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.

We don't control everything. There are genetic influences. There are environmental exposures we don't control. I cannot guarantee anyone I counsel that by following what I hope is the good advice I offer them, they will live long and prosper. That's what I'm hoping for but I can't guarantee that. What I can tell them is this: "Look, I can help you firmly grip the wheel, and you can steer the ship. You're never going to control the winds and you're never going to control the seas. But if you sail well you can get through just about anything."

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 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.

When I went to medical school, I was taught about two basic kinds of diabetes: juvenile onset and adult onset. From the time I did my training in medical school to the end of my residency we were already seeing the transformation of adult onset diabetes into Type II, which is what we call it now, which from my perspective is a euphemism we have draped over this condition to conceal the fact that what was a chronic disease in midlife is now epidemic in children. Frankly, Type II diabetes in a seven year old is adult onset diabetes. We just don't want to confront that unpleasant fact.

I think basic disease care access and basic access to health care is a human right. If we need a constitutional amendment to put it in the Bill of Rights, then that's what we ought to do. Nobody with a conscience would leave the victim of a shark attack to bleed while we figure out whether or not they could pay for care. That tells us that at some level, health care access is a basic human right. Our system should be aligned so that our policies match our morality. Then within that system where everybody has access, we need to incentivize prevention, both for the patient and the provider.

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.