HBO’s ‘The Weight of the Nation’ is a wake-up call for America

Next week, the combined efforts of an entertainment giant, a health insurance titan, a group of academic heavyweights, a technology philanthropist and two federal agencies bring forth “The Weight of the Nation,” a four-hour, four-part HBO documentary that gives the nation’s obesity crisis a face.

The program, produced in conjunction with the Centers for Disease Control and Prevention’s “Weight of the Nation” conference in Washington, D.C., balances on a knife’s edge between determined hope and realistic discouragement. In detailing the multiple health consequences of obesity, which now affects 36% of American adults and 17% of our children, the documentary sounds an alarm that is difficult to ignore: “To win,” says the series’ subtitle, “we have to lose.”

Yet the segments painstakingly document how hard the body fights weight loss and how ubiquitously our social and economic systems sabotage our best efforts to shed pounds.

For that to change, biomedical researchers must find ways to disrupt our bodies’ desperate hold on fat and break the link between excess fat and ailments like diabetes and heart disease; restaurant giants and food manufacturers must curb their drive to hawk products that entice our brains’ pleasure centers and promote overeating; health insurance companies must quit their long-standing practice of paying doctors only to treat obesity-related diseases and make it their business to prevent obesity in the first place; and Americans must band together, pull themselves and their neighbors off the couch to exercise, and agitate for policies and communities designed to fight fat and promote health.

It is a daunting challenge. Not surprisingly, then, the documentary’s message -- and the views of many of the would-be leaders of a campaign -- tilt heavily toward the objective of obesity prevention.

Today, there are 12.5 million obese American children. With better school lunches, better access to fresh food and a firmer public grip on the junk food being promoted, some can still be diverted from a cruel statistic that emerged from the landmark Bogalusa Heart study: 77% of obese children become obese adults, while only 7% of non-obese children do.

For the nation’s 78 million obese adults, the documentary serves up a hearty platter of “You can do it!” with a hefty side of “It’s too late.” A parade of experts is shown exhorting obese adults to focus on losing 5% to 10% of their body weight, the modest minimum set out for weight-loss drugs seeking approval from the Food and Drug Administration. That, along with regular exercise, may help offset some of the dangerous consequences of obesity, they say.

Left unsaid is that neither exercise nor modest weight loss is likely to move these patients from the obese side of the nation’s ledger.

In the documentary, Columbia University pediatric endocrinologist Michael Rosenbaum seems to say it all. Hunched over a spreadsheet with his colleague Dr. Rudolph Leibel, Rosenbaum explains: “You can talk about obesity prevention if you can sustain a lower weight here,” he says, jabbing a pen at a line on the chart. “But once you get here,” he shakes his head gravely, “it’s over with.”

Medicare and Medicaid have decided to reimburse primary care physicians for providing patients “intensive weight-loss counseling.” But there’s a hitch: Patients must already be obese to get such treatment.

“Weight of the Nation” is a production of HBO and the Institute of Medicine, with support from the CDC, the National Institutes of Health, Kaiser Permanente and the Michael and Susan Dell Foundation. Its segments air sequentially on Monday and Tuesday, May 14 and 15. In a bid to gain the widest possible audience, HBO will provide free online access to all of the documentary’s segments at theweightofthenation.hbo.com.

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