Although the United States is the most powerful nation on earth, the one area in which this country does not excel is health. And the future is not bright. Almost a third of our young children are obese, and many do not exercise. No matter how much information becomes available about the dangers of a sedentary lifestyle and a diet heavily dependent on processed foods, we don't change our ways.

Ideally, Americans should be able to translate financial well-being into habits that lead to longer and better lives, untroubled by expensive and chronic medical illnesses. Yet, in the United States, as well as Western Europe, Russia, and many other affluent countries, the majority of adults are overweight and undernourished.

While high-quality nutrition is readily available throughout the United States, the American public, rich and poor, is drawn to eating unhealthy food. Indeed, the list of top calorie sources for Americans includes many items I do not consider "real" foods, including milk, cola, margarine, white bread, sugar, and pasteurized processed American cheese.

Though smoking has received a lot of attention for the dangers it poses to public health, and cigarettes have been heavily lobbied against, obesity is a more important predictor of chronic ailments and quality of life than any other public scourge. In a recent survey of 9,500 Americans, 36 percent were overweight and 23 percent were obese, yet only 19 percent were daily smokers and 6 percent heavy drinkers.

Several reasons for this epidemic of obesity in modern life have been offered. There is the pervasive role of advertising in Western society, the loss of family and social cohesiveness, the adoption of a sedentary lifestyle, and the lack of time to prepare fresh foods. In 1978, 18 percent of calories were eaten away from home; the figure is now 36 percent. In 1970, Americans ate 6 billion fast-food meals. By 2000, the figure was 110 billion.

Poor nutrition can also result in less productivity at work and school, hyperactivity among children and adolescents, and mood swings, all of which heighten feelings of stress, isolation, and insecurity. Even basic quality-of-life concerns such as constipation are affected, resulting in Americans spending $600 million annually on laxatives.

With time, the ravages of obesity predispose the typical American adult to depression, diabetes, and hypertension and increase the risks of death in all ages and in almost every ethnic and gender group. The U.S. Surgeon General has reported that 300,000 deaths annually are caused by or related to obesity.

The incidence of diabetes alone has risen by a third since 1990, and treatment costs $100 billion a year. The illnesses caused by obesity also lead to more lost workdays than any other single ailment and increase pharmaceutical and hospital expenditures to palliate untreatable degenerative conditions.

Government policy has had limited power to stem the tide of obesity, yet our nation's leaders have supported formal reports calling for a national effort to raise awareness of the dangers of being overweight. As a part of the Healthy People 2010 initiative, the federal government has proposed several steps to reduce chronic diseases associated with diet and weight through the promotion of better health and nutritional habits.

It has set dietary guidelines and has encouraged physical exercise, but these efforts have not managed to change the minds, or strengthen the hearts, of most Americans. It is clear to the public that a minor change in one's eating habits will hardly transform one's life so readily. So the public turns to magic cures, pills, supplements, drinks, and diet plans that simply don't work or are unsafe. After a few failures, they give up hope.

Unlike for many diseases, the cure for obesity is known. Studies with thousands of participants have demonstrated that the combination of a dramatic change in eating habits and daily exercise results in weight loss, including a 60 percent reduction in the chance of developing chronic ailments, such as diabetes.

Disseminating detailed information on these barriers is relatively easy, yet the plethora of diet books and remedies have created a complex and contradictory array of choices for those who are desperate to lose weight. With the publication of Dr. Joel Fuhrman's book, outlining a perfectly rational, straightforward, and sustainable diet, I believe we are witnessing a medical breakthrough. If you give this diet your complete commitment, there is no question in my mind that it will work for you.

Mehmet C. Oz, M.D.
Director, Cardiovascular Institute
Columbia-Presbyterian Medical Center

Copyright © 2003 by Fuhrman, Joel, M.D.