One is a ruling minority of the healthy few who rely on vegetable gardens, personal trainers and spa getaways to stay fit. The other is the majority of Americans, who are overweight or obese, many of whom risk their own form of assisted living — XXXL clothes, mobility scooters and diabetes treatments that can tip over $50,000 a year.

“One Nation, Overweight” is a CNBC documentary on Tuesday that provides a chilling portrait of a health epidemic that endangers all Americans — without being overly alarmist or too sanguine. And while that doesn’t sound like a big deal, this program stands out in a landscape cluttered with mixed messages and grossly distorted images of reality.

Television used to ignore obesity; now it wallows in it. But the effort to portray the problem — and the solutions — mirrors the way most Americans eat: the most basic facts are larded with sugary entertainment and creamy dollops of instant gratification.

Weight-loss reality shows like “The Biggest Loser” turn obesity into a contest, painting the solitary, often costly struggle against obesity as an exhilarating and financially rewarding team sport. Even do-good missions feed the appetite of viewers accustomed to supersize entertainment. The British chef Jamie Oliver tried to tame the eating habits of an entire town in West Virginia, called the fattest place in America, for his reality show, “Jamie Oliver’s Food Revolution.” Not surprisingly, French fries won.

Meanwhile, series like “Drop Dead Diva” and “Glee,” which recently devoted an episode to a character’s battle with her weight, try to preach self-acceptance by showcasing plus-size heroines who learn to value their physiques. Mostly, they present an unrealistic image of a world populated by whippet-thin women, each of whom has one large friend.

“One Nation, Overweight” isn’t a treat, but it’s rich in salutary warnings. It begins at the Cleveland Clinic, one of the top destinations for growing numbers of patients — some weighing 500 and 600 pounds — who want to have their stomachs stapled. (There were 220,000 such procedures done in 2009, according to CNBC.) The corridors of the bariatric ward, filled with hugely fat people who can barely walk, provide the kind of flesh-and-blood look into the future that was the apocalyptic message of the animated movie “Wall-E.”

And that future may not be so far away. Kenneth E. Thorpe, a health economist at Emory University, discusses a study he published that warns that if current trends continue, the cost of treating weight-related illnesses will double to $344 billion a year by 2018.

The CNBC correspondent Scott Wapner interviews experts who describe obesity as a disease, but the obese people he speaks to rarely blame their size on genetic predisposition or other extenuating circumstances.

“I did to this myself,” says Henry Butler, 62, who was 330 pounds when he went to the Cleveland Clinic. “Who said I had to eat all that?”

School cafeterias are part of the problem, and CNBC visits a school in Virginia where snack carts sell sticky buns, candy bars and chips three times a day. The principal explains that the profits go to help after-school sports programs, a vicious — and viscous — cycle.

There are schools and workplaces that are trying to fight back, including the owner of a car dealership who pays for his overweight employees to join a $2,500 weight-loss program — he says it saves him tens of thousands of dollars in health costs. An inventor demonstrates his answer to a sedentary work force: a machine that allows an employee to work at a computer terminal while walking on a slow-moving treadmill.

Over all, CNBC provides a broad, sensible look at a problem that is not new, but is increasingly dire. There are a few journalistic lapses, however.

The film spends quite a bit of time on a promising weight-loss drug, Qnexa, that is awaiting approval from the Food and Drug Administration. It helps suppress appetite and has had better results than similar drugs in clinical trials, according to the documentary.

Mr. Wapner interviews Leland F. Wilson, the chief executive of Vivus, the maker of Qnexa, who is predictably bullish. So is the only research scientist shown on camera, Dr. Michelle Look, a sports medicine specialist who is a lead clinical trial investigator on Qnexa and a paid consultant to Vivus.

A deputy director of the F.D.A. is interviewed but doesn’t say much about Qnexa, except to explain that his agency is under pressure from advocacy groups to speed up approval of anti-obesity drugs.

Particularly because so many viewers are overweight and desperate for a medical breakthrough on obesity, CNBC should have also interviewed an independent scientist who could have added a grain of salt to Mr. Wapner’s boosterish report.

And credibility, once shaken, is hard to restore. Jim Trudeau, a small-business owner from Madison, Wis., who attended a weight-loss program at the Biggest Loser Resort at Fitness Ridge in Ivins, Utah, lost 200 pounds, but has another 200 or so to lose, since he started at 600. Mr. Trudeau is an articulate and sympathetic figure, but it’s hard not to wonder if he was picked for his personality, or because “The Biggest Loser” is on NBC, a sister network to CNBC.

“One Nation, Overweight” takes a serious look at a serious problem, and it would be better if it showed more discipline in curbing its own weaknesses.

via The TV Watch – CNBC Explores a Big Nation of Big People – NYTimes.com.

Adults may stave off weight gain by simply spending less time watching television, according to a new study led by a researcher now at the Stanford University School of Medicine. Overweight adults who cut television time in half were more active, burning more calories as a result.

“Taking away time spent in front of the television has the potential to improve a person’s activity levels,” said Jennifer Otten, PhD, postdoctoral scholar at the Stanford Prevention Research Center and lead author of the study, conducted at the University of Vermont.

The study, published in the Dec. 14 Archives of Internal Medicine, determined how reduced television watching affected calories eaten, energy used, body weight, time spent sleeping and the balance between calorie ingestion and activity in obese and overweight adults.

On average, American adults watch five hours of television a day, the third most time-consuming activity in our lives — after sleep and work. Watching television expends fewer calories than other leisure activities that take its place, including reading, writing, telephone conversations and desk work. The more time adults spend in front of the television, the more likely they are to suffer from obesity, diabetes and cardiovascular disease, said Otten.

The study followed 36 adults, weighing in above the healthy range, who watched an average of five hours of television daily. After three observation weeks, half of the participants were limited to 50 percent less television for three additional weeks, using monitors that controlled their screen time. For the last week of each three-week period, participants wore activity-monitoring armbands, kept sleep logs and answered phone surveys about their diet.

The group instructed to halve their television did not change their calorie intake but burned 120 more calories a day on average, creating a trend of negative energy balance. “The energy burned is equivalent to walking more than a mile,” said Otten. “We don’t know if these short-term changes will translate, but the results may be similar in a longer term study and could prevent weight gain.”

The results from television reduction studies in children, similar to this one, have comparable effects on energy balance, though it was achieved through different means. With children, short-term study results were consistent with longer studies in which researchers found that instead of activity increasing, children’s food intake decreased and they lost weight. The difference may be because children’s diets are less set in stone, they may be more prone to advertisement-induced cravings or they are generally less inactive, said Otten.

“We’ve known for a decade that reducing children’s television viewing is one of the most effective ways to prevent weight gain, so it is great to finally see a study like this in adults,” said Tom Robinson, MD, the Irving Schulman Endowed Professor in Child Health at Stanford’s School of Medicine, who was not involved in the study but has conducted TV studies in children. “Dr. Otten and her collaborators have demonstrated that reducing TV viewing has the potential to be as important for controlling adult obesity as it is for children.”

More information: Arch Intern Med. 2009;169[22]:2109-2115.

via Less TV time may help overweight adults burn more calories, researcher says.

The cost-effectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children.

Objective: To model the health benefits and cost-effectiveness of banning television (TV) advertisements in Australia for energy-dense, nutrient-poor food and beverages during children’s peak viewing times.Methods:Benefits were modelled as changes in body mass index (BMI) and disability-adjusted life years (DALYs) saved. Intervention costs (AUD$) were compared with future health-care cost offsets from reduced prevalence of obesity-related health conditions.

Changes in BMI were assumed to be maintained through to adulthood. The comparator was current practice, the reference year was 2001, and the discount rate for costs and benefits was 3%. The impact of the withdrawal of non-core food and beverage advertisements on children’s actual food consumption was drawn from the best available evidence (a randomized controlled trial of advertisement exposure and food consumption). Supporting evidence was found in ecological relationships between TV advertising and childhood obesity, and from the effects of marketing bans on other products.

A Working Group of stakeholders provided input into decisions surrounding the modelling assumptions and second-stage filters of ‘strength of evidence’, ‘equity’, ‘acceptability to stakeholders’, ‘feasibility of implementation’, ‘sustainability’ and ‘side-effects’.Results:The intervention had a gross incremental cost-effectiveness ratio of AUD$ 3.70 (95% uncertainty interval (UI) $2.40, $7.70) per DALY. Total DALYs saved were 37 000 (95% UI 16 000, 59 000). When the present value of potential savings in future health-care costs was considered (AUD$ 300m (95% UI $130m, $480m), the intervention was ‘dominant’, because it resulted in both a health gain and a cost offset compared with current practice.

Conclusions:Although recognizing the limitations of the available evidence, restricting TV food advertising to children would be one of the most cost-effective population-based interventions available to governments today. Despite its economic credentials from a public health perspective, the initiative is strongly opposed by food and advertising industries and is under review by the current Australian government.International Journal of Obesity advance online publication, 4 August 2009;

via The cost-effectiveness of removing television adve…[Int J Obes (Lond). 2009] – PubMed Result .