While in Hong Kong, I once stood at a busy intersection waiting for the light. A Chinese woman walked up, peered into a cage of full of chickens and quickly pointed to one. The attendant reached in, pulled out the chicken and with a meat cleaver promptly removed its head. He tossed the chicken into a barrel of boiling water. In no time he pulled it back out, plucked it, carved it and rolled it inside a scrap of newspaper. The lady tossed a few coins into the man’s palm. He handed her the package, and she promptly joined me in the crosswalk as the light changed.

Traditional Chinese value food still teeming with life. In contrast, public health education has taught Americans that food is fuel and to consume specific amounts of recommended nutrients. Fast food changed all that. Now, Chinese and Americans suffer from obesity at alarming rates.

Obesity worries the Congressional Budget Office, which sees the problem as one of gripping importance to the economy. In a recent brief the CBO reported that:

» From 1987 to 2007 the fraction of overweight adults increased to 63 percent from 44 percent while the share of obese adults more than doubled to 28 percent from 13 percent.

» Health care spending per capita for obese adults exceeded that for normal adults by 8 percent in 1987 and 38 percent in 2007.

» If obesity continues to rise at its current rate, health care spending for all adults will rise to $7,760 in 2020 from $4,550 in 2007.

How do we trim pounds and dollars? Consider Slow Food, a global association founded in Italy to stem the tide of mindless calories from fast food and the "disappearance of local food traditions and people’s dwindling interest in the food they eat, where it comes from, how it tastes and how our food choices affect the rest of the world." There is a huge difference between a piece of fruit grown on a giant farm on the mainland and sent by container ship compared with one grown on the islands and sold to you with a smile by the local farmer in one of our farmers markets.

Michelle Obama set a wonderful example for the urban population when she planted a vegetable garden with inner-city children on the White House grounds. In its first year the garden harvested an estimated 1,000 pounds of produce, which was shared with homeless people and United Nations diplomats alike.

We’re told that Oahu’s population is too large to achieve self-sufficient food production. Perhaps, but we can certainly do better. My family decided to pull out the ornamental plants on our modest bit of aina and plans to optimize the space for an edible garden. If you live in an apartment or condo, consider joining a community garden.

Edible schoolyards can make a big difference in the way children develop their relationship to the earth and to the food they eat. To plant a seed, tend a garden and enjoy the harvest is an experience that will be remembered for a lifetime. To bring that harvest into the home, cook a meal and share it with loved ones will leave a child forever changed.

When I care for an obese patient, we usually try to agree on one doable change at a time: hold the soda, curb the fries or katsu, only one scoop rice. This approach often enables people to shed some easy pounds. But durable change will only come about when we, as a culture, shift our relationship to the food we eat by cultivating an interest in how it is grown and where it comes from. Remember to take time in life to prepare and share healthy meals with people you care about.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc., www.manakaiomalama.com. Submit your questions to info@manakaiomalama.com.