50 MILLION MEMBERS BY 2010

America is the fattest nation on the face of the earth. And in the last 20 years, America has become the fattest nation in civilized history. What does this mean? To begin with, it means that 97 million Americans-55% of American adults-have been clas- sified by the National Institute on Health as carrying so much extra poundage that their weight consti- tutes a serious threat to their health. It means that 58 million American adults have now been classified as "clinically obese." As such, they are substantially more vulnerable to almost every con- ceivable health problem. And it means, says Dr. Gordon Jenson, Director of Clinical Nutrition at Vanderbuilt University's School of Medicine, that obesity, which is now killing over 300,000 Americans every year, is a "crisis of epidemic proportions."

Stress is also pandemic in American society. 38% of Americans now state that they "always feel rushed." Some 60% of Americans feel that stress is negatively effecting their health, and 78% of Americans say that they need to reduce the amount of stress in their lives. Americans lead the world in per capita consumption of stress-related medications.

Every day, millions of older Americans become progressively disabled. With each passing year, they lose more and more of their ability to perform such basic functions as walking, or getting in and out of a car or chair. Their risk of complete disability, mental and physical, increases each and every day.

America's health care system is riddled with contradictions. For example, millions of Americans are subject to chronic illnesses, such as hypertension, arthritis, diabetes, osteoporosis, heart disease, depression, anxiety, and sleep disorders. And yet, for all of these conditions, there is an acknowledged,

proven, and cost-effective therapy. Sadly, most of the men and women who suffer from these condi- tions have neither the confidence, competence, nor support needed to utilize this therapy. America also spends more on medical care than any other nation in the world. In 1998, Americans spent more than a trillion dollars on health care-almost 15% of the nation's Gross National Product (GNP). Whether measured in per capita spending (almost $4,000 per person per year), or percentage of GNP, the U.S. spends 30% to 70% more on medical care than any other industrialized nation in the world. Yet, despite this outlay, America ranks nowhere near the top in the longevity of its citizens, public satisfac- tion with the nation's health care system, or any basic measure of healthy living.

In many ways, America's health care system is the envy of the Western world. Many of its leading hospitals and leading physicians are justly regarded as world leaders in every branch of medicine. America leads the world in medical research and medical technology. Yet, today, America's health care system spends 98% to 99% of its resources on diagnosis and treatment-on taking care of people after they become ill-rather than on preventing illness in the first place. Even today, America's primary care physicians receive virtually no training in prevention, health promotion, and health education. Nor are they taught how to motivate patients to take better care of them- selves. These physicians, who comprise the very front line of American medicine, receive no reward, recognition, or other kind of motivation to help their patients live healthier lives.

Dr. C. Everrett Koop, the former U.S. Surgeon General, puts the implications of this failure in the starkest possible terms: "Under America's present health care system you had better take charge of your own health because no one else is going to do it for you."

THE FORCES OF INACTIVITY
America has an educational system that produces more inventors, entrepreneurs, Nobel Prize winners, scientific and literary leaders, and technological breakthroughs than any country in the world. But it is also an educational system that, year after year, in state after state, has progressively abandoned its commitment to providing daily physical exercise for its boys and girls, aged six to 18. As a result, America's children are now following their parents' example and are becoming the fattest young people on the face of the globe. Today, roughly one in five American children is clinically "obese." This percentage increases every decade.

America is the greatest food-producing country in the history of civilization. Its food production and food marketing industries, the envy of the whole world, spend billions of dollars every year relentlessly encouraging Americans to eat more, drink more, and snack every chance they get. This industry invents scores of new foods, new snacks, new drinks every year. America's restaurants compete on seeing which can offer the biggest and greatest number of helpings, the fullest portions, and the most gargantuan menus.

America has the largest and most aggressive television industry in the world. Its television programming is incessantly marketed in every conceivable medium. Millions of Americans now have between two and five television sets in their homes. Experts predict that Americans will soon choose from as many as 500 television channels, each one beckoning viewers to settle in, become more sedentary, and lose themselves in lethargy. Nor will the television industry have much trouble doing so. Americans are the most prodigious television viewers in history. Today, America's children spend 10 times more hours watching television than they spend in all forms of outdoor activity.

America has become the greatest automobile culture in world history. More Americans own auto- mobiles than any other people on the face of the globe. Millions of American families now have two or three cars to make sure that no one ever need walk, bicycle, or make any physical effort beyond turning the ignition key of their automobile when they want to get somewhere. The entire culture of suburbia is predicated on non-stop car travel from place to place. Once daily walking was a normal part of everyday urban or rural life. Now most walking occurs to and from a car.

America invented, and continues to lead, the modern computer industry. With each passing year, more and more Americans spend more and more of their work lives staring into a computer screen. The computer is an enormously positive and productive force in the business and educational life of our society. But it is one more force conspiring to make every Americans less active with each passing year.

These, then, are the daunting array of forces facing America's health club industry: Almost every major force in society-e.g., the automobile, computer, entertainment, food production and consumption- urges Americans to become sedentary and fat. And so here lies the great challenge facing America's health club industry: To prepare itself to resist immense cultural forces which, left to their own inexorable ways, would drag the country down into a collective lifestyle consisting of two primary activities: sitting and eating. It is in the context of this immense challenge that IHRSA and SGMA launch their 50 million member plan.