by Laurie Zuckerman, co-author

As a mother of two, I am well acquainted with the anguish of mother guilt. Am I irrevocably damaging my baby's pyche by letting him cry it out at 2 a.m.? Will my six year old miss out on some great potential as an Olympic hopeful because I couldn't squeeze in gymnastics lessons on top of her dance and martial arts?

But mothers may now be able wipe at least one worry off their lists. A group of British researchers studied the hypothesis that if a woman is overweight during pregnancy, the higher levels of sugar and fatty acids in her blood would affect the developing fetus, predisposing the child to poor appetite control, a slower metabolism and eventual obesity. They reported this week that obesity during pregnancy is not strongly linked to obesity in the offspring.

But mothers aren't totally off the hook. (C'mon we never are.) Children who have obese parents have more than twice the chances of becoming obese as an adult compared with children born to lean parents, according to a New England Journal of Medicine article.

The reason, in part, is genetics. Although the genetic role of obesity is only just beginning to be understood, scientists are uncovering certain genes that are associated with excess weight. In a recent article in Science, researchers identified one gene called FTO that increases a person's risk for obesity. There are likely to be others.

Obviously, however, the story doesn't end with genetics. Numerous studies have shown that children's diet and exercise habits follow those of their parents. No surprise there. Almost any parent can tell you that children learn by example (even "and sometimes especially" when we don't want them to follow in our footsteps). Of course, as we talk about extensively in the book, America's obesity-inducing environment doesn't help.

There is yet one more serious consideration that any woman carrying extra pounds should consider before conceiving. Beyond the question of how that extra weight may impact her offspring's future weight, obesity in pregnancy raises the risk of a host of issues including delayed diagnosis, increased need for cesarean or instrumental delivery, pre-eclampsia, eclamsia, gestational diabetes, and blood-loss. Obesity in pregnancy also increases risks to the unborn child, including neural tube defects, spina bifida, heart defects, and delivery-related neonatal morbidity.

As a mom who worries, I hate to throw out this scary list of risks. The good news is that pre-pregnancy weight loss significantly reduces pregnancy complications. So if you are overweight and thinking about becoming pregnancy, talk to your doctor first.

by Laurie Zuckerman, co-author, The Fattening of America

When it comes to monitoring my kids' eating habits, I have to admit that I'm slightly less obsessive than Eric. (I'm still fainting that he let Max eat FOUR Krispy Kremes - see blog below). Still, I was pretty psyched when I went to the Valentine's Day party at my daughter's school and saw that Yana was the only kindergartenerthere who opted for a cup of water. The rest of the kids were quite literally drinking the Kool Aid. (Yana did have two cookies and a pile of chips in front of her "you can't win em all.")

But one place I've found I can rarely win is a restaurant. Have you ever wondered why the junkiest food on the menu especially in nicer restaurants is housed under the kid's menu? The choices are typically a plate of fried food, a burger, a hot dog or a pile of pasta. (Macaroni Grill's Kid's Double Mac and Cheese, by the way, has a whopping 1,210 calories.)

I actually have no problem with Yana eating the occasional hot dog or French fry. And I'm a sucker for mac and cheese myself. But it does get under my skin that only very rarely does a kid's meal come with any fruits or vegetables.

Why is that? Is there a perception that America's kids are vegetable phobic? Well, maybe. Think about the tremendous success of books like Deceptively Delicious and The Sneaky Chef.

I don't know if I just have an unusual kid, but Yana never complains when she seessome veggies on her dinner plate. Yes, right there in plain view, not pureed and hidden away in her chicken nuggets. (My baby is still on strained carrots and Cheerios, but I'm hoping, though not necessarily expecting, he will someday follow his big sister's good example.)

Because I do my best to include some fruits or veggies in every meal, I tend to get a little peeved when we eat out and the inevitable plate of fried food is served up veggie free. Of course, I could have ordered for Yana from the regular menu. In fact, sometimes I do, but both the cost and the portion size always strike me as a little out of hand.

So what gives? Are the chefs, in fact, just responding to their customer's demands? (Remember the example in Fattening of what happened when Ruby Tuesday's downsized some of their portions? Customers were furious, and sales dropped.) So would customers complain if some veg appeared on their kid's plates? What if the costs of the kid's menu items went up?

Personally, I would be more than happy to pay a bit more to get some more greens in my kids" it's an option I usually choose when it's offered on the side. But am I the typical customer? Or do the chefs (and restaurant corporations) have it right? Do they know their target market? Are Americans really so veggie phobic? You tell me.

Those of you who read The Fattening of America remember my friend Mark. He's the guy who had the unprotected sex with the woman from planned parenthood. Mark was used to introduce the notion of morale hazard. This is the economic concept that says that, due to insurance, individuals may change their behavior and not engage in as much preventive care. As discussed in the book, Mark is a thrill seeker, at least when he has health insurance. In coverage lapses, which happen frequently for Mark because he changes jobs more often than my son changes underpants, Mark lays low to ensure he won't wind up with any hefty medical bills that he can't afford to pay.

I then asked the question of whether or not we think rising rates of obesity may be the direct result of generous insurance coverage for seniors (i.e., Medicare) or more indirectly to the extent that insurance speeds up the innovation period for new drugs and devices. In other words, are people not engaging in healthy behaviors because they know there will be a pill or procedure that will cure what ails them, even if they carry a few extra lbs. Even better, Medicare or private insurance will likely foot the bill.

Although this was primarily an academic discussion, I believe the answer is yes, many people will engage in less healthy behavior thanks to insurance and advances in medical technology. Now I have proof, although I'm not proud to admit it. If you read the book, you'd know that I'm an avid runner. I find few things more enjoyable than a nice run through the woods. It turns out that all of this running can't counteract the poor genes that I inherited from my parents. In spite of running 25 miles per week and generally eating a good (although admittedly not great) diet for the past ten years, my cholesterol continues to go up. At 37, my total cholesterol is 250 and my ratio of good to bad cholesterol is really poor. Heart disease runs in my family so I'm fairly concerned about it. I hate to take medications but cholesterol drugs seem to be a marvel of modern science. My understanding is that they work great and with few side effects. They are also fairly inexpensive. So, although I was hoping to cure my high cholesterol with diet and exercise, that did not pan out. In the next week or two I plan to make an appointment with my doctor and ask to be prescribed some type of cholesterol medication.

So here's where things get interesting. Yesterday I was working at home and decided to go to the local Carolina Cafe with my wife and baby for lunch. To be honest I'm not a big fan of the restaurant but it's in the neighborhood and I can walk down there. I usually get a turkey sandwich but yesterday I ordered the less healthy Italian sub. My logic was that since I'm going to be on cholesterol drugs some time soon, why not go with the Italian? The drugs will offset any negative effects of the sandwich. Regardless of whether this logic is even correct (I'm not even sure it is), the point is that I made a conscious choice to eat what I believe to be the less healthy meal (although admittedly I ordered the sub with pretzels and unsweetened tea) knowing that I've got the drugs to help right the ship. So my question is, if I'm making this type of tradeoff, how many of my tens of readers are doing it as well? Let me know.

By the way, the sub did not compare with Quizno's but it was pretty good, and actually cheaper.

A study was published the other day that suggests that obese people cost less in medical expenditures than non-obese people (http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050029). That seems hard to believe given that obesity has been shown to increase the risk of lots of medical conditions, including diabetes, hypertenion, high cholesterol, CHD, cancer, osteoarthritis, and lots of others. Given that, it would seem to also cost a lot of money to treat. And in fact, it does. I’ve published numberous papers showing that obese individuals cost more in medical expenditures than non-obese individuals. So what’s going on?

The authors claim is that even though obese individuals have higher medical costs while alive, they end up dying earlier. In other words, normal weight individuals cost less, but for a longer period of time. If the differential in life expectancy is large enough, than normal weight individuals could indeed have greater lifetime medical costs than obese individuals because they are alive for so much longer. That is the conclusion these authors come to. The problem is, at least in the U.S., that claim does not hold true. Several recent papers, including one published by authors of the Centers For Disease Control and one of my own that is not yet published, have shown that overweight and most obese individuals do not have a substantially shorter life expectancy than normal weight individuals. Given that, there is no way they could cost less over the life cycle. It is true that those with a BMI over 35 (for someone 5′10” that would be about 240 lbs) do live, on average 3-5 years less than normal weight adults, however, their medical costs are much higher than normal weight adults, so again, no savings from obesity even for this small percent of the overweight/obese population. Now, it may be that in the Netherlands, the focus of this paper, that treatment costs are much less and mortality for obese individuals much greater so that their results are correct, but they certainly do not generalize to a US population. So there are no savings due to obesity. Contrarily, there is a savings from smokers, who die much earlier and never collect on the taxes they pay into the social security and Medicare trust fund, let alone all the taxes they pay on cigarettes.Given these findings, in efforts tosave money, should our government give away free cigarettes and tax the krispy kremes and Big Macs? What do you think?

I’m a big runner. I’ve run 5k’s, 10K’s, half marathons and several full marathons. But the most fun I’ve ever had at a race occured this past saturday at the Krispy Kreme Challenge http://www.krispykremechallenge.com/. The race melted together two of my favorite pasttimes, running and eating. The goal of the race was to run two miles, eat one dozen honey glazed krispy kreme donuts, and run two miles back. All in under an hour.

There was a team of runners whose shirts each had the nutritional facts of the dougnuts

Doughnuts: 12 Original Glazed Krispy Kreme Doughnuts

• 2400 calories
• 1200 fat calories
• 144g of fat
• 36g of saturated fat
• 60mg of Cholesterol
• 1140mg of sodium
• 120g of sugar
• 24g of protein

These guys weregreat. Another guy ran with a stick extended out in front of him with two donuts bouncing on a string on the end. Like a dog at the race track, he never took his eyes off the prize. The run was only $15, one of the cheaper races I’ve entered, and that brought out lots of college students and other runners. In all, 3,000 dozen donuts were handed out. The race organizers let baby joggers enter (I pushed Leah, my one year old) and this was one of the few races around where dogs were welcome. I wish I had known as I left mine at home. He loves to run and eat doughnuts. It was truly a family event.

The best part of the race for me was thatIran it with my son as well as my youngest daughter. He’s only seven and not really into running, but the promise of a few doughnuts and getting to see people puking was enough to get him to come out and join the fun. We were not disappointed. It was cold at the start and he was unhappy until the race started. At that point we jogged for about 15 minutes and then jogged/walked til we got to Krispy Kreme, which was 2.2 miles from the start at the NC state belltower.

At the dougnut store there were tables piled high with boxes on boxes, each containing one dozen glazed krispy kremes . My son grabbed a box and held on to it like it was a Pokemon EX card, which if you don’t know, is very valuable to a 7 year old.

If you’ve read my book, you would know thatI am a zealot when it comes to not letting the kids eat too much sweets, but on this day I let Max go to town. I told him he could eat as many donuts as he could get down in ten minutes. He ate 4, which is more than I was expecting. In case you are curious, I had 2.5 and they were awesome. Max might have downed one or two more but he was distracted by the many college kids (including many girls) attempting to get their dozen donuts downso they could run back to the finish. It was a site to see.

Max and I mostly walked the two milesback to the start. He had a bit of a stomach ache (surprise surprise) and was not up for running. However, he was having a blast watching people puking along the route. I could see the joy in his eyes when this one young woman proudly told us she puked five times on the run back. I believe the wheels of our baby jogger pierced a pool of her vomit. Max was in heaven.

The best part about the race was that it raised $20K for children’s hospital, which is a really great cause. I also got to spend some time with my kids, getsome exercise, eat a fewdoughnuts, and laugh a lot. So we ate more doughnuts than we typically do. It was totally worth it. Max also jogged/walked 4.4 miles. Although he burned fewer calories than he took onfrom eating 4 doughnut, it was totally worth it. Moreover, he now claims that he is willing to do short jogs with me, which if true, would be a great way for us to spend quality time together while getting some exercise.

We don’t eat doughnuts often, but in the future, when we do I’ll make sure they are krispy kreme. I’ll also make sure to do this race again next year. And I know Max will be running right along side me.

Much to the chagrin of my wife, I managed to sneak in a Las Vegas weekend with the boys. I was in Phoenix on friday for work and it just did not seem to make sense to rush home right after the meetings given I had a free place to stay at the Bellagio, compliments of my wealthy cousin (I’m on the hide a bed though). Turns out that Las Vegas hotels are in the minority of hotels in the US that still allow smoking. And not just on the casino floor, but in the hallways, shops, and rooms as well. I woke up today smelling like an ashtray. I really hate the smoke.

Today’s question,life from Las Vegas,is should the government ban smoking in casino’s, bars, or other private establishments. Although this is not directly an obesity question, it gets back to the larger issue of the proper role of government when it comes to risky behaviors.

In my opinion, the government should not ban smoking in private establishments. I say this even though I benefit from these laws. The reason I take this view is that the market should be able to solve this problem. For example, where I live in Chapel Hill, there are some bars that allow smoking, and some that do not. On the rare occasion that I go out with my friends, we go to the non-smoking bars. However, I have one friend who is a smoker, and when I’m with him we sometimes go to the smoking bar. It’s always a debate. I don’t like it when he gets his way but I could certainly choose not to go there if I wanted to. Same goes for the Vegas casinos. If they do not want to ban smoking, then they run the risk of losing my business and the $40 I lost last night playing blackjack. I doubt they’d be too heartbroken.

One might make the argument that employees in smoke-filled establishments suffer from the smoke. That is true but the market should be able to compensate them as well. Those who work in risky jobs typically make higher wages to compensate for the higher risks. Coal miners, for example, make pretty good money as a result of the health risks this job entails. Why doesn’t government outlaw coal mining?

For the record, I think smoking is a terrible habit and would certainly never want my kids to become smokers. But that does not mean I think government should make cigarettes illegal or ban smoking in places where minors are even allowed to go. I do think an appropriate role of government is to regulate smoking in PUBLIC places, and am glad that most public places have become smoke free. However, what one does in the privacy of their own home or private establishment, should be left for the individual proprietor to decide. We, as patrons, can then decide if we want to patronize it.

There is a clear link between this discussion and obesity. Anyone see it?

Gotta run. I’m off to the (smoky) blackjack tables. Let me know if you disagree.

And no. I am not talking about people from Poland. Everyone knows they are not to be trusted. I am also not talking about Hillary vs. Barack, as everyone knows those pollsare fabricated. I am talking about the poll on my main page asking whether or not obesity is a problem. It turns out that 2/3rds of the nearly 400 folks who responded think it is not. These results contradict other polls that I cite in the book where about 2/3rds state that obesity is a big problem. How can that be? Well, one obvious answer is that people who find their way to my website are not representative of the general population and therefore their results are highly biased. It would be like asking a bunch of people from Boston who their favorite football team is and then concluding that America’s team is the New England Patriots. This is clearly incorrect as every one knows that America’s team is the Philadelphia Eagles, at least that is my team. So, what is the value of these polls. Well, they are valuable for making statements of those who take the poll, but useless for trying to make out of sample predictions. So, of those who found my site and took the survey, 2/3rds believe that obesity is not a problem. 1/3rd believes it is. For the general population, results are likely to be very different and our survey offers no insight into that question.

One thing that I am hopeful of is that some of these 2/3rds read my book so they are making an informed vote. I wonder what percent of the 2/3rds who said it is not a problem are actually obese? That might make for an interesting next survey, assuming I could figure out how to do that. For the record, I think obesity is a problem. As discussed in the book, I think obesity is a real problem among our youth that should be addressed via government policy. I also think obesity is bad for those businesses who are not in the business of profiting off of obese consumers. Businesses should (and do) worry about obesity the same way they worry about the high costs of health insurance. I expect they will increasingly take actions to address obesity in the workforce. Some of which will be hotly debated but the truth is thata healthier workforce (unless it comes at significant cost) is good for business. I also think obesity is a problem for government who has to pay the high costs of excess weight. Of course, as discussed in the book, the solutions to these problems are not obvious. Now, is obesity a problem for the obese individual, I also think the answer is yes, just perhaps less so than the problems that would arise if the individual were forced to lose weight. More food for thought.

So Iam happy to report thatthe book is starting to get a fair amount of attention (although certainly not all positive). Much of it is based off an article that was published that I think does a fair job introducing some of the concepts described in the book. You can see the article here http://news.yahoo.com/s/afp/20080110/hl_afp/lifestyleushealthobesity_080110170913

If you want to see what some are saying about what they think to be my take on this issue, you can see it here. http://kateharding.net/2008/01/11/open-for-discussion-obesity-now-a-lifestyle-choice/.

After his coverage of the Las Vegas porn convention, you can see what the Stranger’s Dan Savage’s readers had to say about me and the book here

http://slog.thestranger.com/

I also received an email from a 400 lbman who thanked me for writing the book. He is a member of the Girth and Mirth, aSouthern Californiagroup for large people and their admirers. He wanted to thank me for pointing out thatthere are people who choose to be obese for a variety of reasons.

Given all the bashing I’ve received from the bloggers,it was nice to get some positive feedback. The problem is that I’mconvinced that neither he northe vast majority ofbloggers have read enough of the book to understandwhat my position really is.

The point of the book is not to say whether or not being fat is good or bad. I merely am pointing out that changes in the economy are what is driving the rise in obesity rates.However, I disagree with anyone who says that being obese (note - not overweight but obese)does not increase risks for disease and disability. There is just too much evidence suggesting it does.But losing weight and keeping it off comes with it’s own costs, so people make choices and some people are choosing to weigh more than they would in decades past as a result of the changing economy. As I point out in the book, we could choose to live like the Amish and eschew technology (and fashion) but that is a large sacrifice to make to be thin. And for many, including myself, it’s not worth it.

For those who disagree with me and argue that obesity is purely genetic, I point to the rapidly rising rates of obesity over the past few decades. Genes just don’t mutate that quickly. This is not to say that everyone can be skinny, nor that there are not many people who are genetically predisposed to be overweight or obese, but the reality is that these people are the minority of overweight or obese people. If they were not, we would not have so many more of them today than 40 years ago.

Because of the adverse health risks, I think we are doing our kids a disservice by letting them fatten up before they are capable of making good choices (and I think choosing not to diet and exercise may be a good choice for some). This is no different than the age limits on smoking and drinking or mandatory schooling. Until kids are mature enough to make good choices, parents and goverment need to step in. What falls to the parents and when government should step in is a subject best left for another day.

Just after I graduated college, I worked in this popular sports bar in Ann Arbor. Believe it or not, I was the "cook". I made tons of fries, wings, burgers, and my specialty, the Philly chicken cheese-steak. In case you did not know, I am from Philly. Of course, nothing was healthy but we'll leave that discussion for another day. Today I was pondering the topic of discrimination, specifically when it comes to obesity. It got me thinking back to that bar in Ann Arbor.The owner and managers used to have a meeting after interviewing waitresses (we had no waiters) and decide on, what they called, their f@#kability rating. A high rating almost surely got them the job. A low rating and they had no chance. These guys were clearly pigs, and they slept with most of the waitresses (I slept with none, although not for a lack of trying), but that actually had little to do with the rating. You see, the thing is, the waitresses that scored well in the rating brought in lots of business, generated the most tips (of which I got a percent) and helped increase the bottom line for the bar.

Is this good business? Yes. Is it legal? Yes. Is it discrimination? Well, that depends on how one defines the term. For example, it's no accident that the girls from Victoria Secret all happen to have nice figures. Victoria Secret discriminates against people who do not have nice figures. They do it, of course, because more attractive women help them sell more bras and panties. The sports bar did it because more attractive women helped them sell more burgers and fries. Is there a difference? If so, it's more subtle than you might have initially thought?

So, what do you think? Is it ok for restaurants, say Hooters, to use physical features in their hiring practices? How about other worksites? In most states this is perfectly legal. What about weight, should firms use that as a guide for who to hire, or how much to pay them? Let me know what you think. Later this week I'll log on and give you my two cents. I just might surprise you.

If you are like me, you've probably already begun to fatten up for the winter. In fact, it is not uncommon for adults to gain 5 pounds or more between Thanksgiving and New Years. It is no wonder that American's most common New Year's resolution is to lose weight. With any luck, we can drop those extra pounds and be ready to go by next Thanksgiving. However, the reality is that most of us will fail in our efforts to lose the weight. Evidence suggests that 95% of those who lose weight fail to keep it off for at least two years. As a result, and as you've undoubtedly seen in countless news stories, Americans have a weight problem. Currently, two thirds of U.S. adults are above the normal weight range, making normal anything but.

So as Americans cascade out of the government's normal weight range, does this mean that it's time for government to step in and take measures to encourage citizens to do what we are incapable of doing ourselves and reverse the obesity trend?

Government isn't about to ban Thanksgiving, but in fact, policymakers at the state and federal level are increasingly proposing new legislation aimed at lowering obesity rates in America. At the federal level, these include such recently introduced bills as the Healthy Foods for Healthy Living Act, the Medicaid Obesity Treatment Act, and the Commonsense Consumption Act.

Many critics say that government, by trying to influence the weight of the population, is overstepping its bounds and trespassing on the rights of citizen's. What is becoming less compelling is the counter-argument that these intrusions are warranted on the grounds that they improve public health.

If you are substantially overweight, then weight loss would almost certainly do you some good. However, for those of us who are only slightly overweight, say 30 pounds or less, the evidence is less than compelling.

What evidence am I talking about? Evidence presented, in fact, by the federal government. A recent study by researchers with the Centers for Disease Control and Prevention reveals that mortality rates among those who are only moderately overweight are actually lower for noncancer, and non-Cardiovascular (CVD) causes that for those who are "normal" weight and not statistically different for cancer or CVD. A second study shows that today's obese population has lower cholesterol and blood pressure values than normal weight adults did 25 years ago.

So why then is government increasingly anxious for us to shed some pounds? It is not so we'll look better at the annual X-mas party or because weight loss will boost our self esteem and make us more attractive to the opposite sex. Although these might well be valid reasons for us, government has an ulterior motivation.

Whereas the health benefits of weight loss among the moderately overweight is debatable, there is no question that excess weight is taking a financial toll on businesses, insurers and you guessed it, on government. Although we might not be dying off early due to our excess weight, and our cardiovascular profile isn't looking so bad, the underlying reason is that we are increasingly counting on the health care system to take the place of what a healthy diet and physical activity used to do.

For example, of the top 25 most prescribed drugs on the market today, 10 of them target hypertension, high cholesterol, and diabetes, three diseases clearly promoted by excess weight. In addition, last year alone there were over 1.5 million medical procedures performed in the U.S. aimed at opening clogged arteries, another common problem among the weight challenged. The drugs and procedures are having the intended effect, but at a significant cost.

I published a paper several years back showing that overweight and obesity are responsible for about 9% of all medical expenditures in the U.S., or about $90B per year. Moreover, thanks to the Medicare and Medicaid program, half of this total is paid by us, the taxpayers. As a result, Each taxpayer finances about $180/yr for obesity-related medical costs in these programs. Indeed, these costs may be the government's primary motivation to get us to drop the donuts, strap on the gym shoes, and shed some pounds.

However, I want to point out one key fact that rarely makes its way into the obesity policy debate. Any effort by government to encourage people to lose weight, unless it saves more money than it costs, will only raise our taxes even more, regardless of whether or not it is effective at getting people to lose weight. Unfortunately, cost-saving obesity interventions have yet to be identified. So until they do, obesity may be taking two significant bites out of the government coffers.

Food for thought as we eat our way into the New Year.