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Obesity (transcript)
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DR. SALGO:  MAGAZINE COVERS AND NEWSPAPER HEADLINES CALL IT A NATIONAL CRISIS.  CONFRONTED WITH THE HEALTH AND SOCIAL COSTS OF OBESITY, AMERICANS THIS YEAR WILL SPEND MORE THAT $30 BILLION IN THEIR BATTLE OF THE BULGE, AND MOST OF US WILL LOSE THE FIGHT.  ARE WE DESTINED TO BE FAT?  AND WHAT'S SO WRONG WITH A FEW EXTRA POUNDS, ANYWAY?  WE TACKLE THESE QUESTIONS AND MORE, COMING RIGHT UP ON SECOND OPINION.
 
 MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION.  THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING.  THE JOSIAH MACY JR. FOUNDATION AND THE PARK FOUNDATION.
 
 DR. SALGO: WELCOME TO SECOND OPINION, WHERE EVERY WEEK, YOU CAN HELP SOLVE A MEDICAL MYSTERY AND LEARN MORE ABOUT YOUR OWN HEALTH CARE. I'M YOUR HOST DR. PETER SALGO.  TONIGHT, OUR CASE FILE CONTAINS A STORY OF ASHLEY AND REGINA. WE HAVE ASSEMBLED A HEALTH CARE TEAM TO TACKLE THEIR CASE.  SOME OF THE PANEL ARE DOCTORS, SOME ARE NOT.  ONLY ONE PERSON ON THE PANEL HAS READ THE CASE FILE, AND THAT IS ELISSA ORLANDO OUR CIVILIAN OVER THERE.  HELLO ELISSA.
 
 ORLANDO: HI PETER.
 
 DR. SALGO: AND EVERY WEEK WE HAVE A PRIMARY CARE PHYSICIAN ON THE PANEL, AND TONIGHT IT IS DR. LOUIS PAPA. 
 
 DR. SALGO: OUR CASE TODAY BEGINS IN A HIGH SCHOOL GUIDANCE COUNSELOR'S OFFICE WHERE WE MEET ASHLEY AND HER MOTHER REGINA.  ASHLEY IS 16 YEARS OLD, THAT IS NOT UNUSUAL IN A HIGH SCHOOL GUIDANCE COUNSELOR'S CASE, BUT SHE IS 5'4" AND SHE WEIGHS 196 POUNDS.  I SUSPECT THAT IS UNUSUAL.  ASHLEY'S MOM REGINA IS 34 YEARS OLD, AND SHE WEIGHS 238 POUNDS ON A 5'2" FRAME.  THAT IS A LARGE WOMAN I WOULD SUSPECT.  LOU, WHAT IS YOUR FIRST TAKE ON ASHLEY AND REGINA?
 
 DR. PAPA: WELL, IT IS NOT THAT UNUSUAL, THAT IS KIND OF A COMMON SCENARIO UNFORTUNATELY.  THEY ARE BOTH OBESE.
 
 DR. SALGO: IS IT THAT COMMON EVERYBODY, OR IS IT MY IMAGINATION? 
 
 DR. KATZ: THE RATE OF OBESITY IS RISING RAPIDLY IN BOTH CHILDREN AND ADULTS IN THE UNITED STATES, BUT THE RATE OF EXTREME OBESITY IS RISING EVEN FASTER. 
 
 DR. SALGO:  WE'RE TALKING SOME SERIOUS NUMBERS HERE, RIGHT? SHE IS 5'2", 238 POUNDS.
 
 DR. KATZ: THE MOTHER'S BODY MASS INDEX IS PROBABLY OVER 40, WHICH IS STAGE 3 OBESITY, REALLY A SET UP FOR SERIOUS CHRONIC DISEASE, AND OBVIOUSLY HER DAUGHTER IS FOLLOWING IN HER FOOTSTEPS.
 
 ORLANDO:  IS THE DAUGHTER OBESE, ARE THEY BOTH OBESE THEN?
 
 DR. KATZ:  YES, HER DAUGHTER'S BODY MASS INDEX IS ABOVE 30 CERTAINLY.
 
 DR. SALGO: WHY DON'T WE BACK UP, WHY DON'T YOU DEFINE BODY MASS INDEX FOR ME OVER HERE.
 
 DR. KATZ: SURE, IN MEDICAL TERMS WE TALK ABOUT EXCESS BODY WEIGHT AS A MEASURE OF WEIGHT FOR HEIGHT. AND THE BODY MASS INDEX IS JUST AN ADJUSTMENT OF WEIGHT FOR HEIGHT.
 
 DR. SALGO: IS THAT WHAT YOUR MOTHER USED TO SAY, "YOU'RE NOT BIG, YOU'RE BIG BONED" I MEAN, IS THAT WHAT WE ARE TALKING ABOUT?
 
 DR. KATZ: WELL, THAT SORT OF IT, YOU'RE NOT TOO HEAVY, YOU'RE JUST TOO SHORT.
 
 DR. SANDERS: A LITTLE BIT OVERWEIGHT FOR A CHILD... YOU OFTEN SEE THEM GO OUT BEFORE THEY GO UP, BUT THIS SEEMS TO BE EXCESSIVELY OUT, AND I THINK THAT HER PEDIATRICIAN, THEY USE DIFFERENT BMI TABLES BECAUSE OBVIOUSLY KIDS ARE QUITE DIFFERENT, I'M SURE THAT HER BMI PUTS HER IN THE OBESE CATEGORY.
 
 DR. PAPA: PLUS YOU HAVE TO LOOK AT HER MOM.
 
 DR. SANDERS: YES, ABSOLUTELY, GENETICS ARE PROBABLY 70% OF OBESITY.
 
 DR. MUSTILLO: WELL, LIFESTYLE WITHIN THE FAMILY.
 
 DR. SANDERS: ABSOLUTELY.
 
 DR. SALGO:  BUT BEFORE WE GO ON, HAVE WE REALLY DEFINED BMI?  JUST NAIL THIS FOR ME.  WHAT EXACTLY--HOW DO YOU DEFINE IT?
 
 DR. KATZ: IT IS THE WEIGHT IN KILOGRAMS OVER THE HEIGHT IN METERS SQUARED THAT IS THE TECHNICAL MEASUREMENT.
 
 DR. SALGO: IN HUMAN TERMS IT IS POUNDS...
 
 DR. SANDERS: POUNDS PER SQUARE INCH.  THAT'S WHAT IT IS.
 
 DR. KATZ: IT IS WEIGHT ADJUSTED FOR YOUR HEIGHT AND YOUR BODY SURFACE.
 
 KAT CARNEY: BUT DO MOTHER AND DAUGHTER REALIZE THAT THEY HAVE A PROBLEM? I KNOW WHEN I WAS YOUNGER AND I WAS OVERWEIGHT, I DIDN'T REALLY KNOW THAT I WAS OBESE, SO WHAT IS THEIR TAKE ON THEIR SIZE OR WEIGHT.
 
 DR. SANDERS: I HAVE SEVERAL PATIENTS WHO HAVE BMIS OVER 50, AND I OFTEN HEAR THEM SAY "YOU KNOW, I LOOK AT MYSELF IN THE MIRROR AND I FEEL LIKE, I'M JUST NOT THAT BIG, I MEAN, YOU KNOW OTHER PEOPLE ARE THINNER, AND THINNER IS MORE IN FASHION, BUT I'M NOT THAT BIG, AND IN THEIR MINDS THEY ARE NOT THAT BIG."
 
 ORLANDO: BMI--IT'S STILL A WEIRD TERM TO ME, WHEN YOU SAY OVER 50, NOW THAT IS SOMETHING ELSE I HAVE TO KEEP TRACK OF IN TERMS OF ALL THE NUMBERS THAT MY DOCTOR IS HITTING ME WITH CAN WE JUST SAY THAT YOU ARE FAT OR THIN, OR YOU ARE OVERWEIGHT OR YOU ARE NOT OVERWEIGHT?
 
 DR. SALGO: IS THERE SOMETHING WRONG, DOESN'T ELISSA MAKE A GOOD POINT? THEY'RE FAT.  WHAT'S WRONG WITH FAT?
 
 DR. KATZ:  IT IS NOT A MEDICAL TERM.  WE'VE ALL LEARNED OVER RECENT YEARS THAT YOU PROBABLY SHOULD KNOW YOUR BLOOD PRESSURE, YOU PROBABLY SHOULD KNOW YOUR CHOLESTEROL AND IN A SOCIETY WHERE OBESITY IS BECOMING THE LEADING RUN AWAY PUBLIC HEALTH THREAT, WE SHOULD PROBABLY JUST KNOW OUR BMI.  IT IS A USEFUL MEASURE, IT IS NOT THAT COMPLICATED.
 
 DR. SALGO:  LET ME ASK YOU A QUESTION, BECAUSE HERE WE HAVE A YOUNG GIRL... SHE'S YOUNG, SHE IS 16.  HER MOM IS VERY LARGE.  IS THERE ANY HOPE FOR HER, HOW MUCH OF THIS IS HER ENVIRONMENT, THE WAY MOM IS FEEDING HER... THE WAY SHE HAS LEARNED TO EAT, HOW MUCH OF THIS IS SIMPLY HER GENES? MOM HAS FAT GENES, SHE'S GONNA HAVE FAT GENES. END OF STORY.
 
 DR. MUSTILLO: IT IS AN INTERACTION BETWEEN GENES AND ENVIRONMENT.  YOU CAN HAVE THE GENE FOR OBESITY AND NOT BE OBESE.
 
 DR. SALGO: I MEAN EVERYBODY HAS HEARD, WHO HAS BEEN FOLLOWING THE NEWS IN THE MEDICAL LITERATURE AND THE MEDICAL LITERATURE IN THE NEWS, WHICH IS OFTEN COMPOUNDED.  THIS TERM LEPTIN, AND THE LEPTIN GENE AND THE FAT GENE AND YOU TURN THESE THINGS ON AND YOU'RE DESTINED TO BE FAT FOREVER.
 
 DR. KATZ: WELL, LET'S LOOK AROUND. NOT ALL THAT LONG AGO, 50 YEARS AGO, CERTAINLY 100, WE KNOW THAT PEOPLE TENDED NOT TO BE FAT.  HAS LEPTIN CHANGED IN THE LAST 50 YEARS? HAVE OUR GENES CHANGED IN THE LAST 50 YEARS? ALL OF THE PHYSIOLOGY DESIGNED TO HELP US SOAK UP AND STORE CALORIES, BECAUSE CALORIES USED TO BE SCARCE, THAT'S BEEN IN PLAY FOR MILLENNIA, WHAT'S CHANGED IN THE LAST 50 YEARS IS THE ENVIRONMENT. OUR GENES ARE STABLE, THEY ARE NOT THE PROBLEM.  THEY DO MAKE US SUSCEPTIBLE TO THE TOXICITY OF A MODERN ENVIRONMENT AWASH IN CONVENIENT TASTY CALORIES AND TECHNOLOGY THAT DOES EVERYTHING OUR MUSCLES USED TO DO.
 
 DR. MUSTILLO: AND WHAT HAS CHANGED, IF YOU LOOK AT HOW STABLE GENES HAVE BEEN, LOOK AT WHAT HAS CHANGED OVER THE PAST 10 - 20 YEARS.  OUR PORTION SIZE HAS CHANGED, ACTIVITY LEVELS IN YOUTH HAS CHANGED... 
 
 DR. SANDERS: OUR HABITS.
 
 DR. SALGO: SO WHAT I AM HEARING FROM YOU IS THAT YOU ARE NOT NECESSARILY DESTINED TO BE GENETICALLY FAT.  IT IS NATURE, BUT THERE IS ALSO NURTURE.
 
 DR. SALGO: LET'S MOVE ON JUST A LITTLE BIT WITH THIS CASE, BECAUSE I HAVE MORE INFORMATION FOR YOU, THAT WE HAVE BEEN WITHHOLDING. SO REGINA, HER MOTHER, WORKS.  SO WHAT SHE DOES TO PROVIDE FOR HERSELF AND HER FAMILY IS HOLD DOWN A NUMBER OF JOBS WHICH DOESN'T ALLOW HER TO FEED HER DAUGHTER THE WAY SHE MIGHT LIKE TO FEED HER DAUGHTER, SO SHE GIVES HER DAUGHTER MONEY TO GO OUT AND BUY LUNCH AND DINNER EVERY DAY.  NOW WHAT DOES SHE DO WITH THIS MONEY? WHAT DO YOU THINK, ANYBODY GUESS WHERE SHE GOES?

(PANEL ANSWER OVER EACH OTHER)
 
 DR. SALGO: SHE GOES TO THE VENDING MACHINES, THE FAST FOOD. AND WHAT ARE YOUR THOUGHTS ABOUT THAT--FAST FOOD IN AMERICA AS KIDS' DIETS?
 
 DR. PAPA: THE MORE CONVENIENT THE FOOD IS, THE WORSE IT IS GOING TO BE FOR YOU.
 
 DR. KATZ: WE CAN ASK OURSELVES WHEN THIS CHILD GOES ON TO DEVELOP DIABETES, WILL TIME BE FOUND TO GET HER TO THE DOCTORS? WILL TIME BE FOUND TO BUY MEDICAL SUPPLIES? AND THE ANSWER IS YES.  WE NEED TO START MAKING CONTROL OF WEIGHT AN INVESTMENT IN HEALTH AS A PRIORITY BEFORE IT GETS SO SERIOUSLY OUT OF CONTROL, SO SHE AND HER MOM NEED TO WORK TOGETHER ON GETTING HEALTHIER FOODS IN THE HOUSE, CREATING HEALTHIER OPTIONS FOR HER, AND MAKING PHYSICAL ACTIVITY A PART OF WHAT THEY DO. 
 
 DR. SALGO: ASHLEY WAS BOTTLE FED, DOES THAT MAKE A DIFFERENCE AS WE GO DOWN THE LINE. DOES IT MAKE A DIFFERENCE IN THESE KIDS?
 
 DR. KATZ: YES WE DO HAVE GOOD EVIDENCE ACTUALLY, THAT A PROTRACTIVE PERIOD OF BREASTFEEDING--AT LEAST 6 MONTHS, PREFERABLY A YEAR--SETS YOU UP WITH A DEFENSE AGAINST OBESITY. IT IS NOT A GUARANTEE, AND CERTAINLY YOU CAN BE THIN AFTER BEING BOTTLE FED, BUT IT DOES MAKE A DIFFERENCE.
 
 CARNEY: WELL, AND EVEN IF YOU DO HAVE A GENETIC PRE-DISPOSITION TO BE OVERWEIGHT, THAT IS JUST THE HAND YOU ARE DEALT WITH. THAT DOESN'T EXCUSE YOU FROM MAKING LIFESTYLE, LIKE IF YOU WERE PLAYING POKER AND YOU GET A HAND, AND YOU ARE LIKE, 'THIS HAND REALLY STINKS,' ARE YOU GOING TO GIVE UP THE GAME? YOU KNOW FOLD RIGHT THEN AND THERE, YOU STILL WANT TO PLAY THE GAME. 
 
 DR. SALGO: WHAT ABOUT THIS FAMILY STRUCTURE?  I MEAN, HERE'S A YOUNG KID WHO'S GIVEN TWO MEALS A DAY IN THE FORM OF CASH... GO OUT AND FEED YOURSELF, I MEAN, ARE WE SETTING OUR KIDS UP TO FAIL THIS WAY?
 
 DR. SANDERS: ABSOLUTELY, ABSOLUTELY. 16 YEAR OLDS MIGHT BE ABLE TO MAKE MANY GOOD CHOICES IN THEIR LIVES, AND I THINK WE SEE THAT OFTEN.  BUT IF YOU GIVE THEM MONEY AND CARTE BLANCHE,  THEY ARE GOING TO MAKE MANY BAD DECISIONS BECAUSE THE PRESSURES ARE THERE PUSHING YOU TOWARDS BAD CHOICES, WHAT YOU NEED IS A STABLE PERSON TO PULL YOU BACK TO REASONABLE CHOICES.  IT HAS TO BE EASY TO DO THE RIGHT THING, NOW IT'S EASY TO DO THE WRONG THING. 
 
 DR. MUSTILLO: THE CHOICES ARE AVAILABLE TO CHILDREN AND ADOLESCENTS, LOOK AT THE SCHOOL LUNCHES, LOOK AT THE FOOD THAT IS IN THE VENDING MACHINES.
 
 DR. KATZ: IT IS NO DIFFERENT FOR ADULTS, THE CHOICES ARE JUST BAD EVERYWHERE.
 
 DR. PAPA: PETER, DOES SHE MOVE?
 
 DR. SALGO: DOES SHE MOVE?
 
 DR. PAPA: DOES SHE MOVE? DOES SHE EXERCISE? WHAT DOES SHE DO, BECAUSE THERE ARE TWO SIDES TO THIS EQUATION.
 
 DR. SALGO: I WANT TO ADVANCE THE CASE JUST A LITTLE MORE, IF YOU WILL LET ME. SHE GOES BACK TO THE GUIDANCE COUNSELOR'S OFFICE BECAUSE HER MOM WAS CALLED BY THE SCHOOL SAYING, "THERE IS A PROBLEM OVER HERE." SHE WAS CALLED, NOT BECAUSE SHE WAS OVERWEIGHT, BUT BECAUSE ASHLEY WAS OUT OF CONTROL IN SCHOOL, WHICH I SUSPECT WAS A COMMON PHONE CALL. AND WHAT WE LEARN FROM THE GUIDANCE COUNSELOR IS THAT ASHLEY PHYSICALLY ATTACKED A CLASSMATE, AND THE CLASSMATE HAD AN AWFUL NAME FOR HER, SHE CALLED HER THE "HUMAN BALLOON" ... THE HUMAN BALLOON. SO MOM IS ANGRY. SHE IS ANGRY BECAUSE HER DAUGHTER ATTACKED THE CLASSMATE, AND WHEN SHE CONFRONTS ASHLEY ABOUT THAT, ASHLEY BREAKS DOWN AND TELLS HER MOM JUST HOW UNHAPPY SHE IS BEING THIS HEAVY. HOW COMMON IS ALL OF THIS?
 
 GROUP: EXTREMELY COMMON, VERY COMMON.
 
 DR. SANDERS: I MEAN, I THINK THAT, NOT EVERYBODY STRIKES OUT, BUT EVERYBODY WHO IS OBESE, ESPECIALLY IN SCHOOL BEFORE KIDS REALLY CAN CENSOR WHAT THEY SAY, THERE'S THE CULTURAL STIGMA THAT WE ASSOCIATE WITH OBESITY.  WE DON'T BLAME PEOPLE FOR BEING HYPERTENSIVE, WE DON'T BLAME PEOPLE FOR HAVING HIGH CHOLESTEROL--WE BLAME PEOPLE FOR BEING OVERWEIGHT.
 
 DR. SALGO: WE DON'T BLAME THEM FOR BEING HYPERTENSIVE RIGHT? BUT THAT'S BECAUSE THEY DON'T EAT TO GET HYPERTENSIVE WE SEE EATING AS A VOLITIONAL ACTIVITY. 
 
 DR. PAPA: YOU DON'T SEE HYPERTENSION, I CAN'T LOOK AT YOU AND SAY, YOU HAVE HYPERTENSION, YOU HAVE DIABETES, I CAN SEE YOU ARE FAT.
 
 DR. KATZ: WE'VE GOT TO PURGE OUR SOCIETY OF THIS STIGMA IN THE SENSE OF BLAME BECAUSE LOOK AT THE DAMAGE IT DOES.
 
 ORLANDO: KIDS ALWAYS TEASE EACH OTHER, THEY ALWAYS TEASE EACH OTHER ABOUT BEING OVERWEIGHT.
 
 DR. MUSTILLO: THERE IS A RELATIONSHIP BETWEEN OBESITY AND BEHAVIOR PROBLEMS IN CHILDREN, THERE IS A RELATIONSHIP BETWEEN OBESITY AND DEPRESSION IN CHILDREN, AND THERE IS A RELATIONSHIP BETWEEN OBESITY AND OPPOSITIONAL BEHAVIOR, CONDUCT BEHAVIOR.  DOES SHE HAVE A HISTORY, DO YOU KNOW OF ?
 
 DR. SALGO: THIS APPARENTLY IS THE FIRST TIME SHE'S BEEN CALLED INTO THE GUIDANCE COUNSELOR'S OFFICE, THE FIRST TIME THAT HER MOM HAS BEEN CONFRONTED WITH ALL OF THIS AND I THINK HER MOM NEEDS TO REMEMBER WHAT WE ALL NEED TO REMEMBER ABOUT THIS, I GUESS BEFORE WE EVEN GO ANY FURTHER, WHICH IS THAT BEING OVERWEIGHT IS A COMBINATION, IT IS A COMBINATION OF NOT ONLY YOUR GENES BUT ABOUT YOUR ENVIRONMENT AS WELL, AND UNTIL I THINK WE UNDERSTAND THAT, THEN WE ARE NOT GOING TO GET MUCH FURTHER WITH THIS DISCUSSION. DO YOU ALL AGREE ABOUT THAT?
 
 DR. KATZ: I THINK THAT IS CRITICAL. IT IS ALSO INTERESTING TO SPECULATE THAT WITH THE RATE OF OBESITY RISING SO FAST MAYBE ULTIMATELY THAT WILL CURE THE STIGMA.
 
 DR. MUSTILLO: IF YOU LOOK IN DIFFERENT COMMUNITIES, FOR EXAMPLE, THE AMERICAN INDIAN POPULATION, THE PERCENT OF OBESITY IS HIGHER IN THE AMERICAN INDIAN POPULATION AND THERE IS LESS STIGMA, THEY HAVE FEWER PSYCHOLOGICAL PROBLEMS.
 
 DR. KATZ: AND THERE IS A DANGER IN THAT AS WELL, BECAUSE THOSE OF US WHO ARE HEALTH CARE PROFESSIONALS, KNOW THAT THIS IS NOT A COSMETIC ISSUE PER SE, THIS IS A HEALTH ISSUE. 
 
 DR. PAPA: THE PORTRAYAL IS THAT IT IS A COSMETIC ISSUE, I MEAN EVEN THOUGH WE TALK ABOUT THIS ALL THE TIME, AIRWAVES BOMBARD US WITH IT YOU KNOW, SURGICAL TECHNIQUES, AND SURGERY, AND THINGS YOU CAN DO TO MAKE YOU LOOK BETTER, THEY ARE NEVER TALKING ABOUT THE HEALTH.
 
 DR. SALGO: HOW MUCH OF THIS OVERWEIGHT PROBLEM IS GENETIC AND HOW MUCH OF IT IS ENVIRONMENT?  50/50?  30/60?
 
 DR. KATZ: IT IS IMPOSSIBLE TO UNBUNDLE THE TWO.  IT'S ALL GENETIC AND IT'S ALL ENVIRONMENT.  IF WE WEREN'T GENETICALLY SUSCEPTIBLE, NO ENVIRONMENT WOULD MAKE US FAT...
 
 DR. SANDERS: WELL ACTUALLY, I THINK THERE HAVE BEEN SOME STUDIES AND SOME PEOPLE ESTIMATE THAT 70% OF IT IS GENETIC WITH 30% BEING OTHER FACTORS. 
 
 DRGO: THIS BRINGS US TO THE OBVIOUS QUESTION... SO WHAT?  WHY DON'T WE JUST SAY... THAT'S THE NORM, SO WHAT?
 
 DR. MUSTILLO: TYPE II DIABETES IN CHILDREN.
 
 DR. KATZ: CARDIOVASCULAR DISEASE.
 
 DR. PAPA: HYPERTENSION DISEASE, CARDIOVASCULAR DISEASE, ARTHRITIS, PULMONARY DISEASE, IT IS A HUGE.
 
 DR. KATZ: YOU KNOW WHERE WE ARE HEADED?  WE HAVE SEEN IN THE LAST TWO DECADES ADULT ONSET DIABETES TRANSFORM IN A CONDITION EPIDEMIC IN 6, 7, AND 8 YEAR OLDS.  DIABETES IS SUCH A POTENT RISK FACTOR FOR HEART DISEASE THAT THE NATURAL CHOLESTEROL EDUCATION PROGRAM TELLS US THAT WHEN YOU TREAT A PATIENT WITH DIABETES, ASSUME HEART DISEASE, I PREDICT ON THIS TRAJECTORY, WE WILL SEE HEART ATTACKS ROUTINELY IN 16, 17 AND 18 YEAR OLDS A DECADE FROM NOW.
 
 DR. SALGO: BUT WHAT ABOUT THE OTHER STIGMA OF BEING FAT?  I MEAN, IS IT JUST MEDICINE, OR IS IT SOCIAL AS WELL.
 
 DR. SANDERS: I THINK IT IS TOTALLY SOCIAL. SHE'S NOT CRYING BECAUSE SHE HAS HYPERTENSION.  SHE COULDN'T CARE LESS WHETHER SHE HAS HYPERTENSION.  SHE'S CRYING BECAUSE SHE HASN'T HAD A DATE, SOMEBODY CALLED HER BALLOON GIRL PEOPLE DON'T LIKE FAT PEOPLE.
 
 DR. SALGO: ARE DOCTORS BIASED AGAINST FAT PEOPLE TOO?
 
 EVERYONE: ABSOLUTELY, YES.
 
 DR. PAPA: A SIMPLE QUESTION FOR KAT. KAT YOU LOST A LOT OF WEIGHT.  DID YOUR DOCTOR EVER SAY TO YOU, YOU ARE OBESE.
 
 CARNEY: NEVER SAID IT ONE TIME.
 
 DR. KATZ: AND PART OF THE REASON IS, DOCTORS, FOR THE MOST PART, HAVE NOT FIGURED OUT HOW TO BROACH THE SUBJECT COMFORTABLY. I COULD TALK TO YOU ABOUT YOUR HIGH BLOOD PRESSURE BECAUSE NEITHER OF US WOULD THINK THAT I WAS SAYING IT WAS YOUR FAULT.
 
 DR. SANDERS: THE PATIENTS ARE READY TO HEAR THIS FROM THEIR DOCTORS.  IT'S DOCTORS WHO WORRY THAT THEY WILL HURT PEOPLE'S FEELINGS.
 
 CARNEY: I DIDN'T REALLY WANT TO HEAR THAT I WAS OVERWEIGHT, I WANTED TO HEAR, SO WHAT DO I NEED TO DO?  CAN YOU GIVE ME A PLAN THAT I CAN FOLLOW?
 
 DR. SALGO: BEFORE WE GO FURTHER WITH THIS CASE, GIVE ME A NUMBER, HOW MUCH WEIGHT DO YOU HAVE TO LOSE PER WEEK TO MAKE YOUR DOCTOR HAPPY, TO MAKE YOUR BODY HAPPY?
 
 DR. KATZ: FRANKLY, I DON'T LIKE TO SEE PATIENTS LOSE MORE THAN A POUND, A POUND AND A HALF A WEEK AND HERE'S WHY. THE MORE RAPIDLY YOU LOSE WEIGHT, IN THE SHORT TERM, SO YOU LOSE 14 POUNDS IN 12 DAYS, GREAT...THE MORE YOU REBOUND, THE MORE YOU OVERSHOOT AND GAIN IT BACK WITH INTEREST.  YOU'VE GOT TO BE DOING THINGS THAT ARE SUSTAINABLE. IT IS NOT ABOUT A DIET YOU GO ON, IT IS ABOUT LIFESTYLE CHANGE.

 DR. SALGO: SO IF I HEAR WHAT YOU ARE SAYING CORRECTLY, ONE OF THE IMPORTANT THINGS THAT EVERYONE REALLY SHOULD REMEMBER ABOUT WEIGHT LOSS, IS THAT MODEST WEIGHT LOSS, SLOW MODEST WEIGHT LOSS IS AS IMPORTANT AS THE END WHERE YOU ARE GOING. THE JOURNEY IS AS IMPORTANT AS THE DESTINATION.
 
 CARNEY: JUST FROM SOMEONE WHO HAS LOST THE WEIGHT, REALLY FOR ME THE JOURNEY WAS MORE IMPORTANT, AND THE NUMBERS ON THE SCALE WEREN'T THE JOURNEY, THE NUMBERS ON THE SCALE WERE THE RESULTS OF THE JOURNEY. THE JOURNEY WAS THE CHANGE IN MY LIFESTYLE THAT I MADE. I CAN'T CONTROL, NO MATTER WHAT I AM DOING, I REALLY CAN'T CONTROL WHETHER I LOSE 1 OR 2 POUNDS OR 5 POUNDS A WEEK, BUT I CAN CONTROL WHAT I PUT IN MY MOUTH AND HOW MUCH PHYSICAL ACTIVITY I CAN GET.
 
 DR. SALGO: I'LL TELL YOU ONE THING. SHE GOES TO THE DOCTOR'S OFFICE, ASHLEY GOES IN, HER MOM IS WITH HER AND WHAT DO YOU THINK THE FIRST THING THAT ASHLEY ASKED FOR THE DOCTOR TO DO?
 
 DR. SANDERS: DIET PILLS.
 
 DR. SALGO: NO.
 
 ORLANDO: GASTRIC BYPASS.
 
 DR. SALGO: BUT YOU'RE CHEATING, YOU KNOW THIS CASE.
 
 ORLANDO: BUT WHY NOT, EVERYBODY IS DOING IT. THAT IS THE ANSWER.  WHY NOT?
 
 DR. SALGO: IS IT A RATIONAL ANSWER?
 
 DR. PAPA: THE PROBLEM I HAVE WITH A GASTRIC BYPASS AS A PRIMARY CARE DOCTOR IS, MY REASON FOR THE PATIENT WANTING TO LOSE WEIGHT IS FOR THE HEALTH.
 
 DR. KATZ: THIS IS A MEDICAL DECISION AND SHOULD BE MADE AS SUCH.  IN MEDICINE, WE DO A LOT OF DANGEROUS THINGS BECAUSE WE HAVE TO.  BUT WE ONLY DO A DANGEROUS THING LIKE SURGERY WHEN NOT DOING IT IS EVEN MORE DANGEROUS.  SO SURGERY IS NOT A GOOD IDEA FOR THIS GIRL IF THERE ARE BETTER OPTIONS THAT ARE LESS DANGEROUS AND MORE CONDUCIVE.
 
 DR. PAPA:  BUT IT IS ALSO NOT A BETTER IDEA FOR THE PATIENT EITHER, IF SHE IS NOT GOING TO CHANGE HER BEHAVIOR BECAUSE BARIATRIC SURGERY FAILS, AND I THINK THERE IS A MISCONCEPTION THAT RIGHT NOW, OK WE CAN SEE THOSE CHANGES, WHAT HAPPENS 20 YEARS DOWN THE ROAD? THAT IS MY CONCERN, BECAUSE I AM GOING TO BE TAKING CARE OF HER.
 
 DR. SALGO: ALRIGHT, BARIATRIC SURGERY, THAT IS STOMACH STAPLING, GASTRIC BYPASS, WHATEVER YOU WANT TO CALL IT, THAT SURGERY IS NOT AN OPTION FOR HER.  WHAT ARE YOU GOING TO PRESCRIBE FOR HER?  SHE'S BEEN DOING LOTS OF DIETS, THEY HAVEN'T WORKED, I CAN TELL YOU THAT SHE HAS BEEN A YO-YO DIETER.
 
 DR. SANDERS: I MEAN, SHE'S TRIED EVERY DIET, BUT HAD SHE REALLY BEEN SUPPORTED IN WHAT SHE IS DOING, I MEAN, HAS SHE WORKED WITH SOMEONE, HAS SHE HAD SOMEBODY HELPING HER MAKE THE DECISIONS?  LOSING WEIGHT AND CHANGING YOUR LIFESTYLE IS A HUNDRED DECISIONS YOU MAKE A DAY, AND MOST OF THOSE HAVE TO GO IN THE RIGHT DIRECTION, DOES SHE HAVE SOMEBODY WHO CAN HELP HER LEARN HOW TO MAKE THOSE DECISIONS, I MEAN, GOOD LORD SHE IS ONLY 16!
 
 DR. MUSTILLO: UNLESS HER MOTHER HAD DONE IT WITH HER.
 
 DR. SANDERS: I'D SAY IT'S CLEAR THAT HAS NOT
 
 DR. SALGO: IS THIS BEAT UP HER MOTHER TIME? HER MOTHER IS NOT HOME, SHE IS WORKING TO KEEP HER IN SCHOOL...
 
 ORLANDO: WHAT IF SHE DID SOMETHING LIKE THE ATKINS DIET, WHICH PEOPLE SEEM TO LOSE WEIGHT ON THE ATKINS DIET, I MEAN IT IS A DIET BUT IT SEEMS TO WORK, IT SEEMS TO WORK OVER THE LONG HAUL.
 
 DR. PAPA: EVERY DIET WORKS. EVERY DIET THAT COMES OUT HAS WORKED, AND THE REASON WHY IT WORKS IS BECAUSE IT MAKES YOU PAY ATTENTION TO WHAT YOU ARE DOING, THAT'S THE MAIN CRUX OF IT, IT MAKES YOU WATCH WHAT YOU'RE EATING.
 
 DR. KATZ: IN SOME WAYS, LEARNING HOW TO EAT WELL IN THIS TOXIC NUTRITIONAL ENVIRONMENT WHERE BAD CHOICES COME SO EASILY, IS A LITTLE BIT LIKE LEARNING TO SPEAK A FOREIGN LANGUAGE. THERE IS A LOT OF EFFORT INVOLVED. I WOULD WANT TO START MEETING WITH HER REGULARLY, I WOULD WANT HER MOM INVOLVED, AND I WOULD INDICATE THAT THE TWO NEED TO BE A TEAM, AND I THINK THE MOM NEEDS A DISCUSSION ABOUT HER WEIGHT NOT IN A WAY THAT IS JUDGMENTAL, BUT TO INDICATE THAT HER HEALTH IS AN ISSUE TOO.
 
 DR. SALGO: SO HERE IS WHAT I WOULD LIKE YOU ALL TO DO... I'M HER MOM, AND SHE IS SITTING RIGHT NEXT TO ME, NICE GIRL. GIVE ME A PRESCRIPTION.
 
 DR. KATZ: THE VERY FIRST THING I WOULD DO SINCE EATING OUT OF THE HOUSE SEEMS TO BE A BIG ISSUE, I WOULD ASK THEM TO INVEST $2.80 IN AN INSULATED SNACK PACK.  AND TELL THEM, WHEN MOM GOES TO THE SUPERMARKET, GET THE FOLLOWING ITEMS...FRESH FRUIT, BABY CARROTS, WHOLE-GRAIN CEREALS, NON-FAT YOGURT, DRIED FRUIT, NUTRITIOUS FOODS, AND SHE SHOULD PUT THOSE IN THAT PACK EVERY MORNING AND TAKE THEM WITH HER AND START LEARNING TO TURN TO THAT RATHER THAN THE FRENCH FRIES AND THE FAST FOOD RESTAURANTS WHEN SHE GETS HUNGRY.  FIRST STEP.
 
 DR. SANDERS: I WOULD ALSO SUGGEST THAT THEY HAVE TO START MOVING.
 
 CARNEY:  I WOULD ALSO SAY IT'S ABOUT PERSPECTIVE TOO. YOU KNOW, YOU HEAR A LOT OF MESSAGES THAT DIETS DON'T WORK OR THIS IS GOING TO BE REALLY HARD. FOR ME, I HAD TO GO "ALRIGHT THIS PROBABLY WON'T BE THE HARDEST THING I EVER DO, BUT I CAN DO IT," WHEN I BELIEVED THAT I COULD DO IT, AND THAT I WAS GOING TO MAKE THE EFFORT, THAT CHANGES MY PERSPECTIVE ON HOW I'M GOING TO APPROACH THINGS.
 
 DR. KATZ: AND THERE'S A SIMPLE TOOL THAT'S USED IN BEHAVIOR-CHANGE SCIENCE, TO HELP PEOPLE GET THERE, CALLED A DECISION BALANCE. AND YOU JUST PUT ON A PIECE OF PAPER, CHANGE, DON'T CHANGE, PRO'S, CON'S. I WOULD MAKE THAT HOMEWORK FOR HER.
 
 DR. SALGO: SOUNDS LIKE YOU'RE RECOMMENDING COUNSELING TO ME.

DR. KATZ: WELL, WE WOULD PROVIDE THE COUNSELING, SOME OF US WHO DO THIS, THERE IS A NEED FOR COUNSELING, SHE BASICALLY NEEDS TO CHANGE HER LIFESTYLE, THAT'S NOT AN EASY THING.
 
 ORLANDO: OK WAIT, CHANGE HER LIFESTYLE, CHANGE HER DECISIONS, CHANGE THE TOTAL WAY THAT YOU THINK ABOUT THE FOOD THAT YOU EAT EVERY DAY, START MOVING AROUND, GET A COUNSELOR, SHE SOUNDS LIKE AN ALCOHOLIC TO ME, IT SOUNDS LIKE A 12-STEP PROGRAM TO ME.
 
 DR. PAPA: SHE'S GOING TO NEED TO DO THAT AFTER SHE HAS A FIRST HEART ATTACK, OR WHEN SHE'S DIAGNOSED WITH DIABETES, IT'S GOING TO HAPPEN. SO IT'S BETTER OFF THAT IT HAPPEN NOW, BEFORE THAT SETS IN.
 
 ORLANDO: DOES IT TAKE THAT LEVEL OF COMMITMENT AND LAYERS?
 
 DR. KATZ: IT'S PROBABLY HARDER TO CHANGE YOUR DIET THAN TO ADDRESS SOME OF THESE OTHER THINGS LIKE ALCOHOL, IT'S EXTREMELY DIFFICULT. AND YOU CAN'T JUST WALK AWAY, YOU KNOW, TOBACCO, TOUGH ADDICTION, BUT YOU CAN SAY NO AND BE DONE WITH IT AT SOME POINT, FOOD YOU HAVE TO LEARN TO LIVE WITH FOR THE REST OF YOUR LIFE.
 
 DR. SANDERS: EXACTLY, AND IT'S VERY HARD.
 
 DR. SALGO: I HEAR WHAT YOU'RE TELLING, THIS IS GOING TO COST ME MONEY, THIS IS GOING TO COST ME TIME, I HAVE TO WORK WITH MY DAUGHTER IN THE MORNING BEFORE I GO TO WORK.  HOW REALISTIC IS THIS?
 
 DR. MUSTILLO: BUT IF SHE HAD ANOTHER SERIOUS ILLNESS, WOULD YOU SAY I DON'T HAVE TIME TO TAKE HER TO TREATMENT?
 
 DR. SANDERS: IF SHE HAS CANCER, YOU'RE NOT GOING TO SAY I DON'T HAVE TIME FOR CHEMOTHERAPY.
 
 DR. PAPA: THERE'S A PERCEPTION THAT YOUR WEIGHT LOSS IS, YOU'RE AT RISK, YOU'RE AT RISK, YOU'RE AT RISK, OH NOW YOU'RE NOT AT RISK ANYMORE. IT'S MORE LIKE A STAIRCASE. I MEAN, EACH POUND THAT YOU LOSE, YOU IMPROVE YOUR RISK. SO EVEN THOUGH YOU MAY NEVER GET TO YOUR IDEAL BODY WEIGHT, I MEAN I HAVE TO BE REALISTIC WITH MY PATIENTS, IF I TELL THEM, NOPE YOU'RE NOT THERE YET, NOPE, NOT ANYMORE, I WON'T PAY ANY ATTENTION UNTIL YOU'RE RIGHT THERE
 
 DR. KATZ: THERE'S ANOTHER CRITICAL ISSUE IN THIS CASE.  MOM IS WORKING SEVERAL JOBS TO MAKES ENDS MEET.  THESE PEOPLE PROBABLY DON'T HAVE A LOT OF MONEY EITHER AND SO WHEN YOU ARE LIMITED IN RESOURCES, TIME AND MONEY, YOU HAVE FEWER OPTIONS AND I THINK IT'S ONLY FAIR TO SAY WHATEVER ADVICE WE HAVE FOR THIS GIRL AND HER MOM, THAT THE ENVIRONMENT NEEDS TO BE CHANGED, BECAUSE THE DECK IS STACKED AGAINST THEM.
 
 DR. SANDERS: WE TELL PEOPLE YOU SHOULD EXERCISE MORE AND EAT LESS BUT WE DON'T REALLY TELL THEM HOW TO DO THIS, I MEAN, THIS IS NOT A NEWS FLASH.
 
 ORLANDO: AND THAT'S HARD, I MEAN NO MATTER WHO YOU ARE, NO MATTER HOW MUCH MONEY YOU HAVE OR DON'T HAVE, WHERE YOU'RE LIVING, IT'S STILL REALLY HARD, YOU SAID IT'S EASIER TO KICK ALCOHOL OR SMOKING.
 
 DR. SALGO:  YOU'RE BASICALLY SAYING THIS IS AN EMOTION-LADEN MOMENT, THAT THERE IS A HUGE EMOTIONAL OVERLAY TO ALL OF THIS.
 
 DR. KATZ:  BUT YOU CAN HELP GET OVER THAT BY SAYING LOOK; WERE GOING TO WORK...AND THIS IS WHAT WE DO IN MEDICINE WHEN YOU HAVE TO BREAK THE NEWS TO SOMEONE ABOUT A CANCER DIAGNOSIS--WE DEAL IN BAD NEWS, IN DIFFICULT NEWS BUT WHAT WE SAY IS 'ALRIGHT THERE IS A PROBLEM HERE, THERE IS A CHALLENGE, WERE IN THIS TOGETHER AND THERE ARE SOLUTIONS AND LETS TALK ABOUT WHAT WERE GOING TO DO'... BECAUSE ALL OF THE SUDDEN, IN FACT, THERE IS THIS PROFOUND SENSE OF RELIEF.  WHAT HAS JUST BEEN A BURDEN IN MY LIFE AND A SECRET IS NO LONGER A SECRET AND I CAN SHARE THE BURDEN.
 
 DR. MUSTILLO:  WELL I THINK DAVID IS EXACTLY RIGHT. YOU LAY IT ON THE LINE BUT THEN YOU SAY THERE'S HOPE, THIS IS WHAT WE CAN DO.  AND IN THIS CASE I THINK THAT IT'S SO EASY TO SAY WE DON'T HAVE TIME OR WE DON'T HAVE MONEY, OR THIS IS TOO DIFFICULT,  BUT TO SAY 'LETS SIT DOWN LETS FIGURE OUT WHAT YOUR SCHEDULE IS, LETS FIGURE OUT WHAT YOUR RESOURCES ARE AND LETS MAKE A PLAN FOR YOU OF HOW WE CAN...
 
 ORLANDO:  BUT ARE YOU GOING TO TELL SOMEBODY THAT IT'S GOING TO BE REALLY HARD, AND YOU'RE GOING TO HATE IT FOR A LONG TIME MAYBE AND YOUR GOING TO STRUGGLE EVERY DAY?
 
 CARNEY:  IF SOMEONE HAD SAID THAT TO ME IN THE BEGINNING I WOULD OF COME BACK TO THEM NOW AND SAID "YOU LIED.  YOU LIED TO ME, IT WASN'T AS HARD AS YOU MADE IT SOUND"
 
 DR. SALGO:  IT WAS EASIER THAN YOU THOUGHT IT WOULD BE?
 
 CARNEY: ABSOLUTELY.
 
 DR. SALGO: THE CASE ACTUALLY GOES A LITTLE FURTHER, BECAUSE SOME GOOD THINGS HAPPEN, ASHLEY ACTUALLY DID GET INVOLVED, HER MOTHER GOT INVOLVED, THEY SAW A PSYCHOLOGIST, AND HER MOTHER GOT HER ON THREE MEALS A DAY, BETTER MEALS AND SHE STARTED WALKING WITH HER DAUGHTER...JUST AS YOU GUYS...THEY WERE LISTENING TO YOU.
 
 DR. SALGO: BUT ASHLEY IS ONLY 16, SHE IS MAKING PROGRESS, SHE IS LOSING WEIGHT...WHAT IF SOMEBODY IS OLDER? IS IT FIXED IN STONE, ONCE THE DAMAGE IS DONE, CAN YOU DO THIS WHEN YOU ARE OLDER, I MEAN SHOULD OLDER PEOPLE JUST GIVE UP?
 
 ORLANDO: WHAT ABOUT HER MOTHER?
 
 DR. SALGO: WHAT ABOUT HER MOTHER?
 
 DR. KATZ: WE DO TALK ABOUT OUNCES OF PREVENTION, POUNDS OF CURE, SO THE LONGER YOU WAIT THE MORE YOU HAVE TO DEAL IN CURE RATHER THAN PREVENTION, SO ASHLEY IS THE BENEFIT HERE OF ANTICIPATORY INTERVENTION, SHE DOESN'T NEED TO GO ON AND DEVELOP DIABETES, BUT IT IS NEVER TOO LATE.
 
 ORLANDO: BUT I AM OVER 40, AND IF SOMETHING HAPPENS, EVERYTHING GETS HARDER. SO I MEAN IT MIGHT BE ONE THING FOR THE YOUNG LADY BUT FOR REGINA, FOR HER MOTHER, IT'S GOING TO BE A DIFFERENT STORY IF SHE WANTS TO DO THE SAME THING, RIGHT?
 
 DR. SANDERS: IT IS HARDER, BUT WHAT CHOICE DO YOU HAVE? WE WOULD ALL LIKE TO TURN BACK THE CLOCK, BUT IT'S NOT AN OPTION, YOU DON'T GET TO PICK.
 
 DR. KATZ: IT DEPENDS ON THE GOALS, ELISSA.  IF YOU ARE TALKING ABOUT LOSING WEIGHT FOR THE MOM, YEAH OKAY IT IS GOING TO BE RATHER DIFFICULT, BUT SHE IS GOING TO DERIVE HEALTH BENEFITS FROM WALKING AND EATING BETTER HOWEVER MUCH WEIGHT SHE DOES OR DOESN'T LOSE, OUR FOCUS SHOULD REALLY BE ON A HEALTH LIFESTYLE, BECAUSE THAT SHE CAN CONTROL, MAKING HEALTHIER CHOICES.
 
 DR. PAPA: I HAVE A SECRET FOR YOU, IF YOUR WEIGHT WAS NORMAL, YOU'D STILL NEED TO DO THOSE THINGS.
 
 DR. SANDERS: ABSOLUTELY. 

 DR. PAPA: THERE IS A MISCONCEPTION THAT IS WITH EVERYBODY, I DON'T CARE WHAT YOUR WEIGHT IS, IT IS A LIFESTYLE ISSUE THAT NEEDS TO BE ADDRESSED.  I HAVE PATIENTS FOR THE SAME REASON IF THEY THINK THEIR BLOOD PRESSURE IS CONTROLLED WITH PILLS, AND THEIR CHOLESTEROL IS CONTROLLED WITH PILLS, I DON'T HAVE TO EAT WELL, I DON'T HAVE TO EXERCISE.  MISCONCEPTION. EVERYBODY NEEDS TO DO THIS.
 
 DR. SANDERS:  I THINK PORTION SIZE IS REALLY, REALLY FUNDAMENTAL, AND I THINK IT IS PROBABLY MORE IMPORTANT THAN WHAT MAKES UP THOSE THINGS, AS LONG AS YOU CAN EAT FOODS THAT MAKE YOU FEEL FULL, AND STAY FULL, SO THAT YOU CAN EAT A REASONABLE AMOUNT OF FOOD.
 
 DR. MUSTILLO: I THINK IT IS IMPORTANT TO THINK ABOUT, NOT JUST TO THINK ABOUT WHAT IS NOT IN FOODS IN TERMS OF FAT AND CARBS, BUT WHAT IS IN FOOD, WHAT IS GOOD FOR YOU IN THERE.
 
 DR. KATZ: WE ARE NOT CLUELESS ABOUT THE BASIC CARE AND FEEDING OF HOMO SAPIENS. THE VOLUMES OF EVIDENCE THAT TELL US THAT FRUITS, VEGGIES AND WHOLE GRAINS PREVENT CANCER, PREVENT HEART DISEASE, PREVENT DIABETES, ARE REALLY EVERY BIT AS CONVINCING AS THE EVIDENCE THAT BEING PHYSICALLY ACTIVE IS GOOD FOR HEALTH.
 
 DR. SALGO: WELL, I'LL TELL YOU WHAT I HEAR EVERYBODY HERE SAYING AND I THINK IT IS SOMETHING THAT OUR VIEWERS PROBABLY KNOW AS WELL, BUT WE OUGHT TO TELL THEM AGAIN, BECAUSE IT IS SOMETHING THAT, ALTHOUGH IT IS SIMPLE, APPARENTLY IF I HEAR YOU CORRECTLY, NOT ENOUGH FOLKS ARE PAYING ATTENTION TO, THAT IT REALLY IS VERY SIMPLE. LOSING WEIGHT IS EXERCISE MORE, EATING LESS. IT'S EASY TO DESCRIBE, I KNOW IT IS HARD TO DO, BUT LETS JUST TAKE A VERY CLEAR DESCRIPTION, IF YOU LOSE ONE POUND A WEEK, EVERYONE SAYS OH MY GOODNESS, THAT IS NOT WHAT I HEAR ON TV, ONE POUND A WEEK, ADD IT UP, AT THE END OF THE YEAR YOU HAVE LOST 52 POUNDS, NOW SUBTRACT TWO WEEKS FOR CHRISTMAS, A WEEK FOR THANKSGIVING, YOU ARE STILL DOWN 49 OR 50 POUNDS, AND EVERYBODY WOULD AGREE THAT HIS IS A REASONABLE AMOUNT OF WEIGHT TO LOSE NO?  I HATE TO END THE DISCUSSION, BUT THAT IS JUST ABOUT ALL THE TIME THAT WE HAVE FOR TODAY. WE HAVE COVERED A LOT OF GROUND THIS LAST HALF HOUR SO I JUST WANT TO SEE IF I CAN SUMMARIZE WHERE WE'VE BEEN, ALL THE WAY THROUGH ALL OF THIS.  WEIGHT IS A FUNCTION OF GENES AND YOUR ENVIRONMENT COMBINED, NOT ONE, NOT THE OTHER ENTIRELY, EVEN MODEST WEIGHT REDUCTION IMPROVES YOUR HEALTH, AND IMPROVES YOUR WELL BEING, AND AGAIN THE BOTTOM LINE, I KNOW YOU'VE HEARD IT BEFORE, YOU ARE GOING TO HEAR IT AGAIN.  EAT LESS, EXERCISE MORE IT REALLY IS THAT SIMPLE, NOW I AM NOT SAYING IT IS EASY... IT'S HARD, BUT PEOPLE DO IT EVERY DAY. AND AGAIN, YOU LOSE A POUND A WEEK FOR 52 WEEKS, 52 POUNDS A YEAR, THAT'S A LOT OF WEIGHT. THAT IS A LOT OF WEIGHT, EVEN IF YOU ARE TREMENDOUSLY OBESE. I WANT THE THANK ALL OF YOU FOR BEING HERE, THIS WAS SIMPLY TREMENDOUS. OUR FINAL MESSAGE IS THIS, TAKING CHARGE OF YOUR HEALTH, MEANS BEING INFORMED, AND HAVING QUALITY COMMUNICATION WITH YOUR DOCTOR.  I'M DOCTOR PETER DR. SALGO I'LL SEE YOU NEXT ON SECOND OPINION.
 
 SEARCH FOR HEALTH INFORMATION AND LEARN MORE ABOUT DOCTOR/PATIENT COMMUNICATION ON THE SECOND OPINION WEB SITE.  THE ADDRESS IS PBS.ORG.
 
 MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION.  THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIO-VASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING. THE JOSIAH MACY JR. FOUNDATION AND THE PARK FOUNDATION.


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