather have cheeseburgers, and be 50 pounds overweight for the rest of my life."  My Dad is one of those people.  The trouble is the government should not be trying to skew this 'cause I think it's a free market.  And we should all have our ability to figure out where we fit in that place.
PENNY LEE:
What's wrong with disclosing the amount of the calories?  Things-- you know, it's interesting to hear, Justin.  You know, you want all about it being personal responsibility.  But don't you think-- I mean-- I mean, to ask you a question, most of the children get their food right now, you know, while they're-- during-- while they're in school.  Shouldn't the government have the responsibility to make sure that those school-- that those foods served in their schools have the highest nutrition available-- ability?
JUSTIN WILSON:
Absolutely.  You have to satisfy cost, right?  Schools have limited budgets.  You have to satisfy taste.  Kids have to want to eat it, and you have to satisfy health.  And, unfortunately, it's very difficult to get all three at once.
PENNY LEE:
Right.  But-- and so I applaud the efforts right now by the-- by the President in trying to increase and-- and upgrade the nutritional standards that we have right now.  I mean, the bills that are moving through Congress right now actually would increase the nutritional standards.  So those are some positive things.  Again, you were asking legislatively what we could do.  That's another example of something that could be done.
JIM GLASSMAN:
I wonder if Scott-- agrees with the-- the idea put forward by a lot of people, that we ought to have taxes on the kinds of foods that cause people to get fat, just as taxes seem to work pretty well with cigarettes in deterring people?
DR. SCOTT KAHAN:
We live in a society in which the most unhealthy and most high calorie foods are also the cheapest foods.  They're also the most heavily marketed.  They're also the largest portioned, and they're also the most available.  And that creates a cond-- the conditions for obesity to take hold.  If you were going to create a society from scratch with the expressed intent of creating-- weight gain and obesity, this would be it.

And so one of those factors is price, and price is an important determinate of people's decision making, whether it's around food or-- or other things.  So small increases in price in unhealthy foods combined with decreases in price on-- on healthy foods like fruits and vegetables and lean meats-- would go a long way.  And the studies show that-- it would go a long way toward making people-- or toward helping people make the right decisions around food.
JIM GLASSMAN:
What about-- bariatric surgery, where essentially your stomach is almost completely removed-- that seems to work?
DR. SCOTT KAHAN:
There's different types of bariatric surgeries and different ones work differently.  We only have a few years worth of data on it.  And over the course of a few years, for certain people it does tend to work.  We-- we still need longer term data.  That said, once it comes around to bariatric surgery or for the most part-- once it comes around to weight loss programs like what I do, the horse is already out of the barn.  We need to prevent.  We need create the conditions for health long before obesity takes hold 'cause it's much, much harder to-- lose weight than it is to prevent weight--
JIM GLASSMAN:
But are you opposed to bariatric surgery?
DR. SCOTT KAHAN:
I think that it's an appropriate treatment for appropriate people.  I think that it's being overhyped in the media.  I think that it needs to be-- if it's going to be done, it needs to be combined with a really aggressive education campaign before and after the surgery.  It can't be like other surgeries.  Other surgeries, you go in, you cut the person open, you fix something, and then you let them go, and that's it.

And that's what a lot of surgeons are doing with this surgery, and it's totally inappropriate.  'Cause ultimately they still have to make healthy decisions around food.  They still have to make healthy decisions around physical activity.  And if they don't-- learn about that, if they don't get to the underlying roots of why they weren't making healthy decisions before, then things generally won't change.
JIM GLASSMAN:
Are genetics destiny?
PENNY LEE:
Oh-- I'll have to defer to the doctor (LAUGH) on-- on that one a little bit.  But, you know, I mean, I think that--
JIM GLASSMAN:
I mean, in other words-- are--  are some people just genetically predisposed to be overweight or obese, and there's not much anybody can do about it?
PENNY LEE:
You know, I mean, I grew up, I think, as the poster child for fat kids of America.  I mean, I was an overweight child.  But it was something that was stressed in us, and-- and through exercise and through health, you know, was able to have a little bit more healthier lifestyle.  But-- you know, I will defer to the doctor as far as if we're genetically disposed.  I don't know if the research is done.
JIM GLASSMAN:
So what do you think?
DR. SCOTT KAHAN:
Genetics have-- have-- a strong impact in people's weight.  It's not the only thing, and people can-- work hard and lose weight and maintain weight without it.  But genetics are absolutely important.  Now when you look at the whole population, okay?  You have about a third of the population that is clinically obese.  You have another third of the population that is overweight.  And then you have another third of the population that is either normal weight or underweight.

Now some of the people in the normal weight population are like Justin, and they go to the gym constantly.  And they work out really hard, and they eat really healthy, and that's wonderful.  But most of the people in the normal weight group are actually eating the same things, and-- exercising just as little as the people in the overweight group.
JIM GLASSMAN:
That's really unfair.
DR. SCOTT KAHAN:
It is.  The main difference is they're lucky.  They have good genetics.
JIM GLASSMAN:
Let me ask you, Justin.  You know, one of the ways to discourage people from-- from doing things we don't want them to do is to make it more expensive for them.  So-- or-- or maybe make it cheaper for them to behave the right way.  One way you could do that is through health insurance.  I mean, shouldn't we, for example, have higher health insurance premiums for people who are overweight?  Or maybe cut the health insurance premiums for people who are underweight?  Couldn't government mandate that?
JUSTIN WILSON:
It could-- but the research--
JIM GLASSMAN:
Well, actually I think that's-- I think that's illegal in many states--
JUSTIN WILSON:
--Well--
JIM GLASSMAN:
--But do you think they should?
JUSTIN WILSON:
It depends on how you look at it.  And frankly, a lot of insurance companies are already doing it because they do it as a positive step.  You know, I think most researchers would agree-- would agree that, sort of, goading-- the-- the stick approach to weight loss-- the-- the penalizing people who are overweight is not a good way to lose weight.

It creates a defeatist attitude, and it creates a situation where they just, sort of, give up.  And they say-- I--  and-- and it also says you can just pay the price to not have to be healthy.  So what health insurance companies do instead is they create wellness programs.  They create subsidies for going to the gym like mine.  And they create situations where people can-- where they can subsidize people who are leading healthy lives without penalizing-- without penalizing anyone who's not leading a healthy life.  And I think that's the proper role.

You know, on genetics, I think the difficulty is, right, we're all-- we have to all play the hand we're dealt.  But I think the discussion of obesity as a genetic issue-- it creates a frustrating degree of defeatism.  And it creates this notion that, "I just can't overcome it."  It's the same problem with labeling a disease or saying food is addictive.  These are all attempts for-- by people to give reasons why they can't lose weight, and then they won't.
PENNY LEE:
But I actually believe that we do need to classify obesity as a disease.  Because it is one of those areas-- right now, the doctors aren't diagnosing it.  They're diagnosing it for Type 2 diabetes.  They're-- diagnosing for hypertension.  But until we get at the absolute root cause, which is obesity, we can't put them in a prevention.  We can't put them in-- in a treatment situation.  So doctors right now are ignoring it.

They're-- again, they're-- they're doing it for the outlining, but they need to address the core.  And health insurances should step up, and they should be able-- doctors should be able to diagnose it, get the reimbursement.  Therefore, put them into-- a treatment plan.  Put them into-- you know, a prevention area.  And be able to get it so we do need to classify it as--
JIM GLASSMAN:
And the health reform bill does include-- I think, a requirement that-- counseling be provided?
PENNY LEE:
Counseling, but we still need-- but we still--
JIM GLASSMAN:
Be reimbursed?
PENNY LEE:
But we still need to have it-- does-- it as--
JIM GLASSMAN:
What about--
PENNY LEE:
--The root cause.
JIM GLASSMAN:
--Bariatric surgery?  Should $30,000-- removals of stomachs-- be required to be-- a payment that an insurance company makes?
PENNY LEE:
I-- I think after doctor's supervision and-- and doctor-- consultation if that is what the procedure is that they have-- diagnosed for you, and one that you need to-- to occur, then yes they should be-- be-- be able to have that treated or that-- have that coverage there for the health insurance.  So yes.
JIM GLASSMAN:
What about that, Justin?  What about just getting a little bit of help from government either informationally or with some other kinds of programs?
JUSTIN WILSON:
And you'll hear no argument from me against the government giving information or the government acting in places where it has a nexus between people's-- you know-- the-- transportation or the-- schools.  So on and so forth.  Frankly, there's not any policy that could be passed that would affect, I think, that very fundamental decision that's being made short of calorie rationing-- you know, North Korea-style food shortages.  Because that is (LAUGH) the ultimate extreme--
JIM GLASSMAN:
I don't think anybody's--
JUSTIN WILSON:
--No--
JIM GLASSMAN:
--Advocating North Korea-- but--
JUSTIN WILSON:
--No one is advocating that, but all of these policies that are in the-- the middle of the wash--
JIM GLASSMAN:
You're-- you're-- you're saying, and-- and I think this is a good way to conclude.  This is a very difficult problem both for public policy and for individuals-- dealing with it.  But clearly it is a problem that Michelle Obama is now addressing, and it seems to be-- on everyone's radar screen right now.

So thank you all.  Thank you, Justin.  Thank you, Scott.  And thank you, Penny.  (MUSIC) And that's it for this edition of Ideas In Action.  Join the conversation online at IdeasInActionTV.com, where you can see past episodes, voice your own ideas, and dive deeper into the issues with commentary and background information.  Or take the discussion with you by subscribing to free podcasts of the program on iTunes.  Thanks for joining us for Ideas In Action.  I'm Jim Glassman.
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