Dr. Pamela Peeke is equal parts sunny and tough. The bestselling author of Fight Fat After Forty, Body for Life for Women, and Fit To Live, Peeke is a physician and chief lifestyle expert at WebMD. She says she believes “people are more powerful than they think,” and she refuses to ignore the social and environmental factors that entangle our personal choices. That’s why Peeke will argue that “Obesity is the government’s business” at the Slate/Intelligence Squared live debate in New York on Feb. 7.
A self-professed “communicator,” Dr. Peeke (her patients know her as Dr. P) is bursting with ideas about how the government can educate consumers and inspire kids, including more in-school fitness programs and a Facebook page for the U.S. Department of Agriculture. Last week, we talked about some of her ideas, as well as the magic of apple pie and the travesty of the 20-story hamburger.
Here are excerpts of our conversation.
SLATE: Let’s start with the burning question. Is obesity a choice?
PEEKE: Obesity is not a choice. It’s a complex situation, an interplay of countless factors. It can involve a potential in people’s lives—they have a potential for being obese, perhaps through genetic lines, but by controlling other variables, they can dampen that significantly. This is a matter of awareness, enlightenment, and being equipped with the appropriate tips, tools, and techniques. You’re not just some passive person whom obesity whacks in the head. It may not be your fault that you have whatever genetic or environmental cards you have, but it is within your domain to make some choices that will help control your weight.
SLATE: So obesity is not a choice, but it’s possible to make choices that prevent you from being obese?
PEEKE: Yes, and it’s possible to lose weight despite being genetically predisposed to obesity. I have legions of patients who have done this. It takes mental and physical fitness; I link the two all the time. I have to. I’m tired of people treating the body like a dog you take for a run.
SLATE: What is mental fitness? Is it willpower?
PEEKE: It’s more than that. Current research shows that a strengthened prefrontal cortex from physical activity allows you to rein in impulsivity. You don’t need more than 30-45 minutes of walking a day to get the effects. Also, people who do regular physical activity can dampen the effect of the FTO gene, which is a very powerful gene associated with obesity, by 40 percent.
Let’s say you’re born with the worst genes on the planet and you feel doomed, like you just want to eat a lot. If you exercise on a regular basis (as well as meditate, by the way), you’ll make the right choices more often. You’ll be more mindful and less impulsive.
SLATE: Where does the government come in?
PEEKE: I am not advocating for a nanny state. I don’t want someone taking my mother’s chocolate-chip cookie out of my hand. Oh my God, it’s a food felony! I mean, that’s ridiculous. I’ll just score it somewhere else. But there’s a lot the government can do. Number one is promoting research. Last time I looked, the National Institutes of Health had a congressional budget. We need to use that budget to understand the underpinnings, the hot new research that’s coming out. Another thing we need is education at 900 different levels—from the Department of Health and Human Services to the Centers for Disease Control to the U.S. Food and Drug Administration. We need it to be free, easily accessed, easily digested. I’d love to see more education platforms on television, radio, and the internet. People should constantly be hearing appropriate information about food, physical activity, environment, stress, and everything else that can contribute to the obesity epidemic.
SLATE: But there’s so much information already out there. Do you think it’s made a difference?
PEEKE: People are not making the connections. You’re motivated to change when you see a greater reward in doing something else. That’s why the way in which the information is communicated is absolutely critical. If you give the best information in a dry format, I don’t care how right it is—it’s very hard to digest and to relate to your own life. Talking about health is lethally boring. If you and I start talking shoes, we could talk for hours. It stirs up this pleasure in our minds. But now, when I flip the conversation over to obesity, there’s dead silence, right? As a communicator, my job is to turn the boring factoids into what I love to call simple, sexy, sticky sound bites. You make it so interesting and fun that someone says, “Oh my god. I never knew that.”
Here’s another thing the government can do better: infrastructure. As a citizen, I can’t create a park or make sidewalks happen when they’re not there. We should have tons and tons of voluntary campaigns, such as the Presidential Active Lifestyle Award and Let’s Move, which get people inspired without ramming it up their nose. We’ve got dead land just sitting around in Detroit, in all kinds of places. Why couldn’t the government take some of that land and convert it into organic gardens? Science shows that when children grow their own, they eat their own, meaning that if they grew that zucchini, they’re going to eat it with pride.
SLATE: Why frame any of this as a war on obesity? Why not just encourage people to move more and eat better?
PEEKE: You’re asking, I think, whether “healthy” and “overweight” are mutually exclusive. It’s really about where you start. Twenty-five years ago, someone with 20 pounds to drop was in dire straits. Today, physicians get people with over 100 pounds to drop. Let’s say I’m working with an average-heighted woman of about 220 pounds. There’s not a single person who thinks a 5-foot4 woman should be north of 200; that’s just ridiculous. So we really concentrate on getting out of that red zone. Now I’ve got her down to 160 pounds. She’s physically fit, just ran a 10K, but you know, her little body, it’s rough. She’s not going any lower, and the BMI says she’s overweight. But she’s actually in better shape than someone who is 130 pounds and 5-foot-4 and never exercises and eats trash.
Of course, if you’re currently average-weighted—the three of you left in the United States—I’m all about obesity prevention. I’ll say, “Come on now. Grow up. Eat your whole foods, be physically active, learn better stress management, meditate, whatever.”
SLATE: Do you agree with your debate opponent Paul Campos that the obese are unfairly stigmatized?
PEEKE: Oh, yes. When I say things like “Grow up,” I’m being facetious. Obese people are living in hell. They can’t find decent clothes. Most people stereotype them on multiple levels. They’ve got self-denigration, poor body image, all the rest of it. What you want to do is show them tremendous compassion. At the same time, educate them. Give them credible tools to be able to help themselves. We do this with smoking all the time, providing drugs, patches, cessation programs, and apps. But unlike with smoking, [obese people] need a team behind them that understands the risks and in a very compassionate way offers appropriate, palatable, doable programs.
SLATE: An obese white woman makes $1,855 less, on average, than a white woman in the normal BMI range. How can the government combat fat discrimination?
PEEKE: They can combat it to the degree that if someone in your office were interviewing people and overtly refused to hire someone on account of her weight, that’s illegal. Of course that happens very rarely. Far more often, you have five candidates, two of whom are obese, and neither of the obese people get the job. The bias is streaming quietly in the background.
One place to start is popular culture. Look at that show on television now, Mike and Molly. Can you imagine it airing 30 years ago? Never! And suddenly there they are, and they’re funny and cute and also struggling with their weight, and they both know it. They say it out loud. And they’re bringing obesity out of the closet. You can’t regulate the way people are thinking, but you can change the culture, change the language.
SLATE: What do you think about how pop culture currently defines the ideal body?
PEEKE: Oh, for women? Far too thin.
SLATE: If the government can regulate junk food advertisements on the grounds that they promote harmful habits, should it be able to regulate ads that celebrate dangerously skinny women?
PEEKE: What really needs to happen is that leaders in the industry, like Donna Karan, need to stand up and speak out. They need to start hiring healthy-looking models and paying them well.
SLATE: What got you interested in nutrition, food, and weight?
PEEKE: I love the study of nutrition because it involves everything from science to real beauty. It’s very primal: gardening, growing herbs and taking them into the kitchen, coming full circle. Also, as a physician, I’d never had one course in nutrition, but you’re supposed to consult your physician before undertaking any sort of diet! What for? When I finished my mainline training, I did a number of years in intensive care and trauma. I had to keep people alive, and I had to learn on the job, because no one ever explained to me how these macronutrients work in the human body. I knew you needed a certain number of calories to stay alive after sustaining massive burns—but I wanted to go further. At first, when my patients asked me questions about what to eat, I sat there clueless. That’s why I went back to school.
SLATE: Are there any food products sold today with no redeeming value whatsoever?
PEEKE: It’s interesting that you say “redeeming value,” because people like to have balance and freedom of choice. If they want to have a fried Twinkie at some county fair, I’m going to cringe, because I think Twinkies are science fair projects. I don’t know what they are. But they’re someone else’s treat.
What really horrifies me is when they take a regular hamburger and turn it into this 5,000 calorie stack of everything. It’s a heart attack in a gigantic pile. There is nothing wrong with a decent burger, but piling it up for 20 stories is completely absurd. Your body is not going to like what you just did to it. I don’t care how young you are.
SLATE: Should the 20-story burger be banned or regulated?
PEEKE: No. That tack is only appropriate in the context of dietary supplements, where you see absolute harm to life and body. Aside from the FDA protecting me from pharmaceutical scams, I am against regulation. I support the government continuing to take nonregulatory roles, but doing them better. For instance, agencies are communicating now, but it’s so boring I could shoot myself. Where is the social media? Where is the Facebook page explaining USDA labels?
SLATE: What is your favorite dessert?
PEEKE: I’m old-fashioned. There’s nothing in the world that gets me going like a scoop of vanilla ice cream—just a little scoop—and a slice of hot apple pie. I don’t eat a whole lot. Just a little bit. I believe in the fine art of tasting more than anything else.