Editor’s Note: Dr. Katja Van Herle is a professor of Medicine at the Scripps Research Institute in La Jolla, CA, where she heads the Community Outreach for Education Center (CORE). The division works to make a difference in people’s health and overall lives by educating them about basic science research. She’s also a clinical faculty member at the David Geffen UCLA School of Medicine, where she sees patients in a private practice, offering research knowledge to better their lives through a program called from "Bench to Bedside."

Below is an excerpt of an edited conversation between Mary Wells and Dr. Katja Van Herle about the health-care crisis, the death of community medicine, the reality of an obesity vaccine and more. To hear the conversation in its entirety, click the play button on the audio icon above.

KATJA: … We know that this disease — and especially in children unfortunately – is plateauing in adults – Type-2 diabetes. But obesity and diabetes and heart disease is still rising faster than ever in our children between eight and 15 years old, especially young girls. There are probably a number of reasons for it. One is that we know that all children, right at the time of puberty, have what we call “insulin resistance.” What does that mean? You know how little babies kind of plump up right when they’re about to start walking? They kind of grow fat and then they grow tall, and then they start walking. Well, it’s funny because we do this just before we go through puberty and get the first menstrual cycles and so forth. Young girls are entering that period of natural physiologic insulin resistance, which means you’re a little bit pre-diabetic, if you will. They’re entering that too heavy going in. So what’s happening is that you’re seeing — because women tend to go through menarche earlier — we develop earlier in terms of our development than boys. Boys will develop years later, even from 15 to 18. But girls are developing between eight and 12. Well, they’re entering that eight-to-twelve range too heavy. And they’re heavier than the boys at that age. And so we feel that then the natural insulin resistance is actually made even worse. You know, women have a higher percentage of fat. We have that on our bodies. That’s how we can have babies. That’s part of child bearing. So, unfortunately, young girls are taking a hit here.

So is McDonald’s getting a bum rap? They’re getting a bum rap in the sense that — and I’m not a hired gun for McDonald’s Corporation, we work with other corporations — they’re getting a bum rap because no one entity should take the blame for this. This is a societal problem. It has everything to do with the fact that both parents are out working far too many hours, no one can buy fresh fish and fresh food anymore. It’s not happening. There’s no time in the day for it. It’s becoming more and more expensive. Now with gas prices, I can tell you, people aren’t doing their daily shopping all the time. They have to go to places like Costco. And when you bulk up and buy all that, what you’re buying is food with a long shelf life. So, to me, if you target one company, and they are the biggest – by far bigger than anyone else in that world of quick service restaurants – if you target one company, it’s a Band-Aid. You’re not going to get to the solution. You’d have to look at everything from getting physical education put back into schools, like one of the programs we’re doing; understanding the science of why people actually make more fat cells when they have the genes for Type-2 diabetes, that’s the science that we’re doing. And then you have to get into the clinic with the new medications and changes that we know can actually stop this process right away.

MARY: Are there new medications?

KATJA: Yes, there are actually. We’ve got some really good ones. We have new methods now where we are understanding how insulin is secreted with other hormones. We now can mimic those hormones in injectable forms, some in tablet forms. But it’s not insulin. It’s actually co-secreted with insulin. So what we see is that these other hormones — which are also made with insulin at the time of a meal — these hormones actually cause feedback back to the brain to stop hunger. And that allows people to lose weight. And, in fact, it also sends signals to the stomach and the gut. So what we’re seeing in this new generation of drugs is that we are really, again, understanding the basic science and able to not only get someone’s blood sugar down without having to give them an insulin injection, for instance, but you actually are returning normal physiology. And that’s available in the clinic. And that’s why Big Pharmaceuticals is so important.