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Now, I tell that story so you can think about that behavior change, that investment, that prior predisposition compared to the challenge of tobacco or obesity. I think a moment’s reflection will persuade any of us that we are really not yet serious about the investment needed to make significant changes in smoking, eating, and activity behaviors, although we have had significant success in reducing tobacco use. The 50 million people who are former smokers is an extraordinary success, but one fact that wasn’t mentioned this morning is that, on average, the remaining smokers smoke more than the people who quit smoked before they quit. We are getting down to a harder core than in the previous smokers, and we still have the problem of new beginning smokers.

Now, to our question about policy for tobacco and obesity, I think first there are meaningful lessons to be learned from the tobacco story thus far, because it is a tremendous partial success. The lessons to be learned and to be translated include the scale of investment subsequent to the tobacco settlement that has been deployed and, in public health terms, lavished on the problem, the degree of success yet with still more to do, and how far we are from similar progress in obesity. If we had done a color chart of the country’s smoking rates like the color chart of obesity rates we saw this morning, it would have gotten progressively lighter but there would still be plenty there to work on. The main message is that the scale of commitment required is orders of magnitude beyond where we are accustomed to thinking in preventive programs aimed at fundamental behavior change.

For obesity and for tobacco, the amount of investment is still not where it needs to be. The reason for that is simply that there isn’t any one entity with the resources that has an interest in making the changes in the right direction. It is a social good for which social investment is required, and that is hard to mobilize. Part of our task is thinking together about how we can and will be successful in mobilizing the necessary investment. I am eager to hear what stimulating thoughts others here have and what we can discuss together.

Dr. Robert Croyle, Director, Division of Cancer Control and Population Sciences, NCI: One of the lessons of the tobacco control movement from a science perspective is that there were a lot of programmatic activities that we tried out early on in school-based prevention and other domains that were not terribly informed or effective. One of the reasons was that we grossly underestimated the importance of addiction and that we were dealing with an addictive drug. Once that was more clearly recognized, we were able to bring to bear pharmacological agents to help deal with the addiction, and we were able to double cessation rates.

Therefore, in obesity and physical activity, given so much of the research effort is focused on obesity and weight loss at a clinical level as opposed to the public health effort, we, in collaboration with CDC and others,



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