Regina Benjamin on Childhood Obesity

Before she became America's top doctor, Regina Benjamin was a family physician caring for patients in Bayou la Batre, Ala., a shrimping village along the Gulf Coast. Today, her home is the nation's capital, where Benjamin is undertaking an enormous challenge: improving the health of every man, woman, and child in the United States. Already, Benjamin has experienced the unpleasant side of political ascension. After she was nominated as Surgeon General, a public debate ensued: was she too overweight for the job? Benjamin says her weight struggles started in her 40s, and she understands the challenges faced by so many other Americans. But she's clearly more interested in talking about the big picture than about herself. Her goal is to turn the public dialogue about obesity from the negative ("Here's how sick you'll get if you're fat") to the positive ("Here's how good it can feel to be healthy"). She wants Americans to learn how to enjoy good eating and exercising and also demand it in our schools and communities. In one of her first interviews as Surgeon General, Benjamin talked with NEWSWEEK's Claudia Kalb about her hometown Alabama clinic, which was destroyed by Hurricane Katrina and is now being rebuilt; her role in first lady Michelle Obama's "Let's Move" initiative; and the fact that she is a Star Trek junkie. Excerpts:

You issued the report "The Surgeon General’s Vision for a Healthy and Fit Nation" in January. How is it related to first lady Michelle Obama's "Let's Move" initiative?
They're very much related. I am looking at building a healthy and fit nation for all ages. The First Lady very smartly decided to focus on childhood obesity, and the two come together because we certainly need to focus on our future, our kids. But we also need to make sure the rest of the family is healthy and fit, as well. I want the whole nation—everybody—to start to look at health and wellness as something they want to do, not something they have to do. I think we've done a good job letting people know that we need to be healthier, that we need to eat better, exercise more. Now, we need to give them the tools to be able to do it.

Is obesity a personal challenge or a public-health problem?
I think the ultimate decision maker is going to be you. I think people want to make good decisions. You look at how much they spend on all these weight-loss products. We in the public sector and in the private and business sector, we need to give them ways to help them make those good decisions. But ultimately those decisions are theirs.

Talk about your experience working in your hometown clinic in Alabama. Was access to food a big challenge?
It's a small town, a shrimping village, so we had lots of seafood. We taught people to stop frying things as much and start broiling and boiling. You don't stop eating fried foods, you stop eating them every day. We started to see people change the way they prepared their food—how to make gumbo without it being so oily and greasy and still taste very good.

Schools are struggling with their budgets and have economic agreements with the food industry for vending machines and competitive foods. How do you resolve this?
There are realistic challenges. As a family physician, I've been on both sides—on the side of sitting here trying to pull snack machines out of the kids' school and sitting here trying to raise money for the band uniforms. There's an argument, which I think is a pretty good argument: is it worth it to risk the kids' future by having the vending machines there? Some things you just have to do. And find some other way to buy the band uniforms … Hopefully the parents will go to their PTA meetings and challenge their school boards and say, "healthier environments for our kids." You can't be too overly prescriptive because you don't want to seem like government is running everything. And yet you want to be supportive. It's a tough balance, but that's where I think the role of parents comes in.

HHS Secretary Vilsack said recently that he struggled as an overweight child. You have talked about your own challenges. Is stigma still a problem?
For me, it's not. I'm pretty secure in my self-esteem, but I do think it's important that I understand the challenges that people face every day. [At the end of the day, people say], "I'm starving, I'm exhausted, I just want to get something and put my feet up." I understand that. At the airport, where do you find something healthy? You're driving and pull up at gas station, there are no healthy options. We need to make it easier to be healthy.

What's your preferred exercise option?
At home [in Alabama], I exercised on my back porch. I used to do aerobic exercise tapes. Here, I go to the gym and I'm learning how to do the elliptical. And the treadmill. I like hiking. I play golf and walk. I want to climb Kilimanjaro very soon. I would like to do it within the next year.

Have you hiked tall mountains before?
I've hiked. Not that high. I watch Star Trek, and on Star Trek, the black lady's name was Uhura. Uhuru is the tip of Kilimanjaro; it's the highest peak on the African continent. I remembered that. I said, "I'd like to do that some time."

Would you like to share any personal details related to childhood obesity?
I wasn't fat as a child. My battle with weight came later, in the last 10 years, when I was in my 40s.

Can you compare childhood obesity to tobacco? Obviously, you have to eat, but you don't have to smoke.
There are a lot of similarities. We just have to put an effort behind it and take it on as a public-health issue. You make a good point: you don't have to smoke; you do have to eat. The other challenge with obesity and being overweight as a society is that we also have other weight issues, particularly teenagers dealing with anorexia and eating disorders. You have to be very careful not to overly emphasize things or you can go too far the wrong way. And that's why I like to focus on being healthy and being fit.

How do you avoid sending the wrong message?
You need to talk about it in a positive way, saying, "I want to be fit enough that I can do the things I want to do. I want to be fit enough to go climb Kilimanjaro. I want to be fit enough to go dancing with my grandkids or go fly a kite or go ride a bike."

Do we need more creative, innovative approaches to tackle obesity?
This isn't necessarily an innovative fix, it's everyday, little bitty steps. There's nothing magical. Park your car a little farther and walk the extra steps. Take the flight of stairs instead of getting in your car. Cut down on some of those sugary drinks we drink. Drink more water.

We've talked about the first lady's initiative, schools, individual choice. Who are other important players?
We haven't talked much about the role that physicians and clinicians play. I think it's a major role in that people trust their doctors and they trust their nurses. It's important that as clinicians we measure the body mass index, the BMI, and, if we can, the percentage of body weight and fat. And have these discussions with the patient and let them know where they fit. Because oftentimes, you'll tell them what their weight is but you don't talk about it. You say, "You need to lose weight." I think parents also don't realize the big role that they play. Some of the studies show that if your parents are overweight, you have a 70 percent chance of being overweight as well. Kids want to be like their parents, they look up at them. So parents, set a good example.

What are your other goals as Surgeon General?
Prevention and wellness is the basis of everything. Tobacco is a big issue for me. You may have read that my mother died of lung cancer from smoking. She started smoking as a teenager. When she died, she was 75. But that was preventable. The rates of smoking aren't going down anymore. In some populations, they're going up. Certainly by now, we should have a smoke-free society, but we don't.

Did you ever think you'd become the nation's doctor?
I never thought of it. I've always admired the job and certainly, jokingly, I told [former Surgeon General] Dr. [David] Satcher—he was my medical-school professor—I'd seen him one time in his uniform, and I said, "I really like your uniform, I'd like one like it one day." I was joking; didn't think it would come to be. It's rewarding. It has been so far.

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