We are facing a flood tide of factors into our daily lives and the lives of our children that conspire against weight control, and for that matter, health, any single policy or program we use to turn the tide is like a single sandbag. You put down the sandbag on the banks of the river. You could ask the question: Have we held back the flood? A sandbag isn't designed to hold back the flood. A sandbag is designed to be part of a levy to hold back the flood. It doesn't matter if it's a good sandbag, maybe a perfectly good sandbag. By itself it can't fix the problem.

The metaphor I routinely use is polar bears in the Sahara desert. You take creatures adapted to the cold and put them in the heat, the very traits that allow them to survive in one environment will conspire against them in the other. We are polar bears in the Sahara with one important distinction: we are smarter than the average bear. Once we identify the nature of the problem, we can think our way out of it. But it begins by acknowledging you didn't fail because you couldn't succeed. Because you didn't even know what the scope of the problem was. It's not your fault.

There is one thing that very reliably try to trumps the food supply and that is food demand. At the end of the day, the business of business is business and they are just trying to keep the customers satisfied, it depends what we want. The problem in our current mess is we want all the wrong stuff. Why do we want the wrong stuff? Because taste buds are very malleable little fellows. They learn to like what they know. We're bathing our taste buds in too much sugar, too much salt, too much processed food all day long. That's what they know and crave.

Balanced, sensible nutrition: eat food, not too much, mostly plants, a healthy diet ala Michael Pollan, modern physical activity on a daily basis, modest weight loss - translated into a 58% reduction in the occurrence of diabetes. A clear indication of the power of lifestyle over health. The challenge now is the development of the community-based programs that will translate what we learned in the diabetes prevention program and put it to work in every town in America.

We have literature indicating that overwhelmingly, health is influenced by a very short list of modifiable behaviors topped by three: tobacco use, physical activity and dietary pattern. You could modify those three things; you can change people's fate. I wanted to change those. Smoking cessation, important but relatively simple - a lot of people are working on that. Physical activity: important to me, important to health but also relatively simple. I like nutrition. It's complicated; you really need to learn a lot of stuff to be an expert there.

What we need to do now is recognize that it is the sum total of human ingenuity that is responsible for the epidemics of chronic disease. Throughout most of human history, calories were scarce and hard to get, and physical activity unavoidable. Calories are now abundant, and physical activity is hard to get. We took an unstable, uncertain food supply and fixed it. What now passes as exercise and requires specialized footwear used to be called "survival." You had to do it. Now you never have to do it. We solved it too well. Now we don't need our muscles for anything.

I naturally gravitate toward the big picture which isn't necessarily advantageous when you go on to a career in research because successful researchers usually choose a pretty narrow channel. So having tunnel vision actually helps you stay where you are supposed to stay. The big picture in medical care was looking at the underlying causes of all of this pathology. I really wanted to do something about that and play a meaningful role in changing the trajectory of people's lives and their health and by changing their health, changing the quality of their lives.