Being American is bad for your health


“Americans are sicker and die younger than people in other wealthy nations.” 

That stark sentence appears in the January 2013 issue of the Journal of the American Medical Association, and it comes from the authors of a landmark report – “Shorter Lives, Poorer Health” – on differences among high-income countries.

You probably already know that America spends more on healthcare than any other country.  That was one of the few facts to survive the political food fight pretending to be a serious national debate about the Affordable Care Act.

But the airwaves also thrummed with so many sound bites from so many jingoistic know-nothings claiming that America has the best healthcare system in the world that today, most people don’t realize how shockingly damaging it is to your wellness and longevity to be born in the U.S.A.

This is made achingly clear in the study of the “U.S. health disadvantage” recently issued by the National Research Council and the Institute of Medicine, which was conducted over 18 months by experts in medicine and public health, demography, social science, political science, economics, behavioral science and epidemiology. 

Compare the health of the American people with our peer nations – with Britain, Canada and Australia; with Japan; with the Scandinavian countries; with France, Germany, Italy, Spain, Portugal, Austria, Switzerland and the Netherlands.  Side by side with the world’s wealthy democracies, America comes in last, and over the past several decades, it’s only gotten worse.

With few exceptions – like death rates from breast cancer – we suck.  Our newborns are less likely to reach their first birthday, or their fifth birthday.  Our adolescents die at higher rates from car crashes and homicides, and they have the highest rates of sexually transmitted infections.  Americans have the highest incidence of AIDS, the highest obesity rates, the highest diabetes rates among adults 20 and older, the highest rates of chronic lung disease and heart disease and drug-related deaths. 

There is one bright spot.  Americans who live past their 75th birthday have the longest life expectancy.  But for everyone else – from babies to baby boomers and beyond – your chances of living a long life are the butt-ugly worst among all the 17 rich nations in our peer group.

In case you’re tempted to blow off these bleak statistics about American longevity by deciding that they don’t apply to someone like you – before you attribute them to, how shall we put it, the special burdens that our racially and economically diverse and culturally heterogeneous nation has nobly chosen to bear – chew on this: “Even non-Hispanic white adults or those with health insurance, a college education, high incomes, or healthy behaviors appear to be in worse health (e.g., higher infant mortality, higher rates of chronic diseases, lower life expectancy) in the United States than in other high-income countries.”  And by the way, “the nation’s large population of recent immigrants is generally in better health than native-born Americans.”

Why are we trailing so badly?  Some of the causes catalogued by the report:

The U.S. public health and medical care systems:  Our employer- and private insurance-based health care system has long set us apart from our peer nations, who provide universal access.  The right loves to rail against “socialized medicine,” but on health outcomes, the other guys win.

Individual behavior: Tobacco, diet, physical inactivity, alcohol and other drug use and sexual practices play a part, but there’s not a whole lot of evidence that uniquely nails Americans’ behavior. The big exception is injurious behavior.  We loves us our firearms, and we don’t much like wearing seat belts or motorcycle helmets. 

Social factors:  Stark income inequality and poverty separate us from other wealthy nations, who also have more generous safety nets and demonstrate greater social mobility than we do.  In America, the best predictor of good or bad health is the income level of your zip code.

Physical and social environmental factors: Toxins harm us, but our pollution isn’t notably worse than in other rich nations.  The culprit may be our “built environment”: less public transportation, walking and cycling; more cars and car accidents; less access to fresh produce; more marketing and bigger portions of bad food.

Policies and social values:  To me, this is the richest, and riskiest, ground broken by the report, which asks whether there’s a common denominator – upstream, root causes – that help explain why the United States has been losing ground in so many health domains since the 1970s: 

“Certain character attributes of the quintessential American (e.g. dynamism, rugged individualism) are often invoked to explain the nation’s great achievements and perseverance.  Might these same characteristics also be associated with risk-taking and potentially unhealthy behaviors? Are there health implications to Americans’ dislike of outside (e.g., government) interference in personal lives and in business and marketing practices?”

My answer is yes, but I’d plant the problem in recent history and politics, not in timeless quintessentials.  Since the 1980s, in the sunny name of “free enterprise,” there’s been a ferocious, ideologically driven effort to demonize government, roll back regulations, privatize the safety net, stigmatize public assistance, gut public investment, weaken consumer protection, consolidate corporate power, delegitimize science, condemn anti-poverty efforts as “class warfare” and entrust public health to the tender mercies of the marketplace. 

The epidemic of gun violence has been fueled by anti-government paranoia stoked by the gun manufacturers’ lobby, the NRA.  The spike in consumption of high-fructose corn syrup has been driven by the food industry’s business decisions and its political (i.e., financial) clout.  In the name of fiscal conservatism, plutocrats push for cuts in discretionary expenditures on maternal health, early childhood education, social services and public transportation.  The same tactic that once prolonged tobacco’s death grip – the confection of a phony scientific “controversy” – now undermines efforts to combat climate change, which is as big a danger to public health as any disease.

More accidents may be shortening our lifespans.  But we’re not getting sicker by accident.


Marty Kaplan is the Norman Lear professor of entertainment, media and society at the USC Annenberg School for Communication and Journalism.  Reach him at martyk@jewishjournal.com.

Local diabetes fighter goes global with Discovery Health Channel documentary


Dr. Francine Kaufman has seen the incidence of diabetes skyrocket in the last 30 years. The pediatric endocrinologist is director of the Comprehensive Childhood Diabetes Center at Childrens Hospital Los Angeles, and she says the disease’s local increase is part of a worldwide phenomenon.

In Los Angeles, the number of adults with diabetes stands at about 600,000, or 8.6 percent of the population, up from 6.6 percent in 1997. Nationally, 20.8 million children and adults — about 7 percent of the population — have diabetes. Worldwide, more than 180 million people are estimated to have diabetes, a number expected to double by the year 2030.

The author of “Diabesity: The Diabetes-Obesity Epidemic that Threatens America and What We Must Do To Stop It,” Kaufman has been on the front lines of fighting these escalating numbers as a clinician, researcher and a former president of the Diabetes Association of America.

Now Kaufman is turning to the small screen to bring attention to this global epidemic in a one-hour, commercial-free Discovery Health documentary narrated by actress Glenn Close, “Diabetes: A Global Epidemic,” on Sunday, Nov. 18.

Kaufman spent six months visiting every continent except Antarctica to explore the challenges of diabetes as well as the success stories. Logging about 150,000 air miles, she visited clinics, met with government officials and spoke directly with patients.

“There’s a common theme: Diabetes can potentially devastate people’s life anywhere, both the countries with tremendous resources and the countries with almost no resources,” Kaufman told The Journal. “It knows no boundaries.”

Diabetes is an inability of the body to use or produce insulin, a hormone that regulates blood sugar. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves. Ninety percent of people with diabetes worldwide have Type-2 diabetes, which is largely the result of excess body weight and physical inactivity. Lifestyle changes can delay or prevent its development, which is why Kaufman is so passionate about the issue.

Kaufman’s journey began in December 2006 in Capetown, South Africa, during the 19th World Diabetes Congress. Traveling to the city’s outskirts, she saw the poor living in shacks that lacked running water or electricity. She visited a residential hospital where children receive care because their families cannot provide it. While some don’t believe in Western medicine, others suffer due to unreliable insulin delivery or a lack of resources to refrigerate the perishable animal hormone.

At each destination she visited, Kaufman found cultural factors that impact diabetes:

  • In Los Angeles, she focused on the largely Latino patient population, whose genetics and dietary customs pose problems. “I was raised on rice, beans, tortillas, meat and cheese,” explains one woman, whose weight had once reached more than 300 pounds.
  • In India, a country with a history of starvation, the populace largely perceives obesity as a sign of health and wealth. Street vendors sell fried foods on every corner, and the bikes that Kaufman had seen on her previous visit have been mostly replaced by scooters and cars. The cultural practice of bare feet poses particular challenges because diabetics often lose sensitivity in their feet. As a result, small cuts can go unnoticed until they become infected or gangrenous.
  • In Australia, a country associated with physical fitness, Kaufman learned that citizens are now more likely to watch sports than participate in them. And the country’s Aboriginal population, whose bodies are hardwired to store calories, have an astounding 50 percent prevalence of diabetes.

    However, Kaufman also saw some successes.

  • In Helsinki, Finland, the government’s proactive approach to prevention showed that those at high risk of developing diabetes could decrease their risk by 58 percent. Peka Puska, director general of the National Public Health Institute, told Kaufman, “We have to change the environment so the healthy choice is the easy one.”
  • In India, Kaufman visited a comprehensive clinic that treats 100,000 patients and addresses every aspect of diabetes care. In one location, patients see specialists such as dentists, dieticians and opthalmologists, and can purchase items including medication, food and special shoes.

“I would love to be able to replicate that in Los Angeles,” she said.

While Kaufman did not visit Israel as part of the documentary, she said she was there last month for a symposium hosted by D-Cure, an Israeli nonprofit organization that funds diabetes research and collaborates with research projects around the globe.

“With its focus on healthcare and technology, Israel is likely to emerge as an international player in finding solutions [to the diabetes epidemic],” Kaufman said.

At the same time, Israel’s rate of diabetes is 7.8 percent.

“It’s a struggle there like it is for all of us from cultures that intermingle nourishing with nurturing,” she said. “It’s hard to overcome how we were raised, where our grandparents were starving, and overweight was a sign of health.”

Whatever a nation’s specific challenges relating to diabetes, the disease is universally devastating when not managed, Kaufman said. She does, however, have the prescription.

“To manage it, you need a government that can give resources; a health care system that is focused on it; the environment in which you live supporting a healthy lifestyle; and, ultimately, your own personal choice of whether you’re going to do everything you can to combat this or not.”

“Diabetes: A Global Epidemic” will air on Discovery Health, Nov.18, 9 a.m. For more information, see http://health.discovery.com/centers/diabetes/diabetes.html and

http://www.d-cure.org/English/

Do Day School Health Programs Make the Grade?


Twenty parents from the Emek Hebrew Academy in Valley Village have come on a chilly winter evening to hear Dr. Francine Kaufman, a national expert on diabetes and childhood obesity, talk about promoting children’s health. Although the school has 455 families, Rabbi Sholom Strajcher, the school’s dean, is not discouraged by the modest turnout.

“We have to change the culture…. It’s a challenge,” he said.

Strajcher (pronounced Striker) tells the group he’s been overweight since childhood.

“When I was growing up, no doctor or teacher ever mentioned my weight,” he said. “I am reaping the result of all those years.”

He is not alone. In fact, Strajcher’s students are even more likely to struggle with weight issues. According to the Institute of Medicine, an agency under the National Academy of Sciences, more than 9 million U.S. children above the age of 6 are considered overweight or obese. The litany of health consequences associated with obesity — diabetes, cancer and heart disease, to name a few — might result in today’s children becoming the first generation in American history with a lower life expectancy than their parents. For children born in 2000, their lifetime risk of developing diabetes exceeds 30 percent.

Many can name factors contributing to these alarming trends: An increase in sedentary activities, such as television and computers; greater demand for convenience foods; advertisements targeting kids with high-fat foods, and an environment that discourage walking and physical activity. Given the breadth of the problem, solutions require action on all levels of society — from government and business to schools and families. Jewish day schools, which may not see their role in the equation, have been slow to address these concerns.

But some have begun to take action.

Let’s Get Physical

At Jewish day schools, the demands of a dual curriculum coupled with limited outdoor space can cause physical education to take a back seat. This is decidedly not the case at Valley Beth Shalom (VBS) Day School. When Head of School Sheva Locke joined the Encino school four years ago, one of her first priorities was instituting an athletic program. The school now employs an athletic director and two full-time coaches who supervise physical education classes and activities at recess and lunch.

The athletic department also runs an extensive after-school team sports program. Kindergarteners through third-graders can join in a Junior Sports Club, while fourth- through sixth-graders can participate in competitive sports, including basketball, soccer, football and volleyball — and 98 percent of them do. The teams compete in the San Fernando Valley Private School League. VBS provides transportation to off-site games to make participation easier on parents and children.

“The focus was on getting as many children as possible to participate and to play,” Locke said. “The problem solving and goal setting that goes along with having a physical fitness program is equally as important.”

During the school day itself, VBS provides physical education twice a week, a figure fairly standard in the day school world. For students who don’t participate in after-school physical activities, that amount is woefully inadequate, according to physician Fran Kaufman, professor of pediatrics at USC’s Keck School of Medicine and head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital of Los Angeles.”

“Kids should be active for 60 minutes each day,” she said.

The state of California requires that children in first through sixth grade have a minimum of 200 minutes of physical education time per 10 days of school, which averages 20 minutes per day. In seventh through 12th grade, the time requirement doubles. (According to the California Center for Public Health Advocacy, 51 percent of school districts reviewed failed to meet the state’s minimum requirement for physical education time.)

Those numbers fall far short of the 60 minutes daily recommended by Kaufman and the USDA’s Dietary Guidelines for Americans. And as Emek’s Strajcher points out, not all of that time involves being active.

“Even when kids are supposedly playing, how much of that time is spent waiting for a turn?” he asks.

At Maimonides Academy in West Hollywood, instructor Alan Rosen has designed a unique program where lessons on character and values are integrated into physical education. On the play area used by the elementary school students, circles painted on the blacktop list such values as responsibility, humility, effort and cooperation. The words are incorporated into songs and games, and are referred to in the course of regular physical activities.

“If it’s important, you find the time,” said Maimonides’ principal, Rabbi Karmi Gross. “Physical activity doesn’t have to be divorced from what else is being done.”

By the Book

Inside the classroom, the content and amount of wellness-related curriculum varies from school to school. An informal survey taken by the Bureau of Jewish Education of Los Angeles on nutrition education garnered responses from only 10 schools out of more than 30. Of those, half had no “formal” nutrition curriculum, and relied primarily on teacher-generated materials.

Because health is not a subject for which the state requires standardized testing, public school districts vary in the degree of emphasis they give the topic. Los Angeles Unified School District specifies knowledge and abilities that students are expected to master in grades four, seven, and high school.

In both public and private schools, a dedicated health class is generally taught in middle school. Seventh graders at Abraham Joshua Heschel Day School in Northridge take a health and life sciences class that focuses on the physiology and biology of the human body. An eighth-grade nutrition unit includes a screening of the school version of “Super Size Me,” in which the filmmaker traced his odyssey eating McDonald’s fare exclusively three times a day for one month, and how his body suffered as a result.

“We talk about individual choices and about society, and we discuss where responsibility lies,” said science teacher Liz Wenger. “We look at how society is changing the way we eat, such as not eating at home as much, and eating larger quantities and higher fat foods.”

The students calculate their own caloric intake and use a calorimeter to measure the amount of food energy in various foods. They also build pumps to replicate the heart and use stoppers to illustrate cholesterol build-up.

VBS employs a full-time nurse whose duties include teaching health-related lessons to all grade levels. At Milken Community High School, ninth graders take a class, designed with input from a health educator and a rabbi, which explores physical, social and emotional health as well as sexuality and tobacco, drug and alcohol abuse.

Ess, Ess Mein Kind

Learning about nutrition doesn’t necessarily translate into action. Most of the schools interviewed expressed concerns about the food they provided to students, not only through formal meal programs, but also informal means such as class parties or incentives.

Eating can be an emotionally charged issue given its integral role in Jewish practice. The ubiquity of food is illustrated in the oft-repeated definition of Jewish holidays:

They tried to kill us. We survived. Let’s eat.

“Every time we celebrate, we celebrate with food — and there’s nothing wrong with that,” said Emek’s Strajcher. The question is what kind of food and how much. He said that traditionally, when students began to learn the aleph-bet (Hebrew alphabet) in school, the rebbe would put a drop of honey on each letter so that the children would associate learning with sweetness. Even in the synagogue itself, congregants throw candy for auf-rufs (engagements), bar mitzvahs and other celebrations.

Some parents are troubled by the amount of sugary snacks given to their children.

Kaufman noted that packaged kosher snacks can be some of the worst offenders in terms of saturated fat content.

Last year, Emek parents formed a committee and worked with the school’s caterer and a nutritionist to improve the healthfulness of school lunches. Parent Amy Leibowitz, who spearheaded the committee, said it was a challenge to satisfy nutritional, budgetary and kashrut considerations simultaneously. The results included adding fruit and salad, subtracting dessert, serving foods that are baked instead of fried, serving leaner, lower-salt meat, and making water available at mealtimes. She said that classes now celebrate all the month’s birthdays at one time to limit the influx of sugary treats.

Maimonides also revised its lunch program, and modified the practice of using food as an incentive. Instead of giving Israeli chocolates as rewards, principal Gross now gives Israeli postcards.

“We’re not yet where we want to be,” he said. “But we’ll eventually get there.”
Vending machine soft drink sales — a tempting source of revenue for some schools — will likely decline due to a decision announced in May by the nation’s largest beverage distributors to discontinue selling beverages with more than 100 calories to schools. It is estimated that the practice will affect 87 percent of the public and private school market.

As schools grapple with decisions regarding food policies, Emek’s Strajcher says that they can look to Judaism for a model of dietary self control.

“Kashrut [shows us that] when it comes to food, there has to be a certain discipline,” he said.

And as Eileen Horowitz, principal at Temple Israel of Hollywood, noted, “The [mission] for a Jewish school is teaching how to make good choices. That applies to how we talk to a neighbor as well as what we put in our mouth.”

Just Do It

Some administrators cited the challenge of fitting in adequate time for physical activity and comprehensive health education on top of an already full dual curriculum.

“There’s tremendous pressure for time,” acknowledged Dr. Roxie Esterle, Heschel’s associate head of school. “It’s a very full day and it gets fuller and fuller,” she said, mentioning computers and technology as examples.

Secular schools also struggle with these issues. A recently released national report found that the No Child Left Behind Act of 2001 was threatening physical education time because subjects that are not tested — including physical education — receive lower priority. In Los Angeles, 68 percent of high school students failed to meet recommended levels of physical activity according to a 2005 study by the CDC.

Yet, practicality dictates that schools take action on this issue: The California Department of Education states that healthy, active and well-nourished children are more likely to attend school and are more prepared and motivated to learn. The 2006 Shape of the Nation Report, issued jointly by the National Association for Sport and Physical Education and the American Heart Association, recommends that schools across the country “make physical education instruction the cornerstone of a comprehensive school physical activity program that also includes health education, elementary school recess, after-school physical activity clubs and intramurals, high school interscholastic athletics, walk/bike to school programs and staff wellness programs.”

Given that Judaism mandates the care of our bodies, Jewish day schools have an imperative to address these issues.

“If you’re not healthy, it’s hard to serve God with fullness,” Strajcher said. “Your soul can only do what it needs to do when your physical self is intact.”
He hopes to spare his students from facing the weight issues that have plagued him since childhood, and from the dire consequences which may result.

“If this is preventable and we can do something about it, it’s our obligation to do so,” he said.

Health Report Card for Schools

To determine how well your school promotes wellness, here are some questions to ask:

  1. How much physical education time is allotted?

  2. Is the physical education instructor certified?
  3. Are children actively engaged during physical education and recess?
  4. Does the school offer after-school activities or team sports?
  5. Do health lessons address nutrition and physical activity?
  6. What is the content of school lunches, and who determines this?
  7. Are fresh fruits and vegetables offered daily?
  8. Does the school have a policy on desserts and snacks?
  9. Is there a vending machine on campus? What does it offer?

Wanted: A General in the Obesity War


Obesity is the fastest growing health threat in this country, currently on track to overtake tobacco as No. 1.

The Centers for Disease Control and Prevention estimates that 30 percent of American adults older than 20 (more than 60 million people) are obese. The percentage of youths ages 6-19 who are overweight has more than tripled since 1980 to more than 9 million.

The lifetime risk of Type II diabetes is headed toward 30 percent for boys and 40 percent for girls, putting these kids at greatly elevated risks for debilitating health problems, like kidney and heart disease, amputation and blindness.

Locally, more than half the adults in Los Angeles are either overweight or obese, while 21 percent of the children are overweight, with an additional 19 percent at risk of becoming overweight.

And while Jews are far from immune, obesity is not an equal opportunity affliction — African American and Latino communities have obesity rates triple that of whites, and poorer Americans are almost 50 percent more likely to be obese than wealthier Americans.

The seriousness of the problem has begun to attract considerable attention both inside the public health community and beyond. Our state and local governments have been active in responding to this epidemic — from Gov. Arnold Schwarzenegger’s Obesity Task Force and his tireless cheerleading for more physical activity to the Los Angeles Unified School District’s (LAUSD) healthy beverage initiative, which notably brings healthier food and drinks to schools without diminishing snack revenues.

The nonprofit sector has also mobilized through a variety of projects that empower kids to lose weight by making smart diet and lifestyle choices, and through innovative organizations like Students Run L.A., where young Angelenos train for the L.A. marathon. Forward-thinking foundations have pitched in some of their considerable resources to fight obesity.

Meanwhile research/advocacy organizations like the Center for Food and Justice at Occidental College have expanded their missions to address obesity, noting that many of the same families at risk for hunger are also at the greatest risk for obesity.

So why the need for another alarmist editorial when we already find some of our best and brightest organizations fighting obesity? The answer lies in the dual nature of the epidemic.

At one level, obesity is an extraordinarily uncomplicated problem. According to Dr. Francine Kaufmann, head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles, obesity is on the rise because we simply take in more calories in food then we expend in energy. Yet finding a correspondingly simple solution has proved maddeningly difficult.

Reversing the tide requires taking on, in a coordinated manner, the variety of factors responsible for the epidemic, from unhealthy diets, insufficient exercise, reliance on automobiles, inadequate nutrition education, excessive junk food, scarcity of fresh produce to many other complicated, interrelated causes related to the way we now live. And while many of these causes are being addressed individually, success in fighting this disease requires a strategy that coordinates the present multiplicity of approaches.

To introduce this higher level of strategizing, we are proposing the creation of a joint county, city (and, if possible, LAUSD) obesity coordinator. The office would be modeled on the city’s AIDS coordinator’s office created by Mayor Tom Bradley, but would include the county to take advantage of its public health and health care resources and the LAUSD as one of the country’s largest educational institutions, while also leveraging the bully pulpit available to the mayor.

Following the successful AIDS coordinator model, the obesity coordinator would have various responsibilities:

• Education/Public Health. The coordinator would create an education campaign, leveraging the city and county media infrastructure, as well as the school system and a prevention program targeted at encouraging healthier food and lifestyle choices.

• Policy/Coordination. The obesity coordinator would spearhead the development of county-citywide obesity policies to ensure that governmental and nongovernmental responses to obesity are adequately coordinated.

• Analysis. The coordinator would analyze the efficacy of existing programs and facilitate long-term studies of the current approaches to identify and consolidate around the most successful ones.

• Programs. Following on the pioneering work of the food policy organization, California Food Policy Advocates, we would encourage the obesity coordinator to explore creative solutions, including programs to introduce green grocers into neighborhoods that currently lack access to quality fresh produce. These programs would require minimal capital (possibly leveraging new markets tax credits and other innovative financing sources) to help create and capitalize local businesses that sell fresh fruits and vegetables.

We believe that the Jewish community has a role to play in the campaign to appoint an obesity coordinator and to win the battle against obesity. Generating the political will to create an empowered obesity coordinator will require pressure from many communities, including our own.

In addition, many existing institutions can participate in this fight, from Koreh L.A., The Jewish Federation’s reading in public schools program that could incorporate obesity education curriculum, or Mazon, the anti-hunger effort, which could expand its mission to confront the obesity epidemic through its network of food banks.

Ultimately, this is a complicated and long-term problem that will require the kind of effort deployed against AIDS and smoking.

The appointment of an obesity coordinator would enable more effective cooperation and strategic management of our resources and hasten the day when we turn around this burgeoning affliction.

Brian Albert and Tanya Bowers are members of the New Leaders Project, which was founded in Los Angeles in 1990 and links Jewish values with a commitment to civic activism.

This op-ed piece is the first of three by members of
the New Leaders Project (NLP), a Jewish civic leadership training program of the Jewish Federation’s Jewish Community Relations Committee. Participants researched three pressing issues — education,
housing and health — and presented their proposed solutions to a panel of community experts.

Q and A With Dr. Francine R. Kaufman


 

Obesity has reached record rates among children and adults, bringing with it increased risk for developing diabetes and related health problems. In addition to the more than 18 million Americans currently living with diabetes, another 41 million are considered prediabetic, and are likely to develop the disease unless they take action.

In her new book, “Diabesity: The Obesity-Diabetes Epidemic That Threatens America — And What We Must Do to Stop It” (Bantam), Dr. Francine R. Kaufman describes how reversing these trends requires efforts from all levels of society.

The immediate past president of the American Diabetes Association and the head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles, Kaufman spoke with The Jewish Journal about the magnitude of the problem, its causes, and strategies for changing the course of this epidemic.

The Jewish Journal: How have rates of obesity and diabetes changed over recent years?

Dr. Francine R. Kaufman: There’s been such a huge increase that we’re now calling it an epidemic. And it’s not only affecting adults, but also children. The number of overweight children has tripled since 1970. Cases of Type 2 diabetes among children have grown from a negligible number in the early 1990s to about 25 percent of new cases today.

JJ: Why are we seeing so much weight gain among children and adults?

FK: Our lifestyles have markedly changed: The amount of physical activity has markedly diminished in the community setting, in homes and in schools. The amount of sedentary behaviors — such as television, computers, video games and instant messaging — has markedly increased. And the quality and quantity of food is markedly different.

JJ: You advocate applying the strategies used by the anti-tobacco movement to purveyors of fast food and junk food. Where does personal responsibility fit in?

FK: The fundamental difference between the anti-tobacco campaign and this issue is that everyone has to eat but no one has to smoke. In both cases, personal responsibility is important. People need to be concerned about their health and motivated to get active and eat appropriate amounts of quality food.

However, there are lots of people who don’t have the option to make these healthy choices. It’s not realistic to expect a woman who’s on welfare, has three kids and is working two jobs to go to the Whole Foods store — which she can’t afford — and have the luxury to cook this wonderful meal — which she doesn’t have time to do — and then go exercise with her children.

We have to be able to fit healthy behaviors into our daily lives rather than segment them out. Our work places, our communities, our schools and our faith-based organizations must allow us to make healthy food choices and engage in physical activity.

For example, it’s not easy to be healthy at most workplaces. Employee cafeterias offer fare that’s high in salt, fat and sugar. Vending machines sell sodas, candies and chips. Stairwells are dingy and hard to access. It doesn’t have to be this way. Workplaces could [offer incentives to] employees to be active, serve healthy snacks in their cafeterias and vending machines or subsidize employee gym memberships.

JJ: In your book, you describe how your Grandma Sadie, who eventually developed diabetes, grew up undernourished in Russia. Her diet changed when she came to American and was exposed to abundance for the first time. How does your grandmother’s experience parallel the experience of our society?

FK: In Los Angeles, there are still a lot of new immigrants who [don’t] have an abundance of food like we see here. After starving or having tremendous food insecurities, they come here and overindulge. My Grandma Sadie hid food. If she went to a restaurant, she took home all the rolls and the sugar. She couldn’t shake the mentality of scarcity.

The grandmas of my patients have tremendous impact on the health of their children and their children’s children — just like Sadie did for us. They don’t want to limit the amount of food their grandchildren can have and don’t understand why they should.

Also, many children in this country live in communities where all they see are liquor stores, convenience stores and fast food restaurants. It’s not the equivalent of living on the Westside. It’s hard to find a grocery store in some parts of town. The quality of the produce is not equivalent. The produce is more expensive and people have less money to spend.

JJ: These are formidable obstacles…

FK: I think there’s movement afoot to address these problems: The federal government, originally led by Health and Human Services Secretary Tommy Thompson, has promoted the message. Congressional leaders have become aware that we need to improve the health status of America. Locally, I chaired a task force for the Los Angeles County Board of Supervisors, who are putting the recommendations into action. And Los Angeles Unified School District’s ban on selling soft drinks was a clarion call to the nation.

JJ: So there’s hope.

FK: I’m very hopeful. There is positive change. We have to make these changes. If not, diabetes will devastate us. In 2002, diabetes cost the nation $132 billion. One in three children born in the year 2000 will develop diabetes in his or her lifetime. The New England Journal of Medicine just published and article projecting that this generation will not live as long as the previous one because of obesity-related diseases.