CHAPTER NINE.

IT'S HOW YOU MOVE MY STORY, WITH JOSHUA HOLLAND, CHRISTIE HEFNER,.

MAGGIE MURPHY, DAVID KIRCHHOFF.

Changing how you move is every bit as important as changing how you eat. In fact, the two habits work closely together. According to the American Council on Exercise, if you diet without exercise, 25 percent of every pound you lose is lean body ma.s.s. When you lose lean muscle, your metabolism slows down, making weight loss even more difficult. On the other hand, the higher your percentage of lean body ma.s.s, the faster your metabolism-and the faster your metabolism, the more calories you can burn.1 I used to think of this as my antidote to bingeing. I would stuff myself with junk food and then exercise so compulsively that some people called me "an exercise bulimic." I'm not sure that's an official diagnosis, but it did seem like a good description of my manic ability to calculate exactly how far and how fast I would need to run to burn off a pizza or a pint of ice cream. I spent so much time obsessing over this in college that I barely managed to study, or even attend cla.s.s. The same thing happened when I got into the work world. Early in my career, if I wasn't at the TV station working, it was a pretty safe bet that I was out running someplace.

I am no longer doing those internal calculations, and no longer spending all of my free time running. My att.i.tude toward exercise is a lot less compulsive now, and a lot healthier. It's still a big part of my life, but in a very positive way. Honestly, exercising is how I keep my sanity and reduce my stress.

It's also how I maintain my health. Research tells us that regular exercise lowers the risk of early death, coronary heart disease, stroke, high blood pressure, type 2 diabetes, and even some types of cancer. Unfortunately, not enough people are paying attention to that message: the federal government's Healthy People 2020 report estimates that nearly 80 percent of adults aren't doing enough aerobic or muscle-strengthening exercise.2 My strategy for fitting physical activity into my life is to make sure to keep moving, no matter where I am. Washington, DC, is the center of the political universe, so I'm there a lot for Morning Joe, and no matter how busy my day is I find a way to squeeze in some exercise. Every time I head to Georgetown for lunch, I go first to the "Exorcist steps," made famous by Father Karras' headfirst fall in the movie, and run them up and down. So far, at least, my head hasn't started spinning, and it hasn't caused projectile vomiting, but I have burned some extra calories.

I prefer to run outside whenever I can, rather than limit myself to the gym, and that allows me to exercise almost anywhere. My friends, colleagues, and business a.s.sociates know that I often return phone calls while I'm out running. I can get a lot done on that four-mile daily run, although I sometimes use it just as a "time out"-a chance to clear my head.

At home, I often add ten minutes of arm work with ten-pound weights to my routine, and three times a week I jump on the elliptical trainer for twenty-five minutes more. The whole regimen is pretty simple, and it's one that I can work into my hectic schedule, which is the key to doing it regularly.

My penchant for grabbing a little piece of my workout at every opportunity draws some chuckles among my crowd, but they have gotten used to it. They know that if we pa.s.s a steep hill when we take the show across the country, I might just whip off my heels and run up and down it a few times. It turns out that even celebrity trainer Joshua Holland, whose clients include Madonna, agrees that's a sound approach to staying fit. Although he is the director of training at the exclusive CORE club in New York City, Josh doesn't think exercise should begin and end at the gym. "Fitness includes everything from walking to work to taking the stairs instead of the elevator," he says. His advice: "Move well and move often, and do as much of it as you can."

Fitness includes everything from walking to work to taking the stairs instead of the elevator. Move well and move often, and do as much of it as you can.

-Joshua Holland In a society where so many people work in sedentary jobs and power tools do most of our heavy work for us, we have to incorporate activity into our daily lives very consciously. I remember as a kid, we used to rake leaves for hours on fall weekends. It was just a routine, and we never thought of it as exercise. Now a leaf blower does the job in fifteen minutes with nearly no effort at all, and we don't get any health benefits. Maybe we should go back to raking leaves again. Or consider the trick that worked for Dr. Nancy Snyderman's daughter: she traded in her power lawnmower for a push mower and lost weight as a result.

Nearly every weight-loss plan includes exercise, but just how much do we need? Federal guidelines recommend two and a half hours a week of moderate aerobic activity, combined with muscle-strengthening activities at least twice a week.3 Healthy adults who follow those guidelines cut their risk of dying prematurely by nearly one-third. People who suffer from chronic diseases benefit even more, cutting their risk of premature death nearly in half. And the benefits aren't just for the body. Studies have shown that even moderate exercise is an effective antidote to depression, and a report by the Mayo Clinic indicates that it helps elderly adults ward off dementia.4 But more isn't always better. My guiding principles used to be "the more I exercise, the more weight I will lose," but that's not necessarily so. A study from the University of Copenhagen compared three groups of men in their twenties and thirties. One group was sedentary, another worked out moderately for thirty minutes a day, and a third group exercised strenuously. At the end of thirteen weeks, the sedentary men weighed the same and the strenuous exercisers had peeled off about five pounds. But the "biggest losers" were the men on the moderate exercise plan, who shed an average of about seven pounds apiece.5 Food diaries showed that the men who exercised the most seemed to have gotten hungrier and ate more as a result. They also moved less over the course of the rest of the day. Those who were putting in thirty minutes of moderate exercise daily, by contrast, continued to consume the same number of calories. Just as important, the formal exercise seemed to motivate them to make changes in their daily activities, like taking the stairs instead of the elevator, and they had enough leftover energy to actually do it.

For most of us, that's good news: you don't have to train as hard as a professional athlete to lose weight and be healthier. What you do have to do is make the commitment to develop what David Kirchhoff of Weight Watchers International calls the "exercise habit." "Habits can be forces of tremendous good or forces of horrific evil," David writes in his blog Man Meets Scale. "How many of us drink a gla.s.s of wine at a certain time of day because it's just what we do? How many of us feel the need to have a snack on our lap when we watch TV at night, even when we're not hungry? These forces are deeply rooted in our neural pathways. However, if habits can get us into trouble, they can also be the force that makes healthier life permanent."

Psychologists say it can take as little as two months to develop a new habit. What if only sixty days stand between you and a healthier life? "I finally turned into a six- or seven-day-a-week exercise person, and it is the greatest gift of my life," David told me. "It's annoying to hear people talk about how their exercise is a gift to them, but there's some perverse truth in it, no matter how miserable I might look in a spinning cla.s.s. It really does take time to make all these little tiny shifts in your life that culminate in a healthier way of living."

Jesse Fox, an a.s.sistant professor of communications at Ohio State University, is using technology to give people a powerful incentive to exercise. Her avatars, or "virtual humans," show people what a healthier, more fit version of themselves can look like. When she was a graduate student working at the Virtual Human Interaction Lab at Stanford University, Dr. Fox found that these doppelgngers were effective at modifying the behavior of their human counterparts. As partic.i.p.ants in her experiments exercised, they watched their avatars lose weight and get in shape. When they cut back on exercise, their virtual "you" gained weight back. The study found that subjects with avatars exercised forty minutes more over the next twenty-four hours, compared to the control group. The avatars also influenced the way people eat, Fox found.

There is other technology available that is somewhat less futuristic, but also very helpful. All sorts of new devices can track your activity levels and measure just how hard you are working. I visited a friend in her office recently, and I was really taken by how great she looks. I said so, and she reached into her sweater and pulled out something that looked like a thumb drive for a computer. It was actually her Fitbit, which is essentially a pedometer on steroids. A little over two inches tall, and barely more than a half-inch thick, the clip-shaped Fitbit weighs less than half an ounce and costs about $100. You can carry it with you everywhere to measure how far you walk, how many stairs you climb, and how many calories you burn during the course of a day. When you synch the monitor with your other electronic devices, you can also get workout advice and plans from trainers and athletes.

Tools like this are coming on the market every day. Nike has its own device, called the Nike+ FuelBand, to keep track of your activity. Like the Fitbit, the bracelet tracks every step you take and every calorie you burn. It also lets you set activity goals and shows your progress throughout the day. "Tools like Fitbit and FuelBand make people more aware, and if that's the goal, then it's doing its job," says Josh. "If I look at my Fitbit or my FuelBand and I see that my points or my steps are considerably lower than they should be, I may go for a small run just to get those points up. Once again, that goes back to what? Moving more."

Becoming fit helps you come a lot closer to looking and feeling like the person you want to be.

Just eating less won't do it. "Everybody talks weight loss, but what you really want is a change in body composition, meaning less fat and preferably more muscle," says nutritionist Lisa Powell, who believes it is a mistake to focus only on calories. "If you are a large, pear-shaped body and you diet and lose weight, you're going to be a small pear-shaped body. If you don't like your shape, you need to exercise if you want it to be fit and lean."

If you don't like your shape, you need to exercise if you want it to be fit and lean.-Lisa Powell Canyon Ranch's Christie Hefner nicely summarizes my goal for both myself and my girls. "Your appearance should reflect you as a healthy person. That means that you're physically active and that you eat well, which I think are good areas of concern for girls, boys, men, and women, versus insecurities having to do with 'I don't look like that model' or 'I weigh too much.'"

Your appearance should reflect you as a healthy person. That means that you're physically active and that you eat well.-Christie Hefner Christie does Pilates regularly, works out at the gym, and loves to play tennis, ride her bike, and ski. "I've always paid a lot of attention to wanting to feel and look healthy, so I have been active in sports all my life. I was raised to eat healthy, and it was something I focused on."

She believes that magazines and other media need to show more images of vigorous women. When she was head of Playboy, she presided over a gradual change in the look of the women who appeared on the magazine's pages. "For many of the early years, you would never have seen athletic women in the magazine," she recalls. "That changed, not just in the appearance of women who were modeling in the magazine but in the appearance of actual athletes like Gabrielle Reece, a volleyball player, or Katarina Witt, the skater. We featured women with strong physiques, and they were both powerful and s.e.xy."

Those kinds of images help to shift att.i.tudes about what we consider beautiful and encourage the next generation of girls to value exercise. For some older women who did not grow up playing sports, and never developed the habit of exercising, it's harder to get started.

Maggie Murphy of Parade magazine was in high school in 1972 when Congress pa.s.sed t.i.tle IX to ensure that girls have the same opportunities to play sports as boys do. "Team sports were not part of my era. I became an entertainment journalist because I sat home and watched TV and then figured out how to make a living at it," she laughs. Maggie calls herself a robust, hip-py Irish woman and notes, "There was a real disconnect in the past for women about how to lose weight. Look at Betty Draper on Mad Men, starving herself, then breaking down and eating voraciously. I want to say, 'Betty go out for a walk. You might be able to eat a little more turkey on Thanksgiving if you went for a walk.'"

Luckily, Maggie eventually did discover the benefits of exercise, even if Betty has not. She started with an aerobics cla.s.s in college and eventually graduated to running, where she pushed herself to run a ten-minute mile. When a knee injury undermined that effort, she discovered SoulCycle, an indoor cycling cla.s.s that combines sweat and inspirational affirmations from the cla.s.s leader. Well-known devotees include Chelsea Clinton and Lady Gaga. Maggie calls SoulCycle her perfect exercise, and says, "I spend forty-five minutes sweating like crazy and I am set for the day."

I spend forty-five minutes sweating like crazy and I am set for the day.-Maggie Murphy A lot of people perceive barriers to physical activity that aren't really there. Two reasons some adults say they don't exercise, according to Healthy People 2020, are the cost and the perception that it takes a lot of effort. Neither turns out to be true. What exercise does require is discipline, and that's where Olympic athletes have something to teach us. We can't expect to reach their fitness levels, but we can match a little bit of their determination.

After training some of these elite athletes at the London Olympics in 2012, Josh Holland became convinced that discipline was the foundation of their success. "What I took away from that experience was how disciplined these people are. To me, that is what it boils down to. They were blessed with certain talents and physical attributes, but I think they have a talent in discipline as well."

Beyond making a commitment to exercise, your approach is limited only by your imagination.

When Josh posted videos on Facebook featuring a unique exercise every day for a year, he proved that neither a gym nor any kind of special equipment is required to work out. One of his favorite pieces of exercise gear is a jump rope; it's inexpensive and simple to use, and it fits right into your purse or suitcase. Most of his videos were not shot in a gym. "They were either in my apartment, or maybe out in a park," he said. "We all have a chair in our home, we all have a bed, we all have a sofa. That's really all you need. I've done exercises on chairs, including pushups. You can pick up the chair, you can curl with it, and you can do squats. Or how about just standing up on your own two feet and doing jumping jacks, pushups, or sit-ups?"

More exercise pros are getting away from workouts that require elaborate machines and focusing on what they call functional movements. Diane's trainer Andy DeVito used that approach to help her recover from hip replacement surgery and improve her fitness. "The philosophy is based on getting your body to move and work in ways that it was meant to, like climbing, crawling, pushing heavy objects; things that humans were designed to do," Andy explains. "A lot of the workouts we do simulate those movements and functions of the human body. We've stopped doing these activities because we're sitting at a desk all day."

Sitting turns out to be dangerous not only to our weight-loss efforts, but to our health, so that's another powerful argument for moving. An Australian study, based on twelve hundred partic.i.p.ants, found that after age twenty-five, every hour of television you watch reduces your life expectancy by nearly twenty-two minutes.6 So if you watch six hours of TV a day, you'll take about five years off your life. That's actually worse than the impact of smoking cigarettes, according to the report. And it's not the TV that hurts you, it's the sitting.

Other studies have confirmed the correlation between sitting and premature death.7 The science is new here, and we're still not sure exactly why sitting for long periods is so harmful. One theory is that surplus "fuel" builds up in the body when we don't use the large muscles in our legs, because processes needed to break down fats and sugars slow down or shut off, and blood sugar levels rise as a result. We know that the average person burns 60 more calories an hour when standing than sitting. We need to do more research to really understand what's going on, but I'm alarmed by the findings.

Personally, I can't stand still, so this actually isn't much of an issue for me, but if you spend most of your work day at your desk, think about a few ideas for mixing it up. Stand up while you're making phone calls, keep the trash can on the opposite side of the office, walk around during your coffee breaks. Small changes add up and can make a big difference, both to your weight and to your lifespan.

Getting Americans moving again begins with the decisions each of us makes as an individual. But it doesn't stop there. And that's the topic we'll discuss next.

CHAPTER TEN.

LEADING THE CONVERSATION.

MY STORY, WITH DR. NANCY SNYDERMAN, KATE WHITE,.

DR. DAVID KATZ, REBECCA PUHL, DR. EZEKIEL EMANUEL,.

REAR ADMIRAL JAMIE BARNETT (RETIRED), MAYOR MICK.

CORNETT, DR. ROBERT l.u.s.tIG, DONNY DEUTSCH,.

SENATOR CLAIRE MCCASKILL, SENATOR KIRSTEN GILLIBRAND,.

JOHN BANZHAF, CHEF LORENA GARCIA.

The conversation that Diane and I have been having, and the ideas that experts have shared here about how you think, eat, and move, mirror the conversations I think we need to have as a nation.

Overweight people are in the majority in this country. We need to fix that, but we can't do it unless we are prepared to have an open, honest, and caring discussion-not one that stereotypes, blames, or disdains overweight people. The problem belongs to all of us, and so does the responsibility to find solutions. We need to face this head-on.

Morning Joe is all about conversation. By talking with people on all sides of an issue, we often find a meeting place somewhere in the middle, someplace we can settle, agree, and move forward. I don't think we are there yet on obesity, but there is a lot of constructive and public talk going on around the country. Many concerned people are trying to find ways to get us on the right track. I hope that hearing about their att.i.tudes and policies can help us change.

If you'll pardon the pun, what follows is some food for thought. As I said at the beginning of this book, you won't agree with me on everything, and you may not agree with some of these folks either, but let's consider what they have to say. Some of their prescriptions just might work.

A good place to launch a broader conversation about the national obesity crisis is to talk about the ideas we have about a healthy body. That begins with an honest look in the mirror. Although Hollywood stars may seem to be wasting away, most of us are not. "As the population becomes fatter, study after study shows that instead of feeling bad about ourselves, we have entered a collective state of denial about how big we're actually getting," writes health writer and blogger Tara Parker-Pope. "While researchers admit that some denial may have to do with personal embarra.s.sment, the consistency of the findings suggests that neural processing and psychology probably both play a role."1 NBC's Nancy Snyderman thinks we need to get the word fat back into our vocabulary, and I agree with her. I know that Diane was very hurt when I first told her she was fat, but she now uses the term herself, and it is helping her face her own situation. We should talk about being fat, not to be pejorative, but because we have to tell the truth. By trying to be politically correct and socially sensitive, we end up skirting the whole issue instead.

Clothing manufacturers also help us do that, by allowing women to brag about wearing a size 0 or a size 2, according to Kate White, former Cosmo editor and author of I Shouldn't Be Telling You This: Success Secrets Every Gutsy Girl Should Know. "There's been all this downsizing in clothes. I ordered a pair of pants from a catalogue. I put them on and I was swimming in them. And I realized, what used to be my size has now been increased; it's still the same size but they've really blown out the waistline."

David Katz says that the tendency to tell ourselves little white lies is normal human behavior. "We tend to think we're an inch taller than we are, and we tend to think we weigh a bit less than we do," he observed. "We tend to think we eat fewer calories and we all tend to think we exercise a bit more than we do." When each of us admits the truth about our own body weight, we begin to understand that we have a shared problem.

At the same time, a lot of us struggle to respond in a healthy way to all of the media images suggesting that women who are beautiful must be thin. The average woman in America weighs almost 163 pounds and wears a size 14. So when Ralph Lauren hires a gorgeous six-foot-two model who is a size 12 as the face of his "plus size" line of women's clothing, he sends a message to every woman about what the fashion industry thinks.

"We have billion-dollar diet industries, billion-dollar fashion industries that communicate the message that women must try to conform to very unrealistic ideals of physical attractiveness," complains Yale's Rebecca Puhl. "Thinness has come to symbolize core values in our culture."

We have billion-dollar diet industries, billion-dollar fashion industries that communicate the message that women must try to conform to very unrealistic ideals of physical attractiveness.

-Rebecca Puhl What's happening is that as American women are getting heavier, models and actresses are getting skinnier. Kate White recounts looking at older photographs of Christie Brinkley and Cindy Crawford and realizing that those models "were not skinny, skinny girls. They were very healthy looking, very feminine, and lush almost. When actresses became more of a fashion influence in Hollywood, they got skinnier, too. You look at Jennifer Aniston compared to how she was when she first started in Friends; there's a big difference."

Kate says that when she was at Cosmo, "I encouraged our team to use models that aren't super skinny. I reject super-skinny models. I think it's important for us in the media to show women who are natural looking, who are curvy, who are more like the Christie Brinkleys who have luscious, healthy bodies."

I reject super-skinny models. I think it's important for us in the media to show women who are natural looking, who are curvy . . . who have luscious, healthy bodies.-Kate White For Kate, it was a matter of showcasing good health-she didn't want to highlight a super-skinny body, but she was not keen on showing more plus-size models in Cosmo either. "I feel that we've run amok in this country with nutrition and food. And the way you deal with it isn't to say, 'Okay, well, we'll start showing people who are putting themselves in health danger,' just as I wouldn't show people smoking."

So how do we start championing bodies that are a healthy thin? For one thing, let's act on the latest science and start early. Dr. Zeke Emanuel tells me we should get kids on the right path even before they are born.

"We might think of in utero effects," he explains. "We know that a woman can have a big impact on the size of her baby and the amount of fat on the baby. We may need to think about pregnant women and the diversity and the nutritional content of what they're eating. We do have some good evidence that once you create fat cells, you can't really get rid of them, and therefore later in life it gets very hard-not impossible-but very hard to lose weight."

We might think of in utero effects. We know that a woman can have a big impact on the size of her baby and the amount of fat on the baby.

-Dr. Ezekiel Emanuel If the tendency to be overweight starts in the womb, so might the craving for certain foods. But people can change their desires, according to Yale Prevention Research Center's David Katz.

"Taste buds are very malleable little fellers," he says. "When they can't be with a food they love, they very quickly learn to love a food they're with. They like what they're used to."

Taste buds are very malleable little fellers. When they can't be with a food they love, they very quickly learn to love a food they're with.

-David Katz So here's the really good news: research shows that taste buds can be retrained to like better foods in as little as one or two weeks!

"Imagine if all that stands between us and one of the more ma.s.sive opportunities in the modern history of public health is a hill only two weeks high?" asks Katz hopefully. "How do we help the public understand that they need a week or two to get used to it, and then they'll spend the rest of their lives being perfectly satisfied with a food that's much better for them?"

It's probably not quite that simple, as my own experience with eating mostly healthy foods and occasionally going on a binge suggests. But educating people at every opportunity can certainly help. The messages about food, weight, and health should be coming from lots of different places so that we hear them over and over again.

People who have learned how to eat well, enjoy their food, and maintain a healthy weight can share some of their secrets with people who still struggle. Supermarkets can help by installing interactive screens and other technology so that people know what's in the food they are buying. Some of the nation's leading grocery stores are already doing this, and others can follow. One innovation to adopt is the NuVal System, created by David Katz and his team, which scores food from 1 to 100 based on how nutritious it is. NuVal scores are placed right next to the price tags on store shelves, making comparisons easy.

Doctors also need to take more responsibility to educate their patients. Unfortunately, many of them don't even know where to begin, since only 30 percent of US medical schools require a nutrition course. Most graduating medical students say their nutrition education was inadequate, which tells us we need to do a much better job incorporating it into the medical school curriculum.2 Talking to parents about their kid's weight makes many doctors particularly uncomfortable, either because they don't know how, or because they realize it's going to anger some parents. "I can't tell you the number of parents who hate the doctor for initiating the conversation, like it's the doctor's problem," Dr. Snyderman says. "But it's the doctor's responsibility to be a child's advocate and call it as you see it. That means getting a kid help."

If an obese child or adult has a checkup, it should be the first topic the doctor raises. Instead, we have fat people walking into the doctor's office all the time and it never even gets mentioned. How is that possible? You don't walk in there with cancer and not have a doctor mention it. They take your blood pressure, check your temperature, check everything else, and weigh you. Then they should sit down and have a talk and explain how you can lose some dangerous weight.

That's more likely to happen when the businesses that pay for health insurance start insisting on it. A lot of companies are already experimenting with payment plans that reward doctors for preventing illness, instead of paying them for every health service they provide. Some are negotiating insurance contracts that encourage medical practices to improve the way they treat complex chronic illnesses. I'd like to see doctors make more money if they successfully manage interrelated health problems, such as overweight, high blood pressure, and diabetes, as a single package. I'm also in favor of reimbursing employees for seeking out nutritional counseling, and providing discounts on insurance premiums when a worker reaches certain health targets.

All of these are great ways to get people committed to improving their own health, while reducing the cost to employers. Put the right incentives together, and we can create a win-win.

Obviously schools, where our children get 40 to 50 percent of their daily calories, have a big role to play in educating the next generation about food, health, and weight, and in making smart choices available.

It may surprise you, but the military is taking a lead role in pushing for better food in the schools, and I applaud that. "When we have somebody show up at our doorstep who wants to get into the armed forces and they're overweight, we have to overcome eighteen years or more of lifestyle habits," says Rear Admiral Jamie Barnett (retired) of Mission: Readiness, the organization of retired military officers that promotes investments in youth. "It's pretty difficult. We really need to be able to start in early childhood with the right nutrition, the right fitness, and the right development in order to ensure that they have the best shot not only in the military but in the workforce in general."

When we have somebody show up at our doorstep who wants to get into the armed forces and they're overweight, we have to overcome eighteen years or more of lifestyle habits.

-Rear Admiral Jamie Barnett (retired) It's not the first time military officers have stepped forward with their concerns for our young people. Barnett points out that after World War II, the military helped convince Congress to pa.s.s the National School Lunch Act. Back then, too many Americans were unable to serve in the military because they were underweight and malnourished. Now, too many young people can't serve because they are too fat, so the military is trying to get junk food out of the schools and exercise back in.

"This is a longitudinal problem with a longitudinal solution," Barnett says. "What we really need to do is start with the kids who are in preschool, kindergarten, and elementary school."

Retired top bra.s.s from all branches of the military are visiting schools across the country, and they tell me they are shocked by what they have seen. One school district in Kentucky didn't even have an oven in the cafeteria. "All they had were deep-fat fryers. Guess what they were fixing for their kids?" asks Barnett.

That's pretty basic. I could not have imagined a school district without a stove and other tools to make healthy food.

Along with equipping our schools properly, we also need to make sure that school nutritionists have proper training and authority. I'm not entirely sure what they are doing right now, but I think nutritionists should be holding seminars with students, cafeteria workers, teachers, princ.i.p.als, and school boards to talk about how to make the right food available.

I'm particularly enthusiastic about the kind of work that Venezuelan-born chef, restaurateur, author and television host Lorena Garcia is doing. Lorena goes into the schools to train the staff that actually prepares the food, encouraging them to be creative in making the small changes that can put a lot more nutrients into meals. "We're really giving them a reason, and motivating them to start cooking a little more with ingredients that they already have, just stepping away from processed foods," she says.

Everybody should have nutrition, weight, and health in mind when they make food-related decisions for their cafeterias. To me, allowing schools to sell soda, candy, and high-fat snacks in vending machines, or la carte on the lunch line, defeats other efforts to serve healthier meals in schools. I'd like to see all of that prohibited.

And we have got to put exercise back into the curriculum. So many schools have cut way back on gym cla.s.ses and recess, and some aren't offering them at all. "We take normally rambunctious children, send them to school, bolt them to chairs all day long so they can grow up to become adults we can't get off couches without crowbars, and we medicate them in the bargain," complains David Katz.

With all the emphasis on test scores, it's not always easy to sell schools on the need to make time for kids to exercise. But what if kids actually perform better when they have a chance to get some physical exercise during the school day? We should fund research to find out more about that. "Kids need to get up periodically and run around, period, end of story," says Katz, who is the father of five children.

Katz has developed a novel approach, called ABC for Fitness, which gets kids moving in cla.s.s. "We developed a program where cla.s.sroom teachers could dole out activity bursts right there in the cla.s.sroom for three minutes at a time, five minutes at a time, eight minutes at a time, at their discretion, throughout the day, whenever the kids needed it," he explained. "We matched the activity bursts to grade level and subject matter, and pointed out to teachers how they could teach during the activity burst."

To see whether ABC for Fitness made a difference, researchers conducted a study of over a thousand schoolchildren, and sure enough, the ones offered activity bursts improved their fitness, were less disruptive in the cla.s.sroom, and needed less medication for asthma and attention deficit disorder.3 The program, which is free, is distributed in schools throughout the United States and can be used at home, too.

I love this idea. Kids need to move. They need to sweat. We should be insisting that our schools make that happen.

I'm also really interested in some of the ideas being discussed in urban-planning circles about designing communities for health. We should be thinking more about getting sidewalks throughout our towns and cities, providing safe parks that are easy to get to, and locating schools and businesses within an easy bike ride from residential neighborhoods.

Oklahoma City mayor Mick Cornett emphasized those kinds of strategies at the same time he put his entire city on a diet.

Cornett began his effort in 2005, truly the best of times and the worst of times for his city. Back then, Oklahoma City was getting some attention and respect, showing up on lists like "Best Places to Get a Job" and "Best Places to Start a Business." But that same year, Men's Fitness magazine published a list of America's fattest cities, and Oklahoma City was right near the top.

"It embarra.s.sed me," recalls Cornett. He was even more embarra.s.sed when he went to a health information website, typed in his height and weight, and discovered that he qualified as obese. "It took that website to point out that I was a part of the problem," he admits.

The mayor's first step toward solving it was to put himself on a diet. Then he persuaded a private donor to fund a health initiative, beginning with a website, thiscityisgoingonadiet.com, which offered everything from diet tips and shared journals to corporate challenges and exercise opportunities. Cornett called a news conference at the zoo, stood in front of the elephants and declared to residents, "We're going to lose a million pounds."

We're going to lose a million pounds.

-Oklahoma City mayor Mick Cornett Forty-seven thousand people signed up, and five years later the city had reached its goal of one million pounds. It was a remarkable accomplishment. What made it work?

For starters, Cornett took a leading role in the conversation and talked about his own story first. If he was going to put his city on a diet, he knew he would have to be honest about himself in the process. "I had to become comfortable talking about weight loss, how personal it is, how sensitive it is, how difficult it is, and my own lifelong struggles to keep my weight off."