I was recently a guest speaker at the Milken Institute Public Health Summit 2016 in Washington, D.C. along with experts in academia, government and the private sector on the front lines of fighting the obesity epidemic everyday. I participated in a panel entitled “Waistlines of the World: An Update from the War on Obesity,” moderated by CNN Correspondent Cristina Alesci.

The global obesity epidemic is worse than we thought. A study of 200 countries shows that 1 in 8 people are obese.

And according to a the CDC National Center for Health Statistics, 20 to 39-year-olds in the United States have an obesity rate of 36%². This age group is relatively young and relatively disease free, but they may be stressed about their economic situation. Often the answer to stress is a soft drink or chips and they may not have the time to exercise adequately.

So how do you change behavior? There’s a lot of science on that. There’s something called the Prochaska and DiClemente’s Stages of Change. You make them aware, you educate them, you move them to action and once they take action, you continue to reinforce that action over time so that they maintain it.

Some very sad data about exercise gyms came out in the Wall Street Journal last week showing that for most gyms by the end of one year they only have 7% of participants in the gym. It’s a little better for cross fit and cycling. But very, very discouraging results. So what I think what’s needed is a person-to-person contact, beyond our technology. And we have evidence now that there are these mirror cells in the brain which are involved in autism and when you look in someone’s eyes and scan both brains as you tell a story and engage someone, the two brains start to “light up” in the same places. So you can get a person to understand where you’re coming from. There aren’t enough doctors and pharmacists and dieticians to do this so I think we need to get to the public; we need to get to the lower socioeconomic groups where this problem exists. And we need to go to a person-to-person change model where people are incentivized to change and then reinforce with ongoing care where somebody calls you up and makes sure that you’re staying with that behavior. We don’t have that now in public health. We have pronouncements, but we really need to reinvent our intervention for this particular problem.

Medicare announced with a great deal of fanfare their intensive program for Type 2 diabetes with just a very few visits. I think for this particular problem you almost need daily contact. And that’s why moving to a public intervention model at the right socio economic level is very important. There is a book, The Health Gap: The Challenge of an Unequal World, by Dr. Michael Marmot. What he talks about is we have all of the physiological lists like exercise, eat less fatty foods, etc. But there’s another list: Do you have a job? Is your neighborhood safe? Do you have a place to exercise? Does your employer give you time to exercise? Until we deal with the social determinants of health, obesity is going to be very much determined by that.

And Dr. Nicholas Christakis at Harvard has documented this in the Framingham community where he looked at obesity over a 32-year period and he found that if you knew people who were obese you were more likely to be obese and if you knew people who were thin, you were more likely to be thin, based on BMI data. So this social interaction and connecting people together is very important… it has to be multidisciplinary with exercise, psychological support and the education all needs to be part of it. But what we know is that there’s not enough protein in the American diet. They eat a little bit for breakfast, a little bit for lunch then a huge amount for dinner, much of which they cannot utilize. So it’s about exercise, protein, psychological support and getting contact with people. I think it’s almost a daily social modeling for another person. You have to model the behavior yourself.

Our red meat has changed since we were kids, and not necessarily for the better. We used to use meat tenderizer as an enzyme to make it softer. Today the cattle are raised to have a lot of fat inside the muscle to make it tastier and add more flavor. The extreme of this is Kobe beef in Japan, which is mostly fat with little tiny bits of red meat. And I think plant based proteins are something we need to advance and the dietary guidelines talked about healthy eating patterns including a vegetarian eating pattern. I think the Millenials are embracing a more plant-based diet and many of them are semi-vegetarian or vegetarian in their eating practices from a health standpoint. So I think that we’re seeing some movement in American dietary practices. By the time the dietary guidelines have gone through the meat grinder of politics and influence, what comes out is a message that, in television terms, is a message with a really low ‘Q’ factor, it doesn’t really motivate people. People don’t pay attention to the advice. It’s too vanilla, if you will.

People need to be learning how to get low-fat proteins in their diet, reducing refined grains and increasing fruits and vegetables, it’s not rocket science, and get 45 minutes of exercise every day. If you do those things in combination then incentivize people, economically or otherwise, to do that … I think that’s the solution to the obesity epidemic.