Each day I exercise I should be accompanied by the Dallas Cowboy Cheerleaders, who would spritz me with a cooling mist of beer when I appeared overheated. At the end of my run I would be handed $100 by my health insurance company because it was so grateful I was keeping fit and thereby saving it money.

Other than bodacious babes and bucks as incentives, what does it take to motivate Americans to keep fit and healthy? It seems such a stupid question; fitness and good health should be their own reward, and the fact that everyone wants them should be enough to move most of us from torpor to the treadmill. If that were adequate motivation, however, Americans would not be gaining weight at a rate that seems likely to pull Mother Earth out of her orbit in a few more years, the couch would not be our national logo, and our national position on most issues would not be recumbent.

With more than 60 percent of us overweight and only 30 percent of us exercising regularly, the simple question of what it takes to motivate us is beginning to get a lot of attention from employers, insurers, healthcare professionals and policy wonks. The National Security Administration may know what you say on your cell phone, but we don’t know a lot about what it takes to motivate people to get and stay fit. We don’t know why some run for exercise and others run from it. We don’t know why some people eat just half of what is on their plate and others eat the food, the plate and the table.

We know what does not work: nagging by the doctor or the government, making people feel guilty, threatening them with heart attacks in their future, telling ourselves we will exercise tomorrow, buying yet another piece of workout equipment, etc. Even getting diabetes because of too much weight does not persuade many patients to get the weight off, just as getting emphysema does not convince some smokers to kick the habit. If that worked we would all have the physique of Lance Armstrong, and most people who lose weight on a diet would not gain it all back within a year.

A person’s fitness is a matter of personal responsibility and choice, but the issues are more complex than that. How does an individual who wants to get healthier keep up the motivation to do that? What tricks and incentives work to keep at it? And if one chooses to maintain an unhealthy lifestyle, should anyone else care or should we all just pay the added costs through our higher taxes and insurance premiums without complaint?

The people who pay for the healthcare are profoundly interested in what it takes to make sleeker, more aerobic Americans. There is tons of healthcare money to be saved by the losing of tons of American fat and in all of us adopting healthy lifestyles. Business costs, taxes, and health insurance premiums are all being driven by the size of our bottom lines, and untold billions could be saved if we were a nation of fitness freaks with cholesterols in the 150s and chiseled pecs.

Many employers and health insurers are betting that money may be one motivator for better health. Some are paying employees to participate in health risk screenings that identify unhealthy lifestyles, overweight status, and early markers of diseases such as hypertension and diabetes. Consumer-directed health plans are a relatively new health insurance product in which employees who stay healthy may save some money on their share of their health insurance premiums.

However, some employers are taking an even harder line, by refusing to hire smokers, for example. Moreover, it is not difficult to imagine employers desperate to control healthcare costs taking a coercive approach with workers whose failure to adopt a healthier lifestyle is costing the employer money for the workers’ diabetes, high blood pressure, etc. Employers motivating employees to get healthier is potentially a double-edged sword.

When it comes to getting Americans to adopt healthy lifestyles we are novices, just as we were getting people to quit smoking 40 years ago. At that time almost twice as many Americans smoked as do now. We changed that by applying a broad range of interventions over 40 years, chipping away at the problem one smoker and one potential smoker at a time. We educated each other about the myriad diseases that cigarettes cause smokers and those around them. We researched quit-smoking techniques to see which ones worked and which ones were a waste of time and breath. We changed public policy to support the war on cigarettes. We made cigarettes more expensive, turned more of America into smoke-free zones, restricted the advertising of cigarettes to children and teenagers, and never, ever gave up.

We have to do the same with the fattening of America, because the sedentary lifestyle is the cigarette of the 21st century. The cheerleaders just don’t have 40 years to wait for us all to get motivated this time.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.