MR. PAUL BROWNFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your community with the world. I'm NPR's Paul Brown sitting in for Kojo. Eighteen days into the new year, your resolve might be waning, and that diet you started on the 1st may not seem as appetizing today. But if you're like most Americans, you'll try to lose weight at least four times this year. So the odds are good that even if you've given up on one already, you'll give another new diet a try.

MR. PAUL BROWNAnd while today's fad diets don't revolve around grapefruit, cottage cheese, or cabbage soup, you at least had an idea of what you were getting into with those. The diet buzzwords of today don't tell us much. We'll find out a lot more about diet, nutrition, a healthful lifestyle and the sort of balance you may be looking for. You can join us by calling 1-800-433-8850, or you can email us at kojo@wamu.org. And once again, that phone number, 1-800-433-8850.

MR. PAUL BROWNWe'd love to hear about your pursuit of a balanced life through nutrition. Have you had a hard time losing weight? Have you wanted to feel better? How do you do it? How do you make sense? How do you work your way through all of the diets out there, the nutrition plans, all of the advice coming at you, and all the food being pushed on you from one direction or another, from home, to the food industry, to you name it.

MR. PAUL BROWNOur studio guest, Katherine Tallmadge is a licensed dietician and the president of Personalized Nutrition. She's also the author of "Diet Simple: 192 Mental Tricks, Substitutions, Habits and Inspirations," and she's the president of the D.C. Metro Area Dietetic Association. Katherine, welcome back to "The Kojo Show."

MS. KATHERINE TALLMADGEThank you. And I'm a registered dietician.

BROWNThat's good to know.

TALLMADGEThank you.

BROWNAlso with us, Lawrence "Larry" Cheskin, is the founder and director of the Johns Hopkins Weight Management Center. He's also a professor of health, behavior, and society at Johns Hopkins School of Medicine, and the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health. May I call you Larry, Larry?

MR. LAWRENCE CHESKINOf course, please.

BROWNGood. Welcome to "The Kojo Show." So as we get started here, and calls are already starting to come in, what is the key to a healthy lifestyle and nutrition? I understand about 75 million Americans are dieting at any given time, and they're a fickle bunch. What makes a fad diet so attractive, and what makes a good diet worth sticking with?

TALLMADGEWell, I hate fad diets. They take the joy out of eating and of living. They're depressing, demoralizing, and they're doomed to fail.

BROWNAnd why is that?

TALLMADGEAnd that's because by definition they're temporary. In fact, they should be temporary. Five things that you have to look for in a good diet are, number one, they have to be able to be enjoyed, and something you can follow for life. It has to be a strategy that makes you feel good, and it has to be a way of living that's flexible, and that science has shown can improve the quality and maybe even the length of your life.

BROWNLarry Cheskin, what do you think? Let's just sort of open the door here, and then we'll get into some more specifics.

CHESKINThat is certainly a desirable standard way to try to help people change their habits. I would say that I am often not as much of a purist as that, and I am willing to do something that is a little more aggressive that may not be in fact what you want to do for the rest of your life, but most people, particularly if they struggling with a large amount of weight they want to lose, adopting the healthiest of diets is not gonna make you lose 50 pounds, and you need to do something more aggressive, at least in the short term while learning what you can do to help maintain that. And it's difficult in or environment to maintain. It's very easy to slip back into old habits.

BROWNI want to come back to Katherine in just a second here, but Larry, specifically when you talk about doing things that are more dramatic, what would they be?

CHESKINWell, the program that I run at Johns Hopkins has a very in-depth assessment where we try to understand, yes, you may have five people the same height at weight, but they probably each got their -- a different set of ways. And if you just put people on a healthy diet or put them on a fad diet, you're not as likely to see targeted improvements as when you figure out, you know, what has trigged them straying from the path of good diet, and what has caused weight gain.

CHESKINAre they eating because they're stressed, are they eating, you know, in an unhealthy way, or are they eating healthy food and just in the evening semi-binging, and that takes a very different approach.

BROWNWhen you see some of those things happening, how do you counsel people? What do you say, say if someone appears to be eating in a fairly healthful manner during most of the day, but then binging at night on things that really will not help them maintain a proper weight and feel well, or if you see someone who just cannot seem to get away from some of the foods that we seem to be hardwired to like from some recent research I've seen, fats, sugars...

CHESKINYes.

BROWN...foods that were rare and hard to come by back in the early days when we were hunter gatherers, and that we would gorge on if we had the chance. What do you tell people?

CHESKINWell, first, I tell them that we really need to get to the bottom of it, that this is not completely a mystery. Nobody gains weight by I call it immaculate weight gain. Everyone who gains weight is eating too many calories for whatever their body needs are. So we can figure out where the extra calories are coming from and what they're doing, but what we really need to understand is what the circumstances are.

CHESKINIs this purely environmental, you know, the whole country is not getting heavier because we're all, you know, binge eating. On the other hand, some individuals may be binge eating, and the environment is pushing us generally in the wrong direction.

BROWNKatherine, what do you advocate? You gave us sort of the overview, what are some of the specifics for you?

TALLMADGEWell, a client shared a familiar story. She went to a spa, lost six pounds in a week, gained it all back after a few days of being home. She considered going on a cleanse or a liquid diet, but she was fearful that she would gain the weight back again, and I warned her, that is the dilemma with dieting. The dilemma is, once you're losing weight, you feel great, but too often the results are fleeting. The struggle has been going on for decades, and the challenge remains the same. You cannot diet forever, and at some point you must transition from the diet to an eating plan and lifestyle which maintains your weight and health.

TALLMADGEMy Diet Simple approach, and the approach of most people in the field of nutrition who study nutrition and weight loss, registered dieticians, are to start with that transition, to start in a way of eating that you -- that can last, and the studies are pretty clear that shrewd, small, simple changes which can be easily incorporated into your daily routine lead to success. That's my philosophy.

BROWNLet's go to the phones for a moment and talk with Jamie here in Washington D.C. Jamie, what's on your mind?

JAMIEHi, how are you doing today?

BROWNDoing great.

JAMIEWonderful. I just have a quick comment. First of all, thank you guys for both coming on. I think this is a very important issue to talk about. But what I wanted to say is that I absolutely hate the word diet.

BROWNMm-hmm.

JAMIEI think that it needs to be more of a lifestyle change more than anything. Just simply eliminating foods from your -- that will give you temptation. Not going out to eat, not -- knowing what you're putting into your body is really the important part. I've been doing this resolution diet, healthy lifestyle thing since January 1st and feel a million times better just from these simple things that I've changed in my life by not putting these types of things in my mouth.

BROWNWhat got you going on that? Why did you make this resolution this year?

JAMIEWell, I have always been active, all throughout high school (unintelligible) weight, but I kind of miss my body from high school, you know. It just...

BROWNMm-hmm.

CHESKIN...and the way I felt and, you know, staying active. So a part of going to the gym and then just also a lifestyle change.

BROWNJamie, what have you changed in terms of what you eat and what you don't eat? What -- describe your foods now, what's your nutrition plan?

JAMIEOkay. Well, I used to go out all the time to eat. I would go to, you know, Chipotle, or, you know, go to a restaurant and order whatever I felt like on the menu and not really give too much thought about what I was putting into my mouth. Since that time, I've actually gone to eat only once this year, and I was able to control what I put in my mouth, and have an apple instead of a cookie, and make coffee at home, and make sure I have the right amount of sugar, and all that types of stuff, just the little changes.

BROWNAnd how big of a difference has it made for you?

JAMIEOh, I feel great. The energy level is just amazing. I feel -- I wake up in the morning and I'm ready to take on the day, and I sleep really well at night now.

BROWNDid you predict that that might not happen? Were you, you know, did you feel deprived at all at first, and think, well, this is, you know, is this gonna really do anything for me, and then -- or did you really believe going into that that there would be some significant positive changes for you?

JAMIEWell, that's a good question. I'm not exactly sure what I wanted out of the -- what I was expecting out of it. Going to the gym I did not expect to like. I actually really enjoy it. And then as far as the energy and things, it's just -- I was (unintelligible) if you don't have these types of foods in your home, then you're not gonna have those cravings because it's nothing you're putting in your cabinet or in your refrigerator.

BROWNSo I take it you went around after the start of the year and just got rid of anything in the house that you didn't feel you should be eating and didn't want to eat?

JAMIEYeah. Well, I mean, I didn't throw it out, you know. I got rid of -- I ate whatever I had and then, you know, by the beginning of the year, I said, okay, no more.

BROWNMm-hmm.

JAMIEGoing to the grocery store is much easier now because it's just you can go there and you know what you like, you can make things delicious. You don't have to deprive yourself of delicious food, it's just finding different ways to satisfy yourself.

BROWNJamie, has it been hard for you to give up restaurant culture? I mean, restaurant eating is both fun for some people from the standpoint of food, or at least we think it is, and it's also -- a restaurant is a social gathering place. People love to hang out in restaurants and bars. They're the subject of TV sitcoms for heaven's sakes.

JAMIEOh, yeah.

BROWNHow difficult has that been from a social standpoint for you, and what have you done with it?

JAMIEYou know, it was actually really hard at first, because, you know, everyone says, oh, you know, let's go the bar after this, let's go to a restaurant, go meet there, but throw yourself a party. I have my little dinner parties almost every night whether it be one to six people come over to my house and -- or my apartment and just -- we just chill and have a good meal that I've prepared, and I actually take great pride in the fact that I'm making my own food and people are enjoying (unintelligible) .

BROWNWell, Jamie, thanks very much. Your story is certainly an interesting one. Katherine, do you have a comment here?

TALLMADGEI think Jamie's story is excellent. It's an excellent example of how small changes can make you feel great. And Jamie has found a way to socialize with food in his own home, he's not giving up the socialization of restaurants, he's made the best of it. And people tell me just after a very short time, after one small change like, you know, eating more fruit as snacks, or getting up in the morning and just doing ten minutes of exercise, that's enough to make a difference in how they feel.

BROWNLarry Cheskin, can you weigh in here as it were on what Jamie's found out through just doing this since the start of the year?

CHESKINWell, certainly I have nothing but admiration for Jamie. I would point out, though, that most people that I see, most of my patients, you know, would not find it acceptable to -- I think he said he hasn't eaten in a restaurant in two years.

BROWNMm-hmm.

CHESKINAnd that is not a small change. That is for what most people would be a rather extreme change.

BROWNThat's a profound change. So...

TALLMADGEI think you can eat in restaurants and lose weight, but there's a certain strategy you need to use.

BROWNMm-hmm.

TALLMADGEAbsolutely.

BROWNMm-hmm. We'll be coming back in just a moment. We want to take a brief break here. And Jamie, thanks again for calling "The Kojo Nnamdi Show." The number 1-800-433-8850 if you'd like to call and join the conversation about nutrition, lifestyle, a balanced life, weight loss. We'd like to hear about your successes, your failures, the areas where you want to improve, and we'll be back also with an expert from the Cleveland Clinic in Ohio after the break. Stay with us.

BROWNWelcome back to "The Kojo Nnamdi Show" on WAMU. I'm Paul Brown from NPR sitting in for Kojo today, and we're talking about diet and nutrition, weight loss, and a proper nutritional and health balance in your life. Call us at 800-433-8850. We have a number of calls on the line, folks stay with us, we will get to as many of you as possible, but this is a topic that clearly interests a lot of people.

BROWNWith us, Katherine Tallmadge, licensed dietician, the president of Personalized Nutrition -- registered, sorry about that. Let me get that right this time. And she is also the of "Diet Simple: 192 Tricks, Substitutions, Habits, and Inspirations." She's the president of the D.C. Metro Area Dietetic Association. Larry Cheskin is the founder and director of the Johns Hopkins Weight Management Center. He's also a professor of health, behavior, and society at Johns Hopkins School of Medicine and the Center for Human Nutrition at Johns Hopkins Bloomberg School of Public Health.

BROWNJoining us now also is Dr. Caldwell Esselstyn, Jr. He directs the Cardiovascular Disease Prevention and Reversal Program at the Cleveland Clinic Wellness Institute. He's a medical researcher and a clinician who pushes the eating of a whole foods plant-based diet, and the author of the book "Prevent and Reverse Heart Disease." Dr. Esselstyn, welcome.

DR. CALDWELL ESSELSTYNWell, Paul Brown, I thank you, and I'm happy to join with Katherine Talmadge and Dr. Cheskin with you today.

BROWNDelighted to have you with us, and full disclosure, I have taken Dr. Esselstyn's one-day workshop at the Cleveland Clinic on nutrition and health because heart disease runs in my family. There seems to be a genetic predisposition, and I wanted to get out ahead of this story myself and not suffer the same fate that my dad and several of the ancestors had, and so I found Dr. Esselstyn and have been on his program for quite a while with, I should say, great success.

BROWNIt dramatically lowered cholesterol level, and very, very good health outcome from doing this. So I'm hoping that I'll beat my dad, Caldwell, if I could call you by your first name on the show here, by, you know, 20 or 30 years. I'd love to get 20 or 30 years on dad, and I think he'd like it too. (laugh) But can you describe for us your plan briefly, and one of the things that I've drawn from my discussions with you has already emerged in our discussion on the show here, which is that you don't view what you are recommending as a diet. You view this is as a lifestyle. You view it as a way to live. Can you help us understand what you're advocating and how you see it?

ESSELSTYNWell, I should share with the other discussions that my group of participants or patients are pretty special because they've had a shot across the bow, but they've been very frustrated. They've had their first stent, maybe their second or third stent, maybe they've had a bypass, and they just don't want to have any more of these, or they've got symptoms of chest pain and they just would as soon try to avoid their stent or their bypass.

ESSELSTYNAnd what we pretty much have developed and discovered is that coronary artery heart disease, or the thing that causes heart attacks is truly nothing more than a toothless paper tiger that need never, ever exist, and if it does exist, it need never progress, and we ought to be able to reverse it. And so what we really have paid attention to is when you first look at the epidemiology of this disease, you'll find that even today there are still cultures on this planet where current coronary artery disease is virtually non-existent.

ESSELSTYNIf you were a cardiac surgeon hanging out your shingle in rural China, the Papua Highlands, Central Africa, or the Tarahumara in Northern Mexico, forget it. You better plan on selling pencils.

BROWNSo it sounds to a certain extent here as though what you're getting to is that it's what's in your food that counts.

ESSELSTYNAbsolutely.

BROWNAnd what's not in it.

ESSELSTYNIt's what passes through your lips everyday...

BROWNMm-hmm.

ESSELSTYN...that determines whether or not you destroy what all experts would agree is the inception of heart disease when you start destroying this magic interlining of the artery, it's carpet, we call it the endothelium, and it makes an absolutely magic molecule, nitrous oxide when it is there in plentiful amounts, really totally protects us. But we know now that there are certain foods in the American diet that literally every time you have them, within minutes your endothelial cells take a further hit or injury, and decreases their capacity to make our protective nitrous oxide.

BROWNNow, from reading your book, I understand that some of these foods includes oils, refined flours, sugars, things of that sort. So can you tell us, Caldwell, what you recommend briefly that people eat, and then I want to get some folks in on the phone and talk about some of the challenges that we've all been discussing in creating a healthful nutritional lifestyle. What do you recommend?

ESSELSTYNWell, certainly for somebody who comes in with heart disease, we want to immediately stop any further injury to the endothelium and that means we ask them to stop all oil.

BROWNMm-hmm.

ESSELSTYNAbsolutely drop of any kind of oil. Stop. Same thing is true of dairy. Casein injures endothelium, and the same is true of anything with a mother or another thing with a face. Meat, fish, chicken, and turkey gone, as well as the sugars, the nuts, the avocado and the caffeine in coffee. So once you get people to understand -- now, this is -- they're gonna say this is something like radical or extreme.

ESSELSTYNI will agree that it is a significant change, but I would think that we ought to apply the term radical or extreme to the diet that guarantees that Americans will be obese, that we have an epidemic of hypertension, epidemic of diabetes, epidemic of heart disease, 1.2 million stents per year. Now in addition to taking the gasoline out of the fire, we have to really emphasize foods that we think are going to be very powerful in assisting recovery of the endothelium and that would certainly be all these red, yellow, and especially the green leafy vegetables.

BROWNAnd your patients, I understand a lot of your clients have also achieved significant weight loss on this diet. I want to go to the phone now and speak with Ron if I could from Silver Spring, Md. Ron, tell us your story.

RONYeah. Well, I have -- I'm 54 years old, and I've been battling the -- I'm a heavy set person anyway, and I've been battling weight since I was a kid, and 15 years ago we started having some very -- I've been here 20 years. Fifteen years ago we started having some very mild winters here, and I started -- I said, you know, this (unintelligible) bike. So I started riding my bike in January, and I said, you know, I can do this all the time.

RONSo I started the riding -- it kind of snowballed. I just started eating better, I started changing my diet certainly Monday through Thursday. I still, you know, have my fun on the weekends, and that's a point I wanted to make just talking about what the doctor just said just now, you know, that is a bit extreme to get rid of all those fun things to eat. I kind of leave myself some wiggle room on the weekends, but certainly Monday through Friday until supper time I'm a lot more vegetables, a lot more fruit, you know, the six or seven fruit and vegetables per day, I'm at least that plus.

RONAnd just staying away from red meat and eggs and just all the bad things over the last number of years, like I say, I've been doing this 15 years, and initially I lost about 20 pounds, and I started at 230, and I've been in the 205 to 208 over the last number of years, and again, you know, I'm pretty happy, but all I'd like to stress is that, you know, some, you know, the word lifestyle change has come up several times during this conversation, and that's what it's all about, you know.

RONYou don't need to diet as long as you -- if you change your lifestyle to make it healthier and certainly I also advocate, you know, four or five times a week getting some, you know, good cardiovascular exercise, they go hand in hand, and once you start getting some success it kind of just builds and builds, and once you're used to it, it's like, okay, this is my life now. I'm happy with it and it works, it's healthy.

BROWNSo at that point you don't want to give it up, but you've got to have some will power at the beginning, Ron, it sounds like.

RONWell, you know, okay. I'm the type of person I have pretty strong willpower, but this wasn't even, you know, it's not -- willpower's not that necessary because it kind of just trading bad things that you used to eat for good things that still taste good. I mean, a lot of like a lot of raw carrots, like baby carrots.

BROWNMm-hmm.

RONThey're sweet, they're wonderful, and they're just good for you. I eat at least an apple an day which is, you know, Ben Franklin's old staple. And, you know, apples are, same thing, they're absolutely delicious.

BROWNHas it kept the doctor away?

RONWell, you know, the thing, my doctor -- I've had the same doctor for 12 or 13 years now. I see him twice a year, and every time he looks and his mouth drops and he goes, you're amazing. You're the only 54 year old person that I know that I see that every time I see you, you're a pound or two less, and your cholesterol is down, and you're just in better shape than the last time I saw you. And I said, well, you know, I said, well, maybe everybody should get on a bike, or start just a slight regimen of workouts per week, and just order more fruits and vegetables, and stay away from the red meat and eggs and cookies and junk food, and again, you start feeling so good about it that it just kind of -- it kind of feeds on itself.

BROWNWell, Ron, listen, thanks for calling. This is a tremendous story, and you're willpower could become the stuff of legend. I want to get all three of our experts in on this next question here, and so Caldwell Esselstyn, I'll be back with you with in a little bit. Stick with us here, because I want to get everyone talking. Katherine Talmadge and Larry Cheskin, it seems that one of the keys to creating some sort of balanced nutrition program and a lifestyle that is healthful and that you can continue, and each of the three of you has described things that people might try, takes a certain amount of willpower.

BROWNSo where do you get that, and how in your professional lives do you counsel your clients to pull together the willpower they need to make what would be a pretty profound change for most people in a society which is constantly pushing process foods of all sorts at us from every possible angle, billboards, TV, handheld devices. You walk down the street and you see signs advertising foods that you know may not be good for you. So how do you work with your patients? Let's go around the circle here and go to Larry first.

CHESKINWell, it's -- obviously this is a critical question, because there is nothing that is that rocket science about how you control your weight and have a healthful appetite. We understand that very well. It's doing it that's the difficulty, and motivation is a very tricky thing. Sometimes motivation arises from what we sometimes call teachable moments. You know, you have, as you described Paul, you have a father who dies at an early age, or you have something that is -- that brings it up in front of your nose.

BROWNYeah. Caldwell says a lot of his patients have had what he called a shot across the bow.

CHESKINYes. So that is certainly a motivator that can work, although remarkably enough, unless you're in the intensive care unit in a hospital, sometimes even that fades rather quickly for most people, because we don't want to think about it, and it is very difficult to make major changes, so...

BROWNBut say if you don't even have that, if you're just overweight and you're sick and tired of being overweight, and you really want to lose some weight, what do you do? What do you say to your clients?

CHESKINI think some role modeling is important, so it's very difficult for us as care providers to, you know, just like the cigarette smoking doctor can't sit there and say you should quit smoking...

BROWNMm-hmm.

CHESKIN...somebody who's not watching their diet can't advise people to do something different from what they're doing, and also role models within the family. If you have a family member or friend, there've been numerous studies now showing that it's not, you know, just what we eat, it's what our friends eat that will influence what our body weight is and what our diet is. Controlling the sort of micro environment in your home is very important. If it's simply not there, you're unlikely to jump in your car and go drive to, forgive me Dunkin Donuts, but if it's sitting on the counter, it's got your name on it.

BROWNKatherine Talmadge, what do you do to help your clients in a situation like this?

TALLMADGEWell, number one, I've had the problem myself. I grew up with a mother that fought weight her whole life, and I chose nutrition in college without realizing the influence my mother had. She suffered so much. I really wanted to help other people with this problem. I'm passionate about it, and I understand what people go through. And I have to say, there are many studies of successful weight loss maintainers, and they rarely do anything extreme.

TALLMADGEA vegan diet is an option, but not the only option to reverse heart disease for instance. It happens to my clients every day. I reverse diabetes, cholesterols plummet by a hundred points, and that's on a diet that they enjoy. You talked about the environment. We do live in an obesogenic toxic environment for this problem. So one of the things that I have to do as a weight loss counselor is teach people how to overcome those societal barriers, how to make realistic attainable goals, develop specific action plans, control their environments, as well as create a system of support in their family and among their friends.

TALLMADGEExpecting occasional slips is very important. We know that people who are successful at maintaining weight loss have just as many slips and stressors in their lives as people who relapse, and whereas people to relapse will feel devastated by a slip. So there are several factors that we know will help people lose the weight, make changes in their habits, reverse heart disease, lower their weights, and do it permanently but with flexibility, choice and enjoyment.

BROWNCaldwell Esselstyn, how do you help patients make what could be a fairly profound lifestyle change in your case, since you advocate an oil-free, vegan diet? What do you tell your clients?

ESSELSTYNPaul, first of all, let me correct it that we really don't -- I treat vegans for heart disease. Vegans eat French fries, vegans eat oil, and vegans eat glazed donuts. So yes, we're really seeking that patients should follow a whole foods type of plant-based nutrition. But I think that I greatly respect what Dr. Cheskin and Katherine Talmadge have said. Our approach is a little different in that I think there is a sort of totally mistaken concept presently by the cardiology community that the reason that they don't talk about lifestyle is they feel patients won't follow it.

ESSELSTYNWell, if you really ever followed the training of most cardiology physicians, they really don't have a great deal of time that is spent on lifestyle modification. And what we try to do is we're synergistically in the spirit of cooperative endeavor with our cardiology colleagues that take over this part of the dimension of the care of the patient, and when it comes down to willpower, that's not gonna really be the answer.

ESSELSTYNWhat we found that really seems to work is if we show the patient respect, and I think the greatest way that a physician can show a patient respect is by giving them time. And we have a program that really is a very intense counseling seminar that I conduct at the Cleveland Clinic Wellness Institute that is five hours long, and we know that if a patient with heart disease from California, Texas, or Florida, they can't come and spend days at a time in Cleveland.

ESSELSTYNSo they come with a spouse coming for free, and we usually take about 10 or 12 participants at a time, so we have about 24 or 25 in the room, plus several physicians who may be apprenticing with us, and that whole five hours is spent initially having them fully understand in terminology and vocabulary about how it is that they developed this disease in the first place. So whether it's a high school dropout, or whether it's a CEO of a company, they're gonna understand exactly what went on and caused them to have this heart disease, and then we're gonna tell them exactly what they can do to halt any further injury and to begin to reverse this.

BROWNI'm hearing from...

ESSELSTYNAnd so this is further motivated by the fact that we can show them the angiograms of patients from our earlier study...

BROWNMm-hmm.

ESSELSTYN...where they did reverse their disease.

BROWNMm-hmm. Well, so I'm hearing here three things -- role models, appropriate goals, and taking adequate time, plus the very important issue of having the respect for the client or patient that one would want to have accorded to one's self, and that that simply helps -- it can help you can achieve a goal when you know that you are respected. So these are some very interesting tools it seems to me to help people attain and maintain a healthful weight and good physical conditioning and chemical balances inside the body.

BROWNWe'll be back in just a moment. We want to take a brief break, and we'll go to the phones. If you're waiting on the line, I know we have a number of calls. I hope you'll stick with us, and we'll back in just a second. I'm Paul Brown of NPR, sitting in on "The Kojo Nnamdi Show." Stay with us.

BROWNWelcome back to "The Kojo Nnamdi Show." We're discussing diet, health, nutrition, and a balanced lifestyle. I'm Paul Brown from NPR sitting in for Kojo, and with us today Katherine Talmadge, a registered dietician, president of Personalized Nutrition. Lawrence "Larry" Cheskin, the founder and director of the Johns Hopkins Weight Management Center, and Dr. Caldwell Esselstyn, the director of the Cardiovascular Disease Prevention and Reversal Program at the Cleveland Clinic. Thank you all. Let's go to the phones here and see if we can speak with Melinda in Washington, D.C. Melinda, what's on your mind today?

MELINDAWell, actually I have a comment and then sort of a couple of things to pose.

BROWNMm-hmm.

MELINDAThe first thing is I do think it's very important that we consider the socioeconomic factor. This is a topic near and dear to my heart because it's also the business that I'm in and, you know, study after study shows that those who are in a lower socioeconomic group have a much more difficult time, and that, you know, in general have a lot less access to care. So that's sort of a comment that I think need to be put into the mix.

MELINDAThe other piece is the fact that, you know, despite our great efforts as clinicians, the recidivism rate is enormous. I mean, you could pick a number, 90 percent, 95 percent, and for sure as one of your panelists said, there are wonderful long-term success stories, but if you look at the aggregate, the recidivism rate is just quite awful. And given that, when you start moving into the obese, morbidly obese, overweight with co-morbidities, I would -- I think one of the things that important to consider, and I'm interested in hearing your panelists comment on this, is weight loss surgery, bariatric surgery, because it is at the moment the only solution that has a long-term positive effect particularly with people where you're looking at hypertension, diabetes, et cetera. So that's my comment, and I thank you very much, because this, as I said, a fascinating show for me.

BROWNThank you very much, Melinda. Let's go to Larry Cheskin first, who may be able to address this. What about weight loss surgery? And we'll go around the group again.

CHESKINWell, I will get to weight loss surgery. I wanted to comment briefly, because this is a very important point about socioeconomic status.

BROWNMm-hmm.

ESSELSTYNAnd yes, unlike in developing parts of the world where the richer you are, the more likely you are to have a weight problem, in the United States it's the opposite. And part of this is, you know, Dr. Esselstyn's diet is wonderful, it clearly shows great benefits like the Dean Ornish approach, slightly different.

BROWNRight.

ESSELSTYNBut it's a more expensive way to eat, and requires more food, shopping, preparation, et cetera. So it's less convenient, and in the United States at least, poor people will have a hard time following not just, you know, motivation wise, but paying for and doing that sort of plan. I think our food policies could be another whole hour's talk, but, you know, emphasize foods that maybe not the best for us, which is a problem. And recidivism, we can learn a lot.

ESSELSTYNI think Katherine mentioned -- I think she was talking about the National Weight Control Registry, you know, where we can learn what successful people who have lost weight and kept it off, do.

BROWNKatherine, what is successful? What do you recommend specifically? You have, I think sort of a list of practices that you give to people.

TALLMADGEWell, how to make resolutions successful.

BROWNMm-hmm.

TALLMADGENumber one, you have to realistic attainable goals, and they should be about what you're going to do, not what you're going to be, and very simple. You have to develop a specific action plan, publically declare your resolution, track your progress by recording, arrangement your environment so that it helps rather than hinders, and reward your successes, expect occasional slips, cultivate social support. These are all established behaviors that behaviorists have shown and the Weight Loss Control Registry has shown are necessary for prolonged sustained benefits.

BROWNMelinda, does that make any sense to you?

MELINDAOh, absolutely. I think, you know, these are things that, you know, across the board I think everybody understands. I think the big thing is though that it is pretty indisputable that there is a huge recidivism rate, and for those people, you know, time and time and time again, the frustration of losing, gaining, losing, gaining, I think becomes exhausting actually.

TALLMADGEThe reason that happens is people go on fad diets. They're not adopting changes that can last. Fad diets cause yo-yoing, and we've got to as a nation stop encouraging people to go on diets that they can't maintain. The obesity epidemic, it's the single greatest threat to public health in this century.

BROWNNow, I think we have an agreement there amongst all three of our panelists today, that this epidemic is a serious threat to public health. Dr. Esselstyn, many people would consider your plan to be somewhat radical, both from its low fat content and as Larry Cheskin here said, the relative difficulty of preparing the food and the cost. How do you help your clients achieve a long-term adoption of your program and counsel them so that they don't experience recidivism?

ESSELSTYNWell, as I said, the most important thing is to give them the time and the education, and it's amazing the amount of material that we can supply in five hours. One of the things that I wanted to mention earlier too is that what becomes so powerful for the patients who have cardiovascular disease, is that they are going to know full well that they themselves are the locusts of control for this disease, not the cardiologist, not the drugs, not the operations, not the stents or the bypasses. They themselves are the locusts of control, and that is such an incredible gift of power to them.

ESSELSTYNAnother thing we found out that we're just now reviewing our last 200 that were preparing for a peer reviewed submission in a peer review journal, and it's interesting. We're running about a 90 percent compliance, and we're very pleased with that. One of the things that we think is important also is that these 10 or 12 participants are very willing to share emails and phone numbers so that they can continue to support and contact each other when they leave, and we think this is a very important adjunct. But we're quite pleased with the 90 percent that we've been able to identify.

BROWNI want to get Larry Cheskin in here. He's got a comment and possibly a question, but Larry?

CHESKINWell, yeah. I was just wondering about your response to Paul's question about, you know, practical issues are we dealing with, you know, educated, relatively high socioeconomic people, or what?

BROWNOne of the things that Caldwell seems to be saying is that persuading people that they are in control is helpful, but what about the socioeconomic side of it, because it can be both expensive and time consuming to comply with your plan.

ESSELSTYNI think that's an excellent point that has to be addressed, and we find that the foods that we are asking these people to eat, really can be obtained at a very reasonable price. I think the classic example of this is that I was recently in a film that was out last year called "Forks Over Knives," and one of the persons in that film was a wonderful African-American woman who was 38 years of age, SanDera Nation, and she had never even heard of what asparagus was when we started, and she was diabetic and she was considerably overweight, and she absolutely marvelous in the way that she really took hold and really got this job done, and she's an absolute star.

ESSELSTYNBut she -- I use her because she's such an example of how people who perhaps have not had all the benefits or the financial resources equally can do this if you're willing to spend the time with them and show them the basics and how they can shop and prepare these foods without having costs get out of control at all.

BROWNSo to a certain extent you seem to be saying that the idea that the foods are vastly more expensive, or significantly more, may not actually be true?

ESSELSTYNYeah. That doesn't --when you really get into and look at it carefully, my son, Rip, who is a retired fireman who wrote the book "The Engine 2 Diet" who now works with Whole Foods, they've really gone into quite interesting detail and you can do this very economically when you're creative with it.

BROWNYeah. Well, thank you very much. Let's go to the phones here to Scott, and Scott, if you are still with us, I think you have a pretty interesting question. It's one we haven't considered so far this hour.

SCOTTYeah. Mine's kind of on the opposite end of the spectrum. I'm 23, and I'm six foot, but I weigh about 135 pounds, and I exercise about four times a week. So I was wondering if there were any healthy ways that I could gain some weight so I could get to a better body weight.

BROWNLet's go all around the table here. Why don't we start with Katherine?

TALLMADGEWell, of course, you know, I work with a lot of people who need to gain weight, and, you know, for those very, very thin folks out there who need to gain weight, do you know that it's harder to gain weight if you're naturally slender like that, than it is to lose weight. I know people who want to lose weight just want to strangle them. But (laugh) ….

BROWNI've had that experience. You can't see me, but I've had that experience.

ESSELSTYNGod, I love an honest woman.

BROWNScott, I'm your type. This is a question that I'm very interested in hearing the answer to.

TALLMADGEBut in terms of our obesity epidemic, we really need to improve nutrition literacy, cooking skills among families, schools need to provide education, nutrition education, preparation. Really our emphasis should be on prevention, changing our environment. In the meantime, those of us in the trenches who have to help people hear and now improve their health have ways of helping people overcome those barriers of not being educated in schools, but our country needs to do a better job of educating people so that we can prevent obesity.

BROWNLarry Cheskin, if you had to gain weight, how do you do it?

CHESKINYes. Well, Scott, to more directly address your question about how to gain weight, you know, in a safe, healthful way, it would obviously be best to see a dietician to get specific advice, but generally speaking, sort of the opposite of what we tell people to lose weight, in that you want to do higher energy density foods. So in this case, Dr. Esselstyn's diet would not a good approach of eliminating all oils. Oils and fats have nine calories per gram. We eat to volume as much as we do to calories, so your body recognizes a stretching stomach more than it does your body calculate the number of calories you've eaten.

CHESKINSo you want to get in a large amount of calories in a relatively small volume would be the approach, and to just keep reminding yourself to eat regularly through the day and not save it all for dinner.

BROWNCaldwell, what if you were slim and still have a predisposition to heart disease and you really want to gain a little bit of weight? We only have a moment or so here, but what would you recommend since you do not agree that eating oils is a good thing, so we've got several perspectives here. But if you had someone who had a predisposition to heart disease, but still need to gain weight, what you tell them?

ESSELSTYNWell, I certainly don't think I'd ask them to eat more -- a greater volume of foods that are going to absolutely injure their endothelium, but there's no question that as Dr. Cheskin points out, they definitely need a balanced program here where they are getting more in the way of calories. And somebody like this, I would encourage them to eat perhaps extra snacks throughout the day that are nutritious, that are healthful, that are not gonna create injury, maybe extra bowls of cereals.

ESSELSTYNSometimes people like to get rice mixed with mushrooms and peas, which is an extra bonus when you heat it up in the microwave, maybe it's gonna be a whole wheat bagel with some hummus that doesn't have tahini or olive oil in it. In other words, there are creative ways that we can work with those people to help them from losing weight. We always have a saying though that our average weight loss in the program is 18.6 pounds for those that are losing weight, and I always reassure them by telling them that look, we have never had anybody disappear. (laugh)

BROWNWell, thank you. Scott, does that help you at all, the -- our answers from the three panelists here?

SCOTTIt did, yes. Thank you very much.

BROWNWell, I certainly hope that you have some success moving it up above where you are now if you feel that you're a little more slender than you want to be.

ESSELSTYNI have one little comment I can make...

BROWNSure.

ESSELSTYN..and that's we've -- there's a recent study out about athleticism and staying lean and hard and fit, and it just goes to show you how you cannot really isolate yourself away from vascular disease. There was a group of 100 Germans who were marathoners, and the requirement for the study was they had to run two or three marathons a year before I think their average age, something, was about 55. Ninety out of those hundred had cardiovascular illness when they were carefully studied.

ESSELSTYNSo really it's something that somehow we've got to get into the educational environment to really make these people begin to eat more sensibly, because right now when we graduate people from high school, not only do you get a diploma, but a hundred percent come out with coronary artery disease proved by autopsies of those who died of accidents, homicides, and suicides.

BROWNSo you're looking for a way around that. Listen, I want to thank all of you. This has been a fascinating discussion. Katherine Talmadge, registered dietician, president of Personalized Nutrition, author of "Diet Simple: 192 Mental Tricks, Substitutions, Habits and Inspirations." Larry Cheskin, the founder and director of Johns Hopkins Weight Management Center, and Caldwell Esselstyn, director of the Cardiovascular Disease Prevention and Reversal Program at the Cleveland Clinic.

ESSELSTYNWellness Institute.

BROWNThank you very much. And thanks to you all. Appreciate your being on the air with us on "The Kojo Nnamdi Show" as we've discussed nutrition, health, and a balanced lifestyle. Hope we can all talk again soon.

CHESKINThank you.

BROWNI'm Paul Brown from NPR. You've been listening to "The Kojo Nnamdi Show," and thanks so much for being with us.