Dr. Francine Kaufman loves a food fight, especially if sugar is involved. The head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles, Kaufman is a pioneer in the campaign against juvenile obesity and the rise of "adult-onset" Type 2 diabetes in children. The professor of pediatrics at USC's Keck School of Medicine makes her case in the recently published "Diabesity: The Obesity-Diabetes Epidemic That Threatens America--and What We Must Do to Stop It" (Bantam). Kaufman, who also co-directs a community research project in South and East Los Angeles to create urban gardens, farmers' markets and other nutritious alternatives to junk food, gave us some talking points recently.
You use the term ''diabesity'' to warn that obesity-linked diabetes is a public health crisis.
To prevent diabetes, we [have to] conquer the obesity epidemic. Right now over 60% of American adults are either overweight or obese, and 30% of children.
You argue that the obesity that brings on deadly diseases often results from small-scale daily habits. How?
If your job requires an extra half hour of commuting, that's a half hour you have lost for a walk in the evening. Or you work in a place where the staircase is at the far end of the building, so you stand in line at the elevator. We need to find opportunities: taking a flight of stairs, reaching for water rather than soda. These things take conscious commitment.
You seem to propose a rethinking of the American way of life, from city planning to banning junk food from hospitals.
What we have done as a species is develop technology and skills to combat starvation: agriculture, the domestication of animals, the Industrial Revolution, refrigeration and packaging. We now have so many energy-saving devices that none of us need to move. Until now, this has been labeled as progress. Now we have to decide: What will future progress be?
Many patients described in your book are lower-income Angelenos who are Latino or African American. Do you see the obesity-diabetes crisis as disproportionately impacting poor people?
Yes. It's not a level playing field. There are whole neighborhoods [in Los Angeles] in which you wouldn't walk outside your door. We have families who live on a budget of $2 a day per person if they are lucky. What [they can afford] is highly processed, cheap sources of excess fat and sugar calories.
Type 2 diabetes used to be rare in children. When did you realize that a fundamental change was underway in children's health?
In the mid-'90s. We were starting to see a doubling and tripling of the number of overweight and obese children. An elevation of blood sugars. High blood pressure. Abnormal liver tests. We can all think of the patient [when the lightbulb went off]. It dawns on you that this isn't Type 1, it's Type 2 diabetes.
What is your strategy for helping people make healthy lifestyle changes?
It's not uncommon for a family to tell you a child drinks a liter of sweetened beverages a day and that dad drinks two liters. Or that they eat Cheetos while watching TV. And that they have fast food five times a week. The way to help change behavior is to give education on what's in that food, why it isn't good for you. We aren't asking for astronomical changes. We are asking for small changes that will bring better health over time.
You've complained about the McDonald's at Childrens Hospital and griped about rich desserts at medical conferences. Are you ever labeled a stick-in-the-mud?
Just a thorn in the side. When I first started [at Childrens] in 1975, we sold cigarettes. It became socially unacceptable for a healthcare institution to sell cigarettes. We have to get to that same [attitude] around health lifestyle. It is not OK to sell sodas here. It is not OK to have a gift shop that sells candy. We just celebrated an anniversary of a new project, and the administration sent around chocolate cupcakes. I sent off an e-mail to everyone: "I'm appalled." My e-mails always start with, "I'm appalled."