An interview with Dr. Kelly Boswell reveals insights into obesity today and why so many people in America are struggling with this chronic problem.

Even though we know it's unhealthy, why are so many people (both adults and children) overweight or obese today?

"Research shows that the rapid increase in obesity (and as a result, obesity-related illness) is due to the profound changes in the American way of life over the past three decades. Many of our daily activities have been mechanized; drive-thru services, remote control and automated labor-saving devices have dramatically reduced the amount of physical work that we do just performing daily tasks. Children have largely replaced physical play with TV and computer time. Neighborhoods have moved away from having activity centers such as parks and sidewalks. Children who participate in formal organized exercise programs still don't burn off enough energy on a daily or hourly basis to counteract the amount of time children are spending sedentary. In addition, our average daily diet is mostly high-calorie processed foods made by people other than ourselves, whereas one generation ago, the vast majority of meals were prepared at home. As a result, there is an imbalance between the amount of energy we spend and the amount of energy (food) we consume."

Why is obesity not just a "woman's issue"?

"The rates of obesity cross genders and ages, and obesity-related illnesses are not influenced by gender much at all with the exception of some types of cancers related to hormones. In children, obesity affects their self-esteem and feelings of competence. Research shows that obese children experience about the same quality of life as children with cancer. In addition, if a child is obese, there is a strong likelihood that he/she will be obese as an adult."

Who is really to blame for America's obesity problem?

"There are so many factors; it is not that easy to assign blame to one person or event. The overall consensus of the research community is that in industrialized nations people consume too many processed, calorie-dense foods, and due to modern conveniences, are unable to expend enough energy to maintain a stable weight. We are way past the question of whom is to blame; we need to direct our energy towards finding solutions."

What do you think can be done about this major public health problem?

"First, public awareness must be raised. In the overwhelming majority of cases, the cause of obesity is simple. Obesity is created and supported by a certain lifestyle. The solution is to change that lifestyle. On a global or community level, funds should be directed towards creating environments that decrease the likelihood of obesity: more safe playgrounds, no junk food or sodas in the schools, more sidewalks, etc.

"On a corporate level, what would be very helpful would be to give major food companies tax incentives to create more intelligent Integratives. There should be a public health campaign for parents regarding what being overweight does to a child's self-esteem and the health risks involved."

In your opinion, will taxing, restricting or banning high-fat or high-sugar products reduce obesity?

"No, I don't think so. I think that sort of legislation creates a perception that the public is powerless to make effective changes without corporate reform. We live in a free market. The public is free to make choices about what foods they consume. If the public as a whole indicates a diminished interest in low-nutrient, high calorie foods, the food industry will follow by providing more healthful choices."

We know the dollar figures, but what are the other costs associated with overweight and obesity (both to corporations and to society in general)?

"For corporations, decreased productivity, and more days out of work because of illness. People who are overweight and especially people who are obese are not healthy and tend to have less energy than their normal-weight counterparts. Obesity tends to create low self-esteem, which in turn decreases productivity.

"Regarding society, the costs are staggering. Obesity and overweight are strongly associated with debilitating illnesses and shorter life expectancy. The treatment of obesity-related illness is extensive and expensive. We are developing a sick society; we have a lot of unhealthy children who will become unhealthy adults. The economic costs are huge; the drain on the insurance and medical industries is enormous."

Does obesity mean a person has a lower metabolism? Is there anything that can be done about this?

"There are several factors which influence resting metabolic rate. Genetics, body size, activity level and percent of lean body mass seem to be the most important. People who are obese tend to be much less active than their normal weight counterparts. Their lean muscle mass is proportionally lower than that of physically fit, active people. What can be done? Weight-bearing exercise boosts metabolism by increasing lean body mass. An overall increase in lifestyle activity helps a great deal."

How can I tell if my child is obese?

"Ask your pediatrician to examine your child's growth patterns. Many pediatricians are reluctant to bring up the topic of overweight or obesity because they are concerned about the child's self-esteem. It is best to discuss your concerns without your child being present."

How can I help my child if he/she doesn't want to help himself/herself?

"Discussions should take place in a general manner (not aimed at one family member) that is aimed at improving the health and well being of each person in the family. It is better to create an environment in the family that supports healthy habits around food and activity. This benefits all family members, overweight or not."

Don't some children outgrow their obesity? How can I tell if my child will?

"Mostly, no. Research shows that most children who are obese go on to be obese as adults. On the other hand, a child who is overweight (not obese), but active and consuming a healthful diet at least 80% of the time, is much less likely to be obese as an adult, or to experience obesity-related disease."

What are the signs of an eating disorder?

"For signs of anorexia, note if your daughter stops gaining weight from one year to the next, when she still should be growing. Rigidity, irritability, depressed or anxious mood and isolative behavior are added cause for concern. Body image distortion is a hallmark sign of an eating disorder: this is characterized by a lack of ability to perceive a realistic impression of body size. The signs of bulimia are much more subtle. Usually, people with bulimia nervosa are of normal weight, and are quite good at hiding the behavior of vomiting after eating. In general, I advise parents to pay attention to their own instincts. If you suspect there's a problem, there probably is. It's important to keep a dialogue with your daughter about having a healthy body image, i.e., realistic women, not things you see in magazines and in the media."

Is there any correlation between high achievers and anorexia?

"Yes and no. Genetic and personality research suggests a strong correlation between perfectionism and anorexia nervosa. However, a child can be a high achiever and not be at risk for anorexia at all."

I suspect my child might have an eating disorder. When should I call the doctor? What kind of doctor should I call?

"If you have any suspicion that your child has an eating disorder, ask your doctor for a referral to a psychologist who specializes in eating disorders. A specialist should have access to a dietician who can help coordinate a return to normal eating. Early treatment is essential for eating disorders, both to restore self-esteem and to prevent serious health dangers. The earlier you get treatment for an eating disorder, the higher a chance for cure."

If a child has an eating disorder, does it mean he/she is likely to be an obese adult?

"An unnatural relationship with food almost always leads to an unnatural body state, be it too thin or overweight. The good news is that if caught early enough, the emotional and physical consequences of eating disorders have a good chance of being resolved."

What kinds of misinformation are people getting through our media today?

"We're getting more pressure to be unnaturally thin, when our environment leads us to be unnaturally overweight."

Why should I spend the time, effort, and expense of being in a weight reduction program with behavior modification and dietary instruction when all I really want (need) are pills to lose weight?

"Even the most effective prescription diet aids (i.e., appetite suppressants) lead only to modest weight loss. However in conjunction with a plan for lifestyle change, these medications can be quite helpful."

Dr. Kelly Boswell, a leading provider of psychology services in North Florida and an expert in the treatment and prevention of obesity and eating disorders heads the Boswell Center. The Center offers personalized treatment and follow-up processes that are second to none, with a full spectrum of services, including registered dietitians.

For more information, call (904) 332-9100.

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