For George L. Blackburn, every day starts with a stress test.

The pedometer clipped onto his belt counts all 162 stairs on the eight-floor ascent to his Beth Israel Deaconess Hospital office—along with more than 11,000 other steps on a normal day.

“The average American doesn’t take even 5,000 steps,” he says with not a small touch of pride as he flips open the pedometer’s case to prove his mileage. With 2,000 steps to a Blackburn mile, it’s clear that this white-haired 67-year-old doctor covers a lot of ground.

Blackburn served as director of the surgical intensive care unit at New England Deaconess Hospital from 1973 to 1997, but his main interest now is combating obesity as the Abraham associate professor of nutrition at Harvard Medical School (HMS).

And as government officials attempt to revamp the Food Guide Pyramid by 2005, Blackburn is part of the frenetic effort among nutrition leaders across the nation to convince Americans that the battle of the bulge is a matter of life and death.

“This is urgent, serious business,” he said of his reforms. “The anti-obesity war is number one on the list.”

As part of this effort, Blackburn was one of 400 people who gathered at the Harvard School of Public Health earlier this month to discuss proposed changes to the Food Guide Pyramid, a symbol used by the U.S. Department of Agriculture (USDA) to represent a balanced diet.

“The consensus is that we need a new PR man. Pretty much everyone agreed about that,” said conference organizer Kathy McManus, director of nutrition at Brigham & Women’s Hospital.

Though food experts ranging from researchers to restauranteurs discussed numerous nutritional developments at the conference, the shape and contents of the new pyramid are “still up for discussion,” she said.

Pyramid Scheme

Blackburn didn’t have the answer, but he pointed to a new website put together by the USDA and the U.S. Department of Health and Human Services, which provides an online tool to evaluate one’s daily diet. The Interactive Healthy Eating Index allows users to list foods they’ve eaten—from alfalfa to zwiebek toast—and then enter in an approximate serving size. The website crunches the numbers to compare the users’ food intake to the USDA’s recommended guidelines (see related article, right).

But though the food pyramid is met with wide recognition by most Americans, some nutrition experts believe that it does too little to cut down on obesity.

First unveiled in 1992, the pyramid just wasn’t designed with the epidemic of obesity in mind.

Critics lambaste the four-tiered pyramid for its wide base of grains and its omission of such essentials to good eating habits as water and exercise.

HMS professor Walter C. Willett has even suggested his own recipe for the pyramid, which incorporates new scientific findings about fats and carbohydrates in a seven-tiered design. In Willett’s popular alternative, the bottom tier is exercise and refined grains have relocated to the top.

Others have proposed reshaping the pyramid into a bowl or a following Canada’s model and using a plate. According to Blackburn, the problem lies not with the guide itself but with a widespread indifference toward good eating habits.

“If people did the existing pyramid we wouldn’t need a new one,” he said.

The Fruits of His Labor

Blackburn’s passion for nutrition began early in his career.

As a doctor in the intensive care unit, he noticed that obesity was destroying patients’ health,

“I saw all these overweight people and I saw they weren’t getting there overnight,” he recalls.

This realization motivated Blackburn to return to school, where he earned a doctorate in nutritional biochemistry from Massachusetts Institute of Technology in 1973.

Since then he has been obsessed with nutrition. And his office bears the fruits—and vegetables—of his labor.

On his desk, among the papers of nutritional arcana are drawings of incarnations of the food pyramid. An unopened weight-loss shake sits on the side of the desk—for demonstration, not use. Plastic tomatoes, carrots and apples rest on the shelf behind him, next to a plastic bread loaf and an incongruous miniature lobster.

Though his office shows the lighter side of healthy eating, for Blackburn, nutrition is no laughing matter.

He estimates that the U.S. could save $100 billion in health care expenses if Americans followed healthier regimens.

Though the food pyramid debate weighs heavily on the minds of some nutritionists, Blackburn says the issue of super-sizing will “trump” any changes to the pyramid.

Increased portions are fueling the obesity epidemic, he says.

“We have to use some characterization of serving size that people recognize,” he says, pinching the base of his thumb.

“A serving of cheese is the size of your thumb. The pyramid is not helping people understand,” he says. “They are eating too many servings that are too big.”

—Staff writer Jonathan P. Abel can be reached abel@fas.harvard.edu.