Dr. Rob Lustig on Obesity, Refined Carbs & Fructose Addiction

Dr. Rob Lustig Interview

Dr Lustig: I am a pediatric endocrinologist, which means I study glands and hormones and children. I’m very interested in how the brain controls energy balance; and I’m also interested in signals that come from the body up to the brain. I’m particularly interested in how hormones and behavior interact. A lot of people think that obesity is a behavior; that somehow you’re just too darn fat, you eat too much, you exercise too little, and that it’s your fault. In fact the federal government wants it to be your fault because that way they can deny Medicare payments so there is actual financial incentive to make it your fault. The research that I have done suggests that the behavior (of obesity) is actually secondary to biochemical changes. The hormones that are driving obesity are also driving the behavior. The question is why have the hormones changed? And this is the work that I have been doing over the past 15 years. It has led me to specific thoughts about what has happened and what has changed. It starts even earlier than childhood. It starts in the pregnant mother. The more overweight the mother is when she gets pregnant, the more chance that the child is going to be obese when the child is born.

S: So if your family has a history of obesity, then the chance that the offspring will have obesity also increases.

Dr. Lustig: It’s about a 5-time increase because of that.

S: So in the last 30 years, the influx of sugar in our society has produced even more obesity. And now it’s multiplying?

Dr. Lustig: In fact it’s a geometric progression and that’s what we’re seeing. Despite all of the efforts that the federal government has tried to institute – this thing called Healthy People 2000, well that didn’t work. Now, we have Healthy People 2010 and that’s not working. In fact, the incidence of obesity keeps going up. There’s just a Johns Hopkins study that came out about a month ago that said if things keep going the way they are going, in 2015 41% of America will be obese.

S: Could you estimate the health cost?

Dr. Lustig: It’s going to break the bank.

S: And our federal government is basically saying, “take responsibility for yourself.”

Dr. Lustig: In fact, if the hormonal changes are altering the behavior, which is what I believe based on the research that I’ve done, then you basically can’t control your behavior. It’s not possible. We have to basically get at what the actual cause of the problem is in order to affect change.

S: Would you say of the current obesity epidemic that there are ways of taking care of some of the issues or that the prospects are bleak?

Dr. Lustig: There are the biochemical problems, there are the behavioral issues, and there are the societal issues. My personal feeling is that the behavioral issues are impossible for a population to alter until the societal and environmental issues are dealt with. If you look at any other disorder of addiction which this in fact is, the federal government has three kinds of responses. They have 1) regulation, 2) interdiction, and 3) behavioral modification. For instance, drug programs, they have all sorts of laws, the coast guard and the army to prevent drugs from getting into the country, and we put people in jail for that. For obesity, which is also an addiction, the only thing we have is education. We don’t have regulation or interdiction. And there is nothing on the table. That’s why the fast food suits were being brought to get some regulations. Unfortunately, they have been thrown out by Congress because they have been lobbied to do so. I don’t see any government effort being made to alter the environment to help people with the behavioral aspect of this, the phenomenon of addiction.

S: People don’t think of this as an addiction. That’s part of the education don’t you think?

Dr. Lustig: That’s right. You have to understand what addiction is. Addiction in its simplest molecular form is one biochemical in your brain called dopamine. And dopamine is the addiction neurotransmitter, not a hormone. The more dopamine that one particular area of your brain gets, called the nucleus accumbens, the more the reward is fostered and the more addictive the phenomenon will be. This is how drugs of abuse work, this is how nicotine and alcohol work. Unfortunately, this is also how sugar works. It has been shown in numerous studies that sugar ups your dopamine. The question is why and what can we do about it? Fructose is a particular sugar that is particularly egregious. Fructose is half of sucrose. Sucrose is table sugar, so table sugar is definitely part of the problem. Then, of course there is high fructose corn syrup, which is what every soda is flavored with. It is the first ingredient in BBQ sauce and in ketchup. The question is how did it get there, why is it there, who put it there, and why won’t they take it out?

S: It’s because of the great subsidies in the Midwest for the farm agriculture.

Dr. Lustig: Absolutely. It’s what you do with corn. A lot of people want to turn corn into alcohol, but they won’t because from an economic standpoint, that’s actually not a winner. But it is certainly a winner to turn it into high fructose corn syrup because that increases sales of foods by quite a bit. We have a food industry in this country that currently produces 3900 calories per person per day. We as human beings can only eat 1800 calories per person per day. So the food industry in this country is making more than double what we can eat. Somebody has to eat the rest. Well, who is it? It’s us. Because they have found a way to influence this addiction to make us eat more.

S: The dopamine makes you crave for more.

Dr. Lustig: That’s right. The whole thing keeps going. Food profits are up by 5%. In the old days, before 1980, food profits were up by 1%. So the food companies are seeing a quintupling of their profits since they’ve added high fructose corn syrup to their foods.

K: Do you think they produce more products with high fructose corn syrup, either because it's so cheap or so addictive, to maximize profits?

Dr. Lustig: It’s both. They work together. If the companies made all of these products with high fructose corn syrup but we didn’t eat more, then they couldn’t make more profits then there wouldn’t be more foods on the market. The fact is they are profiting so there is only reason to make more. It’s a self-fulfilling prophecy and it’s not going to get better because there is no regulation.

S: Not only is there no regulation, even if there is some regulation, you see a little bit coming into schools where they are not being enforced.

Dr. Lustig: Absolutely. I’ll give you an example. My daughter, who is 8 years old and in 2nd grade last year, came home and said, “Dad, you’re not going to believe this.” She brought home a carton of Berkeley Farms 1% Chocolate Milk compared to 1% Milk (without chocolate). The 1% Milk had 130 calories and 15 grams of carbohydrates (lactose or milk sugar). The 1% Chocolate Milk had 190 calories, so 60 calories more per carton. It’s like getting an extra half glass of orange juice, with 29 grams of sugar per carton, all of which were high fructose corn syrup. Basically, if you drink a Berkeley Farms 1% Chocolate Milk, you’re basically getting a glass of milk and a half a Coke.

S: So why do they sell this at school?

Dr. Lustig: The school nutrition people say it is the only way to get kids to drink their milk. They need their Calcium and their Vitamin D.

S: Let’s talk a bit about fructose and how insulin turns into fat.

Dr. Lustig: Insulin doesn’t turn into fat. Insulin helps drive energy into fat. Most of your audience knows what diabetes is. Diabetes is high blood sugar and it’s bad for you. It hurts your kidneys, eyes, blood vessels and heart. You can ultimately die from it. Let’s take a diabetic off the street. Blood sugar is 300. That is bad. We give the diabetic a shot of insulin. Insulin lowers blood sugar. Blood sugar goes from 300 down to 100. That is good. Blood sugar went down by 200 points. That is good. Where did the 200 points of blood sugar go? They were in the blood, now they’re not. They went to the fat for storage. That is insulin’s job. Insulin takes whatever you aren’t burning and puts it into fat for storage. Insulin turns sugar to fat. Insulin makes fat. More insulin, more fat – body fat. That is what happens when you don’t burn it. Any calorie that you take in has one of three things. Either you convert it (that is good), store it (not good), or it goes out in your urine (which means you are diabetic -- much worse). That is why exercise is so important because it gives you an opportunity to burn it but it also important because it reduces food consumption. People think exercising increases food consumption but it doesn’t. It actually reduces food consumption and actually helps detoxify some of the sugars that are in your liver. Bottomline: when your insulin is high, you are going to gain weight. There is another hormone in your body, called leptin, that is made by fat cells and goes to your brain and tells your brain you don’t need to eat any more. It also tells your body to burn energy properly. I’ll give you an example. Take a 5 year old. Give him a cookie. What happens?

S: He’s bouncing off walls.

Dr. Lustig: Exactly. You call that the “sugar high.” That’s not the “sugar high.” That’s leptin telling the muscles to burn the energy because it’s trying to stay weight stable. That’s a normal physiologic process. Try that with an obese kid. It doesn’t happen. The kid eats the cookies and there’s no bouncing off walls. The reason is because that kid’s leptin isn’t working right. If that kid’s leptin was working right, number one he’d be thin and secondly, he’d be bouncing off walls with that cookie. But instead, what happens is that cookie ends up as fat and he doesn’t bounce off walls. The reason is that his leptin isn’t working. The question is how come the obese kid’s leptin doesn’t work, whereas the thin kid’s leptin does? What makes that difference? The answer, based on the research that I’ve done, is the hormone insulin. Insulin is suppose to make you gain weight. Insulin drives energy to fat. If insulin makes fat and fat makes leptin and leptin is supposed to keep you from gaining more weight, then you have a nice negative feedback cycle. That is good because then you won’t gain the weight. But if your insulin is blocking your leptin, then the insulin is driving the energy storage (fat storage increases) and blocking your brain from seeing the leptin which means that your brain is starving, which means that you are going to eat more and keep gaining the weight. The question is where did the insulin come from? Why is our insulin higher today than it was 25 years ago? That is where the whole sugar question comes from. That is why this whole fructose issue is so huge because fructose is the single worst aggravator of insulin in our bodies.

S: So if you eat a certain level of sugar, and it messes with your insulin, your leptin is not going to tell you to stop eating.

Dr. Lustig: That’s exactly right.

S: Higher body fat correlates with the inability to use the hormone leptin.

M: I’d like to get back at the 29 grams of sugar found in the 1% Chocolate Milk from your daughter’s school. There was a petition from CSPI back in 1999 to set the maximum amount of added sugars per day at 40 grams. Did you find a safe level for ingestion of sugar?

Dr. Lustig: I haven’t actually done those studies. I don’t know if there is a safe level. I think ultimately there is a reason for eating carbohydrates but it’s not the reason that we should be eating carbohydrates. Carbohydrates are a perfectly good energy source if it is balanced by something else called fiber. Fiber is good. Carbohydrates are made with fiber. There is no carbohydrate in nature that doesn’t include fiber. Think about it. Look at a piece of sugar cane. What does it look like? It’s this big fibrous thing. In the ancient times, people would have to suck it to try to get the little bit of sugar out of this very fibrous stalk. Of course, now we have 100 pound bags just lying around waiting to be turned into doughnuts. Another example is orange juice vs. oranges. Oranges have fiber and 20 calories. Orange juice has no fiber and 120 calories. Which do you think is better for you? So what’s good about fiber? Fiber slows sugar absorption from the gut into the bloodstream, thereby keeping your insulin down. A high fiber meal means your insulin doesn’t rise as high because your blood sugar doesn’t rise as high. The second thing that fiber does is it makes the food move through the intestine faster. There is a satiety signal at the end of your intestine, a hormone that comes out into the bloodstream sooner so that you won’t eat that second portion. That is why they say fiber is more filling because it actually makes that satiety signal start earlier. What we tell our patients is that they have to wait 20 minutes for second portions.

S: So if you eat solid whole food, an apple instead of apple juice, that fiber in the apple slows the insulin in your body and also creates the feeling of not being so hungry.

Dr. Lustig: Apples are fine. Apple juice is not. Oranges are fine. Orange juice is not. Smoothies are also not good.

S: You related juice to being just as bad as soft drinks.

Dr. Lustig: Absolutely. In some ways juice is worse. Number one, people think juice is healthy and it’s not. Whole fruit is healthy.

S: What if it says Organic apple juice?

Dr. Lustig: That’s irrelevant. Fiber is the good part and there is no fiber in the juice. The reason why fiber has been taken out of our diet is because you can’t freeze fiber. Go home and try it. Make a pot of brown rice. Put it in a Tupperware, put it in the freezer. Take it out the next day, and try to reheat it and eat it. See what happens. You won’t touch it. It might work in a shock absorber but you won’t eat it. You can’t freeze fiber. Otherwise, there would be frozen pears and plums in your supermarket. Food companies would like nothing better than to decrease the depreciation on the food that goes bad. They would love to freeze it but they can’t, so they extract the fiber from it. When you go out into the field and harvest the wheat, what color is it?

All: Brown.

Dr. Lustig: That’s the fiber. That’s the husk on the outside of the starch granule that’s on the inside. Of course, we mill it and pulverize it to get rid of the bran. We do it on purpose because we are after the starch on the outside. Sadly, the husk and bran is the good part. You want to eat your carbohydrate with fiber and that will actually solve this insulin problem. Unfortunately, that is the antithesis of processed food and big food. Processed and fast food is fiber-less food. This is on purpose because they have to freeze the food and send it all over the world to the different franchises where they have to cook it up fast. That is why there is no fiber in our diet anymore.

Medical anthropologists examined fecal matter of people who died 50,000 years ago found in caves. They extracted DNA material from the bacteria in the fecal matter in people of 50,000 years ago. The researchers found that human beings used to eat 100-300 grams of fiber per day. Now, we eat 12 grams. That has had a huge impact on the insulin problem. The insulin affects leptin and that affects obesity.

S: Is there a percentage in our daily diet that is healthier for us in terms of recommendation for fiber in grams?

Dr. Lustig: The important thing is that fiber is associated with the food rather than added separately. When you see things like Whole grain Lucky Charms, this is just a joke. That just doesn’t work. You also see foods with added fiber. That is added cereal fiber, which doesn’t work because it is not surrounding the starch granule. What you want is something that says whole grain. That means the wheat granule (the fiber or husk) is still intact. That means it will have the good benefits in terms of nutrition that you need.

S: If you eat an apple and you have the natural sugar with the fiber, it slows down the insulin so that it's taken slower in the body and it also helps to stop the craving to eat more. If you juice it, it goes directly into insulin, which goes directly into fat. The phenomenon of being full does not occur at all.

K: What if you had juice with high pulp? That’s fiber, right?

Dr. Lustig: That will help in terms of moving the food through the intestine faster, but once you have dissociated the juice from the fiber itself, your glucose absorption is going to increase and that is going to raise your insulin. You can get one potential benefit, but you’re not going to get both.

S: If you put fruit in a blender and you blend it, are you going to get the same effect of the fiber?

Dr. Lustig: No, smoothies are a problem. If you go to Jamba Juice, there are on average about 600 calories in one of those smoothies.

M: Right now, we tend to buy a lot of processed food because of its convenience. What about functional foods? When the food manufacturers use refined ingredients and add back fiber separated from the original ingredient, is it the same benefit that we get?

Dr. Lustig: There are two phenomenon associated with fiber. One is the rate of sugar rise and the second is how fast the food gets through the intestine. If you add fiber back, you’ll get the food through the intestine but you won’t affect the rate of sugar rise. So the insulin will still rise, the insulin blocks the leptin and it’s still going to force weight gain. It’s not optimal. It’s better to eat the food naturally rather than refined or processed and then added back.

K: Going back to the smoothie example. If you break down the fiber in a beverage like that, it’s the same thing as if you hadn’t had it whole. Why is that?

Dr. Lustig: The data shows it but I don’t know why.

M: Is it the same thing with potatoes when you eat them baked or mashed?

Dr. Lustig: No, because there is no fiber in potatoes. There is some in the skin but it has very little fiber. The clinic over at UCSF called the WATCH clinic, which stands for Weight Assessment for Teen and Child Health, advocates four simple messages to deal with childhood obesity. We see patients weekly. Our intake clinic for new patients is once a month where we see 12 new patients all on the same day. We do that for economies of scale because the lifestyle intervention that we advocate is better as a group than individually. We have four messages that we espouse in the clinic. Each one is evidence-based, makes sense, and shown to work. 1) Get rid of every sugar liquid in the house. Look at the side of a bottle and look at the calories. If the number is 5 or less, then you are good. If it is 6 or more, then leave it at the store. 2) Eat your carbohydrates with fiber. Again, look at the side of the package and look at dietary fiber, which is under calories on the label. If it is 3 or more, then you are good. If it is 2 or less, then it is garbage. 3) Wait 20 minutes before second portions. That is trying to take care of that satiety signal and try to get them to stop that second portion before it occurs. This last one is the most difficult for a lot of families. 4) Kids buy their TV time with physical activity. Kids are watching 4-6 hours of TV a day. They could be using that time to be doing some thing more beneficial like walking. We tell parents to go to Sears and buy the cheapest treadmill they have. This is priced at $269. Take the TV out of the kids room and put it in the living room. If the kid is watching, they are walking. If they are watching 2 hours of TV, then they are walking 2 hours. If they get tired of walking, then make them go and read a book.

S: Can you illustrate what one of these 10 year olds are like? Are you really seeing 10 year olds that are over 200 pounds?

Dr. Lustig: Absolutely and quite a few. And they are on their way to Type-2 Diabetes. And for the reasons we’ve talked about, because their insulin is high. You can tell that insulin is high because of this rash on the back of the neck, which is called Acanthosis; it is this velvety, hyper-pigmented rash on the back of the neck and in the under arms and sometimes under the breast cleavage and sometimes on the groin. What that is is excess insulin working on the skin. We can just look at the kid and know that the insulin is high. The insulin drives the fat, the fat keeps growing and growing, until one day in the future they’re going to actually outgrow their insulin supply. At that point, they can’t turn sugar into fat, so whatever they take in stays in the blood and rise and now that kid has Type-2 Diabetes. We have seen this huge epidemic of Type-2 Diabetes in children. It used to be that Type-2 Diabetes was never seen in children. It now accounts for 30% of all of our new diagnosis; that is 30% of all our kid diabetics are now Type-2. That is because of obesity, which is due to fructose and insulin.

S: In the past, it was Type-1, which you were born with. Now, kids are acquiring Type-2 Diabetes, which is a phenomenon.

Dr. Lustig: It’s what happens when you outgrow your insulin. Once you have Diabetes, the clock’s ticking until you die. If you get Diabetes as a teenager, your life expectancy is going to be cut markedly short. We already know from statistical studies that if your BMI (Body Mass Index) is 40 as an adult, then your life expectancy is cut by 20 years if you are Caucasian; and by 40 years if you are African American. As a result, you have decrease productivity and an increase in medical expenses. By 2015, 41% of America will be obese. There goes our economy, army, the entire medical care to take care of the obese. There should be a huge outcry but we are too busy to care about this issue.

S: Besides Type-2 diabetes and obesity, what are some of the other things that happen to a child and adolescent?

Dr. Lustig: Fructose causes fatty liver. The fat in the liver builds up and can cause cirrhosis the same way alcohol does.

S: So coca cola can act like booze.

Dr. Lustig: Absolutely. Fructose is alcohol without the buzz. Drinking a can of soda is like drinking a can of beer in terms of what it does to your liver, the number of calories, and of what it does to your leptin. A can of soda and a can of beer are the same. If you feel good about giving your 13-year-old a can of beer, then go to it.

S: So your liver can’t tell the difference?

Dr. Lustig: There’s no difference as far as the liver can see.

S: Fructose is a major ingredient in soft drinks. It is also in every thing that has sugar in our society. So you are chugging this stuff.

Dr. Lustig: At our obesity clinic, we look at the number of calories in soft drinks and juice that our kids come in with. At UCSF, we see a completely multi-ethnic population; we have Caucasians, Latinos, African Americans, Asians, and Pacific Islanders. We have all five major category groups at UCSF. The one group that we don’t see much of are Native Americans. Interestingly, the Caucasians, Latinos, Asians, and Pacific Islanders drink, on average, 200-calories per person per day. African Americans are consuming 400-calories per person per day.

S: Is that a cultural difference?

Dr. Lustig: Absolutely, there is a cultural difference. The African Americans are drinking double what the other groups are. All are obese, but the African Americans double. The first tenet is to get rid of all the sugary drinks. We explain the effect of fructose on the liver and everything else. Then we bring the patients back in 3 months. The Caucasians, Latinos, Asians, and Pacific Islanders have all reduced their sugared liquid consumption close to zero. The African Americans are still at 400. No change; no change at all.

S: What’s the struggle?

Dr. Lustig: Well, we ask the kid “Why haven’t you been able to make this change?” The answer is always the same. One answer from every kid. “Because water doesn’t taste good.”

S: It’s like the milk and the chocolate milk.

Dr. Lustig: Water is what you’re supposed to drink because that’s what keeps you hydrated. So, why does water have to be sweet? Where did this come from? Well, there’s the addiction that we’re talking about. The fact is it is addictive. The fact is that the kids can’t get off it. They won’t because they need it. This is how that dopamine is being driven. That’s how the insulin is affecting dopamine transmission in the brain and it’s causing these kids to continue to crave this.

K: In addition to this being a physiological addiction, do you think it has anything to do with marketing?

Dr. Lustig: Oh, absolutely; of course it does. Who’s in the schools? Who’s paying for the uniforms? Who’s paying for the shoulder pads? Absolutely. In the bay area, SB 965 was passed as an effort to try to get sodas out of the schools in California. In fact, sports drinks and juice are just taking the place. Well, who owns the sports drinks and juice companies? The soft drink companies do, so it’s only changing the vending machines and not the products.

S: So we have talked about SB 965 and they are trying to reduce the amount of sugar in vending machines. But for the football teams, they’re providing electrolyte replacement beverages, which have high amounts of sugar.

Dr. Lustig: Right. Well the sports drinks companies are very interesting. In 1967, when that electrolyte replacement beverage first came out; it contained glucose, sodium, and water. It’s the same thing we use to re-hydrate kids in India who have cholera. It’s an oral re-hydration solution which is why it was invented, which makes sense. Did it taste good? Not really. Nobody liked it. But it was good if you were an athlete because it was an oral re-hydration solution. In the mid-90’s, a soft drink company bought this electrolyte replacement beverage made a conscious decision that they were going to market this stuff as a sports drink to everyone. They had to make it worth drinking so they added fructose to it, so now it’s sweet. Do you need that? No. For 25-30 years, it did not have fructose in it, but it does now. The reason is to get kids to drink it and to get them addicted. So this problem is well known to the soft drink companies, but they choose to market their product and choose to make a lot of money.

S: If you were to build a new food pyramid, what would it look like to you?

Dr. Lustig: First, I’d put exercise at the bottom of the pyramid and it would be three-quarters of the pyramid. To be honest with you, none of what you eat matters if you are getting exercise. Why is exercise so good for you? Because it burns calories? No. Twenty minutes of jogging is one chocolate chip cookie. I mean, it’s a joke. That’s not why exercise is good. Exercise is good for three reasons: 1) It improves your skeletal muscles insulin sensitivity. This means that your body can work better on less insulin. If your insulin goes down, that means your leptin works better. If you leptin works better, that means you will eat less. By helping your skeletal muscle, you are helping yourself. 2) It is the best stress reducer we have. Kids are stressed today like never before. There are all sorts of stressors that when we were kids we never even imagined. The fact is TV is a stress. It has been shown that TV raises your hormone cortisol, which is your stress hormone; and cortisol makes your insulin go up and cortisol makes you eat more. Exercise is the best stress reducer. By keeping your cortisol down, that helps your weight. 3) It’s the one way to get your liver to burn off the fructose and fat accumulated in your liver. Then, your liver works better, and your insulin also goes down. Those are the reasons why exercise is good. If you exercise, it almost doesn’t matter what you eat. Unfortunately, society actually makes you not want to exercise. For instance, no child left behind. As far as I’m concerned, that’s no child moving forward and no teacher left standing. What is no child left behind saying? It says that we have to get kids to do better in class or we’re going to lose federal funding or replace the school. So we can’t let our kids exercise during school hours. We need kids in the classroom. In fact, physical activity has gone down, not up. There was an interesting study done in East Carolina University two years ago where they went into the schools and got the schools to agree to give the researchers 45 minutes a day in vigorous activity for the kids. The question was not what happened to the kids' weight; the question was what happened to the kids' grades? What do you think happened? The grades went up. They took 45 minutes out for physical activity, so that’s 45 minutes less in class and the kids did better in school. The idea that we should keep our kids in class more because of failing grades makes no sense at all. The first thing I would do is scrap the pyramid and put exercise in the pyramid instead. Everything else is secondary.

S: How does your research get to the public?

Dr. Lustig: It’s very difficult. The fact is most of the public doesn’t want to know about science. They don’t want to understand the science. And since the science says that the policy has to change, it becomes very problematic. I used to live in Memphis, Tennessee. Do you know why fast food is so big in Memphis, Tennessee? Not because it’s cheap, tasty, or fast. It’s because it’s clean and air-conditioned. It’s the only place in town that parents could go to escape their own homes. So we brought this phenomenon to the aldermen of Memphis, Tennessee, of course all of who were African American, and said this is what’s going on. Do you know what the response was? Do you want to take away the one thing in life that gives these people pleasure? And I thought, no, he’s got a point. This is a real problem. This is a much bigger problem than just getting education out to the masses. This is a huge issue. What is it about our society that has made people decide that food was their salvation? I don’t get it. I think we have to work with the churches. I think we have to work with the pastors. I think we have to get this out in new ways rather than just journal articles and TV shows. This has to involve the entire African American and Latino community to really make some headway. We really need to partner with people to make this happen.

S: So are the African American and Latino population hit the hardest in childhood obesity? What’s the percentage obesity among female adolescents?

Dr. Lustig: The obesity prevalence of African American girls is 45%. That’s where we are and we need to do something about it. Unfortunately, my talking doesn’t seem to make much difference. We need to find new avenues and new partners to be able to get this message out in a rational way. It’s going to stay difficult as long as the operative word is behavior. We have to make the operative word environment; environment controls the behavior.

S: You can’t expect an adolescent to have the ability to understand nutrition as well as an adult does?

Dr. Lustig: The fact is they can understand the negative consequences but it’s the environment that drives their behavior. Education isn’t enough.

S: The government right now is saying that this is your personal responsibility.

Dr. Lustig: A lot of people draw a parallel between tobacco and obesity. If you look at the reduction in tobacco consumption, which has occurred in California and less so in other states, it basically started with second hand smoke and non-smokers' rights. Up to that point, things just kept going up. In 1964, the U.S. Surgeon General and all the lawsuits made no difference. It was only when second hand smoke and non-smokers' rights were passed in 1994 that we started to see the decline. In fact, it was the non-smokers that made smoking less palatable. How do we do that in obesity? One way, we could say, you have to pay more money to sit on a plane if you are obese. Now companies are saying you’re going to be charged more money for health insurance if you are obese. This is the stick approach, but nevertheless once we start finding ways to bring the non-obese persons' rights into obesity then maybe there will be some behavioral affect.

S: In one minute, if I had a child that is obese and needs help, where would I go to get help?

Dr. Lustig: Your Pediatrician’s office should be the place to go but the Pediatrician doesn’t know anything about Nutrition and doesn’t have any time to deal with your kid's problem. It’s very difficult. The likelihood is you’re going to have to see a sub specialist, such as a Nutritionist. The Nutritionist, in general, says a calorie is a calorie – eat less, exercise more, which of course isn’t going to work. It’s going to require physician education, community leader education, and politician education first and foremost. Unfortunately, the individual family is really left scrambling. It is awful. They can come see me, but of course our waitlist is 6 months long.

S: Well, thank you so much.

Dr. Lustig: Thank you for having me.