We talked before about the lifestyle intervention of the Look AHEAD Trial, and this is an example of helping people at the individual level combat this obesogenic environment, but it took a lot like it took six months of weekly meetings with healthcare professionals, it took meal replacements, working with a physical trainer, working with nutritionist, going in all the time for lab values and so on. It was basically like this intensive life modification. This is not something that we can provide for everyone in a population. Yeah. Now remember just to remind you, it was effective. We had support, we had intensive lifestyle education, so that the top group, diabetes support group and the intervention group, received this intensive lifestyle modification. I showed 10 years worth of data before, but glossed over what happened. The intervention lifestyle groups still did a lot better in the long term, but we can see that without that constant intensive, without those meetings. Drift back. Drift back. Why? Because we're putting people back in that obesogenic environment again. We don't have the intensive individual level of modification. So what we've learned when we're looking at any of these diets, it doesn't matter if we're talking about the Zone diet and one on the meat diet or Atkins, whatever, any of these that we see improvements over time. It doesn't matter what the combination of protein versus kale versus greens on it, kale is going to keep coming up again I know. But should I just tell the story now? I'll go ahead and tell the story. Please do. Okay, here we go. So as you know, I always do the lifestyle interventions as well as part of, I'm not going to ask students to modify something if I'm not willing to do the same. So every year I take a new assessment and I choose one of the many areas that have been identified as a place to improve my diet or improve my activity and all of that. So last year I decided that I was going to do the 5 A Day, have my five fruits and five vegetables every single day. I was going to do it, and I did, but not without some suffering and a whole lot of whining and complaining. So I decided to make myself, I discovered kale in the middle of all of this, actually because I was putting together slides and I was like, wow, kale is like the ultimate food. I'm going to eat a lot of it. Apparently, you can go overboard on kale, I learned, is the short version of that story, that I was having kale smoothies every day as well as two kale salads, it was a bad idea. Wow. Yeah. Anyway, so I was up there lamenting and complaining last year, I was like, "I don't understand, I've improved my diet so much, but I feel not great." Anyway, so then I had to start swapping in like carrots and apples and so on. So what I learned from that is that it was too hard to make that much of a dietary change. It was not something that I sustained. I could not wait to be done so that I could stop that. I do think that it had some trickle effects and that, I mean, now I have a kale salad everyday, I love them. So that's an improvement, but I went overboard and I made it unpleasant, I made myself miserable. But this time I don't get enough fruit I think, so I'm going to try to have that replacement instead of my wheats in or chips or whatever, I'm going to have an apple or carrots in the afternoon and evenings when I get home. That's enough of a significant change that I will, my health will benefit and I'll feel as though I've accomplished something and hopefully will not make myself and miserable in the process. Going back to this. So what we see is that with these very intensive dietary recommendations, that people can achieve improvements, this is weight outcomes, over the course of sustained dietary intervention. My point of this is that there's not really a difference with respect to which magical diet you choose to do. What actually is meaningful is the extent to which people are able to follow it. So it doesn't matter what the perfect recipe is, it's helping people adhere. So these weekly meetings and the group of health care professionals to help with that is what helps people adhere. So back to this whole, it's so simple, we're just supposed to do it, just eat less, just just be active, you can just do that, that's your problem if you can't. Again, the sarcasm. Just eat kale. Just eat a lot of kale, it'll be great. It was not great. Smoothies are good. I have a great smoothie recipe that [inaudible]. If it is just so simple, then how is it that two-thirds of the population is either overweight or obese? These classifications, by the way, are determined based on measurable health outcomes. So it's not necessarily like a weight level where anybody cares that magic number of 25 and the magic number of 30 have been determined, and they've actually shifted over time, based on whether or not there are shifts in cardiovascular risk, diabetes risk, and so on. So that number is the one that there are definite issues with those numbers and with respect to lean muscle mass versus adiposity and so on. But these are the ones that had been determined based on like, ROC curves. So this is how these things are determined, there's probably some political stuff involved too, but it's not like someone's like, ''Let's go 25, that'll be good.'' It's actually based on some modeling. So here we are, it's difficult to lose weight. Weight maintenance is actually even more difficult. So why is that the case? This is now we consider here, is this a personal responsibility epidemic? Is it that people are somehow just not able to take control of their own diet? I really don't think so. Even comparing this then to the extent to which people are able to follow other health recommendations, like people tend to, we don't see any variability since the '90s, in the number of people opting to get a flu shot or go into college. So we're not looking at some educational suppression or something like that, we're not seeing any broad sweeping changes with respect to people just feel like, ''I don't care, I'm going to toss my health out the window.'' Smoking, we've made gains in smoking, meaning that fewer people are smoking in recent years and decades. So the point here, we're not seeing these major societal changes with respect to personal responsibility. So what's happening? This is just more examples. Look here at the seat belt, seat belt's making radical improvements. Why? Potentially, policy improvements, and also like actually putting seat belts in cars. That's good. That didn't happen. We didn't have seat belts in cars when I was little. Really? I don't think so. They were stuffed underneath the seat panel something. They were there, but there was none of this across the body stuff, no dinging bells, no airbags, children not in car seats. It was mayhem, it was the '70s.
