Five hundred million dollars is a lot of money. Why?
Risa Lavizzo-Mourey: The foundation has set as a goal to begin reversing the epidemic of childhood obesity by 2015. But we aren't delusional. In order to reverse the rise in childhood obesity, we are going to need a body of evidence that can fuel a social movement that is like none other that we've had to address in the past. We have to take evidence to action. Rather than looking at multiple different approaches, we have taken the view, based on our history of working on tobacco and other public health areas, that the environment, and policies that shape that environment, matter. If we're going to permanently roll back the epidemic of childhood obesity, we've got to change the environment in which kids grow up, learn their health habits, and make choices. That's an enormous challenge, and succeeding will require the deep engagement of parents, schools, industry, government and media, at the macro level neighborhood by neighborhood, because the problem is most severe in the most communities, urban and rural. But we have to do it.

What's changed in our society in the past 25 years that's causing the obesity epidemic?
Almost everything in our society has changed to get us to the point where we have a massive energy gap between calories we consume and calories we burn each day. The gap for overweight teenagers is roughly 1,000 calories. For all children it's a more manageable number—more like 165 calories.

Why has this energy gap been increasing?
Many fast-food and other restaurants increased portion sizes. It didn't cost them that much more, and they were able to drive sales and profitability. And people are eating out more often. In 1962 we spent roughly 27 percent of our food budget away from home, and now in 2002 it's in excess of 46 percent. That's important because both adults and kids eat more calories on days when they eat in a restaurant—anywhere from 200 to 800 more calories a day. One would hope that with all this extra eating and portion sizes that our kids would be more active. But in fact they are more sedentary than ever, spending 366 more minutes sitting per week than they did in 1981. And what are they doing? Mostly they're watching TV, playing videogames, and using their computers. And when kids are sitting and watching TV, they have a higher probability of taking in more calories. Less than one half of kids get the recommended amount of physical activity. By the time they get to be adolescents, that is down to a pathetic 8 percent. The single most available way for kids to build physical activity back into their daily lives is to include time and resources for recess and physical education in schools. We also need to provide more convenient and safe places where children and adolescents can be active in their own neighborhoods. We are more focused as a nation on getting slimmer than we've ever been. We spend a huge amount of money on this. But this energy gap persists because it's so difficult for us to choose healthy lifestyles as the default, given some of the social issues that exist.

Such as?
Where you live has an impact on whether or not you can choose a healthy lifestyle. If you live in a more affluent area, you have twice as many supermarkets as if you live in a poor area. And proximity to a supermarket is directly proportional to your ability to get affordable, healthy food. Also, in California 51 percent of Latino children and 58 percent of African-American adolescents report eating in fast-food restaurants every day, compared with 36 percent of white children. Where you live also has an impact on your access to physical activity sites. If you have more recreational facilities close to you, then you have a higher likelihood of getting the recommended amount of physical activity and not being overweight. If you live in an affluent area, chances of having a recreational facility within a mile of your house are pretty high. As socioeconomic levels decrease, the chances of having a recreational facility close to where you live are the smallest. Another factor is that the price of fruits and vegetables has risen a lot faster than the price of fat, salt and sugar. For many Americans, their real income has stayed the same or gone down. So if you only have a dollar or two for a meal, you can buy a lot more calories in the form of junk food than healthy food as the default choice.

What does the foundation plan to do to address these big issues?
We plan to begin three new flagship programs. Healthy Kids, Healthy Communities will provide direct support to communities working to reshape their environments in ways that promote healthy living and prevent childhood obesity. We will fund 10 leading communities this summer and release a call for proposals by the end of this year to fund 90 more. We are launching the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity at the University of Arkansas for Medical Sciences to provide information and resources to policymakers and community activists. It will be up and running by mid-September. We will launch a program to support experienced local advocates working with low-income communities of color. Communities Creating Healthy Environments will fund advocacy efforts in 20 communities.

Also, social networks are going to be a critical part of understanding this epidemic and reversing it. I was having a conversation with a U.S. senator not too long ago who said, "You know, Risa, the problem with using policy solutions to address this obesity epidemic is that there is no secondhand smoke. There's no reason why I should care whether the person next to me is overweight or not." But there is. There's a financial cost to all of us.