The Weight of the Nation

The first film in 'The Weight of the Nation' series examines the scope of the obesity epidemic and explores the serious health consequences of being overweight or obese.

The first character we meet is Cindy. Born and raised in Bogalusa, Louisiana, Cindy is the mother of two grown sons and now a proud grandmother. Cindy allowed HBO into her home and life to discuss some very painful things. Only 99 pounds when she got married, Cindy has struggled with her weight ever since her first pregnancy. And it's only gotten harder.

Health and behaviors in early childhood can have serious consequences later on in life. The Bogalusa Heart Study - of which Cindy was a participant - shows that overweight and obese children have risk factors for heart disease, even at a young age.

The obesity epidemic is a problem that's emerged over the last 30 years. It threatens our nation's social, economic and physical health. But, unlike a natural disaster, obesity is often preventable. Although overall obesity prevalence rates appear to be leveling off, there are still far too many Americans who are overweight or obese and who continue to develop health problems as a result. In order to end the epidemic, everyone must be part of the solution.

At the level of our DNA, we're programmed to eat as much as we can to survive and store the extra as fat for future energy use. In a world where calorie-dense, sugar-laden and fatty foods are available around every corner, that's a problem. The good news is that, even if the propensity to gain weight is written into our genes, we're not fated to a lifetime of fat.

As we take a look at communities across the country - from New York City to Santa Ana, California - it is clear that we have all been getting heavier. But the problem doesn't affect all communities equally. The sad fact is that obesity rates are higher in some ethnic communities and in lower-income states. The trends are so extreme that they are attracting the attention of health officials and lawmakers.

Obesity among children is also rising, and it's a real threat that may have lasting health consequences. As Anna Busby says, based on her observations as the nurse of the Bogalusa Middle School Health Clinic, overweight and obese children are at risk of being "on dialysis in their thirties if we don't do something now." The good news is that we can make a difference in our children's lives both now and as they get older by helping them adopt healthy eating behaviors and become more active.

There's a powerful connection between being overweight or obese and having heart disease as an adult. The heart, our hardest-working muscle, spends every second of every day vigorously pumping blood to the farthest reaches of our bodies. The larger we become, the harder our hearts have to work to keep blood circulating. The bottom line: being overweight or obese places you at a higher risk of developing heart disease and suffering a stroke as an adult.

Beyond the cardiovascular system, excess weight has negative consequences throughout the body. "Almost every organ system in the body is adversely affected by having excess body fat," says Dr. Samuel Klein, director of the Center for Human Nutrition at Washington University in St. Louis.

Even a small amount of excess weight, accumulated slowly at the rate of a few pounds a year over many years, can lead to type 2 diabetes. Being over 45 years of age, having a family history of diabetes, being physically inactive and being overweight or obese can increase a person's chances of developing type 2 diabetes. If poorly controlled or left untreated, type 2 diabetes can lead to a number of serious health problems, including heart attack, stroke, kidney disease, blindness, amputation and even death.

Obesity is not only one of the top public health issues facing our country; it's also a threat to our nation's bottom line. Rising obesity rates threaten to drag our economy down through higher health care costs and lower productivity. Currently, 69% of American adults are overweight or obese.


The second film in the series poses a question that almost anyone who’s struggled with excess weight has asked, if only in jest: For all the remarkable high-tech tools available to medicine, for all the billions of dollars in drug research, there’s still no highly effective medication to prevent or reverse obesity – why?

Researchers are, in fact, developing and evaluating strategies to help people reach and maintain a healthy weight, so that they can look forward to healthier lives. Diet is a part of the equation, but most name-brand diets promise quick, dramatic rewards and gloss over the long-term effort needed to keep weight off. Maintaining weight loss is a challenge, and success requires sustained changes in our food and physical activity.

Weight - whether we gain it or lose it - is dependent on our body’s energy balance: We are in balance when we take in and burn off the same number of calories each day. Take in more calories than we burn, and the pounds add up. Take in fewer, and the number on the scale goes down.

Your body’s energy requirements don’t necessarily stay the same throughout your entire adult life. One theory suggests that if you become overweight or obese, your body establishes a new normal weight, called its “set point,” which your body will fight to maintain even after you lose weight.

Shows like ‘The Biggest Loser’ may lead us to believe that exercise is the best or only way to lose weight. But successful programs aimed at losing weight and keeping it off target both eating less and being more physically active.

We eat for all sorts of reasons, not just because we’re hungry. We eat because we’re bored, sad, tired or - all too frequently - stressed. When we eat for reasons other than getting the right nutrition, we affect our weight and put our health at risk. New research suggests that taking time to think about what we eat - and why we are eating - can be an effective way to attain and maintain a healthy weight.

As adults, most of us spend more than half of our waking hours at work. And today’s jobs, many of which require hours a day parked in front of a computer, are often both sedentary and stressful. But there are small steps we can take to eat better and move more at work, even when our schedules aren’t flexible.

Making the decision to set and achieve realistic goals can, over time, lead to big results. And as we learn from Rhonda and Elana’s warm and supportive relationship, having a friend and partner can be invaluable when it comes to the hard work of keeping weight off.

If you have high blood pressure, the doctor isn't going to tell you to bring it down for six months and then do whatever you want. Maintaining a lower weight is similar. It’s an ongoing process that requires work and must be constantly monitored.

But the all effort to maintain a healthy weight does pay off. The Diabetes Prevention Program (DPP), a large, multi-site, NIH-funded study, has shown that high-risk participants (people with “pre-diabetes”) who lost a modest amount of weight through changes in diet and activity levels greatly reduced their chances of developing type 2 diabetes.


Childhood obesity is much more than a cosmetic concern. The health consequences of childhood obesity include greater risk of heart disease, type 2 diabetes, high blood pressure, asthma and other serious illnesses. The combination of these health effects and the dramatic increase in childhood obesity rates over the past three decades causes some experts to fear this may be the first generation of American children who will have a shorter life expectancy than their parents.

Strategies like cutting out TV and sugar-sweetened drinks may help reduce a child’s weight or prevent future weight gain, but not always for the reasons we expect. There is a link between TV watching and overweight and obesity among children. While the act of watching TV - being sedentary and possibly eating snacks while taking in a favorite show - is part of the problem, experts are now looking at what kids watch as well. There is a growing debate over the effects of food marketing on the childhood obesity epidemic and what should be done about it.

For parents of obese children, responsible parenting means more than tackling health challenges head on. It also means doing the hard work of finding supportive, healthy communities that will instill long-term habits that promote healthy living. And it means knowing that some day, every child will be an adult who deserves to know that their parents did all they could to help them grow up healthy and happy. Changes to school lunches are one way to make a major dent in the childhood obesity epidemic. But in too many schools across the country, the lunches being served don’t meet all of the federal government’s guidelines for nutrition. Moreover, the obstacles to changing our National School Lunch Program and the food served in cafeterias across the country are formidable.

Consuming sugar-sweetened beverages, including juice drinks, is also associated with obesity and accounts for more added sugar in our children’s daily diet than any other food. Replacing sports drinks, soda and other sugary drinks and limiting your intake of 100% fruit juice are effective straightforward ways to start the journey to healthier behaviors and lower body fat for kids and adults.

Beyond proper diet, kids need physical activity to lead a healthy lifestyle. With the rise of video games and the decline of physical education in schools, being active isn’t as easy or common for today’s kids.

Schools can become the centerpiece of public efforts to ensure that kids participate in physical activity and develop healthier lifestyles that can last a lifetime. And it makes perfect sense for them to do so: not only will they be nurturing the growth and development of the whole child, but research links physical activity with improved learning capacity. “If they’re not bouncing up and down in gym, they’re going to be bouncing off the walls in class,” says the director of the CDC, Dr. Thomas Frieden. Unfortunately, P.E. has become a low priority in some of our nation’s schools.

The good news is that there are resources available for concerned parents who want to help their kids. With hard work, we can improve the health of our children. The bad news is that there are many barriers to achieving these goals and, unfortunately, a lot of parents don’t yet recognize the seriousness of obesity-related health issues and the help their children need to overcome the obstacles in their environment.


Obesity is a very serious medical condition, no longer viewed as strictly an issue of cosmetics. It’s a contributing factor in the death and disability of too many of our neighbors, friends and family members, and its societal costs are astronomical. Although overall obesity prevalence rates appear to be leveling off, there are still far too many Americans who are overweight or obese - approximately one-third of adults are obese and another third are overweight.

Besides facing an increased risk of premature death, people who are obese are at greater risk of serious medical conditions that can make them very sick, potentially subjecting them to constant pain and suffering and diminished quality of life. Obesity not only drives up health care costs for patients and families, it costs businesses - and the country - tens of billions of dollars in lost productivity and higher employee health costs.

While obesity is often viewed as an issue of personal responsibility, overeating is as much about biology as it is about psychology. There is much we still don’t know about the causes of obesity. Biological research has found that behaviors that are laid down early in life contribute to obesity. Environmental factors, such as access to safe parks and affordable healthy foods, also play a role.

Human beings today live in a biological time warp of sorts: there is a mismatch, or disconnect, between the way our bodies adapted to deal with food scarcity through tens of thousands of years of evolutionary biology, and our modern world of inactivity and abundance - of cheap, inexpensive, calorie-dense, sugar-laden and fatty foods. The world has changed, but our biology has not.

When it comes to obesity and its related diseases, our zip codes may matter more than our genetic codes. The rates of overweight and obesity are higher in lower-income neighborhoods and some ethnic communities. Being poor is about more than not having money - it also means limited access to affordable healthy foods and safe places where children and adults can play, run, walk, and bicycle.

One of the main reasons Americans eat as poorly as we do may be the ubiquity of low-priced, unhealthy foods and their promotion - not only everywhere, but at all times of day. From the processed food sold in grocery stores to the prepared food sold in fast food restaurants, we are surrounded with tempting options that aren’t good for us.

Another major reason Americans eat as poorly as we do may be related to the current effects of government policies dating back decades. The abundance of relatively inexpensive food that Americans enjoy is not an accident of history. Government policies that have subsidized and promoted the production of commodity crops, as well as scientific, technological and market changes, have helped shape the economics of the modern food industry.

The relatively inexpensive food that most Americans consume every day may seem like a good deal, but in fact is a very expensive proposition. Unaccounted for in the price are, among other things, the future health care costs associated with heart disease, diabetes, and other obesity-related diseases. This examines a long-term strategy for trying to improve the American diet.

Despite the enormous challenges involved in fighting obesity, communities like Nashville, TN, are doing something about it - and succeeding. Recognizing that combating obesity is not just an issue of personal responsibility, Nashville is taking serious steps, in partnership with the federal government, to help its citizens be more active and live healthier lives.

The battle against obesity will eventually be won - not by a “silver bullet” government program, pill or fad diet - but by the combined and diverse efforts of individuals, organizations, businesses and governments. We must attack the problem from all directions and with all the tools at our disposal, from building new parks to operating healthy food trucks, opening new grocery stores and other healthy food outlets to planting community gardens and everything in between.

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