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Michigan is a fat state. Our spot in the top 10 varies from year to year and survey to survey, but we’re consistently up there. If we’re not quite a serious challenge to Mississippi and Alabama, there’s always next year, we say, reaching for a second piece of pie.

Or maybe we’re not eating pie. Maybe we’re among the thousands who don’t eat second helpings, who try to eat the pyramid recommendations, who haven’t had a non-diet soda or a full-fat cheese in years, who belong to a gym that perhaps isn’t our second home but a place where we show up often enough that they know our faces. We, too, stare glumly at the numbers on the scale, wondering what we’re doing wrong.

The answer, like weight loss itself, is both exquisitely simple and hugely complex.

Think about it: An entire industry revolves around a solution to the problem that doesn’t even require an entire sentence to express, something everyone knows: Eat less, exercise more. And yet, nothing is more difficult to do. We’ve constructed a modern lifestyle that conspires against us at every turn. We spend hours in our cars, and have in fact constructed our cities to accommodate parking lots over parks. We work punishing hours at jobs that leave us exhausted, too tired and too stressed to cook, so we hit a drive-through window or takeout joint. (Anyway, because most of our parents worked this way, too, we never learned how to cook much in the first place.) We’re forever being promised a quick fix, a pill or a shot or a new diet that, we hope against all reasonable expectation of reality, will be The One. Fat-free potato chips? One-hundred-calorie cookie packages? We’ve tried them all, and still do.

If you want a measure of how far the insanity goes, consider this passage from the patient information for Alli, the over-the-counter version of Xenical, a drug that promotes weight loss by blocking the absorption of some fats.

Side effects — “treatment effects” — include “gas with oily spotting, loose stools, and more frequent stools that may be hard to control.” And so the patient is advised:

Until you have a sense of any treatment effects, it’s probably a smart idea to wear dark pants, and bring a change of clothes with you to work.

In other words, “People would rather crap their pants than do it the right way.” That is a frustrated Dr. Sam Awada talking, chief of family medicine for St. John Macomb Oakland Hospital. He sees obesity across the spectrum, from childhood to old age, as well as its very serious consequences: heart disease, diabetes, joint damage, stroke. Excess pounds are a time bomb for individuals and institutions, and being a foot soldier in the war against pudge is no fun. Awada is battling not only inertia — who really wants to spend an hour on a treadmill? — but misinformation.

“People think they can count their daily routine as exercise, the walking around they do in the course of their jobs,” he says. We walk the dog and call it a workout, perhaps because some guest on the Today Show said every little bit counts, and gardening can be considered physical activity for exercise purposes. But Awada has some fiery preaching to do:

“You have to exercise, and exercise right. You need to spend one hour a day at it, and get your heart rate up,” he says. “Your body doesn’t start to burn fat until after 20 minutes, so if you don’t go at least that long, you’re just burning your stored reserves [of blood sugar].” What’s more, just picking a few fat-free options from the grocery shelves doesn’t make a healthful diet. Fat-free cookies contain extra sugar and other carbohydrates. “Make substitutions that make sense,” he advises. “And be realistic. If you spend 30 years gaining that weight, you’re not going to lose it in two weeks.”

Making substitutions is where Katherine Alaimo excels, but what she advocates is nothing less than reinventing much of modern life, the life that’s making us so fat in the first place. The Michigan State University assistant professor of nutrition has spent much time in study and practice looking at the way we eat and live, and how it defeats our best efforts to change.

“We’ve orchestrated healthy eating and exercise out of our lives,” she says. “I walked to work today, but I could have parked my car free. It’s so easy not to do what we should.”

Alaimo, as a nutritionist, is well versed in how our nation’s agriculture policy has made food — some foods, anyway — almost preposterously cheap. Anyone who’s reached middle age can remember when Coca-Cola was sold in curvy little bottles, when a single serving was 8 ounces. That’s when Coke and other soft drinks were sweetened with cane sugar. Today they’re sweetened with high-fructose corn syrup, which is “so cheap that the packaging is more expensive than the soda,” Alaimo says. It made economic sense for soft-drink makers to put more soda in fewer containers, and so the default single serving became the 12-ounce can and then, the 20-ounce plastic bottle. And if you’re old enough to remember that, you might also recall when a meal from McDonald’s was a hamburger and French fries, both of a size that’s the standard Happy Meal (for children) today.

Alaimo knows these cultural factors may seem insurmountable, but she’s hopeful things will change. As health-care costs rise and the chickens come home to roost, institutions from insurance companies to city governments are trying to find solutions. Witness the greenway initiatives in some communities, many being made as residents demand more recreational opportunities for adults and children. Alaimo herself works with community-garden initiatives in cities like Detroit, which turn vast abandoned lots into places to raise fruits and vegetables.

“There are co-ops that produce fresh, healthy foods for neighborhood residents, or for sale at local markets,” she says. Resource collaboratives give residents help getting such programs under way, providing seeds and equipment, training and support as people generations removed from working the soil get reacquainted with how it’s done. (You can find many of these groups selling their wares at the Eastern Market, in season.)

It’s a long road back from Fat City, as anyone who’s taken the journey can testify. It will require time on both the exercise bike and in front of the stove. We’ll need to use both our sneakers and our brains, and spend less time deluding ourselves. Perhaps we can take some inspiration from our rail-thin new president. Those who knew him growing up described him as “chubby,” the Wall Street Journal reported last summer, adding: “Sen. Obama didn’t begin to slim down until he played basketball regularly in high school.”

That may validate the second half of the simple weight-loss maxim of eat less, exercise more. As for the first part, it might be more properly worded as eat more food that’s unprocessed and closer to its original state — especially fruits and vegetables. And then follow the lead of our new leader.

Anyone up for a little one-on-one?