 Welcome. Good afternoon. We'd like to go ahead and get started. Thank you for coming. My name is Andres Martinez. I'm the editorial director here at the New America Foundation and one of the ringleaders of our fantastic Future Tense collaboration partnership with Slate Magazine and Arizona State University. Future Tense looks at the policy implications and and often times the cultural implications of emerging technologies. We have a channel on the Slate website edited by Tori Bosch who is here with us today, and we do a series of events here in DC and elsewhere. Everything from day-long conferences to we're gonna start a book club soon. We have movie nights all around this question of how are these emerging technologies impacting our lives? A lot of our events treat very large macro issues like the implications of drones for warfare for privacy. We've done things on geoengineering topics that seem very esoteric and distant to our daily lives. This fall we've had a series of events that involve more of our kind of intimate lives. The last big Future Tense event we did was on longevity and what it what's in the near and medium future in terms of the dividends that technology are gonna pay for the lifespan of human beings. And today's event is looking at setting aside how long we're gonna live. You know, how do we live? And I think there's there's a sort of desire to see more of a payoff in terms of our health and our lifestyles from all these technologies that have revolutionized so much of our life. So that is kind of the impetus for today's event. We're looking at what technology means for the future of America's waistline and our ability to lead healthier lives, given all of this knowledge that's at our fingertips that can impact how we behave and how we inform art, the choices that we make. So I'm very excited for today's program. Just in terms of a couple of house rules, this is being webcast. So when there is Q&A, please wait for a microphone and introduce yourself. So it goes without saying that everything you say and that we say is not just on the record or in terms of this room, but it's it's on the web. So to help kick today's event off, I'm going to introduce, we're gonna have a presentation by Alexandra Bruis Slade. Who is partner of ours at Arizona State University. Alex is the director of operations at ASU Mayo Obesity Solutions. Arizona State has a very active partnership with the Mayo Clinic and Alex is very involved in leading that. She's also the director of the School of Human Evolution and Social Change at the College of Liberal Arts and Sciences at ASU. Alex, I will let you get us started. Thank you. So thank you very much for the invitation to come and meet with you all today and talk a little bit about a problem that we hear about in the media all the time. We hear about it around at dinner tables. Families are engaged with it, doctors are engaged with it. Obesity is now one of the most talked about and debated issues that we have in the medical arena, but it's also very very personal. Probably every person in this room in some way or another, regardless of their background, their lifestyle, they worry and think about weight issues. There's almost nobody now that doesn't worry about either being overweight or becoming overweight. It's something that's become both a major policy issue, but also a very intimate part of our contemporary lives. So at Arizona State University, we're tackling the problem that despite now several decades of research, looking at how to fix obesity, many of the standard public health and medical approaches, which focus on the individual and the individual responsibility, which I'll get to in a second, actually don't work. That is obesity is spreading. People are continuing to gain weight. If there's a slight plateau now in adults in the US, it's not a very profound or long-lasting one. Children are now getting fatter and fatter and we really worry. One thing we don't know is what the long-term effects of increasing childhood obesity, because a lot of the adults that are overweight now were not necessarily overweight as kids, so we don't really understand what the long-term health and societal impacts are. If that, there's a lot of panic around the cost of obesity to medical systems. And in fact, some of the biggest concerns are in developing countries now. The middle-income developing countries have the highest rates of obesity increase. There's almost no part of the world now except for essentially sub-Saharan Africa and some of South Asia that is exempt from rapid increases in obesity. The top most obese countries in the world now include parts of the Middle East, as well as all the old players, the UK, the US, Australia and New Zealand, where I'm from. So you might say, I'm an anthropologist. I'm trained in medical and anthropology and human biology, and you might say, well, what does an anthropologist have to do with all of this? So one of the things we do know about obesity is that everybody knows, everyone in this room knows how to lose weight, right? It's a very simple formula. Eat less, exercise more. The problem is it doesn't actually work, because anywhere you go in the world and you ask people how to lose weight, they can always tell you, eat less, exercise more. But telling people, giving people that one piece of information is actually completely insufficient to deal with the scale of the problem. And part of that is because this problem is now embedded in every aspect of our lives. It's how we work. It's our sleep patterns. It's how we get from one place to another, transportation. It's how we organize our children's schooling. It's in every aspect of our lives. So part of what Arizona State University is doing in partnership with the Mayo Clinic is really thinking at the macro to micro level on this problem and trying to figure out if this problem is this large and this complicated and everything, and once you start mapping it out, it's unbelievable, you know how individual exercise and the built environment all interact and so on. How can we find the points of very best insertion for our efforts? Right, so what are the soft spots that we can get into where we can design and develop scalable solutions? So a good solution has to be one that is easy for people to use that is cost-effective, extremely cost-effective that is available to everyone. So there's a social justice aspect to this as well. So it needs to be something that's scalable and not just scalable of people with money, but scalable to everyone. So these are very complicated problems. So what we're doing is bringing people together at ASU we have the largest research intensive university in the country with the largest student body, which is a big advantage. If you want to test anything out we've got the largest number of students resident on campus. So we actually have a wonderful captive set of research collaborators, how do we call them? So we can really start to think outside the box a little bit and with the partnership with the Mayo Clinic what we have is an enormous array of expertise around metabolism, treatment, and intervention. So if you put you know the wide array at ASU which is life scientists, nutritional scientists, engineers, anthropologists, sociologists and so on you actually get this capacity to really think at what are those complex intersections, the points where we would be best intervened because they're going to be the most cost effective and the most scalable. So we've been working on a bunch of scalable solutions through obesity solutions. This includes redesigning school rooms, redesigning dorm rooms. We have a big project at ASU called the active dorm an active at ASU where we're really trying to use technology to influence a very large set of people. As I said we have 80 000 students so that's a a lot of people that we can tackle it once. Okay, so question where does the anthropologist fit into all this? So my own research and I've been working on obesity issues on and off for about 30 years. I started working in Samoa, which was then the fattest so-called fattest country in the world in the in the 1980s. Now everyone else is caught up. You know, we have two-thirds of adults in the US are now overweight or obese but I've been thinking about this for a long time and my point of entry was thinking about body image and how that fits into all this so the work I've been doing is focused on a phenomenon we call fat stigma. In our society people with obesity face very high rates of discrimination. They're less likely to get into college. They're less likely to get a job. They're less likely to get promoted. They're more likely to be teased or bullied. So weight-related bullying is now the number one cause of bullying in schools. Very profound effects emotionally on people. So I'm really interested in how and why that level of stigma emerges and what the implications are for treating obesity. And this is really important because the one thing we do know is that shaming people that is putting stigma on them because of their weight actually undermines rather than encourages weight loss. And yet a lot of our models for thinking about how we deal with weight loss focus on telling the individual that they should be ashamed and they need to do something about it. But in fact there's a growing amount of scientific evidence that that that shaming in itself is actually counterproductive in terms of weight loss. If people become develop lower self-esteem and they get depressed it actually doesn't help with weight loss at all. It's quite the opposite. So my particular research is an anthropologist. We work in about 15 countries now. We're really interested in what's happening globally. We're seeing that weight stigma that used to be a very Western phenomenon is now a globalized phenomenon. Everywhere you go people say that fat is bad for moral reasons, not just for physical reasons. And we're really interested in unraveling that, figuring it out and figuring out at a social level how we can deal with stigma in a way that makes it possible to design public health and medical programs that don't shame the individuals. So they actually end up being more effective in supporting weight maintenance in the ways that make cultural sense but also good health sense. So that's what I'm working on. I'm thrilled to be here today and thank you very much for the warm welcome. This first session is about how to engineer food to help combat the obesity crisis. And my name is Laura Helmuth. I'm the science editor for Slate Magazine. And our panelists today, we have Rob Post who is now chief science officer at Food Minds. And he was at the USDA and was responsible for overseeing the MyPlate consumer communications program. So you've seen this. This is the one where you can, it's actually the intuitive public health outreach program where what you eat and what you're taught about actually makes sense. And then Alex, you met already, Alexandra Brouis Slade who is at OSU, the Director of Operations at the Mayo Obesity Solutions Arizona State University. And then we have David Freedman who is a contributing editor at The Atlantic and a consultant editor for Johns Hopkins Medicine International. And if you haven't read it, I hope everybody here subscribes to The Atlantic. It's where big ideas in New America Foundation ideas often get published. And he has a cover story from the ideas issue a couple of months ago. And it's just terrific. It's a really brilliant expose about what does work to engineer food and what doesn't work to engineer food and how some of the things that we sort of intuitively think of as good ways to stop obesity are actually getting in the way of what would work. So I think, you know, we, as Alex pointed out, a lot of the behavioral engineering, well, I guess not engineering, a lot of the behavioral approaches of saying don't be fat, eat less, exercise more, clearly is not working. And so in this session, we're going to talk about what we can do to food, to make food less obesogenic, make it, you know, what can we do to make what people eat make them less likely to become obese. And I wanted to start with you, Rob. So one of the points Alex made is that the public health interventions really haven't worked that much. But sometimes they do. And is there, you know, are there some guiding principles from the public health interventions that have worked that we should take away? Yeah, I think there are some great examples. And of course, I'll reflect most of my comments on my experience in leading USDA's nutrition policy and promotion agency, which is the Center for Nutrition Policy and Promotion, which has the responsibility for not only setting the dietary guidelines for Americans, but actually implementing them. And a huge change occurred in 2011. With the 2010 dietary guidelines out there, probably the best addition yet, because of the methodology. And sometime, perhaps in this time, I'll get to talk about evidence and science and how it's developed. When it comes to getting consumers' attention, we've learned a whole lot since the pyramid. And that used to be the way to get the dietary guidelines out there in classrooms. Most of you remember that. For about 20 years we had an experience with the pyramid. And there's about 100 years of experience in dietary guidelines, a guidance set at USDA. When it came to really getting consumers' impact or attention, something simple, something that is appealing, something familiar, came through testing. So through consumer research, with kids, with the food assistance populations, with the general population, looking at the messages in the 2010 dietary guidelines, who came up with something new. That was launched in June of 2011. And that was the my plate icon, which is really the centerpiece supported by four components. So what we learned was you can have something simple, yet powerful, something familiar, what is not more familiar than a place setting for most people. And unless you're Stephen Colbert, most people eat off plates or platters, he says, of course, some of us eat out of bags, which is probably true. But for the most part, it's symbolic. And it shows portions. It shows food groups and choosing healthier among food groups. It reminds consumers to choose healthier. So that's been fantastic. And the outreach and the measures, the markers of progress in terms of awareness and recognition and the meaning of it has shown in nationwide surveys has shown that it's quite a different departure from the past and something that's actually gaining traction. So Alex, one of the things that I wanted to talk to you about as an anthropologist, talking about engineering food, it seems like food is like the ultimate engineered thing, as far as domestication, selective breeding, cooking, all these things that are sort of the province of anthropology. And it seems like one of the recent fads is to look at anthropology and particularly paleoanthropology and devise our diets in a way that fits with human evolution. Does that actually make any sense? Is there something to be said for engineering food in a way that sort of reverse-engineers it to some prehistoric state? Well, I think there's a really interesting myth out there about how humans used to eat. And one of the issues is actually pretty good archaeological evidence and also evidence using primate models as well about what the sort of archetypal original diet was that our bodies are designed to process and use. But one of the problems is that there's a disconnect between the science and the way it's being portrayed publicly, but also a lack of appreciation of the fact that humans actually are the ultimate omnivore. So the way our dentition is designed, the way our bodies are designed is essentially to eat this very wide array of foods. And when you look at our evolved biology, a lot of the evolved mechanisms around food have actually occurred since the Paleolithic. So with the domestication of cattle, with the domestication of grains, you actually have a lot of evolutionary genetic change. For example, one of the really interesting changes in human biology has been the capacity to process lactates and milk sugar in adulthood, which is very, very unusual in the animal world. And that's a post Paleolithic, post-domestication adaptation that I think around northern European extraction populations have that capacity. But there's a bunch of other things like that. The other thing that's really coming in an interesting way from the evolutionary literature is this notion that what people think of as food is so fundamental to human survival that probably the notion of a normative meal or what a plate should look like is laid down very early in childhood. And it probably doesn't shift that much because it's so central to cognition and survival and navigating the world in a healthy way when you hunt a gatherer, that probably my plate idea is really interesting because if you can cognitize early what that should look like, then it should stick pretty well. So that will be another way you can use sort of evolutionary thinking to work your way through this. But there's a big disconnect because the people who work in this area, a lot of them are in our schools so we have a number of the top people. We have the top paleoanthropology program in the country. We have a lot of people that work on dietary issues. They don't really talk in a pop environment at all. So a lot of their research actually is not informing and we try, but there's a huge disconnect there and I'm not sure how to get beyond it. And that's part of my job to figure that out. So if you have any ideas, it would be great. It's a problem because there are so many people talking about diet and trying to tell you things about your diet who will fill up that space if the scientists don't. Yeah, that's good luck. I hope you do. And David, so as I mentioned, everybody really needs to read the story and I believe it's available in full online too so you can go back and get it. But one of the things that you point out is that some of our sort of, especially recent notions about what counts as wholesome, healthy food are actually getting in the way of doing anything about the obesity crisis and our sort of emphasis on whole foods type things and all natural and even farm to table, that may be nice for us, but it's really not addressing the public health problem. Yeah, and it is nice for us. I mean, I try to eat that way and I'd recommend that everybody didn't know. We've been telling people to eat their vegetables now for well over a century. Popeye was basically a marketing tool for spinach. How has that worked out? Not that well. So and it's funny, when you get into conversations with people who are really interested in this, they're generally pretty fit looking and it's sort of, we're all just sort of bouncing off each other, those of us that don't really have this problem. But if you start looking at the public at large, so to speak, that does have this problem, then you find out of course that, by and large, they're junk food eaters. Why are they junk food eaters? That stuff's really tasty. It's cheap. It's fast. It's convenient. It pushes all the right buttons in our brain. And so when you say to these people, well, eat farm to table, eat local gardens, eat lots of leafy green vegetables, eat foods that your great grandmother ate, it doesn't do anything for most people. I mean, some people, it's going to change some minds, but most of the people who buy into this stuff don't really have the problem. So the question is, what do we do for the public that really needs help with this? Well, so what I propose in the article was, okay, well, they eat junk food, let's make junk food healthier. How? Let's lower the calories in it. Let's lower the fat and sugar in it, right? Don't we all agree that junk food, calories, fat, sugar, we keep hearing that over and over again. It turns out that science has lots of ways for lowering these things in foods while still retaining all the same neurological hot buttons. So this sounds like a no brainer. The public, not scientists, not experts, but the public was by and large outraged by my article. They hated the idea. You take a look at the comments if you have a chance. I think we're up to 700 comments. I can summarize all of them for you. I am a corrupt tool of the industry and a complete idiot. So let me just say I've never taken a penny, not a single penny from industry ever. I'm a journalist. And I think we have to ask ourselves what's going on here? Why do people have these essentially religious beliefs? And we know they basically come from my colleagues, my fellow journalists. I mean, they would blame me. I'm going to blame them. But Michael Pollan and Gary Taubes and many others have perpetrated a lot of myths that all we need to do with food to fix everything is get everybody eating natural foods that our great-grandmothers ate or eat all the calories and fat you want. That doesn't matter. That's fine. That's not causing obesity. It's all just carbs or it's processing. Somehow when you take food and you put it through some sort of metal hopper in a factory, magically all the goodness goes out of it and all the obesity goes into it. Now no one has ever pinned down exactly where that happens in the factory but yet a huge percentage of the public believes this and doesn't want to hear anything about how we can help the people who most need help. Yeah. And so Rob, because people like us who talk about these things and spend our lunch hours talking about these things tend to know that we need to eat five servings of vegetables a day, what strategies do you use to reach the obese poor, to reach people who can't go on the government website because they're on the other side of the digital divide. How do you reach the people who most need to know and is it a problem of knowledge, do you find, with the obese poor? Well, it's a problem of knowledge. I mean, across the population I think there are particular challenges just like access is a huge issue from hunger and the spectrum to overconsumption and still being nutritionally deficient. We've got some problems. I think there are a lot of, on the federal side, a lot of efforts out there like SNAP education, the programs that are the 15 food assistance programs at USDA do a fantastic job in reaching consumers. And SNAP is the food stamps. Supplemental Nutrition Assistance Program, which used to be food stamps. And so these do serve obviously the millions of folks that are on these programs but others as well with curriculum, with ways of reaching them. So they don't have access to the internet, which by the way, I mean, it is mostly available. If it's not available in a home, it's certainly available at places where individuals who are in need of food assistance can achieve it at a center where they touch base with folks who run those programs. So getting information out there is very critical and making it actionable. And what I call active nutrition is probably the key. So there's a great emphasis on that these days. Certainly in the last four or five years in making sure these programs are effective and certainly in every place in this country where you need them. So Alex, you were mentioning the idea that children very, at a very young age, kind of get a set idea of what a portion size is and what an appropriate meal is. And that seems, I mean, in a way, as you point out, that's a, you know, a teachable moment. That's, you know, perhaps something you can intervene in. But with the rise in childhood obesity, does that mean that it's going to be ever so much harder to make adult obesity go away if children are kind of imprinting on this information at such a young age? Yeah, so we actually really don't understand yet what the long-term effects of the rising rates of childhood obesity are right now. But we know that it is associated increasingly with low income and lack of access and lack of opportunity, which makes it even more concerning because that means it's conflated with poverty. And the moment something is conflated with poverty, you've got a lot of structural things that you're grappling with. And the level of complexity is so incredible. So you can come up with these macro level policies. But the way they play out on the ground programmatically is really, really difficult. Just give you one example. So I have an anthropologist colleague called Larry Shell, who works with Mohawk on the upper, what's the river? Which? Near Albany. I don't know the east coast very well. Anyway, the St. Lawrence, the St. Lawrence waterway. Okay. So they have, you know, a big problem with obesity in the adolescents there. So what he was, so they were trying to move them back to doing more traditional food gathering, as you know, and learning about culture and doing more traditional food gathering, so fishing and wild plants. And they find out that all these items have huge, horrible levels of toxins in them. So now you've gone from one problem to another and body fat actually attenuates the issue of these toxins being in the body. So it's like, you know, what seemed like a really obviously clever solution, because there's all these other factors associated with poverty that go with it that aren't necessarily due to obesity is very, very difficult. And especially, you know, the other thing that people talk a lot about is food deserts. So we've had in Arizona, it's very interesting actually the food deserts are in the part of Phoenix where we've been working were really a function of SB 1070. So you had this change in government policy about immigrants, undocumented immigrants, and what happened was nobody would get in their cars anymore because traffic stops so we get caught. So it's very, very dangerous to drive in a car when you're worried about being caught under these new laws. So people couldn't go to the supermarket because they didn't want to get transport. So now they're shopping in the corner bodega. But then you had a whole nother thing going on, which is people started cooking in their own kitchens and selling the food. So you actually had this movement back towards more healthy meals as well. So these things are just so complicated by all that when you have something that's concentrated in relation to low income and disadvantage in poverty, it's like there's 50,000 other layers of things that you pull one string. So in some ways from a policy point of view, an anthropologist would say is that you have to deal with poverty and then everything else will cascade from that. If you just pull it the food and childhood issue that you're maybe helping a few people, but the structural problems don't disappear. But engineering food is potentially one way to, especially if you engineer the food that poor people eat or able to eat and able to reach, although that can't solve poverty, if we think of obesity as the biggest public health problem facing certainly these communities and probably the whole country. And David, you went to a lot of bodegas and tried to buy some fresh fruits and vegetables. I did, yeah. At least from an obesity point of view it's really appalling what you find in local grocery stores, especially again in the neighborhoods that probably are most vulnerable to this sort of thing. And I was told about a program to remake bodegas in Los Angeles. So I went to one and it was beautiful, really clean and right up front a huge, beautiful, well-lit shelf of gorgeous looking local vegetables right there. Place was completely empty. All the other bodegas I had been to were crowded with people buying pork rinds, fried pork rinds, which by the way, if you've never seen a full large scale fried pork rind, you've got to check these things out. What are they? They're not like this big. Anyway, so in this bodega, lots of vegetables, it was empty. And I stayed there until I had to wait 15 minutes for one person to come in. She ran past the vegetables, grabbed a candy bar page for it and left. So what are you going to do? I mean, I think we do have to do these things. I like the idea of remaking bodegas. I'm totally behind it. But we really have to take human behavior into account. And I think it's sort of being dropped here. People don't make really big changes. They need to make gradual changes. They need support. I mean, it's complicated. We have to do a lot. And if we have, I think, essentially, non-scientific religious-like beliefs about what healthy food is, then we can't speak as one voice. And remember, it took 60 years to reduce the smoking rate in this country from 40% to 20% where it is now. And that's with everybody speaking with one clear voice, don't smoke, 60 years, which is starting out in obesity. And we hear a thousand different things. We have got to get our act together and agree on what it is. And we know what it is. We need ways of helping people reduce calories, reduce fat, reduce sugar. If we can do this stuff, I firmly believe, all the evidence says we can fix this crisis. But we've got to get on the same page on this. Yeah. And so as far as the message goes, the main speak with one voice message, do you think we're making progress on that? Or is it diversified into many conflicting voices from what you see? It is. That's essential. We have been bombarded for so long with so many different views. And it's sort of like the research report of the day when you listen to all news radio. I could go on a soapbox about having consumers understand how to really evaluate evidence, how many people are really studied, how repetitive could this research be and still get the same results? I mean, there's a lot of flaws in research. And so that's one thing consumers, we need to get more consumer education. But a similar one voice, a unified voice approach is key. And that hasn't happened. And here again, I'll reflect back on what USDA, and it's more than USDA. It's the USDA Department of Health and Human Services, all federal sector agencies, and initiatives like the First Lady's Let's Move initiative, where we're all working off the same page. We've got a playbook. It is a paradigm shift from the past. So there are seven essential messages that are drawn from the dietary guidelines. The dietary guidelines do represent the best science-based guidance out there. The problem is we want people to know they exist. It's been a problem in getting that out there. But the idea that there are messages like, enjoy your food, but eat less, there's messages like, make happier plate foods and vegetables, obviously perfect for my plate, make at least happier grains, whole grains. The measurements, the billions of media impressions we're getting for these messages when we work with 8,000 partners. So there are 8,000 partners that have been built in an nutrition communicator's network. Working according to what in the journalism areas is like an editorial calendar, here we've got a message calendar. And so that a certain time of the year, you'll see these messages taken up by representatives of just about every sector, youth organizations, professional organizations, the food industry. And they'll sign on for the messages that work for them. And those messages seem to be resonating. We've got a lot of work to do. I'm not saying that this is a panacea. It's one huge tool among many, but it is the unification. And having everybody agree that these are first-tier messages, they leave a lot of flexibility for just about every organization to really tailor those messages to their audiences. And as Alex pointed out, those messages can't be shame on you. Don't be fat. You'll be sorry. Ugly, unlovable, all these other things. That's the wrong message. Operationalizable. And they've got to come with how-tos. They've got to come with, okay, here's this information. How do I apply it? Yeah. And so when it comes to the message, obviously, as you say, the shame is completely counterproductive and is, if anything, making things worse. Has anybody found good ways to make people enjoy their vegetables or eat more of them or order the egg white, egg McMuffin rather than the regular egg McMuffin? I mean, how that seems like a very tricky thing to get people to want to do for pleasure. So there are a bunch of tricks that have come from food psychology. For example, one set of research that's been done at ASU has been showing that if you take a food that a kid might not like, like broccoli, but you add all these good things the first few times they eat it, then actually they can accept the taste of unadulterated broccoli later. So, and this is really interesting because I've struggled with my own two children. I struggle every day with this. It doesn't matter how much scientific information you have, getting your kids to eat their vegetables is really, really difficult, especially when you're not meant to, you know, say, you know, food trade is one of the things they say, don't food trade, don't make broccoli the evil thing that they have to eat in order to get the dessert. So this notion, actually, I hadn't thought about adding sugar and fat to the broccoli the first 10 times they eat it to make it really lovely and then they get used to eating broccoli, but that's a really, a sort of a counterintuitive trick, but apparently that's one thing that can really work to get kids to accept otherwise unwanted vegetables. But essentially for a parent trying, when you think of a parent trying to manage this in the context of feeding their children, you know, this is an incredibly complex operation and for anyone that has small children, it's basically war. I mean, it is, it's a daily, it's a daily war, it requires huge amounts of effort and outsmarting your children, which is not easy in order to get in front of this. And as I said, you know, I can't get my, you know, one of my kids will not eat vegetables at all. And I have tried every trick that well, it's just suggest you should. So I mean, to give people no hope, but it's not an easy thing. Because what happens is as soon as my kid leaves the house, when they're at school, they're under a different set of operating principles. When they go to someone else's house, there's, you know, I went to pick my kid up from a friend's house the other day and they were sitting there in a pile of Halloween candy wrappers, you know, that obviously spent the entire afternoon unwrapping and eating. So that's part of the complexity of this is that you don't just control, you're not the only person creating the ecology in which your children exist. You know, I actually had one of the teachers from school call me. I was very dogmatic about this when I had my first kid. And now I've got more, I've sort of given up. But with my first kid, I watched everything she ate. I followed all the tricks about, you know, not food trading, not short order cooking, all these things you meant to do with toddlers to get them to eat their food, the eat preferred food. And the teacher called me from school and said, you know, please can you stop sending your daughter with those lunches because she's so left out. And it's become very difficult for her. So it's like a child. Yeah. And that's, I mean, especially for kids, it does seem like candy is, you know, it's a measure of social success. If you know, if you can have and trade and, you know, kind of show off your, your candy and your salty snacks. And it seems like part of the trick. And David, you wrote about this, is that, you know, if people know they're eating healthier food in a way that makes it less satisfying. And also if the food, if you cut the calories too quickly, people are hungry. And if they stay hungry, they're not going to order that thing again. Have you, have you tried the Satisfries yet? It's so Burger King has a new kind of fries out yet, which is called the Satisfries. And they have lower fat and calories. And you wrote about McDonald's trying some things too, and actually being successful in lowering its fat content and salt content. How are consumers responding so far, can you tell? Yeah. So the, so these things are typically not broken out officially, but there's a lot of good evidence that the public is not responding that well. It never has. McDonald's brought out a relatively low fat, lower calorie, quarter pounder in the 1990s called the McLean Deluxe, which is generally known as one of the biggest marketing disasters really in the history of western civilization. They tried for five years to promote it heavily. I thought it was delicious. My wife and I ate it all the time while our kids sat there eating chicken McNuggets to our distress, but there was a period of time where that's all they ever wanted to eat. Now they're all vegetarians, by the way, there is hope over the long run. They eat quite well. But yeah, I thought the satisfies were great, but it's true. And this is well known in the food industry that if you promote the healthfulness of a product, then people who tend to eat junk food at least, which is most of the public, will actually not only suspect that it doesn't taste as good, it actually won't taste as good to them even if you serve them the exact same thing. This has been shown again and again in the studies. Well, it's healthy. It can't possibly taste as good. It turns out that your expectations of taste will heavily influence through your brain how you perceive the taste. So these things really literally taste not as good to people. However, having said that, I firmly believe this is a rapidly changing picture. I think health consciousness is raising in all sectors of the population, much too slowly, of course, and not evenly enough. But I do think over time these things will work. We have to give them a chance. We have to promote them. We have to push them. We have to encourage them. And when these companies come out with their satisfies or their McLean deluxe, we have to not make fun of it and say, oh, you're just disguising the same old process crap as health food because you want to bring in the health food crowd. We hear that again and again. Look, you know, the people who run these, I'm not going to defend these companies. These companies absolutely have a lot to be accountable for. They've given us some horrible foods and they've got to fix this. I think we should make them, frankly, even though that's probably not on the cards. But these people are run by people who have kids. They're not interested in poisoning and fattening the human race. If we give them a chance and give them a way to not go broke offering healthier food, I absolutely guarantee you they will do it. They would like to make this money selling healthier food. Of course they would. Who wouldn't? Well, you know, we all have a role to play, I think, in rewarding them for trying and I think over time it'll work. So I think we'd like to open it up for questions now from the audience. So we have a microphone and since this is being webcast, if you have a question, just wait till the mic gets to you. Hi, my name is Maeve Duggan. I'm from Pew Research Center's Internet Project. We recently released a report called Tracking for Health and we found that about half of people who keep track of their health, whether dietary or some chronic condition or what have you, actually keep track in their heads and the other half keep track either on a mobile phone app or on a spreadsheet or a computer or pen and paper is very popular as well. I know that you all have suggested that personal responsibility alone won't make people change their dietary or exercise habits but I was wondering if you think that there's a space for technology and the technology industry to kind of infuse more strategies and tools that will actually be helpful for people to on their own adjust how they eat and live. Excellent question and very much related to a lot of the work that I've done in the past. A U.S.J. super tracker, great example of three and a half million, probably more, registered users but literally millions of page views and visitors each week, each month. Hugely successful. It has the opportunity for individuals to go to a multi-tiered involvement, just to look for information that applies to them but then dig deeper and register and then become that avid user. So obviously three and a half million folks are out there every day. They were a little disappointed during the shutdown when they didn't have access but the numbers are back up, they came back and when they can journal for themselves, when they can get mentoring and when they can discover for themselves and this is research that's shown when it's self-developed and self-realized. It's a tremendous tool, learning on your own level and not having somebody else tell you but discovering this information and applying it for yourself. There are about 10,000 cues and advice statements based on science. Think about switching out a yogurt for that salty pretzel kind of thing. A way of getting an instant measure for the foods you've eaten every meal of the day in terms of their association with the dietary guidelines for that person's needs, for that individual's calorie needs and their saturated fat and sodium limits. It's very personalized and so the personalization is a big thing that seems to help. Creating an app and a mobile version is in line so that we know from literally thousands and thousands of inquiries. It does have huge interest and it's more than those that are interested. We know when school is in session. We know when universities are in session because the numbers go up and so even if you're not a registered user this has tremendous value it seems to a lot of folks. It's been out there for what just a little under two years, about two years. So here again, time will tell as we learn from this weight management, physical activity tracking tool, dietary quality assessment tool. And then in a mobile version, how successful it is, coming from a really good science base. We hope it gets even better. Hi, I'm Janice Chabrine. I write for Women's Magazines. So give me some examples of those healthy processed foods. I'm going to read your article, I promise, but I'm really curious and maybe on the vegetable side and on the whole grain side. Sure. Do you want samples of healthier, these sort of idea of healthier junk foods, you mean? Yeah, good. Sure. And let me first warn you, my article is really long. I just can't believe how long it ran. But anyway, so don't make promises you can't keep. So I would immediately point to Satisfries, as one we've already mentioned at Burger King. I've tried them to me absolutely indistinguishable from their regular fries. I believe it's 40% fat and 30% fewer calories. To me, I mean, that's absolutely extraordinary. You're familiar probably with one of the best examples, which is diet soda. And I want to say something about that, which I think speaks to some of the other things we've talked about here today. So this idea of artificial sweeteners, now we have Stevia, for example, which is actually most people seem to believe is pretty natural. And yet, it has basically no calories versus sugar has 18 calories per teaspoon. And there's what, 12 calories in a can of 12 teaspoons of sugar in a can of Coke or something? So this is a big deal. Now you've seen, I think probably a lot of you have seen studies where they say, well, it turns out that if you give people diet beverages, they actually gain weight. You guys seen those studies? And there was another one that ran in the New York Times, of course, recently, which is the main source of bad dietary information in America, that the only good studies done on breakfast shows that if you add breakfast, if you eat breakfast, you'll actually be more likely to gain weight rather than the conventional wisdom. Let me show you where those studies go wrong. And once you hear it, it's unbelievably obvious. You take a person who drinks a lot of Coke every day, sugared Coke, and you say, okay, for this study you're done, we're going to actually, you can't drink anymore, instead you're going to drink diet beverage. What have you done? You've cut like 1200 calories out of their diet. Okay, now you have a person who's basically starving. They're starving. What are they going to do? They're going to eat, and generally when you do a massive calorie cutting, they overeat. We all know that. So of course these studies find the same thing with breakfast. We want you to, you've been eating breakfast, we want you to skip it now. Okay, now I'm starving. So you get all kinds of, or I'm going to add a breakfast. I never ate breakfast, now I'm going to add breakfast to my diet. You're just adding a bunch of calories in. So that's not the way things happen in the wild, and that's why these studies go so bad. It's because what happens in the laboratory and in these controlled studies is nothing like what people do in real life. So really be very wary of all the studies, as Rob mentioned, that you see about every day in the news. They don't in general really tell you what's going on in people's lives. And the fundamental problem is that we're very sensitive to a decrease in calories, but we're not particularly sensitive to an increase in calories. So if we eat more than usual, it's not that uncomfortable. But if we eat less than usual, we're quite aware of it. Yeah, that's certainly true for me. And I wonder, so with calorie counts now in Washington D.C., all the chains at least have to either make available or put on their menus what the calorie counts are for the main foods. And I think that's something also that has kind of a mixed literature where people don't always like to know that they're getting low calorie food. And yeah. Any more questions? Hi, I'm Dave Price and I love to eat. If it wasn't for Washington D.C. and I walked, I'd be 700 pounds sitting in front of you, Rob. But for each of the panelists, first of all, you know, joke about it. It's not something to joke about. It's a very serious problem. So I'm going to give you a hypothetical and ask you to respond to it. Tomorrow you're named Foods are, if there were such a thing. And your mission is to cut obesity as drastically, dramatically, and quickly as you can. As you say, it's going to be a long process. It'll be many, many things. What would be the first thing you would do? And you can define first thing however you want, biggest bang for your buck, where you need to start. But okay, this is the very first thing we're going to do on Monday morning. I'll go first. I think access and it relates to food deserts, which were mentioned. Access to foods is a huge issue. And once you have the availability and the variety of foods to choose more healthful versions, which by the way, you get to satiety and you get more fiber. You get more fruits and vegetables in any form, by the way, except juices, perhaps some concerns. But I mean, once you get access, you can deal with the disparity issue of hunger, but you can also deal with the idea of choosing more and a variety. And moderation comes along with that. So whatever I could do to suddenly get in every nook and cranny of this country access, that's what I would do. School lunch programs. I would completely overhaul the entire basis of the school lunch programs, which have emerged out of a set of political interests over time. And they're sort of heading in the right direction, but there's still a lot of problems and it's not. So if you took the very best science and you designed exactly what you'd want kids to eat, it's not what they served right now. So that's where I'd start. I think a real sweet spot would be places of employment. We spend eight hours or more a day there. And people, I think, often eat terribly at work and they sit around. This is the new workplace. We sit there on our butts all day long. This is horrible. A study has shown that a person sitting there, their body resembles dead horse flesh more than living tissue. So what I would do is I would try to get workplaces on board with some sort of program to get people moving around. I do sort of like what Michelle Obama does in schools. I would do it in the workplace. Yes. Absolutely. I would have recess. Totally. Yeah. There's one follow-up on that. As a former educator, you know, you're talking about the complexity. This is just a statement. Yet, if you look at our schools, I agree. That would be wonderful. But the one thing that they're cutting out more than anything else is recess because of the testing, which again gets to the problem that you're arranging. I mean, you know, we need to do something about that or it will never happen. Yeah. I think we have time for one more question. Okay. Gary Blumenthal, World Perspectives. I wonder if the panels have a reaction to the policy constructs of, well, actually in school lunch, you've cut out fried foods and the imposition of taxes and should the SNAP program be limited in terms of what foods they can buy, those kinds of manipulations. Yeah. Well, let me take a quick shot at that first, which is I love all these manipulations. I think they can all work. I think if you make junk food, the bad food, so to speak, more expensive and healthier foods, less expensive, I think that'll help. Yes. Absolutely. That's revamped school lunches. Of course. Are you kidding me? And I even say let's go and regulate the food companies. The problem is much of the American public absolutely will not swallow this. That's American culture. There's, again, an almost religious belief that we shouldn't have the, you know, it's the nanny state thing. The government shouldn't be interfering. We're parents. We should make these decisions ourselves. People don't like the idea of their foods being made more expensive, the foods they love. So you're just going to have a massive problem of public support. So I think these things end up being largely unworkable at least for now, but I think we have to keep plugging away at them. They can be effective over time. One of the interesting things about the commercially available foods now is that the household budget for spending on food has gone down enormously in the last several decades. So people are actually spending proportionately a lot less on food than they used to. So I totally would love to think about policy around some of these large multinational companies. I went to visit with one a couple weeks ago that I won't name. That's one of the very worst. And all the R&D people, I have a background in sales. So that just goes to show what the sort of the general thinking is. They asked me if I could help them figure out how to get people to eat more of their products, which I was there with my obesity solutions tag on us. And if I could, maybe the concluding comments or a response. So I think the food industry is part of the solution. And in all my work at USDA, it has to be. And there have been a lot of successes out there, too, in gradually stealth improvements to food, reducing sodium over time, reducing added sugars over time. That's been proven. It can't be done in all cases. You've got a food science issue in some cases. So I think there are a lot of successes that never get the news. A lot of good stories out there. You can cut the calories and not the profit. And they're in the business to make profit. And people want to eat. And we do feed an awful lot of people. So I think that's very important. I think all the incentivizing, a lot of things, couponing, there are a lot of things that can be done to change the food environment. I'm going to be interested in this next round for the 2015 Dietary Guidelines for Americans. The second meeting is probably going to be sometime early next year. Stay tuned to that because I think this time you've got an opportunity to get to more of those three-dimensional recommendations beyond telling people, hey, target 2,300 milligrams of sodium. How can you do that based on evidence-based interventions? So this is where you get science to support what really works. Lighting in a school lunch line helps. Getting fruits and vegetables upfront has been shown to help. Investing in a light bulb is pretty good if you're talking about scalability. So a lot of things are out there that science has shown changes the food environment. And I think it takes time for those to really get out there and be applied. Okay, thanks everyone for your questions. Thanks very much to the panelists and stay tuned for the next group. I'm Marvin Amore. I'm a Future Tense Fellow at the New America Foundation. What I usually write about is freedom of expression in the internet. When I heard we were doing an event on weight loss and gadgets, I told Ariel, I love diet books, weight loss, gadgets, I love all this stuff. I actually met Jessica, who is the Director of Innovation at Atina Labs, which is an insurance company. When we did a startup weekend, working on the problem of solving food deserts and working to make healthy food more available. You were also at the FDA. What was your title at the FDA? I was a fellow at the FDA. She did innovation work at the FDA. And then we have Walter Thompson, who's the Chair of the American Fitness Index Advisory Board, American College of Sports Medicine, as well as the Associate Dean for Graduate Studies and Research, Georgia State University. You might have seen his work. If you ever read an article that listed the most fit cities in America and were surprised that Minneapolis was at the top, you remember it. It's seared in your brain. And then this is the man who's responsible for that. I won't take all the blame for that. And the title of this panel is Beyond Calorie Counting, Can Gadgets Help Fight Obesity? And we're going to take a broader view of the word gadget. But Brian Russell is the Founder and CEO of Zephyr Technology Company, which makes some really amazing gadgets. And he'll explain to you that have to do with measurement of the body for football players, athletes, military folks. And he's just an expert on fitness and technology generally. So we have an amazing panel. And we're here at Future Tense. So we're thinking big about the future. But let's begin with Walter. Where are we now? What's the landscape based on research? Yeah, that's a great question. But first, I want to be a czar. So actually, the question about what would... Can I be a czar for the day? You can all be a czar. So the question about being a czar is sort of a regulatory question. The question I want to know is, if you were Mark Zuckerberg or Larry Page or Mark Andreessen, what would you invest in? What tech, what gadgets? That's sort of the private sector questions we'll have here. But if you want to be a czar, begin as a czar and then move to tech entrepreneur. Someone who believes that technology can solve every problem. But let's begin, Walter. Where are we now? Okay. Well, from the czar perspective, the American College of Sports Medicine, along with the WellPoint Foundation, founded the American Fitness Index back in 2007. Our first report was in 2008. And there's two different indicators, two sets of indicators. One that we call personal health indicators. And those are the kinds of behaviors that you and I exhibit. How many of us smoke cigarettes? How many of us have engaged in exercise? And if we engage in exercise, was it moderate exercise? How many of us have cardiovascular disease or angina or diabetes? How many of us have health insurance, which we may or may not include in 2014? Not sure yet. And then the second part of that are what we call the community or environmental indicators. It really answers the question, if I want to be physically active, if I want to be healthy, does my environment, does my community support that? So we looked at things like how many baseball fields are in the community, how much acreage is dedicated to parkland, how many dollars our government spend on us per capita on parkland. We even drilled down to how many dog parks there are in farmers markets in the communities. So we had these two sets of indicators and we put the two sets of indicators together for the first time in the history of all of these indices and rankings. Put them all together and came up with a single number. And from that number then, the media, with the media's help, they ranked all of the cities. And now we have a number one city and we have a number 50 city. And as you already indicated, Minneapolis, who would have thought Minneapolis would be the most healthy city in the country, but just to give you one indicator, the city of Minneapolis spends $226 per capita on their parks. The top 10% of the 50 cities that we studied, the top 10% on average spent $101 on their parkland per capita. So Minneapolis, even though they know that in November, December, and January, it's going to be kind of cold up there and people don't want to go outside, they've made investment in indoor recreation centers. They've made investment where investments need to be made to support people who want to be healthy and physically active. Now can you guess who the number 50 city was? You can probably guess who was number 49. Now you're close. Detroit was 49. Oklahoma City was number 50. Interesting, huh? Now, Mayor Cornette, you know Mayor Cornette? Mayor Cornette, when he was the first elected mayor of Oklahoma City, he was obese. And he decided he was going to put the city of Oklahoma City on a diet. And he lost a lot of weight, nobody else did, but he did. But we met with Mayor Cornette because he's very concerned, as you can imagine, with tourist dollars and that sort of thing. He's really interested in making his city healthier. And we were able to go in and talk with Mayor Cornette and make some suggestions, even just taking a carving out a little piece of the park that's inside of Oklahoma City and calling it a farmer's market and inviting all the farmers to come in on Saturday morning. We had a huge impact. So that really resonates with me, actually, since I spent three years as a law professor in Nebraska. And I weighed about 15 pounds more there than I do now. Because it was just so hard to stay in shape in Nebraska. You couldn't find, I always complain about this, you couldn't find soy milk anywhere. No coffee shop, certainly not almond milk or anything with your latte. You couldn't find seafood, junk food everywhere, fast food places. Whereas here or in California where I spend some time, you can always find healthy food, even the smallest of source. And also the weather is better here as you can work outside. It took no effort at all to lose 10, 15 pounds when I moved from there to here. And no effort at all to gain 10 pounds when I moved to Nebraska. But when I'm here and I actually try to make an effort, what I do is I use my fitness pal. I don't know how many of you use my fitness pal? So my fitness pal raised $18 million recently. It helps you log your calories and also your activity. It has a huge database crowdsourced of foods out there so you can scan their bar code or input it. Recently, I wear a basis watch which measures my steps and my heartbeat. You can also have a Fitbit, another company that raised I think 146 million. JobOan raised 100 million. They have the app and everyone's seeing the Nike FuelBand. You see all these different gadgets and devices that are out there that people are using to try to manage their weight, improve their fitness. And we have Brian here. And I just want to ask Brian, what do you think about this? And Brian, tell us about your company. Tell us about this sort of really hardcore gadget that you guys develop. And sort of compare it to the sort of consumer devices that a lot of us know. Thanks. So we do what's called a buy patch. And it can be worn in a special forces shirt, a compression shirt if you're playing the NBA or basketball. It can be a patch if you're a patient. And so through the population there's different ways to wear a wearable, even on the wrist. But we believe you need biomechanics as well as physiology to get an accurate assessment of what you're actually doing. So we can put two traffic cones out on the car park and do a full metabolic test on 50 people at once. So automating and consumerification of your level of fitness tells you where I am and then you can go looking and searching for where do I want to be. And so we close that loop up. So the market at the moment, we're all FDA-cleared and the market seems to be what I call, those devices are entertainment devices that are motivational. They don't have to be accurate. They just have to be fun. The challenge for that industry is after a month, a lot of people stop using them. And then there's the other piece of the market which is FDA and moving back down towards wellness, which is where the big growth market is. And they have to be accurate and consumers trust them because they have FDA. So the gadget though has to take part in socialization, entertainment, some gamification. And so these larger applications and web tools have been used with the gadgets to bring a solution that actually makes change, drives entertainment. If you say get a bad fitness number or you take your blood pressure and get a bad blood pressure number, that's a teachable moment. So if you go and get a web link from the Mayo Clinic about hypertension or obesity, you've just had a bad number. That's when you can actually make a small change. And I think one of the biggest changes is people like B.J. Fargo to Stanford is teaching small changes often will actually make a larger change over time. People like to take a big change because it's a challenge but they won't stay compliant to it. And so in Zephyr we always look at compliance versus motivation and whether how large you are, how sick you are, that generates how often you want to interact with technology and how motivated you are to actually do something about that. So rather than just saying you're bad and do it, it's how do you fit it into somebody's environment. So for special forces, we transmit over their radio which they already take and we fit into their uniform which they're already wearing so they don't have to do anything extra. And now we've got all that data, same for the NBA. We're in their cool looking shirts and they do look cool because they won't wear it unless they look cool. I think where the motivational market is done it's really defined the wrist and we're seeing that social change now that people will be prepared to wear something extra or maybe a slightly large ugly watch because you need to put more technology in there at the moment and that's bigger. And so that social change is going to take a few years. Remember back in the 80s if you had a mobile phone to your ear, you were a yuppie and not very cool to everybody else whereas 19 year olds are now called to have a smartphone. So I think these gadgets and what you do about it is going to be a multi-year adaption in society before it becomes the norm. So I had a moment with my fitness pal which to me made it worthwhile completely just this one moment where I had this great day. I ate well, I was even kind of hungry, I worked out, get to the end of the day and you push a button that lets you know five weeks from now how much you'll weigh if every day were like today. I was like I wonder how light I would be if every day were like today, if I was good as I was today and I pushed the button and I would have weighed just as much in five weeks. And I thought, oh I guess I didn't, I guess I would have otherwise wasted five weeks thinking I was doing a great job and acting fit and then after five weeks wouldn't have lost any weight, got frustrated and not made any changes. So maybe it was a fluke or it was wrong, there were moments where I actually felt like it was helpful to me. But there's fitocracy, there's lots of different things out there that people use for about a month and don't stick with. And even, I don't know what the research is as to things that actually work well. I know Weight Watchers is actually one system that people think works well. I think the problem's complex and it's personalized. So there's not one solution that will work on all of us. So it is complex and there's been some great work by Carton Design and others in California of people want to learn a little bit as they go through. And so these oversimplified tools are very shallow. And so once you fall through the bottom of that, their message, there's nothing else to continue going. I think one of the nutrition versus exercise, there's a lot of misunderstanding where everyone's burning about 150 calories just sitting here and watching this. If you walk, you might go to 200 calories an hour. If you run fast, you'll get 800 calories an hour. So if I go to no fat milk, I put dressing on my ham sandwich at lunchtime or I put some extra sauce on my dinner. If I make three bad choices with my normal meal, I can run for half an hour or walk for 12 to eight hours to burn those three bad choices off. So small choices through the day on nutrition completely outweigh any type of exercise you can do unless you're doing very high intensity exercise. So anybody here that jogs fast, you can eat very bad. The rest of us, you have to make these small, intelligent choices, not change what you're eating, just deciding what you're going to put on top inside a soap booth. And they will be a lot more powerful. So if you reduce by 500 calories a day, you'll lose about half a pound a week. So there's some very simple algebra that you can teach people that they can remember and that we find is very motivational. Maybe you still want mayo, but don't put so much mayo on. 150 calorie ham sandwich doubles if you put the mayo on. That's three hours of walking. Who's got three hours to walk? That's the problem. So Jess, I want to pull you in here. So tell us a little bit about your job at Aetna and the sort of pilots you're running there, the projects you're running, the way you see people thinking about this issue. Sure. So first I can address kind of that stickiness factor. We're going back to that. So it's about a quarter of people will download an app and use it once. And then it's another quarter of people who they're using it. It's going to use it more than 11 times. So that kind of throws that out there of that 40,000 apps that are there for fitness and health for only seeing a very small percentage actually being used. But as to what I do, I'm in the Aetna Innovation Labs and what we do is we pilot solutions for issues that we're seeing now but think theoretically piloting a solution that you wouldn't see till about 2016. So we're able to take early stage companies and early stage ideas and apply them to our population to see, hey, what would happen if we did this? And currently we're actually running a pilot with a company called Neutopia. Neutopia is a diet and weight loss company and what they are able to help us do is take genetic information and test it for three different factors. And from those factors we're able to, they pair individuals with coaches and those coaches help people lose weight. So in addition to having personalized coaching, what the company is also able to do is they track the fitness. So you have a little pebble, you know how much you're walking, it's basically a fit fit. They also are sending out weight protein. And so what we're looking at is if we put all of those things together, will it increase people's weight loss and will it prevent something called metabolic syndrome? So that's kind of- Which means what? What's that? So metabolic syndrome is it leads to obesity, heart attack, stroke, those types of things. So it's something that actually most of us will have at some point and it's basically if you have two or more of these factors, so high blood pressure, high blood sugar, high cholesterol, a large waist circumference, can't count to five. Anyways, basically all of the things that everybody eventually gets. It's like something like 72% of people will have metabolic syndrome. So it's most of us, I mean most people do end up having a stroke or a heart attack. But if you can prevent that by, you know, healthier eating, healthier exercise, then what would that look like? And so actually in this pilot what we did was we targeted those people. So Etna worked with a company called GNS and they brought together these big data and algorithms and so they're able to target individuals who either have or will have metabolic syndrome. And so we were able to bring in the people who are at the highest risk and engage them at this point and say, hey, you either have or you might have within the next year this problem, do you want to start fixing it now? And we've seen great, great engagement. I've actually got a question for you since you worked at the FDA. Sure. I've heard some buzz out there, some concern that the FDA will be interested in regulating apps, sort of making all these different health apps go through a certain process if necessary. Some folks think that'll decrease innovation, some folks think it's necessary. What's the state of play when it comes to the FDA and their role in apps and gadgets for health? So the FDA's role in apps and gadgets is if it's a medical device, they are going to regulate it, right? So if it has an ICD-9 code, you're going to be regulated. What's that mean? So ICD-9 is how you diagnose this in the medical world. So basically, if it is like a, quote, legitimate medical condition and you're going to a doctor and your doctor is going to diagnose it, that's probably going to be regulated. If it comes in and so that. But basically, there's not a lot of apps that will be regulated. The FDA is only seeing about 20 every year that would be regulated. There's only been 100 mobile medical apps ever that have been regulated. Actually, except for technologies, it actually pops up as one of the ones that has been regulated before, the Bioharness, I think. Voluntarily, they went to the FDA to get the sort of stamp of approval. And it only takes about 67 days to get those cleared. So, yes, the FDA is going to be regulating apps, but there's a very, very small subset of apps that they are going to be regulated. So not the entertainment-ish apps, the motivation apps, those aren't... No. You can go, okay. I think health and wellness-related, not really going to be regulated. Okay, cool. So Walter, I had a friend who was trying to lose weight and he was blaming the environment. He was blaming Congress and the food lobbyists. And finally, he said, maybe a socialist revolution to improve our food system is the right way to go, but that's an inefficient way for me to lose weight. And so I wonder, how can I change my own environment? How can I do things maybe with technology, maybe with photography, whatever. Are there any ways for me to change my environment for anyone to make it easier for me at home in my world without moving to South Beach or Sub-Saharan Africa? Yeah, I think there is. Let me just give two examples of that may or may not be related, but I feel like it's essential that we talk about this. I'm from Atlanta. Of course, we like to eat in the Southeast. So most of the cities that are in a low part of our list are from the Southeast. That's okay, because it gives my students a lot of work to do. I'm an exercise physiologist, by the way, so I want to address some of the exercise issues as well. But the Children's Healthcare of Atlanta came out with this series of ads. I don't know if any of you in the audience has seen these ads, but they're in the face. You have a fat kid ad. And they were subject to a lot of ridicule, a lot of criticism, because they were telling these parents, and they were overweight and obese kids depicted on this television commercial. But Children's Healthcare of Atlanta was criticized because they were telling parents that their kids were fat, and their kids were overweight, and you're killing your kids because of it. Now, I see some shock on your face. How could you tell a kid that they're fat? Well, in the state of Georgia, we were 44th out of 50 states, and then the number of kids who were obese. We're trending upward now. That is, trending away from the number of kids who were obese. Now, I can't tell you that the Chowa ads were responsible for that, but what it did is it awakened a lot of Georgians, particularly in and around Atlanta, that we have a significant weight problem with our kids. So we can talk about that as kind of an issue, and that really addresses the motivation issue. And the other is in New York City, Mayor Bloomberg, you probably remember this. Wanted to legislate, and I think that's what you're talking about, socialized food, but he wanted to legislate the size of sugary drinks in New York City. Now, Mayor Bloomberg is a smart guy. He wouldn't have gotten where he is without being a smart guy, whether you support his politics or not, he's a smart guy. He knew that he would never get that pass the legislation, but everyone in this room has heard about it. So what it's done, and what he did, was that he was telling us that we need to do something, us with kids, us that have influence over other kids, us who have influence over other adults, that we have a problem, and the problem is the 32-ounce sugary drinks that we get at all these fast food places. So we've got these different kinds of messages. Some are in-your-face messages. Some are what we would consider full-hearty legislation, as Mayor Bloomberg would have now, probably, would concede that it was, but everyone in the country probably has heard about Mayor Bloomberg's legislation. Now, the other panel was talking about this one fast food organization that about 10 years ago, they introduced the Adult Happy Meal. You remember that? Probably no one does. It was a big press conference here in Washington. I was there at the press club. This fast food company introduced Adult Happy Meals. Everybody said, wow, they're doing something about the obesity problem. They were pedometers in there, so you could go as a parent, you could go to the McDonald's, sorry, this organization, and buy this Adult Happy Meal. Within two years, they no longer provided an Adult Happy Meal. Why? Didn't make any money. These companies that we're trying to legislate, they're in business to make money. So if we say, you know what, you've got to take the quarter pounder and make it a quarter of a quarter pounder, and we're legislating that. They'll never do it because they're not going to make money. So what we need to do is we need to train ourselves to train them on what kind of food that we're going to buy. So speaking about money, when you look at the numbers in the studies, apparently the obesity epidemic, you know, the fact that more than half of Americans are overweight, well over that, actually costs our society and our healthcare system a ton of money, and also costs companies a lot of money because overweight people are more sick, and they might be out more often. There's actually, it adds up across society, the billions of dollars in costs. And this is something that you guys probably are very well familiar with. And I guess my question for you might be what companies are doing to sort of address that problem? What the big economic interests of our society do to address that problem when other companies have a different economic interest? Sure. So what you're seeing is a lot more companies with company wellness programs. You're seeing people say, hey, you know, it'd be great if we could get our employees healthier, and a lot of those do take on obesity as the issue. So you're seeing people do wellness works programs that focus primarily on food and exercise. There is something in the health reform laws where you can receive premium credits on your insurance if you get healthier. And so that's kind of incentive to bring people into these programs. And because of that, I think it's $300. And so you get $300 off your health insurance next year if you are part of this program. And so that's something that really gets people involved and keeps them engaged. And these work, are they actually effective in the programs? That's the theory. We haven't seen, I mean, it hasn't been long enough to actually know if three or five years down the road it's going to work. So they'll itself insure it. And they charge their employees more if they smoke or if they're overweight. So it's direct. We'll just charge you more, and we don't care. So you had mentioned in terms of what works for individuals, informing people about simple math, simple arithmetic, 500 calories a day less, and then small changes over time. What else? You had said that these devices aren't where they should be or gadgets aren't where they, apps aren't where they should be. Where should they be two, five years from now to actually make a difference? How can they incorporate some of these lessons to actually be effective? I think if you look at it at a macro level, there's a certain rate of change that society can adopt. So some of the soup companies have tried to do the right thing, reduce salt, and nobody bought it. And they went back halfway. They didn't go back to the original levels, but they've now discovered that they need a five-year plan to reach the sodium levels they want to be. They can't do it in one step, because people's taste buds have to change over time. So I think gadgets collect data, but you don't want to be looking at that data every day, every minute. And so devices are getting more wearable, as well as more societally acceptable to wear. At the moment, you wear a jawbone or a new gadget, really to make a statement that you're an early adopter in that market, which means we're not touching the mass market yet. So we're going to see that change, I think, over two or three years' time, and then it's just part of your life. And once a month, once a year, you can look at this data and make corrective steps based on it, or you're going to get an email or a message to say, hey, you're out of bounds here, or you're getting close to out of bounds, or your A1C is getting a little bit bad. Kaiser did a great study where they reduced, by a factor of three, diabetics who are pre-diabetic. But once you learn your pre-diabetic, you become very motivated to do exercise. And it was just exercise that reduced the A1C to diabetes. So exercise, not just walking, makes huge health benefits. There's a new science of sedentary science now. When you stand up, when you walk, your blood pumps through your liver and kidneys, you get rid of toxins, you get all those happy drugs that marathon runners know about, so you feel better, you have more energy, and it cycles up in a good way versus cycles back in a bad way. And you deal with stress, and stress and obesity is tightly related, so you need to be able to, how do you get rid of the stress in your life? How do you deal with the stress and metabolize it? So eating is not the way you're dealing with it. So I think there's a whole lot of small changes that are going to happen. Can I ask a question about apps? I've always been fascinated by who uses these apps. And the previous panel said that there were like 3 million people that were logging into this one website. That represents, what, about 8% of the US population? Who is, who are using these apps? I have a pretty good notion who it is. But do you know, or does anybody else know? You mean wealthy people who don't need the apps? Is that what you... I'm talking about the 8% of the population that exercises regularly, that wants to track these things. It's the 93 or 92% of the US population that needs to use these apps that are not using them. The question is, how do we motivate them to use them? I think you alluded to this. Some physicians are actually saying you, this is your prescription for the next six months. And if a doctor says you have to do this, you generally do it, right? Because that's supposed to be healthy for you. So that's going to be, that's a fascinating study, I think. Who's using these apps? And is it really reaching the market that we're talking about today? The people who are not motivated to exercise, people who are not motivated to diet and to lose weight? I think exercise will become a medicine. You'll be prescribed exercise. What we feel strongly at Zephyr, though, is that the one thing that's ignored with the counting steps is people don't have enough time to do enough steps to make a large difference. If you can measure physiology and intensity and guide people into a particular zone, which isn't running a five-minute mile, they can get a huge health benefit in 10 minutes versus walk for an hour. And so people are time poor as well as financially poor. And until we start understanding that people are time poor and how do we give them a small dosage and what they can afford from time, they just can't afford to do it. It's not necessarily motivation, you just can't afford to do it. About five years ago, the American College of Sports Medicine launched a program called Exercises Medicine. It was developed by Bob Salis, who's a physician in California. He was the president of the American College of Sports Medicine back then. And it's actually a trademark name, Exercises Medicine. It's being disseminated worldwide. And it's just that to get physicians to understand that they have powerful influence over their patients. And if the physician says you need to exercise, here's how you do it. And that's the connection to the health fitness industry. With the personal trainer business, it's a $26 billion business in this country. Connecting the personal trainers, the guys that are in the health club, with physicians and really creating this exercise is medicine approach. I think mobile health is converging those too, luckily. So your doctor is going to say here's an app and it's for chronic diseases, it's for health, it's for fitness, it's for nutrition. That whole wellness, fitness, health with mobile health is converging, which is good for all of us, I think. So we've got 10 minutes left. And while I'm having a blast asking other questions and learning, I want to share that joy with you that you guys ask some questions. I do want to make a quick point about this basis watch. Throughout the day when I don't get to my walk total, it's just a sort of running man. But then when I get to the end and I've walked all my steps for the day, it turns into a trophy. And every day I want a trophy. If I can get a trophy more quickly, that'd be great. So your watch becomes bizarre. Yeah. Thank you. I'm Erica Gable Berg. I'm a science writer at Diabetes Forecast, the Healthy Living Magazine of the American Diabetes Association. So a bunch of research has shown that with obesity, really prevention is key. And so what I'm wondering is, are there any efforts to sort of get children hooked on these sorts of gadgets for weight maintenance and kids love their gadgets? And are there any risks of doing that, I guess, stunting their growth or warping their minds in some manner? Could we make fitness apps the new video game? Kids love gadgets. You know, my kids were all my gadgets, especially when they're sick, they become a study. But kids love gadgets and they actually love running outside. So, you know, while the wee is interesting, you're still inside. And if you see kids running outside, there's not many fat ones typically. So I think technology, kids love tablets, kids just get intuitively. I think gadgets connecting that and intuitive entertainment. Try taking an iPad off a kit. It's pretty hard. So if you can get the gadget to tell them something about that. So Leslie Saxon, who's a cardiologist out at USC, her body computing institute is working with Hollywood to make games that are interesting that you have to exercise to do stuff. But I think the industry is finding that gamification is an oversimplification. And there's some motivational pieces that the game developers know how to use to make you want to go back and play Angry Birds. But it's not just that simple. It's one of, you know, societal entertainment. The study that showed why Weight Watchers are successful is people come to the meeting and so it's that socialization and actually turning up. A second study showed they lose weight before they start turning up. They don't want to come too fat. Once they're losing weight and have a good story, then they join Weight Watchers and continue to take part. So, you know, as it was said at the beginning, this stuff's complex, unfortunately. Everybody have apps for kids and exercise. It's just that they don't use them. And which leads me to another point about what kids eat. I got two kids. One's 33, one's 30 now. You know, but when they were growing up, they ate what I put on the table. And if I had a plate of broccoli, they ate it. Or they sat there all day long all night till they ate it. Now, I say that kind of tongue in cheek because, you know, well, it was that way in my house anyway. But I run after school programs in the city of, the inner city of Atlanta. And there, we get USDA snacks and it's generally a bag of chips and a juice box, right? But not in my after school program. I provide fresh fruit and vegetables. I put them on the table in the cafeteria. And everyone said, these kids are not going to eat it. These are middle school kids, 10 or 14 year. They're never going to eat it. I can't get enough fresh fruits and vegetables in front of them because they will eat it. A hungry kid will eat just about anything. So it doesn't have to be a juice box and a bag of chips. You put some apples on the table after school. They're going to eat it. There's been some studies out of USC actually focusing on weight loss and diabetes in kids. And what they used were they used smartphones and you get little text messages back and forth about eating. And there's also been some other games. So they've been doing some studies. It's not widespread. You have some issues when it comes to kids and technology in terms of what you can, what information can and can't be passed back and forth. So it makes it a little bit more difficult. We'll use them in micro-fund. Just one more thing about physical education. The cities that don't do well in the American Fitness Index, they don't require physical education past the fifth grade. In the state of Georgia, our physical education requirement is K through 5. And in the sixth grade, between sixth grade and twelfth grade, in order to graduate high school, you have to have half a unit of health and physical education, which includes things like band and cheerleading and football and basketball. See if that can be waived. So in the states that don't do well in the American Fitness Index, those are generally the ones that don't have a requirement for physical education. And the ones that do, and I'll just give you a really short story, I did a very unscientific study one time. My daughter teaches second grade in Henry County, Georgia. And I said to her, because I knew there was a K-5 physical education requirement. So I said, Jessica, how much PE do your kids get? And she said, 30 minutes. And I said, wow, that's great. 30 minutes a day. She said, no, 30 minutes a week. 30 minutes a week is a physical education requirement. She was teaching second grade. So where are these kids getting their physical activity? It's not during the school day. When are they getting it? After school. Now, think about your own kids. Are they physically active after school? Probably not. Wow, that was a downer, wasn't it? The past two hours have been something of a downer. My name is Herb Simmons. I own a wellness center a few blocks from here. And first I decided to stand because we were told to stand at least once every hour, right? And in fact, it strikes me in terms of this may or may not be fair, but in terms of cultural change that an organization that's having this discussion, no one encouraged us to stand. There wasn't a break for us to stand for almost two hours. So I think that's just an indication of the stickiness of existing cultural standards. But my question is really, I think a pretty simple one, which is, is there some compelling reason why we shouldn't think about relabeling the word or substituting the word movement for exercise, to say diet and movement? To me, exercise, and to lots of people I know and people come to my wellness center, exercise is kind of like the equivalent of vegetables that people talked about earlier. And in fact, you said just a moment ago, exercise as medicine or something like that. Most people don't want to take medicine. So I just wanted to, it seems to me, exercise as a subset of movement. And whether you get your movement from gardening or the gym is less important than your moving. I think there is a level of intensity based on what you want. So if you do weight resistance, you have mechanisms in your heart and your body that help to resist that and lift weights. And it's very cool. That doesn't turn off when you stop exercising. So you continue to get that benefit, that lowest cholesterol, because your liver continues to turn cholesterol into energy. So you get a lot of health benefits from that. If you're using your thighs, that's your biggest muscle. That's pushing more blood through your kidneys and your liver. And so you're getting more filtration of toxins. And so the Stanford has started a department of sedentary behavior. And they've found that simply standing, it's the action of standing using your thighs that's generated that metabolic load. So there's movement, which is very sedentary. I think you need a level of intensity somewhere in that dosage to actually get the benefits you're after. And I think if you do everything good, eating an exercise and don't get any change, you're going to be disillusioned and give up. So I think we need to give people something that's a small dosage with a result and then they can build on that. Otherwise, it becomes faith-based. And I wouldn't expect anybody just to do something because I told them to if they got no result from it. So I would say that we're actually moving towards substituting movement for exercise. If you look at the campaigns coming out of the White House, it's everybody, let's move. That's what the Surgeon General got behind. When you're looking at these fitness bands, it's get to 5,000 steps every day. Does it care whether or not you went to the gym and ran? No, not really. It's did you get to your 5,000 steps? And so I think we're already kind of seeing a paradigm shift where it is going for just move and move every hour as opposed to go to the gym, do your weights, yada, yada, yada. So I think that we're already seeing that. And I think we're also seeing kind of the shift to personalization. And when you get and you make it personalized, then people are more likely to stay engaged. And I think that's why Weight Watchers, you see that working more is because you have this community and it's almost like they're watching you. You see this with the program I was talking about that we're piloting. You know, there's actually Skyping, you have your coach and you're talking back and forth. In terms of gadgets and making them sticky on the personal story, last year I quantified my family. So everybody got a Fitbit. They have a wireless scale. There's a blood pressure cuff. I am watching my dad in California from here. And I know when he hits his 5,000 steps, I know if he's going obese, you can actually see his weight go up and down. I mean, I am on this man. And so if his blood pressure goes a little high, I'm like, dad, how much salt did you have? And so being able to do that is great because I can yell at him. But for me, it's actually a competition because, oh my God, the man walks four miles a day before I even get out of bed. And so, you know, like I'm like, okay, well, if dad can do it, I gotta do it, right? And so then it's a competition thing. So that's made it what's sticky for me. But you see this also in workplace programs because it's everybody move, everybody gets to your steps. Okay, well, now I'm competing with those people in HR. I don't like HR, but you know, or, you know, my friends in the county or what have you. So that's, I think, where we're going. Yeah, thanks for the great question. And thanks for contributing to Washington being number two on the American Fitness Index. By the way, if you want to download this complete report, AmericanFitnessIndex.org, download the entire report. We also have some community helps tips. Now you can download that as well. And then if we're giving out website addresses, zepheranywhere.com. There's a great video of you guys on CNN working with athletes. And then I think we're out of time. This was an amazing panel. Join me in thanking all of them. And thank you for being here.