 Fantastic, it is so good to be here with you tonight and thank you for being the die-hards, the people who will come even at 5.30 in the evening, but I understand the pull of this session. Obesity is one of those topics that I think everyone, everyone deals with personally and if it's not our own struggles with weight, it's the people we love. But the chance to discuss this on the macro level, the costs of it, the solutions, we have a fascinating group here. I'm not going to, I'm not the star, these are the stars sitting with me, so I'm going to introduce them. At the end, we have Glenn Tolman, the chief executive officer of Transcaron. Next to Glenn, we have Dr. Matt, and please correct my pronunciation. Mads Kroesgaard Thompson, the chief executive officer of the Novo Nordisk Foundation. I know you have a lot of insight into this. Next to Mads is Dr. Shamshir Vialil. Yes, spell it right here. And next to me is Nancy Brown. I'm sorry, Dr. Vialil is the founder and chairman of the Burjil Holdings PLC, and maybe you'll tell us a little about that. And next to me is Nancy Brown, the chief executive officer of the American Heart Association. I'm Amy Bernstein. I'm the editor of Harvard Business Review. And when I was invited to do this panel, the first, my first thought went to some family members who lost 50 and 60 pounds each on, wait for it, Osempic, and has changed their lives. They're off their heart medicaid, their blood pressure medications, they have energy, they're doing wonderfully. But I also know that our readers who are organizational leaders are really thinking about this in terms of both wellness and as a health challenge. And what they're struggling with is how to address it in their own organizations. So with that, I'd love to open the conversation. I have a wonderful script here that I'm going to follow to some extent. But I'd love to open the conversation with a question to Glenn about the investments that healthcare providers, actually I'm not going to start with that. I'm going to start differently. I would like to get from you Nancy, a sense of the kind of macro challenge, the healthcare challenge. Sure, thank you so much. And thanks for the opportunity to be part of this panel. Obesity is an issue that we have cared deeply about at the American Heart Association for decades. We first named obesity as an official risk factor for cardiovascular diseases, including stroke, back in the 1990s. And we recognize over those many decades, obesity is one of many risk factors that can elevate your risk of having a heart attack, a stroke, or another serious health, chronic health issue. Obesity, along with proper nutrition, exercise controlling your blood pressure, your blood cholesterol, your blood sugar, your body mass index, not using tobacco and getting enough sleep are what we call the official risk factors for cardiovascular disease. And you can see the connection of obesity to several of these other risk factors. Nutrition, exercise, blood glucose, blood cholesterol levels and blood pressure. They're all related. And we know that obesity, as it stands, is very complex. It's a combination of biologic issues, genetic issues, epigenetic issues, societal issues, behavioral issues. And so finding a one solution fits all is really not the answer. And I think we'll have good agreement on that on this panel today. The alarming thing is the growing rate of overweight and obesity in the United States and around the world. We have 40% of US adults in the United States adults that are obese. We have a large percentage of young children aged two to 19 who are obese or significantly obese. And these numbers and trends are seeing their way around the world. So we must find a comprehensive set of solutions that can provide healthcare providers in partnership with patients, the tools that they need to help people manage their weight so that they can live a longer, healthier life. We know that excess body weight does directly lead to the other risk factors that I mentioned. So it's a critical public health issue and one that we're determined to work to address. How to address this, okay? And I'd love to go down the row and start with you, Glenn, about the potential solutions that you see out there, both in terms of their effectiveness and what excites you in your business. Sure. Well, transcaring is focused on one place while you're helping care are focused in the US. And the idea is how do we make it easy for people to access high quality, affordable health and care. And in doing that, of course, obesity is one of the key challenges. Now, what Nancy said is exactly right and that is there's not one solution that fits everyone. And yet what we really need is one place to go so people know those solutions are all available. And I'll say something sitting next to Mads here that that may be provocative. We're in a unique time in this whole space and it's unique because of that name that everybody around the world knows, GLP-1s. And yet I don't think GLP-1s are the answer. However, they are a critical part of the solution and I don't think we've ever had an opportunity like we have incorporating GLP-1s in a more comprehensive solution for what we call weight health. And that's a bugaboo of mine. My last company was called Lovango, focused on diabetes care. And it always bothered us when people called someone a diabetic. And so I would have loved if I had a chance to name this session and we wouldn't talk about obesity but we talk about weight health because that's really what we're talking about. GLP-1s, great upfront planning and counseling and in some cases, bariatric surgery. All of that fits into a comprehensive approach that I think we have to take. And our focus is working with the largest employers around the world and particularly in the US to help pay for those solutions and get solutions that are cost effective and that last. Because again, improperly used, a GLP-1 isn't a lasting solution. Properly used, it can absolutely change someone's life. So what we have to think about is what's the comprehensive plan? And that's one of the things we do at Transcarant in terms of offering one place for weight health is what we call it. Mads, what do you think of what Glenn just said? First of all, I think it's one of the most complex conditions we can imagine, Nancy alluded to it. We have polygenic risk factors that predispose some more than others. Yet people get stigmatized even though it's not their fault they're genetically predisposed. We have pregnant women with an even epigenetic imprinting of the fetus that is then later on predisposed to develop obesity. So there's so many things we need to think about socioeconomically and even before a woman even gets pregnant with a child. But once you have obesity, we know it's as chronic a condition as hyperglycemia, hypertension, hypercholesterolemia, so it is chronic. And I think the good news is that with the advent of these new pharmacotherapists, they're not the solution in their own right, but they do make it possible to break the vicious cycle. And the vicious cycle is one where whenever you try to diet you lose weight, your basic metabolic rate drops as a consequence to try to counteract that from a genetic perspective so you get back up there. So now at least we have an opportunity to combine diet and exercise, better behavioral situations with pharmacotherapy. And at the same time, get these people a belief in the future because it has been a yo-yo situation where people have tried many things, they fall back within a year or two, try again, et cetera. So I think what we need is really multifactorial intervention which involves dietitians, coaches on physical exercise, pharmacotherapy, at least in many cases, and a better understanding of this as a true chronic condition, I would call it a disease as does WHO, that calls for significant, if I were Nancy, I'd probably also think that most of the cardiometabolic disease that happens nowadays, including heart failure, the so-called HIFPF, is driven by obesity. If you were a cardiologist 50 years ago, it would be much less and driven by other factors. So obesity is even a risk factor for 14, 15 different cancers, actually exceeding the risk of tobacco smoking in many, many countries. So I think we need to take it as it is, a complex problem that calls for many different parts of the healthcare community to intervene. So Shamsher, you're a physician, you're the founder of one of the leading healthcare systems in the Middle East. What do you think of what you're hearing here? So if you ask my experience, I had a close brush with, in 2017, she was called as the world's heaviest woman. So I went to see her in her apartment in Egypt. She was locked in a room for almost many years. So all they were doing was the family moves her around and then we have to use a crane, break the wall of the flat, use a cargo flight. We looked after her for almost six, seven months and she passed away. But again, I think it's something that we have to look at as a whole, as a family as a whole, because it's not just somebody who's obese is suffering, it's the whole family that is. It's a systems problem. It's a huge issue. If you go to schools, the stigma associated with it, you know how you can differentiate from a metabolic to an endocrine problem, how the school teacher, we have a catering company as well along the hospitals. We thought we should do something for the schools. We started a kitchen, we used the dieticians. We were planning the meals. So we realized that how after COVID, especially with the lockdowns and the easy access to Uber Eats and all of them, food has become so easy to access and the fast food culture with all due regards. Again, there is an intrinsic cultural aspect that is changed in this current scenario. Because if you look at the Middle East, right now there's a change where previously it was just the father going to work, but now we have all of us going for work, wives go to work, everyone is not at home. So again, the child is left alone, schools have to be more responsible. We need to look at it as a societal issue as well. So we cannot just look at just as a GLP alone. We used to do close to 10,000 surgeries a year just for metabolic disorders. And now with GLP once, that has reduced. But I don't think like you said, it's not gonna be a solution. You have to look at it as a whole. And I think mental health is a huge issue. The stigma around it is also a problem. People are called with second names, which even in the Indian culture, you can hear someone called along their life with the names associated with their problems. So I think it's an issue. I don't think even it could be an epic, it could be a pandemic as well coming very soon if you don't address it. Are we, Nancy, with the advent of GLP medications, Shamsher just mentioned COVID, are we at a particular turning point? Is this moment different in your view? I think this is a very different moment. Whenever a new solution comes into the marketplace that can be a tool in the toolbox along a continuum, I think it is a big moment. We recognize, first of all, and we believe strongly at the American Heart Association that healthcare should be done in partnership between the patient and the healthcare provider. So if this tool is available and can help someone that is deemed to need this tool, I think it can be very, very effective. We also know that the GLPs, as at least as presented in a late-breaking clinical trial at our scientific sessions meeting in November, for some people with existing vascular disease, they've had a heart attack, they've had a stroke, they have peripheral vascular disease, and they were overweight with no diabetes. It showed an improvement in other cardiovascular risk factors and clearly more work there needs to be done and continued studies need to be done both to validate that and to expand the group of persons who were studied. But these are important moments in history when new solutions come into the marketplace and the market has to settle around how best to integrate them into play. So yeah, the market has to decide, Glenn, you're very close to the market, you deal with employers, how are they thinking about this? Well, I think this has come on very quickly and most employers are not covering GLP-1s today. So that's the first issue. And what they're saying to us is they want a comprehensive program, they want data to show how it works. That said, if you look at the numbers, as Nancy mentioned, four out of 10 Americans fall into this category already and one out of every three Americans has said they'd like to try a GLP-1. So this is going to come together. The way it'll probably work out in the US is normally when something is categorized as a disease, the government begins to cover it. And then once the government begins to cover it, businesses follow. But they're really screaming for a more comprehensive approach to GLP-1s as opposed to take this medication, don't change anything else, don't change your lifestyle, don't change your exercise patterns, maybe continue taking it, maybe don't. That's what we're seeing a lot of today. So I think there's real concerns because if you take the current price points and you do the math, it'll break the healthcare system in the United States. Some would argue that's already broken in terms of how much we spend. So we have to figure out a more comprehensive approach. So I just wonder, given the severity and just the magnitude of this problem, whether that kind of thinking is letting the perfect be the enemy of the good. I mean, Matt, how do you think about this? First of all, I think the big benefit, whether it's bariatric surgery or these rather efficacious new medicines, one big benefit is that a lot of the accompanying comorbidities, I mean, most of the patients we've studied in the company would either have knee arthrosis, they would have hypertension, hyperlipidemia, maybe sleep apnea, maybe a cardiac condition, et cetera, et cetera. That very often what, and I can see a lady in the room here working with Techno Gym physical exercise tools, we see many, many people who just the sheer fact that they lose 15, 18, 20% of the weight enables them to start doing physical exercise programs that they simply couldn't do because of the pain before. So I would agree with everything that's being said, these things have to go hand in hand. We should bear in mind that over time, in the old days insulin was expensive, then four generations went off patent over a period of 100 years. I foresee that GLP-1 will be a volume medicine for many people, including those in low and middle income countries that very often suffer a double burden of disease with both- Will the prices come down? Over time, yes. There will also be more competitors, patents will inspire. We are right now only at the beginning of the era of pharmacotherapy, and I think also the companies have realized that they probably underestimated even the demand situation. So it makes sense you need a multi-factorial approach, but you have to start somewhere, don't you? Nancy, where do you start? Do you mean as the individual or as society? Well, let me, HBR, employers, where should employers start? You know, we work a lot with employers as well at the American Heart Association, and I think employers are seeking information and data. This is a market-driven trend of employees asking employers what are you going to do about these new drugs? That doesn't, when a new blood pressure medication comes along or a new cholesterol medication, hardly is there a line at the door of HR saying, you know, may I have this new cholesterol medication? It gets worked out through the insurance provider, the doctor, and the patient generally offline. I think there's a lot of misinformation about the GLPs, what they are, what the studies, what mark populations have been studied. You know, now many employers, of course, cover the GLPs for persons with type two diabetes. That data has been clear, and employers understand the importance of bringing down the risk that type two diabetics have. I think this cost-benefit analysis work needs to be done, not at an individual employer level, but there needs to be a better understanding of the cost of an individual, you know, short-term, to take the medication, and then there's a long-term cost of individuals who are obese on an employee-sponsored health plan because of the other chronic conditions that they develop. So, you know, this is all just kind of shown up, right? And so we're getting many, many questions from employers looking for guidance on what to do, how to think about this, and, you know, at the American Heart Association, we always follow the science, and we follow our public policy agenda. And I might just say that we've had a very extensive public policy agenda on the obesity topic in the U.S. That starts with things like access to behavioral counseling, access to nutrition services, access to physical activity, reimbursements for certain kinds of physical activity, access to bariatric surgery. All of these things along the continuum are part of the things that we advocate for. This will be another tool in that toolbox, but I do think the confusion will be more than employers are prepared for just based upon the individual demand. I think though there's another issue with employers, and this is a broader healthcare issue, but it will come to fore here particularly with GLP-1s, and that is if you're an employer, you're managing quarter to quarter if you're a public company, and year over year. And so doing the right thing in that 12-month period isn't always possible and isn't always, they aren't looking at a five-year span. And I think if we look at a five-year span, again, what we've heard is you'll see all kinds of reductions in other co-morbidities, which would be a wonderful thing, but they're not, many of the employers are not looking at a five-year span. In fact, we have industries where the turnover, they're turning over 50, 70% of their people in a year. And so the idea of investing in prevention or in these drugs is much less appealing, particularly as the economy tightens. So we really do need a new kind of model and that's true for GLP-1s, but it's also true for, if you look at hepatitis C, there's now a cure, but the cure over five years, it's cost justified. Over one year, it's very tough for an employer to say I'll pay for it with the risk of someone leaving. So I think that's unique to employers and very different. So I'd love to hear your perspective, Shamshear, I spoke to a lot of physicians who took GLP-1s and they seem to be very happy about the feel-good effect. So they think that it improves the productivity. So I think from an employer perspective, it definitely improves the feel-good aspect of the employer because it's an immediate win because others take time. If you come with exercise as medicine or food as medicine, it all takes time, but this one gives them a quick return because I think the productivity aspect improves and there's a feel-good effect which comes with it, although we don't know how long it's gonna stay. So does it feel good for the employee or feel good for the employer? If the employee feels good, the employer definitely benefits out of it. So I think it's a kind of too early, but I think it's a good start and I've seen a lot of physicians taking it now, but my worry is the misuse of it, making it go beyond the point and I think that's where we need to be careful about. And we see already in the United States, supply chain issues, purses for our type two diabetics that can't get their medication because of the flood to the market for individuals wanting to use the product for weight loss. And so all of that has to get straightened out. And again, this has come on so rapidly that I think the promise is so exciting but so many issues to think through and work out. So then let's talk about that. You're passionate about education, right? And certainly the GLP drugs have triggered a new kind of conversation about this. How does it, has that changed the way you think about education and the other factors towards solving this problem? You know, I think we spend a lot of time in resources educating consumers and the public in the United States and in many markets around the world actually. And people are seeking to understand. They want knowledge, they want solutions, they want tools. You know, one of the most interesting and one of the most commonly asked pieces of content from the American Heart Association is actually recipes, believe it or not. People want recipes. And so we have thought a lot about how to make sure that we are giving patients questions to ask their physicians that we're helping individuals understand the suite of solutions they should be thinking about. I think we all agree on this stage. The worst thing that could happen would be if there was a disregard for the importance of physical activity and proper nutrition. Because at the end of the day, losing weight is one thing, but you know, there is a syndrome that we recently have defined and announced at the same meeting, by the way, the CKM Cardio-Key Metabolic Syndrome, which is a syndrome of how all of those factors come together, and it's complicated and has many components. And we must be thinking about all of them. And so we are focused at the AHA of doing the things we do, whether it's through our policy change work, whether it is through our work in communities, our work in digital content, our work with healthcare providers, our work with scientists, our work in helping to explain the science. You know, the trial that I mentioned that was presented at our meeting was a huge area of interest for the media. And you know, we spent three days explaining to the media so they could explain to the public exactly what the trial was. It was not a weight loss trial. It was a trial for persons with existing vascular disease. So, you know, I think that we are being called on and we're up for the challenge of making sure that people know and understand. And one of the biggest things I think that we all can do is make sure that we're equipping people with questions, not giving them answers necessarily, but making sure that they have questions to ask their doctor, to ask themselves about how all of these things fit in their lifestyle. That's name Matt. Yeah, I fully agree Nancy. I would say as a foundation, we fund a center of childhood health, which is about prevention of childhood and adolescent obesity. And one of the findings we've done in some of the research we've supported is that it all starts preschool. We need, and we were at a session a couple of days ago together, we actually need to consider already at a kindergarten level, educating kids about food, about junk food versus healthy food in such a way that they get it, they will actually transfer some of their insights to the family. This is a family-driven condition quite often. That's where it all needs to start. We need to create governmental support for the fact that we need healthy school food. That actually also avoids the socioeconomic skewing where rich children maybe get healthy salads and so on. And many others, they go to get some junk food at the local bar. There are so many things we can do to kind of level the playing field between the different socioeconomic strata. But as Professor Copeland, the former, former, former CDC director said, you need to take care of those below 18 years of age, because that's where your brain has the plasticity to truly change behavior. At our age, it's great what you're doing Nancy, but to cope with this for decades from now and break the curve of the growing obesity pandemic, we need to start early. Yeah, Maz, I couldn't agree more. 10 years ago, actually more like 12, the American Heart Association and the Clinton Foundation created the Alliance for a Healthier Generation, which is focused on children's health and obesity. And we actually have a very sophisticated process of recognizing schools that create healthy environments for children around nutrition, exercise, mental health and resilience. It's a very important way the program is focused mostly in disadvantaged communities in the United States. And with the Robert Wood Johnson Foundation, we created Voices for Healthy Kids, which is an advocacy program where we're spending millions of dollars a year in communities changing public policies. Things like, as an example, in some communities, access to safe places to exercise is a really big problem. So changing policies in communities so that schools are open after hours for families to get exercise, sounds like a very simple thing, not so simple at all. And so I completely agree, starting with youth is very, very important and making sure that we also focus on the triggers that might create a spiraling of unhealthy behaviors in youth. And this is where we at VHA have been very focused on the targeting of individuals in certain communities to high salt, high sugar products, beverages and foods and certainly tobacco products. It starts with people in young ages and there's absolutely targeting going on and that needs to stop as well. So before we go to questions from you or our audience, I'd love to get a sense of, if we are going to solve this problem for access, for equity, what is the single most important place to look? Where do we start? And I'll go down the line. I'll start with you, Glenn. I think if you talk about access and equity, you have to talk about the government and it needs to be covered by governmental programs which focus in, again, at least in the United States, primarily on the underserved under-resourced populations. That said, I think the employers will, for all of the reasons that were mentioned, they wanna keep their good employees happy, they wanna keep them employed. This is kind of a consumer-driven drug. Unlike many of the drugs, consumers want this and they feel better. So for all those, I think employers will get there. I think it'll be a little choppy and I think with help from the American Heart Association and others creating comprehensive programs like the one we offer, which say there's one place to go independent of what solution you need, I think also de-stigmatizing this. So again, I'd like to get rid of the word obesity, talk about weight health because that's what we're all saying. We're saying if you manage your weight, you're gonna be healthier. And that's a good thing that everybody, no matter how much you weigh, should be thinking about as opposed to putting people into this obesity category which is a negative, there's no question, people see that as a negative. So I think it's a combination and we need all hands on deck because this is moving from a epidemic to something well beyond that, a pandemic and it's worldwide. Matt? Well, we've discussed the socioeconomics. Even in Denmark, taking people with a low level of education as compared to academic education have a five times increased risk of obesity and a three times increased risk of additional comorbidities. So I would focus as a government agency a lot on the vulnerable populations, those who are socioeconomically exposed to a very high risk and start earlier as I mentioned because everyone goes to kindergarten. Everyone doesn't go to university. If you start earlier, that's a chance we can break the vicious cycle. I would also realize that there are definitely people who are able to handle this themselves. Those are not the ones that need help. And then I think also to quite honestly follow the evidence because the best evidence we have today is that it's a combination of things. One thing, I mean, yes, you increase your lean body mass by exercising but you compensate later on in the day by turning it down, you're basically a body gradient and overall you become a healthier body composition but you need to add something such as healthy food or maybe sometimes pharmaceutical intervention. So a multifactorial intervention with a special focus on vulnerable populations. I think we need a hybrid solution. We need some historically used techniques like sugar tax and tobacco tax which has helped and we don't want GLPs to be the only go-to solution for this because then I think there's an easy solution for it and we don't want this to become another problem. So we need to think of this issue not just as a ministry of health handling this because we want the ministry of economy, ministry of finance because it's related to all. So we will need to rewrite the rules of engagement especially with kids being too smart these days. We cannot just convince them easily. We need to really show them what it looks like. We cannot create role models by just doing GLPs then they get to fall for the fan craze easily at these days. So I think we need to look at it in a hybrid mode where we give them some values. We teach them things in the house plus schools because school that alone won't be enough because we have seen that people go home and eat what they want. So again like Nancy said, it's so difficult to make them engaged in the schools because they look forward for going just at four o'clock where they go back and do what they want to do. So I think we have to look at the data. We need to see what model works best because it works, what works in US doesn't work in Middle East, what works in the developed world doesn't work in the African part of the world. So I think this is the time that we need to look at it differently. We need to bring the pharmaceutical. We need to bring the governments. We need to bring multi-stakeholder level meetings. We need to call for action enough of thought leaders. We need doers to implement things. And what about you Nancy? I would agree with Glenn, policy change. If you want a large scale change in society around health related issues, it has to start with policy change. And thinking about the spectrum of tools in the toolbox, how are they covered, especially for those persons at the greatest health risk. In this case, maybe those who are most obese or have the likelihood to be most obese or those who can't otherwise afford treatments. We cannot leave people behind. Right, right. And we don't forget the mothers because there's increasing evidence that treating a person, a woman, a couple that once become pregnant and reduce weight even before pregnancy reduces the hormonal and metabolic imbalances and the epigenetic imprinting in the fetus. There's something we can do to help the next generation. Quite simple by losing some kilos of weight even pre-pregnancy according to the latest data. Okay, excellent. Well, now we want your questions. If you'd raise your hand, we have people with mics around the room and they'll come right to you. Any questions? Do I see one over there? No. Yeah, there's one. Oh, yes, right there. Thank you very much. Obviously, America is one of the highest obesity rates and the reason is largely because it's got the biggest food industry. And I just wondered what the panels view about how you would regulate the food industry and what more needs to be done and also with the advent of therapies. Does that reduce the need to regulate the food industry or not? I'd be happy to start on that. I have very strong feelings about that. So I think there are three things to consider. First of all, with the onset of these new therapies, it does not change many simple facts and that is that unhealthy food products are targeted to persons in disadvantaged communities. And so, you mentioned sugary beverage taxes, trying to work in partnership with food companies to change the way that they promote their products to certain populations is very important. I remember years ago having a large food company come and visit us at the American Heart Association and in a casual comment, this is a company that has a number of fast casual restaurants. They talked about the fact that the plate size in restaurants used to be seven inches and now it is 11 inches in the United States. And so portion control matters a lot and we live in a consumer driven society so people equate size amount of food to value and I think that is going to be very hard to change but holding food companies accountable to not targeting individuals with unhealthy products is one thing. Number two, our government, the FDA specifically, has a really important role. We have advocated strongly and the FDA has recently adopted voluntary targets for example, sodium levels in food products which is directly related to elevated blood pressure but also other unhealthy food behaviors. There are many good actors, companies that are trying to do the right things but not all companies are there and so we as advocates have to keep the pressure on on behalf of the people that we serve. And I think also to add on to that is the shopping habits have changed. It's online shopping and it's so easy to access so if you could look at the shopping cart you can see people have started to buy more portions and quantity so that also needs to change. So there needs to be a big educational activity happening in the houses itself. So yeah, the food can be controlled but again if the shopping patterns also need to be addressed in terms of what people buy, what they eat so I think it's going to be multifactorial. And adding to that we're doing some multifactorial interventions in Denmark where one of them is actually using a bit of AI on a supermarket chain online advertising. So if they know a person has a high BMI and a co-mobility what will pop up initially in the suggestions are healthy foods. So that can actually be done in collaboration with food companies. But I also think it's important that the way we label our foods if one company decides to add less sugar and less fat that company will lose if the others don't do the same. So having a systematic, harmonious or similar labeling criteria across the food companies could make a big difference. Well this is, you know to the voluntary targets on sodium as an example that is really what happened, you know a large scale effort that we were proud to play a significant role in encouraging companies and you know sodium although not exactly on topic for obesity but it's complex, you know some food products need salt substances to be able to have a shelf life, right? The largest amount of sodium that people eat is actually in bread, you know most consumers don't understand that bread is the largest place for getting sodium. So there's a lot of things that need to be done and I might just mention one more solution that I think is really important and this is something we and the Rockefeller Foundation in partnership with Kroger and Walmart and America's health insurance plans and others in the United States are looking to create the broad scale large evidence on food is medicine. You know if we could integrate food into the healthcare system and have it prescribed by healthcare providers for those persons where healthy food could make a difference in their overall health and well-being and have it reimbursed like drugs are reimbursed that could be a dramatic change. Right now there are many important programs that have demonstrated the effect to get insurance to cover this at a mass scale at least in the United States. None of these programs have data that is long enough and nor do we understand you know which people for what time and what exact diet. So we are taking that on at the American Heart Association in partnership with the Rockefeller Foundation we have announced a 250 million dollar research study to create the definitive evidence to show that food can be integrated into the healthcare system can be reimbursed like drugs and can be cost effective to society. I wanna I just add two things. One your initial question asked about regulation do we need more regulation. I don't think that's the answer in part because you know what we see in many cases where we've tried to regulate it's actually backfired in some cases. So I do think there's other ways to approach it. One is making it easier. We know that the way that things that are most successful the internet works is what you make easier people do. So if we make it easier particularly for underserved communities to get access to healthy foods and that is subsidized healthy foods make them available. That can have a dramatic impact. Right now the easy thing to do there's food deserts in many places and you can't get anything but fast food. So that's what happens. So one make it easy in the United States we pay farmers not to grow certain foods and vegetables and the like and if we reverse that and distribute those in underserved areas I think that would be one. And second Nancy already mentioned it there's great companies innovative companies out there one is called FoodSmart but there's a lot of them out there that are starting to use technology and when you're using food stamps or other subsidized programs they will actually do just what you said they'll pop up these foods that are healthier and target them to say they're available they're easy to access. So I think that food as medicine is gonna be a big industry and last but not least we do need education because we have to make it very clear that again being healthy which people want to do they just don't know how to do it and that seems counterintuitive but it's really true. We have to make that front and center of what kids are taught from an early age if you want to be vibrant strong healthy successful here's the foods to eat so that would be I think healthcare has become more sick care. It's not at all looking at the wellness aspect so I think I'm of the opinion we need regulations not restrictions we need to encourage people it's a problem which has to be addressed differently to different age groups. The kids needs different calorie labeling and stuff like that. The adults grownups different so I think we need to relook at the whole drawing board we need to rewrite the rules of engagement and as I said I think GLP-1s cannot be the only solution for this. Yeah so I'm afraid we were running out of time but what I'm hearing is first of all GLP-1s are not the panacea we were hoping they were. We need more data up and down this entire social problem it's a societal systems issue. We need more education. We need to deal with we need to focus on young people catch them while they're still impressionable while we can change their thinking and their habits. At the same time don't forget the mothers and then we need to think more creatively. Don't forget the fathers also. And don't forget those fathers but we need to think in creative and constructive ways about how government and industry can work together to solve this enormous growing problem. So thank you so much for sharing your insights to our panel and for helping us think about these solutions and thank you I'm sorry we only got to one question but thank you for being here tonight.