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.

My view of chronic disease prevention of fighting epidemic obesity and diabetes, of turning the tide, is that it is the job of professionals to pave the way and to cultivate the will; to stir people up so that they understand the stakes, so that they recognize that adult onset diabetes stalking children is a clear and omnipresent danger. The wolves are at the door. You must defend hearth and home. And here are the means to do it: we must provide programs, policies, tools and resources so that everybody can do the job.

My view is, in between environmental determinism and personal responsibility, we say, "where there's a will there's a way." It's not true. You really need both and they're somewhat independent. We must both cultivate will and pave the way. If you inspire an impassioned people so that they have the will but there's no way, all around them are walls with no doors or windows. It's terribly frustrating. On the other hand, if you put a very nice way at their feet and they have no will to follow it, that doesn't produce anything very good either. Will is not way. You need both.

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.

We are creatures. We have a link with a native habitat just like every other species. Throughout most of human history, physical activity was unavoidable, calories were scarce and hard to get. In the modern era, calories are unavoidable, physical activity is scare and hard to get. The traits that allowed our ancestors to survive, and let's face it, the survival of our ancestors is the reason that we're here because the people who don't survive and make very crummy ancestors, are our traits. But they're very much at odds with the modern environment.

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.

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.