[Senate Hearing 107-477]
[From the U.S. Government Publishing Office]
S. Hrg. 107-477
GETTING FIT, STAYING HEALTHY:
STRATEGIES FOR IMPROVING NUTRITION
AND PHYSICAL ACTIVITY IN AMERICA
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
ON
EXAMINING STRATEGIES FOR IMPROVING NUTRITION AND PHYSICAL ACTIVITY, IN
AN EFFORT TO STAVE OFF THE OBESITY EPIDEMIC IN AMERICA
__________
MAY 21, 2002
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
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WASHINGTON : 2003
____________________________________________________________________________
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
EDWARD M. KENNEDY, Massachusetts, Chairman
CHRISTOPHER J. DODD, Connecticut JUDD GREGG, New Hampshire
TOM HARKIN, Iowa BILL FRIST, Tennessee
BARBARA A. MIKULSKI, Maryland MICHAEL B. ENZI, Wyoming
JAMES M. JEFFORDS (I), Vermont TIM HUTCHINSON, Arkansas
JEFF BINGAMAN, New Mexico JOHN W. WARNER, Virginia
PAUL D. WELLSTONE, Minnesota CHRISTOPHER S. BOND, Missouri
PATTY MURRAY, Washington PAT ROBERTS, Kansas
JACK REED, Rhode Island SUSAN M. COLLINS, Maine
JOHN EDWARDS, North Carolina JEFF SESSIONS, Alabama
HILLARY RODHAM CLINTON, New York MIKE DeWINE, Ohio
J. Michael Myers, Staff Director and Chief Counsel
Townsend Lange McNitt, Minority Staff Director
C O N T E N T S
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STATEMENTS
Tuesday, May 21, 2002
Page
Bingaman, Hon. Jeff, a U.S. Senator from the State of New Mexico. 1
Frist, Hon. Bill, a U.S, Senator from the State of Tennessee..... 2
Dietz, William H., M.D., Director, Division of Nutrition and
Physical Activity, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control
and Prevention, U.S. Department of Health and Human Services... 5
Prepared statement........................................... 7
Dodd, Hon. Christopher J., a U.S. Senator from the State of
Connecticut.................................................... 16
Austin, Ms. Denise, on behalf of P.E.4Life, accompanied by Ann
Flannery, Executive Director, P.E.4Life........................ 19
Prepared statement........................................... 22
Davis, Sally M., Director, Center for Health Promotion and
Disease Prevention, University of New Mexico................... 27
Prepared statement........................................... 29
Brownell, Kelley D., Director, Yale Center for Eating and Weight
Disorders, Yale University..................................... 30
Katic, Ms. Lisa, Senior Food and Health Policy Advisory, Grocery
Manufacturers of America....................................... 34
Prepared statement........................................... 35
Dickey, Richard A., M.D., Wake Forest University School of
Medicine, on behalf of the Endocrine Society................... 40
Prepared statement........................................... 42
Additional Material
Statements, articles, publications, letters, etc.:
Senator Enzi................................................. 49
Senator Clinton.............................................. 49
Response to questions of Senator Clinton from Kelley Brownell 50
Response to questions of Senator Clinton from Lisa Katic..... 51
John McCarthy................................................ 52
Katherine E. Tallmadge....................................... 54
Myrna Johnson................................................ 58
Connie Tipton................................................ 59
American Dietetic Association................................ 61
National Soft Drink Association.............................. 63
GETTING FIT, STAYING HEALTHY:
STRATEGIES FOR IMPROVING NUTRITION
AND PHYSICAL ACTIVITY IN AMERICA
----------
TUESDAY, MAY 21, 2002
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, D.C.
The committee met, pursuant to notice, at 2:30 p.m., in
room SD-430, Dirksen Senate Office Building, Senator Bingaman,
presiding.
Present: Senators Bingaman, Dodd, Reed, and Frist.
Opening Statement of Senator Bingaman
Senator Bingaman [presiding]. The hearing will come to
order. Thank you all for coming.
Today's hearing is on the issue of obesity and the epidemic
of obesity and the problems associated with it, particularly in
young people.
Obesity has reached epidemic proportions and has become a
major public health problem in our country. It is estimated
that about 61 percent of American adults are overweight or
obese. Obesity rates have increased by 61 percent during the
last decade.
The epidemic is particularly alarming when you look at how
it affects our young people. The percentage of overweight
children has nearly doubled, from 7 percent to 13 percent,
while the percentage of overweight adolescents has almost
tripled, from 5 percent to 14 percent, over the past two
decades.
Although obesity has increased among all populations, this
increase is occurring at disproportionate rates among at-risk,
medically underserved populations which include racial and
ethic minority groups and persons of lower income status.
In my home State of New Mexico, 62 percent of American
Indian adults and 63 percent of Hispanic adults are overweight
according to the statistics that we have been given
Nationwide, obesity among black and Hispanic children
increased by more than 120 percent compared to about 50 percent
among white children from 1996 to 1998.
One-third of children from lower income households are
obese compared to 19 percent of children from higher income
households.
These rising rates of obesity are accompanied by a host of
other health consequences, including heart disease, Type II
diabetes, some types of cancer, stroke, arthritis, breathing
problems, and psychological problems, and many health problems
that are typically thought of in the context of adults,
including early warning signs of heart disease such as high
cholesterol and high blood pressure and Type II diabetes, are
becoming prevalent among children as well.
I think we are all in agreement that there is no one right
way to address this problem. It is a problem that will require
a comprehensive, multifaceted approach that will have to take
into account a wide array of factors that contribute to it.
Improved nutrition and increased physical activity have been
defined as key factors associated with this issue.
Scientifically, it is well-established that healthy diets
and adequate levels of physical activity can reduce the risk of
becoming overweight and obese and help reduce morbidity and
mortality associated with obesity-related diseases.
I worked closely with Senator Frist and Senator Dodd on
legislation that we have entitled ``The Improved Nutrition and
Physical Activity Act.'' That legislation focuses on strategies
for preventing and decreasing overweight and obesity in
families and communities. The legislation includes programs of
evidence-based approaches as well as innovative strategies
designed to get people moving, eating well, engaged in leading
healthy lifestyles across their life span, with a particular
emphasis on youth and school health programs.
Very recently, I worked with Senator Leahy and others on
legislation to impose restrictions on soda machines in schools,
and I received a letter at that point from a substitute teacher
in Albuquerque who said, ``Dear Jeff, I sincerely hope you will
continue to pursue legislation to improve the nutrition of our
Nation's students. As a substitute teacher and parent, I see
firsthand the awful diets that our kids are existing on while
at school. The snack bars which many middle and high school
students purchase their lunches from have plenty of chips,
candy, sports drinks and pizza, but nutritious snacks such as
yogurt and fruit are missing. I have also found that there is
not an easy way for a student to purchase a carton of milk in
many schools. One of my students jokingly told me one day that
he had had a balanced lunch--all the colors were in the bag of
Skittles.''
It is humorous, but in many ways it is unfortunate that we
have students eating bags of Skittles and claiming that that is
lunch.
So I think this legislation is important, and I know that
this issue is extremely important to our country and appreciate
all of you being here.
Let me defer to Senator Frist for his opening comments, and
then we will hear from Dr. Dietz.
Opening Statement of Senator Frist
Senator Frist. Thank you, Mr. Chairman.
The number of Americans who are overweight and obese has
grown steadily during the past decade. The problem is real, and
the problem is one that is increasing. Today, more than 38
million Americans are obese; an estimated 61 percent of adults
are overweight or obese, and 13 percent of children and
adolescents and children are overweight.
The prevalence of being overweight and obese is indeed
increasing among both men and women and indeed all age groups.
The problem is real, and the problem is getting worse.
In the first chart here--and these are charts which have
really been imprinted in my own mind as I address this problem,
because I think they do tell the story of the problem and what
we need to do is see what the appropriate Federal, State and
local response should be.
The first chart covers 1991 in the upper left-hand corner,
1995 in the upper right-hand corner, and 2000 down below. The
Centers for Disease Control and Prevention have tracked risk
factors for chronic disease. In the States colored dark blue,
over 30 percent of adults are classified as obese. As you can
see, this epidemic of obesity is real; it has already across
the country in the past 20 years since 1991, and again, just
for those of you in the back, you can see the increasing blue,
but also the red, which you can clearly see, is greater than 20
percent. You can see that there was no red in 1991, in 1995 no
red--and look at where we are in the year 2000 as the
percentage of adults who are obese is increasing.
In my own State of Tennessee, Tennessee has the seventh-
highest percentage of adults who report no leisure time
physical activity and the 12th-highest percentage of adults who
are overweight.
Perhaps most disturbing to me are the increases among
America's young people. In my own State of Tennessee, nearly 12
percent of high school students are overweight and 82 percent
reported eating fewer than the five recommended servings of
fruits and vegetables per day.
Nationwide, the number of overweight children has doubled,
and the number of overweight adolescents has tripled in the
past decade. Again, for those of you in the back who cannot see
the chart and read along the X axis there, on the far left is
1973 to 1970, and it moves all the way across to 1999. The blue
line is 6 to 9 years of age, and the red line is 12 to 19 years
of age. And again it defines, at least for me, the importance
of us acting, responding, and working together to develop an
appropriate response to this increase.
The Surgeon General wrote last year in his ``Call to
Action'' that ``the prevalence of overweight and obesity in the
United States has truly reached epidemic proportions. An
estimated 300,000 deaths a year are associated with being
overweight or obese, and people who are obese have a 50 to 100
percent increased risk of premature death.'' That is a doubling
of the risk of premature death. ``Being overweight or obese
increases the risk of disease, including heart disease,
diabetes, musculoskeletal disorders, and many other
conditions.''
The third chart uses 1990 data, and the CDC and others are
working to update or modernize that data, and if anything, the
data is likely to be worse rather than better than in 1990. But
this is the leading study in the area, and it shows that poor
nutrition and physical inactivity are the second leading causes
of death in the United States, resulting in about 14 percent of
all deaths.
Again along the X axis is the percentage of all deaths, and
along the top is tobacco, and the second, in red, is poor diet/
exercise, and then comes alcohol, infectious agents,
pollutants, firearms, sexual behavior, motor vehicles, illicit
drug use. Again, that is dramatic.
We have a responsibility to do something about that, and
that something, again, as the Chairman mentioned, we are all
working to decide exactly what that is, and that is why this
hearing today is so important.
The good thing is that it is preventable, and we know it is
preventable; therefore, we know that there is something that we
can do to prevent this dramatic impact that poor diet and lack
of exercise has.
There is not a single solution, but we know that progress
can be made by educating people, by providing more information,
by making better known and more broadly known the healthier
options and increased opportunities for physical activity.
People ask me all the time, ``Do you really want the
Federal Government in this business?'' and the answer is yes,
because we can demonstrate both leadership and, through
legislation, a coordination, a highlighting and a spotlighting
of the problem and potential solutions.
More research, for example, is needed to help us find
solutions and better target interventions. More resources are
needed to expand those programs that we know are successful.
Enhanced oversight, better coordination of existing programs,
and limited pilot programs can help us find innovative, cost-
effective ways to produce and prevent obesity, which will
translate into a reduction in death and premature death.
I do appreciate the Bush Administration's commitment to
making improvements in this area. I applaud Secretary
Thompson's personal commitment to reducing the incidence of
overweight and obesity. As we finished an annual road race here
about 3 weeks ago, I mentioned to him what we were going to be
doing in terms of addressing the issue of obesity and had the
opportunity to thank him, but it also imprinted in my mind the
importance of having somebody like him out there, running,
watching his own weight, watching his own diet, as a real model
for us all.
Today we have made available a summary of the draft
legislation that we are working on, that Senator Bingaman
mentioned, along with Senators Dodd, Collins, Stevens, and many
others. I think today's hearing will help us refine that
legislation with what we hear.
We do plan to introduce bipartisan legislation in the near
future, probably right after the upcoming Memorial Day recess.
In addition, we plan to ask the GAO to look at the way that
nutrition and physical activity programs are organized
throughout the Federal Government and to suggest ways that
coordination and effectiveness could be improved.
Legislation can go a long way, yet we cannot change the
trends of the past two decades through laws and legislation
alone. The Government does not have all the answers. The
private sector has a crucial role to play. The food and
restaurant industries have demonstrated significant leadership.
Already we are seeing an increasing number of advertisements
for fast food restaurants touting healthier options. All of us
have seen that change over the last couple of years. One
national chain has designed its entire advertising strategy
around its low-fat menu options.
There will be new collaborative efforts which we will
promote in the legislation between the Government and the
private sectors so that Americans do have better information
and are equipped to make those healthier choices. We need to
avoid stigmatizing or demonizing any one sector of society and
to build on a coalition of public and private interest to begin
to address this problem on multiple fronts.
Mr. Chairman, I thank you for holding this hearing and look
forward to working with you and others on this committee as we
address a problem which has now reached epidemic proportions.
Senator Bingaman. Thank you very much, Senator Frist.
We have three panels this afternoon. Our first panel
consists of Dr. William Dietz, who is Director of the Division
of Nutrition and Physical Activity in the National Center for
Chronic Disease Prevention and Health Promotion at the Centers
for Disease Control.
Dr. Dietz has been a leader in examining the causes and
consequences of obesity, particularly among children. We
welcome you as a witness today, and we are anxious to hear
whatever you can tell us about how to solve this problem.
Please take a few minutes and summarize your testimony if
you would, and we will include your entire written statement in
the record.
STATEMENT OF WILLIAM H. DIETZ, M.D., DIRECTOR, DIVISION OF
NUTRITION AND PHYSICAL ACTIVITY, NATIONAL CENTER FOR CHRONIC
DISEASE PREVENTION AND HEALTH PROMOTION, CENTERS FOR DISEASE
CONTROL AND PREVENTION, U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Dr. Dietz. Thank you, Senator Bingaman, Senator Frist.
It is a great honor and pleasure to be here, and thank you
for inviting me to comment on this important problem.
I can do little to improve on the epidemiology which you
have summarized so well, but I just want to expand on a couple
of points.
First, 8 million children and teenagers in the United
States are now overweight.
Second, although childhood obesity only accounts for about
one-quarter of adult obesity, childhood-onset obesity in obese
adults tends to be more severe, so it exerts a disproportionate
contribution to morbidity and mortality.
Even so, 60 percent of overweight children have at least
one additional cardiovascular disease risk factor, and 25
percent have two or more.
As you pointed out, we have already begun to see the impact
of childhood obesity on disease. Type II diabetes, a disease
previously limited only to adults, now accounts for as much as
50 percent of new cases of diabetes in some communities.
We pointed out in an article last week that hospitalization
rates for overweight children have tripled over the last 30
years. And as you pointed out, in adults, obesity accounts for
300,000 deaths annually, second only to tobacco-related deaths.
Last year, the Surgeon General's report suggested that
obesity and its complications were already costing $117 billion
annually. The rapid increases in obesity across the population
suggest that these costs are only going to increase.
The CDC has made efforts to develop effective prevention
and treatment strategies through our State programs, State-
coordinated school health programs, and applied research agenda
to develop and refine new approaches and partnerships with
other organizations.
Currently, the CDC funds 12 States to prevent and reduce
obesity and its related chronic diseases through policy and
environmental changes. Most of the State programs have focused
on youth, and with a modest increase in funds this year, some
States will begin to fund community programs.
For example, CDC funds the North Carolina Healthy Weight
Initiative which involves communities in a Statewide task force
comprised of community leaders and health professionals. The
CDC-funded program is a curriculum for 4- and 5-year-olds
called ``Color Me Healthy,'' which focuses on eating healthy
and being active and is being implemented in 71 counties
through cooperative extension and WIC. States could clearly do
more.
One of the most efficient means of impacting the greatest
numbers of children and adolescents and shaping our Nation's
future health is through school health programs. The CDC
through its coordinated school health programs reaches students
in elementary and secondary schools during their formative
years, when many health habits are formed.
CDC and coordinated school health programs are working to
increase physical activity and improve nutrition among our
Nation's young people. While we currently fund 20 State-
coordinated school health programs, much more must be done to
establish healthy eating and physical activity patterns in
young people.
At least four behavior change strategies are currently
justified to reduce obesity and the chronic diseases associated
with it. These include the promotion of breast feeding and
efforts to increase its duration; reduced television viewing in
children and adolescents; increased fruit and vegetable
consumption, and increased physical activity for the
population. Because of time constraints, I will only focus on
physical activity.
Increased physical activity prevents weight gain, maintains
weight after weight loss, and reduces many of the comorbidities
associated with obesity such as hypertension and diabetes.
In addition, physical activity may also displace other
health risk behaviors in youth. In fiscal year 2001, Congress
appropriated $125 million to develop the CDC Youth Media
Campaign which will be launched in June. The campaign will be
directed at 9- to 13-year-olds, and we use the best principles
of marketing and communication to get children excited about
increasing the amount of physical activity in their lives and
helping their parents see the importance of physical activity
to the overall health of their children.
We also for the first time have six evidence-based
strategies around the promotion of physical activity that we
are beginning to incorporate into State programs. These
approaches represent strategies that we can pursue today while
we do the research necessary to identify additional effective
prevention approaches for States and communities.
In summary, obesity in the United States is epidemic. The
consequent increase in diabetes and other diseases caused by
obesity are likely to break the health care bank. Although CDC
programs and strategies have started to address obesity, we
have only begun. We must invest in comprehensive nutrition and
physical activity approaches that link changes in families,
schools, worksites and health care settings to successfully
halt this epidemic.
Thank you, Mr. Chairman.
[The prepared statement of Dr. Dietz follows:]
Prepared Statement of William H. Dietz, M.D.
Good morning. I am Dr. William Dietz, Director of the Division of
Nutrition and Physical Activity at Centers for Disease Control and
Prevention. I am pleased to be here today to participate in this
important discussion of the obesity epidemic.
burden of obesity
The burden placed on our society by obesity and related chronic
diseases is enormous. In the last 20 years, obesity rates have
increased by more than 60 percent in adults. Since 1980, rates have
doubled in children and tripled in adolescents. More than 25 percent of
the adult population in the United States is obese, or approximately 50
million adults. Almost 15 percent of our children and adolescents are
overweight, or approximately eight million youth. Rates of obesity have
increased more rapidly among African Americans and Mexican Americans
than among Caucasians. Obesity in the United States is truly epidemic.
We have already begun to see the impact of the obesity epidemic on
other diseases. For example, Type II diabetes, a major consequence of
obesity, also has increased rapidly over the last 10 years. Although
Type II diabetes was virtually unknown in children and adolescents 10
years ago, it now accounts for almost 50 percent of new cases of
diabetes in some communities. Obesity is also a major contributor to
heart disease, arthritis, and some types of cancer. Recent estimates
suggest that obesity accounts for 300,000 deaths annually, second only
to tobacco related deaths.
The contribution of childhood onset obesity to adult disease is
even more worrisome. Although onset of obesity in childhood only
accounts for 25 percent of adult obesity, obese adults who were
overweight children have much more severe obesity than adults, who
became obese in adulthood. Sixty percent of overweight children have at
least one additional cardiovascular disease risk factor, and 25 percent
have two or more. Hospitalization rates for the complications of
obesity in children and adolescents have tripled.
The combination of chronic disease death and disability accounts
for roughly 75 percent of the $1.3 trillion spent on health care each
year in the United States. Last year, the Surgeon General's Call to
Action on Obesity suggested that obesity and its complications were
already costing the Nation $117 billion annually. By way of comparison,
obesity has roughly the same association with chronic health conditions
as does 20 years of aging, and the costs of obesity were recently
estimated to exceed the health care costs of smoking and problem
drinking.
The rapid increases in obesity across the population and the burden
of costly diseases that accompany obesity indicate that we should not
ignore. The rapidity with which obesity has increased can only be
explained by changes in the environment that have modified calorie
intake and energy expenditure. Fast food consumption now accounts for
more than 40 percent of a family's budget spent on food. Soft drink
consumption supplies the average teenager with over 10 percent of their
daily caloric intake. The variety of foods available has multiplied,
and portion size has increased dramatically. Fewer children walk to
school, and the lack of central shopping areas in our communities means
that we make fewer trips on foot than we did 20 years ago. Hectic work
and family schedules allow little time for physical activity. Schools
struggling to improve academic achievement are dropping physical
education and assigning more homework, which leaves less time for
sports and physical activity. Television viewing has increased.
Neighborhoods can be unsafe for walking, and parks may be unsafe for
playing. Many office buildings tend to have inaccessible and uninviting
stairwells that are seldom used, and many communities are built without
sidewalks or bike trails to support physical activity.
PUBLIC HEALTH APPROACH
Given the size of the population that we are trying to reach, we
cannot rely solely upon individual interventions that target one person
at a time. Instead, the prevention of obesity will require coordinated
policy and environmental changes that affect large populations
simultaneously. The CDC has made efforts to develop effective
prevention and treatment strategies through our State obesity programs,
State coordinated school health programs, partnerships with other
organizations, and an applied research agenda to develop and refine new
approaches.
A COORDINATED STRATEGY TO ADDRESS THE OBESITY EPIDEMIC
Currently CDC funds 12 States to prevent and reduce obesity and its
chronic related diseases. Our support permits States to develop and
test nutrition and physical activity interventions to prevent obesity
through strategies that focus on policy-level changes (e.g., States
assess and rate childcare centers for nutrition and active play) or a
supportive environment (e.g., competitive pricing of fruits and
vegetables in school cafeterias). Examples of these approaches can be
illustrated by the experience in three States.
In Massachusetts, The National Institutes of Health (NIH) funded a
school-based obesity curriculum known as Planet Health. This
curriculum, which integrated reduced fat, increased fruit and vegetable
intake, increased physical activity, and reduced television, messages
in science, math, language and social studies classes significantly
reduced obesity in adolescent girls. The CDC is now supporting the
expansion of this program into public, charter, and parochial school
systems in Boston.
The State of Rhode Island has selected racial and ethnic minority
children enrolled in public elementary schools as the target for
lifelong healthy eating and physical activity behaviors to promote
healthy weight, based on the CDC guidelines for school health, which
were developed with input from the Department of Education. After
surveying half of all elementary schools (including all schools with at
least 25 percent or more Hispanic enrollment) to assess existing
nutrition and physical activity programs, policies, and environmental
supports in schools, the State is developing a systems-level, nutrition
and physical activity intervention that will increase the number of
environmental and policy supports in schools based upon the CDC
guidelines for school health programs to promote lifelong physical
activity and healthy eating. Selected communities with schools where at
least 40 percent of the students are Hispanic/Latino and 50 percent or
more of the student population is eligible for free or reduced lunch
programs will be involved in the program beginning in September. Each
school will tailor intervention components to fit with their school
structure and population while maintaining a common purpose and shared
activities across schools. Program expectations include goals for
student consumption of fruits and vegetables to five daily servings and
participation in moderate physical activity for 30 minutes at least
five times a week.
The North Carolina Healthy Weight Initiative has involved
communities and an energetic statewide task force comprised of
community leaders and health professionals. The group has developed a
curriculum known as ``Color Me Healthy'' for 4- and 5-year-olds that
focuses on interactive, innovative learning opportunities on eating
healthy and being active. Through an innovative collaboration with the
U.S. Department of Agriculture (USDA), implementation of ``Color Me
Healthy'' is underway in 71 counties through cooperative extension and
the Special Supplemental Nutrition Program for Women, Infants and
Children (WIC). These programs help illustrate how CDC-funded programs
translate research findings into practice, and integrate HHS activities
with those of other departments.
In addition to the collaboration with State health departments, CDC
also funds 20 State educational agencies through the Coordinated School
Health Program. This program reaches students in elementary and
secondary schools and strives to increase physical activity and improve
the nutrition among our Nation's young people. Through this program,
the CDC awards competitive grants to State, tribal, and territorial
educational agencies to:
Plan, implement, and evaluate programs, including curricula, to
promote a healthy lifestyle, including programs that increase physical
activity and improve the nutrition of the students at elementary and
secondary schools;
Provide education and training to education professionals,
including physical education, health education, and food service
professionals, in State and local educational agencies; monitor youth
lifestyle behaviors and/or programs to influence them; develop and
implement policies to support effective implementation of school health
programs at the local level; and build effective partnerships with
other Government agencies and non-governmental organizations to support
effective implementation of school health programs.
Examples of these approaches can be illustrated by the experience
in three States. West Virginia has adopted one of the strongest
standards in the Nation for school nutrition. The West Virginia Board
of Education prohibits the sale or serving of the following foods at
school: chewing gum, flavored ice bars, and candy bars; foods or drinks
containing 40 percent or more, by weight, of sugar or other sweeteners;
juice or juice products containing less than 20 percent real fruit or
vegetable juice; and food(s) with more than eight grams of fat per one-
ounce serving. At elementary and middle schools, soft drinks are
prohibited. In addition to implementing effective policies, the West
Virginia Department of Education Office of Healthy Schools collaborated
with the Office of Child Nutrition and the West Virginia Nutrition
Coalition plan and delivered a week-long nutrition symposium for school
food service, health education, and school health services
professionals. These programs impact more than 300,000 students in a
State where over 25 percent of the children ages 5-17 live in poverty.
In California, the State has focused on collaborative efforts. The
California Department of Education serves a population exceeding six
million students, and 63 percent of these students identify themselves
as a minority (42 percent Hispanic, 11 percent Asian Pacific, 9 percent
African American, and 1 percent American Indian/Alaskan Native). To
support collaborative efforts in California, the State's Department of
Education and Department of Health Services formed a joint effort
called School Health Connections (SHC). SHC coordinates funding,
policies, and programs within both agencies and with local school
districts and health departments. SHC accomplishments include:
Collaboration with partners, leading to the passage of legislation
which establishes nutrition standards for food sold in elementary
schools, prohibits the sale of carbonated beverages in middle schools,
until 30 minutes after lunch is served, requires schools to post State
and local laws and policies related to nutrition and physical activity,
and establishes a pilot program for middle and high schools to
implement nutrition standards; the inclusion of health in new statewide
standards for teacher training; added physical fitness test results to
local school districts' accountability report cards; provided training
in school health, including CDC's School Health Index, reaching
approximately 1200 parents and professionals in the fields of
education, public health, and school health; and obtained $6 million
for school outreach for Healthy Families and Medi-Cal for Families.
Finally, the Wisconsin Department of Public Instruction (DPI), in
collaboration with several University of Wisconsin departments,
instituted an annual Best Practices in Physical Activity and Health
Education Symposium. This two-day staff development experience for
teachers showcases exemplary school-based physical activity, physical
education, and health education. Information and resources on physical
education and health education, including health literacy assessment
tools, were provided to all 426 school districts to guide program
improvement. In addition, all Wisconsin school districts received
nutrition education information and training opportunities. More than
3,200 staff were trained on the Dietary Guidelines for Americans 2000,
the importance of a good breakfast, and the relationship of nutrition
to learning.
CDC's coordinated school health program enables State departments
of education and health to work together efficiently, respond to
changing health priorities, and effectively use limited resources to
meet a wide range of health needs among the State's school-aged
population.
PARTNERSHIPS
National or State programs alone will not succeed unless they are
supported by a wide array of partnerships. Nutrition and physical
activity programs must be integrated across other CDC funded State
programs aimed at cancer, diabetes, and cardiovascular disease. In
addition, as the North Carolina program emphasizes, nutrition and
physical activity programs must be linked to other departments, such as
the USDA. Groups that share concerns about the impact of obesity on
other diseases, such as the American Heart Association and the American
Cancer Society are natural allies in obesity prevention efforts. For
example, the CDC is exploring joint training activities with the
American Cancer Society around nutrition and physical activity
strategies within States.
PRIORITY STRATEGIES
At least four behavior change strategies appear justified by the
current State of our knowledge. These include the development of
sophisticated marketing messages designed to increase health behaviors
among youth, the promotion of breast feeding and efforts to increase
its duration, reduced television viewing in children and adolescents,
and increased physical activity for the population. In FY2001, Congress
appropriated $125 million to develop and launch the CDC Youth Media
Campaign using the same strategies used by commercial marketers to
reach our target audience of 9-13 year olds. The campaign will use the
best principles of marketing and communications to deliver important
messages to young people about the importance of building healthy
habits early in life with the full knowledge that today's youth are
very savvy about the messages they receive. The Youth Media Campaign
will be launched in June of 2002 with the focus on getting kids excited
about increasing the amount of physical activity in their lives, and
helping their parents to see the importance of physical activity to the
overall health of their kids.
Breast feeding is unquestionably the most appropriate form of
feeding for most infants, and clearly reduces the incidence of acute
diseases of infancy and early childhood. Recent studies of breast-
feeding indicate that children who are breast-fed appear to have a
reduced risk of obesity later in life. Nonetheless, only 64 percent of
new mothers initiate breast feeding, and only about 29 percent have
continued breast feeding six months after birth. A major research
objective is to understand how to increase breast feeding rates and
duration through strategies such as spouse support or worksite
modifications that permit mothers to continue to feed their children
breast milk after they return to work.
The prevalence of obesity has been directly related to the amount
of time children and adolescents watch television, and therefore
reducing television time appears to be an effective strategy to treat
and prevent obesity. Nonetheless, incentives for parents to reduce the
amount of time their children watch television must still be
identified. Some research suggests that parental concerns about
televised violence or sexuality may be more persuasive reasons than
obesity prevention to control children's television time.
Increased physical activity for overweight patients reduces many of
the co-morbidities associated with obesity such as hypertension,
hyperlipidemia, and glucose tolerance. We now have six evidence based
strategies around the promotion of physical activity. These include
recommendations for physical education programs in schools, promotion
of stairwell use, access and promotion of recreation facilities, social
supports for physical activity, individually adapted behavior change,
and community-wide campaigns.
Medical approaches are an integral part of the battle against the
bulge. When 25 percent of adults are affected with obesity, the
effective translation of proven strategies into approaches that can be
used in primary care settings must become a high priority. We recently
calculated what it would cost if all obese Americans were started on
one of the two available drugs for the treatment of obesity. The costs
of drug therapy were approximately the same as the direct costs of
obesity. This observation indicates that conventional medical therapy
for the treatment of obesity is extremely expensive. However, last year
an NIH clinical trial demonstrated that diet, exercise, and modest
weight loss decreased the incidence of diabetes by almost 60 percent--a
far greater improvement than the pharmaceutical therapy in the
comparison group. These results emphasize the importance of lifestyle
modification in the treatment of prediabetes. We are currently working
with several managed care organizations to begin the process of
translating these approaches into strategies that can be used in
primary care. In a meeting to be held this summer, we will begin the
process of identifying simple and effective counseling techniques that
can be used by physicians, nurse practitioners and nutritionists to
help obese patients. Evaluation of these approaches will be critical.
In summary, this hearing could not have come at a more opportune
time. Obesity in the United States is epidemic. The diseases caused by
obesity like diabetes have also begun to increase, and are already
adding to health care costs. CDC programs have begun to address the
problem of obesity, but are small and just beginning. Nonetheless,
comprehensive nutrition and physical activity approaches to prevent and
treat obesity appear the most cost-effective strategy to reduce obesity
and its complications.
Thank you for the opportunity to talk about this very critical
issue. I would be happy to answer any questions the Committee may have.
Senator Bingaman. Thank you very much.
You do indicate that we need a comprehensive approach, and
I certainly agree with that. Let me go on and read another
couple of sentences from the letter that Cindy Anderson, the
substitute teacher from Albuquerque wrote me. She says: ``I
wonder if it could not improve student achievement, not to
mention behavior and disease risk, simply by not allowing the
sale of candy, soda, and other empty-calory foods in our
schools. It seems so silly to spend time teaching our kids
about nutrition and then not provide nutritious foods for
them.''
You are funding a bunch of initiatives around the country
to teach kids about nutrition as I understand it. Are you doing
anything with regard to the actual providing of nutritious
foods at schools?
Dr. Dietz. That is not the role of the CDC, but we are very
interested in alternative strategies around the provision of
nutritious foods in school lunch lines. For example, we
recently became part of a memo of understanding between USDA
and HHS around the promotion of fruits and vegetables in lunch
lines, and it has already been shown that reducing the price of
fresh fruits and vegetables increases consumption. What we are
trying to look for are sustainable strategies such as
increasing the prices on less healthful items in the lunch
line, thereby sustaining subsidies on fruits and vegetables.
That is one alternative to making other choices available to
children and teenagers.
Senator Bingaman. The idea of funding a lot of these State
initiatives is, as I understand it--and I have always thought--
not just in this area, but in all areas, is to figure out which
strategies work and then replicate them around the country.
How far are we from knowing which of these strategies work
and being in a position to say this should be a national
program, or this should be something that every State
implements, or whatever?
Dr. Dietz. With respect to our State programs, I think we
are still several years away from knowing whether the
strategies which States have initiated are going to be
effective or not. We have set them up in such a way that they
have employed a very careful design; they have often partnered
with universities or prevention research centers and schools of
public health, and in order to not only design the best program
but employ a very careful evaluation to determine whether it
works or not.
But as I said, I think we do have four strategies which we
can employ today. They are the promotion of breast feeding,
reduction in television time, increase in fruit and vegetable
consumption, and increases in physical activity. I think we
have the best data around physical activity, where we know that
there are evidence-based recommendations that suggest that
increases in physical education programs in schools will
increase rates of physical activity and thereby reduce many of
the obesity-associated comorbidities.
Senator Bingaman. I guess I am still not clear as to--now
that we know that exercise is something that we should be
promoting in our schools, what is the extent of the effort that
is being made either by the CDC or by Health and Human Services
more generally or by anyone else, any of the other Federal
agencies, to actually bring this about? Are resources being
provided? I know that we have the PEP bill, but I do not know
how many States that is getting into, how many kids are
actually being allowed or encouraged to participate in physical
activity because of that funding.
Dr. Dietz. I cannot supply you with those data, although I
think we could probably come up with them from the Department
of Education or others who are here in the room testifying
later.
I think that the CDC cannot make schools change, nor do I
think the Federal Government can. Schools are locally
controlled, as you know. I think our job is to provide schools
and communities with the best evidence, the best suggestions
that we know, and rely on them to take those suggestions
forward.
Senator Bingaman. So you think that providing the
suggestions is probably the extent of what we can do, rather
than providing any resources?
Mr. Dietz. If we were to give resources directly to
communities, I would be concerned that those communities
utilize those resources in such a way that they can learn from
what they do, because my concern about throwing money at a
problem without an evaluation is that we are going to spend a
lot of money, and at the end of that, we are not going to have
any better idea of what works or what doesn't than when we
started.
One of the reasons that I have chosen to emphasize State
programs is that I think funds for communities channelled
through State programs at least assures that the communities
will have the best recommendations that we know of programs
that work and can couple those with an evaluation to determine
which of those programs are effective, and those can then be
disseminated to other communities.
Senator Bingaman. You did refer, I believe, to six
evidence-based strategies for increasing physical activity.
Dr. Dietz. Correct.
Senator Bingaman. And presumably those are six evidence-
based strategies, each of which is recommended?
Dr. Dietz. Yes.
Senator Bingaman. So that we have six ways in which we know
that schools can deal with this problem if they will just do
it.
Dr. Dietz. Those recommendations were not limited to
schools. I cited the physical education recommendation as most
applicable to schools. Promotion of stairwell use is one of
those strategies. This is a ready made opportunity for physical
activity to walk up and down stairs. Stairs are rarely in a
convenient place and are rarely attractive.
Access and promotion of recreational facilities is another
recommended strategy which suggests the importance of
partnerships with groups like the park and recreation
department; social supports for physical activity; individually
adapted behavior change, which is more of a clinical strategy;
and community-wide campaigns to promote physical activity.
What we do not yet have is a clear understanding of how to
translate those effectively into community-based programs.
Senator Bingaman. Okay. Let me defer to my colleagues. Both
Senator Reed and Senator Dodd are very focused on this set of
issues and are working with us on this legislation.
Let me call on Senator Reed since he arrived first.
Senator Reed. Thank you very much, Mr. Chairman, and thank
you for holding this hearing.
This is a vitally important topic, and CDC has taken a
leadership role, and I thank you, Dr. Dietz, for your efforts.
The Children's Health Act of 2000 incorporated some
provisions that I suggested with respect to a competitive grant
program for CDC that could be used for intervention models and
prevention strategies for obesity; it could be used in terms of
applied research, public education, provider education and
training.
I realize that all of these provisions are not under your
auspices, but could you give an outline of the implementation
to date of the Children's Health Act?
Dr. Dietz. The Children's Health Act has not directly
impacted our programs, but as I said earlier, we are funding 12
States now, and those States have principally focused on youth.
Rhode island is one of those States, as you know. They are
adopting a variety of strategies. Some are using a WIC-based
approach. Some are targeting African American or other minority
youth. I believe Rhode Island is using a WIC-based approach, as
well as North Carolina.
I think the importance of those programs is that they be
designed in such a way that we know clearly what the target
audience is, and we have good pre and post measures to evaluate
which of those programs is effective, and those can then be
expanded.
I think that is not the question that you asked. You are
asking about the Children's Health Act, which has not, as I
said, impacted on our programs.
Senator Reed. But you deduced my second question, which is
how well we are doing in Rhode Island, one of your 12 States,
and I thank you for your response.
I notice that in conjunction with your efforts, the budget
proposed for the CDC Center for Chronic Disease Prevention and
Health Promotion is going to be proposed to be reduced by 8
percent, less than the fiscal year 2002 funding level. Could
you describe how that reduction would impact on the efforts
that you just talked about and others?
Dr. Dietz. I think the reduction applies almost exclusively
to the Youth Media Campaign. That is currently funded at about
$68.5 million in the 2002 budget and has been eliminated from
the 2003 budget.
Senator Reed. I presume that when it was included in
previous budgets, there was some logic to do that, that there
was some data or at least instinct that it would be good to
tell youngsters not to eat certain things, and certainly, since
there is such a constant barrage of what to eat from every fast
food restaurant in America, do you have any thoughts about the
reduction or elimination of this program?
Dr. Dietz. I think the Youth Media Campaign is a unique
attempt to influence physical activity behaviors of children.
As you know, when Congressman Porter introduced that
legislation, it was with the intent of displacing other high-
risk behaviors like sexual behavior, drug use, alcohol use, and
tobacco use. The choice of physical activity I think is a sound
one--physical activity and other activities--particularly those
that children, in this case, 9- to 13-year-olds, participate in
after school, because that is when these other high-risk
behaviors begin.
I think that to know clearly whether that program is
effective or not is going to require 3 to 5 years of work. The
program will only come out, or the media delivery will only be
at the end of June, and I think there are enough funds in it
for media buys for a year.
The expectation is that that may well change attitudes but
will not likely change behavior because it is such a short run.
Senator Reed. Thank you.
Thank you, Mr. Chairman.
Senator Bingaman. Thank you, Senator Reed.
Senator Frist.
Senator Frist. Thank you, Mr. Chairman.
Dr. Dietz, CDC has gained a great deal of experience
working with States and communities over the years on the issue
of improved nutrition and physical activity, and on the charts
that I showed, it was ``nutrition/activity'' in essence. I know
you mentioned a little bit about this, but what do you think
are the key components or elements of an effective program, and
as we put together legislation or a Federal model and program,
specific things like provider training and education--again,
you mentioned it a little bit--designing environments to allow
increased activities in terms of physical education or just
physical activity and the right sort of environment, and also,
physical education and nutrition education actually in school,
in terms of what you are actually exposed to.
Dr. Dietz. I think there are several important elements of
a comprehensive program. One is that there has to be a
repository of expertise related to nutrition and physical
activity. Those I do not think are the same person in States. I
think that somebody with physical activity expertise is not
likely to share nutrition expertise.
Second, the program needs to be integrated. As you know, we
are funding a number of categorical programs like cancer,
cardiovascular disease, and diabetes. Nutrition and physical
activity strategies to prevent obesity will also influence
those other chronic diseases. So that part of a comprehensive
program is a physical activity and nutrition strategy that is
cross-cutting and engages the secondary prevention efforts that
those categorical diseases are already involved in.
Third, there needs to be integration across agencies. For
example, the USDA EFNEP program and the USDA WIC program all
need to be linked into preventive efforts because they address
particularly vulnerable populations, and it is unlikely and
needless for HHS programs to replicate the tremendous job of
education that a program like EFNEP does. But if we do not link
to those programs, we are going to miss an opportunity.
Third, there need to be partnerships with other
organizations within States, like the American Cancer Society,
like the American Heart Association, which have a vested
interest in the prevention of obesity and its consequences.
Fourth, I think there need to be strategies that explore
what works. We have already talked about that briefly. My model
for that would be funding going through State programs to
communities where small amounts of funding can make an enormous
difference in getting programs off the ground. My concern is
that those State-based programs be coupled with a good
evaluation effort so that we learn what works, so that those
communities themselves can learn what works.
Fifth, I think we need a stronger science base. The
strategies I mentioned--physical activity, breast feeding,
reduction in TV time--are probably just the beginning of those
strategies. They will significantly impact the problem, but it
is not going to eliminate it. And there is a wide range of
applied research that needs to be done and augmented by survey
work.
For example, several recent focus group studies have
demonstrated that parents do not define obesity by where a
child fits on the growth chart. That is very perplexing to
primary care providers, because if they cannot point out where
a child fits on the growth chart and say to a parent, ``This is
a problem,'' and the parent says, ``What are you talking about?
This is not a problem,'' then, we have a problem. What is the
language that we use?
It turns out that parents do not define being overweight as
a problem unless where the child fits on a growth chart has an
adverse impact on the child's self-esteem.
So I think there is a lot of work that needs to be done
around the language that we use to talk to parents about their
child's weight problem. I also think that for the vast majority
of parents, overweight is considered a cosmetic issue, not a
health issue. That conversation has to change.
Senator Frist. Has my time expired, Mr. Chairman.
Senator Bingaman. Well, we do not have the timer on. Why
don't you go ahead with another question?
Senator Frist. Thank you.
Very briefly--and I appreciate the comprehensive nature of
your last answer--extending from the parents' view of what
obesity is, this committee deals with a lot of public health
issues broadly, and public health people think of all sorts of
things, like infectious disease--infectious disease, people can
relate to--when we think of obesity being a public health
issue, it takes some explaining, and part of the reason might
be that many people view being overweight or obese as a matter
of personal choice. It may affect one individual because of
certain behavior, but it does not affect other people.
Could you respond to that?
Dr. Dietz. Sure. I think that to a certain extent, that is
true. While we focus on the prevention of obesity in the
majority of population, we cannot neglect the 25 percent of
adults and 15 percent of children and teenagers who are already
overweight.
One of the things that we are doing this summer is
convening a conference with Kaiser Permanente to look at how to
translate the efficacious recommendations that came out of the
NHLBI Report on the Assessment and Treatment of Obesity into
practical approaches that can be used in primary care.
We are doing something similar around the prevention of
obesity in children through a collaborative project with the
American Academy of Pediatrics and the American Dietetic
Association to try to prevent the development of obesity in
young children, 3- to 7-year-olds, through a focus on the
division of responsibility between parents and children around
food choices and the limitation of television time to one to 2
hours per day.
I think you are absolutely right that clinical strategies
do have to focus on those issues, and what I think we need the
most are approaches which make physicians feel more effective
when they are confronted with an overweight patient.
Senator Frist. Thank you.
Thank you, Mr. Chairman.
Senator Bingaman. Thank you very much.
Senator Dodd.
Opening Statement of Senator Dodd
Senator Dodd. Thank you very much, Mr. Chairman, and let me
begin by thanking you for holding this hearing, and Senator
Frist and Senator Reed for their support of this.
This is a very, very important issue, and it is getting
some attention in the last little bit, but it really deserves
much, much more. I want to begin by thanking you for doing
this.
I was stunned to read the statistics on the number of
children, the number of adults, the number of deaths, and the
costs associated with this. On Senator Frist's last point,
talking about this being a matter of choice--there may be
choice, but there are tremendous effects that we all pay for as
a result of these decisions, so beyond just the individual
effects, obviously, there are effects that go far beyond that.
We are going to introduce shortly--Senator Bingaman may
have raised this before I came in--Senator Bingaman and Senator
Frist are the lead sponsors and I am a supporter of their
efforts on the Improved Nutrition and Physical Activity Act,
the IMPACT bill which I am sure you have already addressed.
We focus on children. The piece that I added was on the
children, because the numbers just stun me, when we start
talking about a tripling of this problem in the last decade--or
is it two decades?
Dr. Dietz. Twenty years.
Senator Dodd. Twenty years. I was stunned to see the amount
of activity--let me just focus on the activity side of this,
even though the diet issue deserves attention--I was stunned to
see that in the last 10 years, I believe, we saw the number of
children involved in activities went from 42 percent to 29
percent, and the trend lines continue to go down.
What is going on here? Why is this happening? Have you
analyzed what is going on in schools? Are school budgets such
that they are cutting back on after-school athletic programs
and during the day? Is that a feature of this? Are schools
reducing significantly the amount of physical activities that
were normally part of the curriculum at the elementary and
secondary levels?
Dr. Dietz. I think that physical activity around schools
has declined in two ways. The numbers that you are citing have
to do with the physical education programs offered by schools,
which amount to 42 percent of schools in 1991 and declined to
29 percent of schools by 1999.
Senator Dodd. Is this a budgetary--have you analyzed this?
Dr. Dietz. Well, we do not have terrific data, but on an
anecdotal basis--and I think this is a pretty widespread
anecdote--most schools have reduced P.E. programs because of
cost and the need to meet performance standards, and that P.E.
is seen as a luxury, one which detracts from school
performance.
I think a clear research need is to demonstrate that
physical activity has an impact on both classroom behavior and
performance. That is something that we do not know.
Senator Dodd. We know it has an effect on the other
behaviors--smoking, drugs, and the like--isn't that true?
Dr. Dietz. That is true. Those adverse risk behaviors
cluster. But the other factor which has influenced physical
activity around schools is that today, far fewer children walk
to school. In part, that is a consequence of community design,
and in part, it reflects perceptions of neighborhood safety.
In fact, when I talk to audiences around the country, 90
percent of those audiences walked to school when they were
children, and only about 20 percent of their children and
grandchildren walk to school.
So not only have schools eliminated their physical
education programs, but the opportunities to include physical
activity as part of a child's day have also diminished.
Senator Dodd. Have you looked over the children-specific
provisions of the proposed legislation that we are offering?
Dr. Dietz. I am not permitted to comment on legislation; I
am sorry. I have looked it over.
Senator Dodd. Do you want to just give me a little wink or
something?
[Laughter.]
Dr. Dietz. I thought that was what I did.
Senator Dodd. Okay. I will take that as a wink. I
appreciate it very much.
We just passed the Elementary and Secondary Education Act;
in fact, we were involved in it in this committee. Correct me
if I am wrong, Bill, but I do not think we did anything on this
particular aspect.
Tell me about these contracts that schools have with some
of our producers of less-than-nutritional-value products. Is
this a growing problem, where, to get exclusive rights, you
give schools a check for a certain amount if they will give you
exclusivity to some of these products, and you also have to
agree to have them available to the kids during the school day.
Tell us about some of those contracts.
Dr. Dietz. I think that what you are describing is
euphemistically called a ``pouring contract,'' which is an
exclusive contract with a soft drink company to stock vending
machines. That is an increasingly widespread practice that is
driven by schools' need for financial resources. They play a
very important role in keeping schools afloat as the tax base
for schools has diminished.
So my professional opinion is that I would not agree that
those vending machines should be replaced in schools unless the
financial support can be replaced. But that does not mean that
all the choices in those machines have to be--
Senator Dodd. What does a contract amount to? Can you give
me a typical--
Dr. Dietz. I do not actually know what a typical contract
is. I was reading something the other day that suggested that a
town outside Atlanta signed a contract over a 5-year period for
$200,000, or an income of about $40,000 to $50,000 a year. That
pays for things like scoreboards, things that a school board
might not choose to fund.
But in any case, the vending machines need not be all
negative. For example, we know from our experience and a study
that we are funding that if those vending machines are stocked
with healthful products, kids will buy them, and that maintains
the bottom line while allowing healthful alternatives like
flavored milk or even water as something in a vending machine
offers a positive alternative for children and still maintains
the level of financial support that schools need.
Senator Dodd. And your concern is that the nutritional
value of these products is substantially lacking.
Dr. Dietz. But it need not be so.
Senator Dodd. Yes. There was a piece by Tim Eagan in the
New York Times yesterday or the day before--did you see that?
Dr. Dietz. Yes, I did.
Senator Dodd. Do you agree with the conclusions in that
story?
Dr. Dietz. I thought the principal conclusion was that
trial lawyers were moving on to prosecute food rather than
tobacco, and I did not agree with that. But perhaps you could
remind me of the other points.
Senator Dodd. They talked about what goes on in the
schools, and they cited lunch time at Fremont High, the largest
school district in the Nation to enact a statewide ban on junk
food. In fact, the two biggest States, Texas and California,
are moving toward phasing out junk food in schools.
What you are suggesting is that there might be an
alternative here, and that is to eliminate junk food but
provide them vending opportunities with more nutritional
products.
Dr. Dietz. Provide choices, and there are strategic ways to
increase consumption of the healthful choices by competitive
pricing, for example.
The other conclusion that I remember that that article
reached was that if adolescents cannot find what they want in
schools, they can leave the open campus and go to the ring of
fast food chains that generally surround many of those high
schools.
So I think that it is not a simple solution, but schools
could do a better job in offering more healthful alternatives
and pricing them competitively.
Senator Dodd. Or, of course, alternatively, we could come
up with better funding schemes to help schools so they do not
have do this in the first place.
Dr. Dietz. Absolutely.
Senator Dodd. Thank you, Mr. Chairman.
Senator Bingaman. Thank you very much.
We have a vote that has already started, so we will need to
adjourn before we start with Panel 2.
Does any Senator have one additional question to put to Dr.
Dietz before we recess?
[No response.]
Senator Bingaman. If not, let us take about a 10-minute
break, and we will resume with Panel 2.
Thank you very much.
[Recess.]
Senator Bingaman. The hearing will resume.
I am sure some other Senators will be coming back in a few
minutes, but to move this along, we will go ahead with our
second panel.
Our witness on this panel is Ms. Denise Austin, who is
nationally known and respected as an expert in fitness. She
offers expert advice and has hosted her own television show on
physical fitness for the past two decades, and she is also a
tremendous example for the rest of us to follow in physical
fitness.
It is a pleasure to have you here. Thank you very much for
coming.
Please go right ahead.
STATEMENT OF DENISE AUSTIN, ON BEHALF OF P.E.4LIFE, ACCOMPANIED
BY ANN FLANNERY, EXECUTIVE DIRECTOR, P.E.4LIFE
Ms. Austin. Thank you. Mr. Chairman and distinguished
Members of the committee, I thank you for the opportunity to
talk about the role that exercise and fitness play in the
healthy development of our children.
Joining me today is Ann Flannery, who is Executive Director
of P.E.4Life.
I am here to talk about physical education in the schools.
I am a mom. I have my degree in physical education, and I have
been in the fitness industry for 23 years. I travel to schools
all over the Nation, giving lectures, trying to motivate kids
to get in better shape. And I have physically seen these kids
who are so out of shape they cannot even run a lap. So I am
here to help promote physical education in the schools, and I
truly believe that if we can get kids doing physical education
three to five times a week, a lot of these problems will be
diminished.
As you can tell, so many of the budget cuts happened about
14 to 16 years ago, and this is when the decline began.
I receive about 2,000 letters and emails each week from
moms all over the country, because I am a mom, and I can
relate. They ask me, Denise, what can I do--my child is
overweight, or my grand-daughter is overweight--what can I do?
The first thing I tell people is to find out how many days
a week they have in physical education. Ask your children. I
ask my kids, ``How many days a week do you have?'' I make sure
that they have at least 3 days a week of physical education.
That way, I know that they are physically active while they are
at school.
Also, of course, as a mom, you do have to instill in them a
healthy lifestyle when they get home, do some activities, too.
But my goal for everybody is to have healthy, happy children
and make sure they get exercise in three to five times as week.
A lot of mothers tell me, ``Denise, I asked my daughter,
and she said she only gets physical education once a week. What
do I do?'' That is why I am here.
Our joint passion to fight obesity and reverse the lack of
physical exercise in our Nation's youth is bolstered by
troubling research finding a corresponding rise in obesity and
diabetes rates.
Dr. William Klish, head of pediatric gastroenterology at
Baylor College of Medicine, found that children today have a
shorter life expectancy than their parents for the first time
in 100 years.
Beyond the physical trials of being overweight, the
psychological effects and social stigma attached to childhood
and adolescent obesity are of equal concern. Self-esteem is so
important for kids.
Most important, the correlation between increased childhood
obesity and decreased school-based physical education is all
too clear. Here are some statistics.
During the 1990s, the percentage of high school students
enrolled in daily gym classes fell by 31 percent. Today, only 8
percent of elementary schools, 6.4 percent of middle schools,
and 5.8 percent of high schools provide daily physical
education. Overall, 25 percent of our school children today do
not attend any physical education class at all.
Here is some good news. With an increase in physical
activity three to five times per week, studies have found a 20
percent increase in improvement in physical fitness, in self-
esteem, school attendance, and academic performance, and a 50
percent reduction in smoking and a 60 percent reduction in drug
and alcohol use.
That is why I am here today. I would like to introduce to
you Ann Flannery, who will speak in behalf of P.E.4Life.
Senator Bingaman. Thank you for being here, Ms. Flannery.
Go right ahead.
Ms. Flannery. Thank you, Mr. Chairman, and thank you,
Denise.
PE4Life was formed just 2 short years ago in recognition
that our Nation's most efficient delivery system for teaching
children how to lead physically active lives, school-based P.E.
programs, has largely been under siege over the past 15 years.
A comprehensive school-based physical education program is one
that includes not only classroom instruction--what we all know
as gym class--but also intramurals, after school activity
clubs, and athletics.
PE is not the same thing as sports. That is one of the
misconceptions that we need to educate people about. Most
parents and community stakeholders are shocked to learn today
that so many of our children do not receive daily P.E. in our
Nation's schools.
We believe that the solution to getting our children
physically active is to foster more public-private partnerships
with schools. Toward that end, we created the P.E.4Life
Institute. It is a partnership with the Naperville Community
Unit School District 203, and it provides in-service training
for community stakeholders throughout the Nation on techniques
to transform their physical education programs from the more
traditional skill-based instruction to more fitness-based
curriculums.
The Naperville Public Schools Physical Education Program
has been named and recognized as a model program by the Centers
for Disease Control and is perhaps the prime example of what as
been coined as ``the new P.E.'' And let me tell you, this is
probably not the P.E. that you had when you were in school,
Senator.
The new P.E. engages every student and stresses lifetime
fitness in addition to introducing children to traditional
games, activities, and individual and team sports, and it
rewards all students for personal improvement. In the new P.E.
today, a P.E. professional is highly likely to use a heart rate
monitor to score a student's success and levels of improvement,
rather than looking at them and asking are they working hard
enough.
This is really the transition that we are talking about
that is going on in physical education that once parents and
communities find out about, their immediate response is: How do
we get that in our own community?
PE4Life commends the Committee and Senators Frist, Bingaman
and Dodd in particular for your work in crafting comprehensive
legislation to address obesity and fitness. We understand that
a bill is likely and appreciate the opportunity to be afforded
to review a draft version.
In particular we applaud the key elements contained in the
draft version, including the community grants and the
coordinated school health program of which physical education
is a part. We have been working hand-in-hand with Dr. Dietz and
Dr. Colby at CDC in their Coordinated School Health Program to
understand how valuable we need to make a physical education
program. We also commend the community nutrition and physical
activity education and the Youth Media Campaign.
But as you proceed with crafting the final bill, there are
three additional focal points that we would encourage for
inclusion. The first is local partnership models. We have seen
the demonstrated success of the P.E.4Life Institute model, and
we are very pleased that the CDC recognizes its efficacy.
Fundamentally, it involves a 30-year teaching professional
named Phil Lawler. He is the director, and he is credited with
being what we are calling the ``guru'' of the new P.E. He
taught the old way, the way that, unfortunately, some of our
teacher prep programs still teach physical education. We need
to move them along. If it is a supply chain management issue,
we need to address the teacher prep programs in physical
education, and they are ready to do that, to learn all the new
technology that is going on in physical education and to learn
fundamentally how to be a community advocate.
So we would like you to take a look at the P.E.4Life
Institute as the model. People over the country in around 200
communities have come to visit in the last 18 months examples
like Owensboro, KY, where the hospital CEO recognized that all
of these outcomes in their community are preventable. He found
out about the Institute, and he took the mayor, the head of the
school board, the head of the PTA, a prominent cardiologist and
P.E. professionals in the community, and they traveled to the
Institute to learn how to do this in their own community. They
got energized, and now you have this community-school
partnership where everyone in that community believes that
every child in our school needs a daily physical education
program.
The next aspect we would recommend is a national study on
school physical education. As Dr. Dietz referred to earlier, we
do not have enough information on what is going on out there.
Forty-seven out of 50 States have something on the books about
physical education, but that does not translate into what is
actually happening at the local level, and we need that; it is
essential.
We are concerned. The CDC's own SHIPS data confirms that
what is required is not necessarily what is happening on the
ground. Such a study should include the physical education
requirements, the extent to which classes are available and/or
mandatory at the elementary, middle, and high school level, and
a comparative evaluation on the curriculum, including the
length of time of classes, the teacher qualifications, the
existence of standards, and the class size.
And then, finally, what we need more than anything,
Senator, is a national fitness test. We need to be able to
assess our children's fitness levels.
The CDC used to conduct the Youth Risky Behavior Survey,
which was a terrific study. We would suggest that we need to
fund that again to track children particularly at the K through
6 level. If we wait until high school and beyond, it will be
too late.
We are encouraged by California's leadership using the
Fitness Gram, a national test developed by the Cooper
Institute. This comprehensive youth assessment includes a
variety of health-related physical fitness tests designed to
assess cardiovascular fitness, muscle strength, muscular
endurance, flexibility, and body composition.
We appreciate the opportunity to be here with you today.
Denise and I are both committed. It is personal to me as well.
My mother was a 30-year physical education professional and
very proud to say that. She made a huge impact of the health of
children's lives.
Physical education is a great delivery system. We just need
to reinvigorate it.
Thank you.
[The prepared statement of Ms. Austin follows:]
Prepared Statement of Denise Austin
Chairman Kennedy, Ranking Member Gregg, Senator Bingaman, and
distinguished Members of the Committee, I thank you for the opportunity
to testify on behalf of P.E.4LIFE--a non-profit organization dedicated
to reestablishing quality physical education programs in our Nation's
schools while promoting the tangible benefits of daily physical
education programs in the healthy development of our children. Also I'm
pleased to be joined here today by Anne Flannery, Executive Director of
P.E.4LIFE.
A PERSONAL MISSION ROOTED IN FACT
Your commitment to addressing the United States' obesity epidemic
is evidenced by today's hearing, and your individual and collective
efforts on this crisis is a common bond we share. Beyond my current
work as the host of Lifetime TV's Denise Austin's Daily Workout, my
personal mission always has been to share the joys of fitness with the
widest possible audience. For ten years, my previous show on ESPN
reached homes in over 82 nations.
Our joint passion to fight obesity and reverse the lack of physical
activity in our Nation's youth is bolstered by troubling research
finding a corresponding rise in obesity rates. Dr. William Klish, head
of pediatric gastroentorology at Baylor College of Medicine, has found
that children today have a shorter life expectancy than their parents
for the first time in one hundred years. Currently, over 13 percent of
children and adolescents are overweight, which is nearly double late-
1970s levels.
Being overweight during childhood, and particularly adolescence,
directly relates to increased morbidity and mortality later in life.
Overweight and obese children have higher rates of asthma, Type II
diabetes, hypertension, and orthopedic complications--conditions that
have emerged only as the onset of this epidemic has accelerated. Beyond
the physical trials, the psychological effects and social stigma
attached to child and adolescent obesity are of equal concern.
And the correlation between increased childhood obesity and
decreased school-based physical education is all too clear. During the
1990s, the percentage of high school students enrolled in daily gym
classes fell by 31 percent. Today, only 8 percent of elementary
schools, 6.4 percent of middle schools, and 5.8 percent of high schools
provide daily physical education or its equivalent for the entire
school year for students in all grades. Overall, 25 percent of school
children do not attend any physical education class at all.
These are disturbing statistics, and I only hope that a comparative
review in 2010 will paint a far different picture.
According to the U.S. Department of Health and Human Services, all
children--from pre-kindergarten through grade 12--should participate in
quality physical education classes every school day. In physical
education class, students develop the knowledge, attitude, skills,
behavior, and confidence needed to be physically active for life. With
an increase in physical activity 3 to 5 times per week, studies have
found a 20 percent improvement in physical fitness, in self esteem,
school attendance, and academic performance--and impressively, a 50
percent reduction in smoking and 60 percent decrease in drug and
alcohol use.
P.E.4LIFE: ACCEPTING THE CHALLENGE
This is why I am honored to be with you today with P.E.4LIFE. I am
proud to be an active P.E.4LIFE supporter, joining noted athletes
Billie Jean King, Herschel Walker, Martina Navratilova, Dominique
Dawes, Stephen Davis, Payton Manning and Steve Young, among others, in
helping this fight. In addition, top companies in the sporting goods
industry, including Adidas, New Balance, Nike, Reebok, Spalding and
Wilson, have joined together with the American Heart Association, the
American Academy of Pediatrics, and other voluntary health organization
to support P.E.4LIFE's mission. Now I would like to have Anne Flannery
discuss several points regarding P.E.4LIFE and the Committee's Obesity
Agenda.
P.E.4LIFE believes that physical education is the beginning of a
lifelong learning process in which schools can play a central role in
teaching our children how to live as active, responsible, and healthy
adults. Our main goals include:
Raising awareness about the physical inactivity of America's youth
and the unfortunate state of physical education across the Nation;
Promoting the need for educational policies that include mandatory
daily physical education classes for children in grades K-12;
Advancing quality model physical education programs in every State;
Empowering physical educators, parents, and community leaders with
the knowledge to become key advocates for quality, daily physical
education; and
Stimulating private and public funding for quality physical
education.
This year, on May 1st, P.E.4LIFE celebrated National Physical
Education Day by visiting over 60 Members of Congress, including
Senators Bond, Frist, Harkin, Reed, Roberts, and Wellstone of the HELP
Committee. We also joined U.S. Secretary of Health and Human Services
Tommy Thompson and U.S. Secretary of Education Rod Paige in promoting
the importance of childhood physical activity as a means of preventing
many of the diseases this young generation is facing.
PEP--ONE PART OF THE SOLUTION
In particular, P.E.4LIFE thanks the Members of this Committee for
authorizing the Carol M. White Physical Education Program, known as
PEP, which was included in the comprehensive education reform bill
recently enacted. Promoting PEP, a competitive Federal grant program
providing grants to schools and school districts for equipment and
teacher training, has been among our top priorities.
PEP grants have allowed us to support and highlight good programs
that are constrained by a lack of resources. While we are very pleased
that PEP received an appropriation of $50 million in Fiscal Year 2002,
P.E.4LIFE does not believe that PEP funding is the exclusive answer to
the problem of lack of physical education problem in America. Overall,
we believe the solution must take hold and be driven at the local
level.
THE P.E.4LIFE INSTITUTE AND NAPERVILLE, ILLINOIS: A CASE STUDY OF LOCAL
PARTNERSHIP
Placing our belief in local leadership and involvement to the test,
we have created the P.E.4LIFE Institute. I have visited the Institute,
which trains communities throughout the Nation on techniques to
transform their physical education curriculum into model programs. By
providing in-service training for community stakeholders on
contemporary physical education curriculum measures, the Institute is
providing strong, grassroots support and continuing education
opportunities for community leaders and is creating advocates for
quality, daily physical education programs within communities
nationwide.
Just one example of how P.E.4LIFE is partnering with local
leadership is the P.E.4LIFE Institute established with the Naperville
Community Unit School District 203.
The Naperville public schools physical education program has been
named a model program by the Centers for Disease Control and Prevention
(CDC), and is perhaps the prime example of what has been coined the
``New P.E.'' This movement engages every student and stresses fitness,
and is beginning to take hold in schools nationwide. Daily, quality
physical education can replace failing or non-existent programs. The
New P.E. stresses lifetime fitness, in addition to traditional games,
activities, team sports, and rewards all students for personal
improvement. More likely to use a heart monitor than a score sheet to
gauge a student's success, New P.E. engages every student--not simply
the relatively small percentage of outstanding athletes.
It has worked in Naperville, and like many success stories, the
movement is spreading. About 30 percent of Illinois schools have
changed to the new model, and officials from over 200 schools around
the country have visited the Institute in the last two years. Two such
examples are Owensboro, Kentucky and Titusville, Pennsylvania. In
Owensboro, Hospital CEO Greg Neelson recognized that most of the
conditions that affected their community's health were preventable. He
read about the P.E.4LIFE Institute and arranged for ten leaders in his
community--including the Mayor, head of the school board, PTA members
and P.E. professionals--to travel to Naperville to learn how to
implement the New P.E. They were so energized that they came back and
put together the same kind of public/private sector partnership whereby
the business community matches the monies pledged by both the hospital
and the school districts, to implement a daily P.E. program in every
school for every Owensboro Child. To date, they have underwritten 6
schools programs and are well on their way to having every child
receive the New P.E. every day. In Titusville, it was the inspiration
of one P.E. professional who recognized that his teaching methods were
no longer sufficient to engaging today's children; Tim McCord called
the Institute, arranged for a visit and in two short years has
completed an overhaul of his school district's P.E. program that has
gotten the attention of both the local media and educators statewide.
CONGRESS' ROLE IN THE BATTLE
P.E.4LIFE commends the Committee, and Senators Frist, Bingaman, and
Dodd in particular, for your work in crafting comprehensive legislation
to address obesity and fitness. We understand that a bill will likely
be introduced in the next few weeks, and appreciate the opportunity
afforded by the Committee to review a draft version.
In particular, we applaud the following key elements contained in
the draft version and encourage their retention as the bill is
introduced:
Community Grants. Local community grants, as outlined in Title II,
to promote increased physical activity in the community are essential.
P.E.4LIFE supports the grassroots focus of this provision. The creation
of parks, bike paths, and recreational centers under this proposed
provision will significantly enhance opportunities to exercise. In
addition, the focus on encouraging business coalitions to increase
workplace activity levels, starting of exercise programs in nursing
homes, leveraging school-based facilities for broader recreational
activities is appropriately targeted.
School Health Program. P.E.4LIFE looks forward to working with you
to implement the School Health Program of Title III, which authorizes
and expands the work of the CDC in encouraging schools to implement
physical education courses and nutrition classes. We are especially
pleased that funding may be provided for staff physical education
training, after hours physical activity programs, and physical
education class planning and implementing. This program would
complement both the PEP program and CDC's school health program by
working directly with schools or school districts.
Community Nutrition and Physical Activity Education. States should
be permitted to use Preventive Services Block Grant funds for community
education on nutrition and increased physical activity.
Health Center Obesity Programs. P.E.4LIFE supports the use of funds
for community health centers, rural health clinics, Indian Health
Center facilities to carry out programs to address obesity and
overweight among their clientele.
Youth Media Campaign. It is very appropriate that the bill devotes
resources to the CDC Youth Media Campaign--an initiative that will all
contribute to increasing physical activity.
As you proceed with crafting the final bill, there are three
additional focal points that P.E.4LIFE would encourage for inclusion.
Local Partnership Models. We have seen the demonstrated success of
the P.E.4LIFE Institute model, are very pleased that the CDC views this
initiative as a model P.E. program. P.E.4LIFE strongly encourages the
Committee to include the tenants of the P.E.4LIFE Institute in Title
III as an ideal model for the training of physical education personnel
and the designing of physical education curricula.
National Study on School Physical Education. P.E.4LIFE also believe
that a comprehensive review on the state of physical education programs
is essential. Topics for a study or GAO Report addressing the level of
physical education in schools should include, at minimum: each State's
physical education requirements; the extent to which physical education
classes are available and/or mandatory at the elementary, middle, and
high school levels in each State; comparative evaluation on physical
education curricula, including the length of time of classes, physical
education teacher qualification, the existence of standards for
physical education, and class size; and measures of accountability for
student achievement.
National Fitness Testing. To enhance our continued understanding of
the obesity epidemic and the role that increasing physical activity
plays in achieving change, P.E.4LIFE recommends that additional
measures for assessing the fitness of our Nation's youth be
established. Creating incentives to States for the conducting of
statewide fitness testing should be considered as the Committee
proceeds.
While fitness testing in schools is not new, we are encouraged by
California's leadership in using ``Fitness Gram,'' a national test
battery developed by The Cooper Institute. This comprehensive youth
assessment protocol includes a variety of health-related physical
fitness tests designed to assess cardiovascular fitness, muscle
strength, muscular endurance, flexibility, and body composition.
Criterion-referenced standards associated with good health have been
established for children and youth for each of these fitness
components. We view Fitness Gram as a model for other States to follow,
and encourage you to include language in the bill that would
incentivize States to conduct fitness testing.
On behalf of P.E.4LIFE, I thank you for the opportunity to testify
today. As one person whose life work has centered on helping all
Americans adopt healthy lifestyle fitness practices and habits, I
greatly appreciate the time that each of you is investing. The
comprehensive agenda that the Committee is forming for the forthcoming
legislation is heartening and appropriate as we together remedy the
obesity epidemic facing America today. Please know that both P.E.4LIFE
and I are willing to work side-by-side with you in the coming days.
Senator Bingaman. Thank you both very much for your
testimony.
Let me try to understand a little more. If I gin up a trip
of school administrators and P.E. professionals and public
officials to come and see your Institute, what do we learn?
Ms. Flannery. You are going to learn a number of things
about how to implement a daily P.E. program. First of all, it
is not the old P.E., and I think we need to raise awareness
about that. The equipment has changed tremendously. You see a
lot of, fundamentally in some ways, health club situations in
the schools--climbing walls--you are seeing all sorts of
activities that children get a chance to learn. But you are
also seeing the adoption of new technology like heart rate
monitors, software programs like FitLinks that allow children
to develop their cognitive skills about what is it like to be
in their target heart rate zone, what is healthy, and what is
appropriate--because we do not just want to train the athletes.
We want to train all of our children to understand how to be
physically active their entire lives.
Senator Bingaman. Denise, do you try to do anything
involving proselytizing on diet and what people eat as well as
the exercise that you are so identified with?
Ms. Austin. Yes, but I am not a nutritionist. My degree is
in physical education. I am a big believer in getting out there
and moving, even it is kids at whatever age, to teach people
the joys of fitness and how much better you can feel about
yourself. I am a big believer that you should eat well 80
percent of the time, have some treats 20 percent of the time--
but the key thing here is that I believe that food is not our
enemy--it is standing still, sitting still--doing nothing is
our enemy.
We need to get kids out there and more active. They are
sitting, watching too much TV, in front of the computer games.
I get my kids out there, and we play tag, ball, anything to
keep them moving. Everyone needs to implement exercise now into
their lives because we sit for 8\1/2\ hours a day. We need to
get up and move.
Senator Bingaman. All right. I am encouraged.
On your Institute, do you worry about nutrition in the
schools, or do you leave that to someone else?
Ms. Flannery. I think the 21st century P.E. professional
also needs training in nutrition. Phil Lawler has an
opportunity with children to address what is calorie intake,
calorie output, in very real situations with the kids. When
someone is learning on the exercise machine and seeing how many
calories they are burning, he can right there say, ``What did
you eat today?'' or ``What are you planning to eat between now
and dinner?'' and it gives very real life examples and teaching
moments, which is what you want so that the child can learn on
a real life basis what good nutrition is all about and what
choices he or she can make.
Senator Bingaman. Thank you. Thank you both very much. I
think your testimony has been great, and I compliment you for
your lifelong commitment to solving this problem.
Thank you very much.
Let me ask the third panel to come forward now and we will
hear from them.
We welcome Sally Davis from the University of New Mexico,
Kelley Brownell from Yale University, Lisa Katic from the
Grocery Manufacturers of America, and Richard Dickey, M.D.,
with Wake Forest University School of Medicine.
Thank you all very much for being here. I appreciate it. I
will give a little more elaborate introduction of each of the
four of you.
Dr. Sally Davis is a Professor in the Department of
Pediatrics and Director of the Center for Health Promotion and
Disease Prevention at the University of New Mexico School of
Medicine. She has 30 years of experience in health promotion
and disease prevention programs, especially in the areas of
physical activity, nutrition, and obesity prevention.
Dr. Kelley Brownell is a Professor of Psychology at Yale
University, where he also serves as Professor of Epidemiology
and Public Health and as Director of the Yale Center for Eating
and Weight Disorders. He is an internationally known expert on
eating disorders, obesity, and body weight regulation.
We also have Dr. Richard Dickey who is both a physician and
a Professor of Medicine at Wake Forest University School of
Medicine and has practiced medicine for more than four decades.
He has focused much of his efforts on the study and treatment
of obesity and obesity-related health complications. He is one
of the Nation's foremost experts on the subject of obesity and
metabolism.
Ms. Lisa Katic is the Senior Food and Health Policy Advisor
to the Grocery Manufacturers of America in Washington, DC. She
is responsible for developing and implementing policies and
programs related to fitness and nutrition. She is also a
registered dietician and is considered an expert on nutrition
policy.
Why don't we start with Dr. Davis and go right across. As I
said earlier, we will take your full statement and include it
in the record as if you read it, so if you could summarize the
main points that we think we should be aware of and do that in
5 or 6 minutes each, that would be great.
Dr. Davis.
STATEMENT OF SALLY M. DAVIS, DIRECTOR, CENTER FOR HEALTH
PROMOTION AND DISEASE PREVENTION, UNIVERSITY OF NEW MEXICO
Ms. Davis. Thank you, Mr. Chairman, for the opportunity to
testify today.
I come before you to share some of our experience in the
battle against the growing epidemic of obesity. For the past 30
years, I have worked in partnership with underrepresented
communities in New Mexico and throughout the Southwest. For the
most part, these communities are rural and culturally diverse,
with Native American, Hispanic, and Anglo families often living
near or below the poverty level.
During these 30 years, I have seen lifestyle diseases such
as obesity and diabetes increase at alarming rates and at
younger ages than ever before. Paralleling these health trends
is a decrease in school physical education and recess, an
increase in the availability of calorie-dense foods, and a less
active lifestyle.
Our Center has been actively engaged in developing,
implementing, and evaluating various interventions to address
the health concerns of this medically underserved population in
the Southwest. I would like to highlight a few of those
interventions specifically related to physical activity,
nutrition, and obesity.
One of our first projects was the Checkerboard
Cardiovascular Curriculum funded by the National Heart, Lung,
and Blood Institute, which was a culturally and developmentally
appropriate classroom intervention that focused on healthy
eating and a balanced diet and on being physically active. For
example, we used stories about healthy Native foods, such as
the story about corn, beans, and squash called ``The Three
Sisters.'' We also taught Native games to reinforce being
physically active.
It was during this project that we learned the importance
of including families in school-based interventions. When
included in the intervention activities, families serve as an
important role model and as powerful reinforcers of the
knowledge and behavior children learn at school.
An example of this from one of our projects is that
grandparents were concerned that their grandchildren were not
as active as they had been when they were growing up and that
the children were eating too much. Elders are honored to come
into the classroom and share their experiences about a time
when physical activity was a part of everyday life.
These stories about the healthy habits they once practiced,
such as running to the East in the morning when they woke up,
and eating with one hand so they would not eat too much,
provide inspiration and cultural pride.
Three other school-based projects also funded by NIH
followed, the most recent of these being Pathways, in which we
partnered with four universities and seven Native tribes. Since
the completion of Pathways, we have had more than 300 requests
from across the country for the intervention materials and
training in their use. Unfortunately, at this time, we do not
have the funds for dissemination, often a problem associated
with research of this kind; once it is developed and lessons
learned, we do not have the resources to share with others.
Although much of our work has been done in schools, as they
are important gathering places in rural communities and a focal
point for reaching children and their families, we believe that
interventions to promote a healthy lifestyle and prevent
disease should be addressed across the life span.
For example, we were approached by the Navajo Agency on
Aging, which was concerned that prevention programs were
overlooking the needs of the elders. This collaboration has
resulted in our providing training and technical assistance on
nutrition and physical activity specific to senior citizens to
the staff of senior centers across the Navajo Nation.
On the other end of the age spectrum is the collaborative
project that we have with Dine College, which is a Navajo
community college, to assess the nutritional status of
preschool children participating in the Navajo Head Start
program.
Yet another study that we recently completed assessed the
availability, affordability, and variety of healthful foods on
the Navajo reservation by conducting an inventory of the foods
available in trading posts and convenience stores. Zuni Healthy
Foods First is another project currently underway that promotes
the intake of selected fruits, vegetables, and other healthy
foods that includes partnering with local grocery stores. We
are also involved in developing a nutritional training module
for the March of Dimes Birth Defects Prevention Task Force
aimed at preconception health education through motivational
counseling.
On the national level, we are the lead center for a CDC
Division of Nutrition and Physical Activity-funded network of
11 universities and 12 State health departments who are working
together to identify innovative approaches to increasing
physical activity, improving nutrition, and preventing obesity.
All the projects that I have presented were made possible
through Federal funding. The science of what we know about
increasing physical activity and improving nutrition and
particularly preventing obesity is very new and therefore, very
limited. If we are to identify solutions to the growing
problems associated with obesity, it is important that programs
like these and others that are innovative, that meet local
needs and are rigorously evaluated be supported through funding
and legislation. We need more programs designed to educate and
support families, including the aging population. Schools and
communities need support in creating healthy and safe
environments for physical activity.
We need to find out what works and what does not work. This
bill to establish grants to provide health services for
improved nutrition, increased physical activity, and obesity
prevention is an important and much needed move in the right
direction to meeting a critical health need of this country.
Thank you.
Senator Bingaman. Thank you very much, Dr. Davis.
[The prepared statement of Ms. Davis follows:]
Prepared Statement of Sally M. Davis
Thank you, Mr. Chairman and distinguished Members of the Committee
for the opportunity to testify today. I am Dr. Sally Davis, Director of
the Center for Health Promotion and Disease Prevention at the
University of New Mexico. I come before you to share some of our
experience in the battle against the growing epidemic of obesity. For
the past 30 years, I have worked in partnership with under-represented
communities in New Mexico and throughout the Southwest. For the most
part these communities are rural, and culturally diverse (Native
American, Hispanic and Anglo) with families often living near or below
the poverty level. During these 30 years, I have seen lifestyle
diseases such as obesity and diabetes increase at alarming rates and in
younger ages than ever before. Paralleling these health trends is a
decrease in school physical education and recess, an increase in the
availability of calorie dense foods and a less active lifestyle.
The University of New Mexico Center for Health Promotion and
Disease Prevention, one of the Centers for Disease Control's (CDC)
Prevention Research Centers (PRC) has been actively engaged in
developing, implementing, and evaluating various interventions to
address the health concerns of this medically underserved population in
the Southwest. I would like to highlight those interventions
specifically related to physical activity, nutrition and obesity.
One of our first projects was the Checkerboard Cardiovascular
Curriculum (CCC) Project named for a vast land area of New Mexico with
a checkered patterned of land ownership that includes Navajo
homesteads, ranches that were once Spanish land grants; other private
land; and public lands administered by the Bureau of Land Management
(BLM) and U.S. Forest Service. The CCC project, funded by the National
Heart Lung and Blood Institute, was a culturally and developmentally
appropriate classroom intervention that focused on eating a healthy and
balanced diet and being physically active. For example, we used
traditional stories about healthy Native foods such as the story about
corn, beans, and squash called ``The Three Sisters.'' We also taught
Native games to re-enforce being physically active. It was during this
project that we learned the importance of including families in school-
based interventions. When included in intervention activities, families
serve as important role models and powerful re-enforcers of the
knowledge and behaviors children learn at school. An example of this
from our projects is that grandparents are concerned that their
grandchildren are not as active as they had been when they were growing
up and that the children are eating too much. The elders are honored to
come into the classroom to share their experiences about a time when
physical activity was a part of every day life. The stories about the
healthy habits they once practiced such as running to the East each
morning when they woke and eating with one hand so they would not eat
too much, provide inspiration and cultural pride. Traditional food
preparation is a favorite activity of both the grandparents and
students and leads to discussions of ways to make food healthier during
preparation. Stories of foot races and long distance running is also a
favorite and remind children of their heritage. A video documentary of
local Native people who have chosen to live a healthy lifestyle
continues to be very popular.
Taking what we learned from the Checkerboard Cardiovascular
Curriculum project and at the invitation of the communities and schools
over the years we developed the Southwest Cardiovascular Project and
the Pathways to Health projects. Our most recent intervention,
Pathways, was with tribes and universities across the country. For
eight years, we worked with schools and communities located in seven
Indian Nations. Using a participatory approach, researchers from five
universities, seven Indian Nations and the National Heart Lung and
Blood Institute developed, implemented and evaluated a physical
activity and nutrition intervention for students in grades three
through five. Pathways was designed by building on a foundation of
previous experience, social learning theory, community-based formative
assessment and cultural concepts representative of the participating
population. The four components of Pathways include classroom
curriculum, family activities, physical activity and school food
service. Family Fun Night includes booths where families can taste
foods such as low fat milk and healthy snacks. Families also learn
things they can do with their children to be physically active and
receive prizes for participating in active games. Short physically
active games designed for the classroom, called exercise breaks, re-
enforce the importance of movement. In the curriculum, students
correspond with other students from other tribes in the Pathways
project and share information about healthy foods and activities common
to each participating tribe. Food service workers learn ways to make
school lunches and breakfasts healthier. Pathways was successful in
increasing children's knowledge about nutrition, physical activity, and
health in general and positively affecting their nutrition and physical
activity behaviors. Parents, school administration and staff were very
positive about the project and especially appreciated the training that
accompanied each of the components. Parents often told us how much they
enjoyed the activities and how much the program had influenced them to
make changes in their daily habits relating to eating and being active.
Since the completion of Pathways, we have had more than 300 requests
from across the country for the intervention materials and training in
their use. Unfortunately, at this time we do not have the funds for
dissemination.
Although much of our work has been done in schools, as they are an
important gathering place in rural communities and a focal point for
reaching children and their families, we believe that interventions to
promote a healthy lifestyle and prevent disease should be addressed
across the life span. For example we were approached by the Navajo
Agency on Aging and a community health educator who were concerned that
prevention programs were overlooking the needs of the elders. This
collaboration has resulted in our providing training and technical
assistance on nutrition and physical activity specifically for senior
citizens to the staff of Senior Centers across the Navajo Nation. On
the other end of the age spectrum is a collaborative project with Din
College (Navajo Community College) to assess the nutritional status of
preschool children participating in the Navajo Head Start program. The
results of this study will provide a data set that can be used to
inform discussion of policy and effectiveness of food assistance
programs and nutritional interventions among Navajo families. Yet
another study assessed the availability, affordability, and variety of
healthful foods on the Navajo reservation by conducting an inventory of
the difference sources, such as trading posts and convenience store,
for purchasing food throughout the Navajo reservation. This project
helps to better understand what foods are realistic to recommend to
families and what food stores should be encouraged to carry. ``Zuni
Healthy Foods First'' is another project currently underway that
promotes the intake of selected fruit, vegetables, and other healthy
foods through a practical, multi-dimensional approach that includes
partnering with the local grocery stores. They have agreed to stock
foods recommended in nutrition classes and take incentive coupons from
those families attending the nutrition/cooking classes.
Nutritionists from the Prevention Research Center are also
developing a nutritional training module for the March of Dimes Birth
Defects Prevention Task Force aimed at ``Preconception Health Education
through Motivational Counseling''.
Since our Prevention Research Center is university-based and we are
located within the Health Sciences Center we have a wonderful
opportunity to reach students and residents in training for the health
professions. We provide hands-on experiences and one-on-one mentoring
for a diverse group of students and residents of all levels. We believe
it is important to include these individuals to better prepare them as
prevention researchers and health care providers of the future.
All of these projects I have presented were made possible with
Federal funding. The science of what we know about increasing physical
activity and improving nutrition and particularly preventing obesity is
very new and therefore limited. If we are to identify solutions to the
growing problems associated with obesity it is important that programs
like these and others that are innovative, meet local needs, and are
rigorously evaluated be supported through funding and legislation. We
need more programs designed to educate and support families including
the aging population. Schools and communities need support in creating
healthy and safe environments for physical activity. We need to find
out what works and what doesn't work in the prevention of obesity and
the improvement of physical activity and nutrition. This means more
funding for prevention research and training of researchers. Pre-
service and continuing education must be provided to health
professionals if they are to provide state-of the-art counseling and
treatment for their patients. The ``Improved Nutrition and Physical
Activity Act'' (IMPACT), to establish grants to provide health services
for improved nutrition, increased physical activity, and obesity
prevention is an important and much needed move in the right direction
to meeting a critical health need of our country.
Senator Bingaman. Dr. Brownell.
STATEMENT OF KELLEY D. BROWNELL, DIRECTOR, YALE CENTER FOR
EATING AND WEIGHT DISORDERS, YALE UNIVERSITY
Mr. Brownell. Thank you for the opportunity to speak.
I love the fact that this bill exists. As much as the
content in it, the fact that this bill is before the country
now, is something quite striking and marks a very important
point in the history of our dealing with an important health
problem.
The folks who have spoken so far today have talked a lot
about physical activity, and that is very important--do not get
me wrong--but we are ignoring the food part of this, and the
food part of it is at least as important as the physical
activity, and it is easy to ignore because of pressure from the
food industry.
I am going to make the point that the epidemic of obesity
exists because of a toxic food and physical inactivity
environment and that until we recognize this cause and do
something bold and innovative about it, we are going to be
losing this battle.
The programs we have heard about today, programs in
communities, are innovative and absolutely need to be done, but
for every case of obesity this prevents, there are probably
more thousands more coming on line because of this toxic food
and physical inactivity environment.
We simply cannot get rid of this problem by traditional
medical treatment or by community programs, because the toxic
forces are so overwhelming. By a ``toxic'' environment, I mean
the physical inactivity that has been explained in great detail
already, but also the fact that food is available everywhere,
all the time, in places where it never used to be. You can eat
a meal in a gas station now. You can eat a meal in a drugstore.
You can eat a meal in a shopping mall. This was never the case
before.
Portion sizes have grown out of control. What used to be
the large is now the small; portion sizes have been manipulated
up, up, and up until the default sizes are absolutely
astronomical.
The food industry pounds away relentlessly at our psyche,
and this is especially true of children in a way that I will
mention in just a minute. This is a David and Goliath contest.
This is a drop against a tidal wave, if you will. Let me give a
few examples.
The National Cancer Institute has $1 million per year to
spend on advertising the Five A Day program to encourage people
to eat fruits and vegetables--$1 million. McDonald's alone
spent $500 million on the ``We Love to See Your Smile''
campaign. One company, one campaign, 500 times what the NCI
spends.
The entire Government budget now for nutrition education is
one-fifth the annual advertising budget for Altoids mints. It
is not surprising, therefore, that one-fourth of all vegetables
served in the United States come as french fries.
The picture with children is especially appalling. The
average American child sees 10,000 food advertisements a year.
A mother or father who gives a compelling media-based lecture
to their child every day of the year would deliver 365 messages
compared to the 10,000 from the food industry.
We are engineering physical activity out of schools. We
feed our children terrible school lunches. We allow the soft
drink companies and the snack food companies to put machines in
our schools. The schools become dependent on this money, but
logos for Coke and other companies show up on scoreboards and
on uniforms and in other places, and more and more, schools are
beginning to look like 7-Elevens with books.
The question is what do we do. First, we have to make a
philosophical judgment ourselves as to how much of our
resources can we contribute to trying to help people who have
the problem already versus trying to prevent it. Helping people
with a problem already smacks of compassion and is obviously an
important thing to do, but it costs a lot, because the
treatments that we have are not terribly effective, although
there are some promising things out there, and they tend to be
fairly expensive. So from a public health point of view, we are
not going to be able to treat this problem away.
This, of course, leads us naturally to the issue of
prevention, and that leads us, of course, to the issue of
children. I think that children are to the obesity field what
secondhand smoke was to tobacco. You can always make the
individual responsibility argument for adults, but when you see
8-year-old children with what used to be called adult-onset
diabetes, probably needing cardiovascular bypass surgery by the
time they are 30, it is very hard to make a personal
responsibility argument.
I think we need to make bold, decisive moves on the level
of public policy, and specifically, I would suggest the
following. One is to make physical activity more available to
the population. This has been discussed in detail.
Second, I believe we need to regulate food advertising
aimed at children. The 10,000 food commercials, by the way, 95
percent of which are for fast food, sugared cereals, soft
drinks and candy, have to be combatted by something, and what I
would suggest specifically is some kind of equal time
legislation that would mandate equal time for pro-nutrition
messages, and money should be put behind developing pro-
nutrition messages.
What happens in our schools has to be changed. Fast foods,
snack foods, and soft drinks should be banned from the schools.
Dr. Dietz is correct--it is not the machines that we are
concerned about; it is what is in the machines. So if children
have healthy foods available, they will eat healthy foods; if
they have unhealthy foods available, they will eat those. It is
a simple matter. Animals will do the same thing when put in a
cage. If children have fast foods available, the snack foods
and the soft drinks, they are going to consume them, and we are
going to have trouble.
Finally, I would recommend that we consider some ways to
reverse the economic picture of food. The fact is that
unhealthy food is easy to get, and it costs relatively little;
healthy food is harder to get, and it costs too much. And as
long as the economics are set up like this, we are bound to
have a society that is going to overeat the unhealthy foods.
If you go to poor neighborhoods especially--this has been
quite well-documented--healthy foods are not available, and
when one does find them, they tend to cost an awful lot,
whereas there are lots of choices of soft drinks, snack foods,
candy, and the like.
I am going to end with a discussion of how we interact with
the food industry around this, and I think this is a very
important philosophical decision that the folks making the
policy will have to deal with.
There is much talk these days of stakeholders, of
coalitions, and words like ``partnership'' get used a good bit.
The way I see our field going is that the food industry is
becoming a part of the decisionmaking progress. Now, I am a
collaborative person by nature, and generally, partnerships and
coalitions are a good thing rather than a bad thing, but we
have to be cautious here, and I think there is a dear price to
pay if we are not careful about how we move ahead. We have to
take some knowledge from what happened with tobacco and the way
the tobacco industry dealt with these issues, too.
This is what I believe the food industry is going to do,
and they have shown many signs of this already. First of all,
they are going to stay and say ``We need more research'';
recommendations that come out of committee meetings and so on
will be watered down and will end up looking like pablum more
than anything bold and decisive.
Second, they have the opportunity to deny, distort and
ignore both the science and common sense. I will give you an
example in a moment. They will say that parents and families
must do the job. Well, if parents and families could do the
job, we would not have this problem in the first place. They
will also make straw man arguments and say things like we
cannot blame the epidemic on one food, we should not make
demons of certain parts of the industry, and that things like a
soft drink tax which several States are considering now will
not wipe away this problem. Of course, they will not wipe away
the problem. It is an enormous, complex problem, and no one
thing is going to get the job done. But those are straw man
arguments.
As an example of this, let us look at soft drinks. The most
authoritative recent study that has been done on soft drink
consumption which was published in a good medical journal, The
Lancet, by Ludwig and colleagues concluded the following, and I
quote: ``Consumption of sugar-sweetened drinks is associated
with obesity in children.'' Common sense will tell you that
that is the case, and data tell you that is the case. However,
the website from Saturday from the National Soft Drink
Association said the following: ``Soft drinks do not cause
pediatric obesity, and further, the soft drink industry has a
long commitment to promoting a healthy lifestyle for
individuals, especially children.'' How can anybody with an IQ
over 8 believe that to be the case?
They also say--and this is actually true, but sad--that
``The revenue generated from the sale of beverages in schools
is an important part of the education funding equation in the
United States.'' If the schools need the money, and if they
need to sign on with corporate America in order to survive, why
can't they sign on with computer companies, with fitness
equipment companies--something other than food, which is
basically helping to poison our children.
It took 40 years to get where we are today with the fight
against tobacco. The industry stalled, ignored the data, denied
the data, and did all the things that are now well-known. You
can just see it coming with the food companies. If they are on
the team, we are going to crawl up the field inch by inch by
inch and make very slow progress. I believe that it is better
to have them on defense than it is to have them sabotaging your
offense.
Thank you.
Senator Bingaman. Thank you, Dr. Brownell.
Ms. Katic, please go ahead.
STATEMENT OF LISA KATIC, SENIOR FOOD AND HEALTH POLICY
ADVISORY, GROCERY MANUFACTURERS OF AMERICA
Ms. Katic. Thank you, Mr. Chairman.
My name is Lisa Katic. I am a registered dietician, as you
pointed out earlier, and I am the Senior Food and Health Policy
Advisor to the Grocery Manufacturers of America.
GMA is very pleased to be before you today. We want to
share our views on food and nutrition. We are the world's
largest association of food, beverage, and consumer product
companies. We employ more than 2.5 million people in all 50
States.
First of all, let me begin by commending the Committee for
focusing on solutions today rather than scapegoats. The
problems that we are addressing today are the result of a
complex combination of factors. That is why we believe the
title for this hearing is appropriate--``Getting Fit, Staying
Healthy: Strategies for Improving Nutrition and Physical
Activity.''
We believe that effective solutions demand a comprehensive
strategy, one that avoids blaming individuals, food companies,
or societal trends. As a nutritionist, I can tell you that this
issue is about calories in versus calories out. The source of
calories does not affect this equation.
The American Dietetic Association says that a healthy
lifestyle involves a well-proportioned, balanced diet and
physical activity. You cannot have one without the other.
With every passing decade, there seems to be a new diet
that focuses on a single food group or nutrient, such as
carbohydrates, proteins, or fats, and these diets profess to be
the answer to all of our weight gain woes. The Atkins diet
first gained popularity in the 1970s. In the 1980s, the
nutrition culprit was fat. Today, obesity rates are rising, and
once again, Americans are turning to failed diets of the past,
and consumers are as confused as ever.
My point is that none of these have worked in the past.
They are not going to work now. Consumers need consistent and
understandable messages about food and health, based on the
best available science. We must take a total diet approach and
forever abandon blaming a single food or nutrient as the cause
of America's weight gain.
Many people come to this hearing today with differing
perspectives, but no one disagrees that physical activity is
the leading cause of health in America. I did say that physical
activity is the leading cause of health in America.
Last year, the Surgeon General called for 30 minutes of
daily physical activity for every school-age child. Sadly
today, we are not even close to meeting this goal. The goal
must be to make physical fitness a part of our culture. Habits
that are learned early stay with us for a lifetime.
Mr. Chairman, it is time to get Americans moving again. GMA
recognizes that our industry has a very important role to play
in improving fitness and nutrition. Our industry has long
supported nutrition education and physical activity programs,
like Take 10, Activate, the Five-a-Day campaign, and Colorado
on the Move, just to name a few.
Our member companies also place a very high priority on
researching and developing new ways to make people's favorite
foods even healthier without sacrificing taste. We know that
taste is the number one reason why people choose food. Many
companies provide financial, technical, and personnel support
for local food banks and community-based wellness programs.
Although we have some suggestions, GMA believes that
legislation currently being drafted by this Committee is headed
in the right direction, particularly the focus on research, on
physical activity, and on nutrition education.
In the area of improving nutrition education, I cannot
emphasize enough that quality research is needed to determine
what actually changes behavior and changes behavior for the
long term. There is a tremendous amount of nutrition
information available, but it is just not always getting
through to the people who need it, like parents, teachers, and
community leaders.
Equally important, the information is not always culturally
appropriate. It is not always available to help at-risk or
minority populations.
Let me just say a word or two about some of the punitive
measures that have been offered as solutions today. Efforts to
tax, ban, or restrict the consumption of certain food are
scientifically unsound and in fact quite counterproductive.
Such proposals lull people into thinking that something complex
can be solved by something simple. Quite simply, they do not
work, and Congress should reject them.
In fact, a study published in the Journal of the American
Dietetic Association states that overly restrictive diets can
lead to enhanced food cravings, overindulgence, and even eating
disorders.
Finally, let us not forget the critical role that
individuals and families play in combatting obesity. While the
Government provides information to help consumers make informed
choices, and the food and beverage industry provides variety,
neither of these is as important as the role that parents play
in establishing proper eating habits for their children.
Parents must also show a good example by engaging in regular
physical activity themselves.
Mr. Chairman, we look forward to working with you as you
progress on your legislation. We have a lot of expertise in
this area, we have a lot of suggestions, and we are also very
committed to helping Americans get fit and stay healthy.
Senator Bingaman. Thank you very much.
[The prepared statement of Ms. Katic follows:]
Prepared Statement of Lisa Katic
Good afternoon Mr. Chairman and Members of the Committee. My name
is Lisa Katic. I am a registered dietitian and a Senior Food & Health
Policy Advisor to the Grocery Manufacturers of America (GMA).
GMA is pleased to appear before the Committee today to share our
views on the issue of fitness and nutrition. GMA is the world's largest
association of food, beverage and consumer product companies. With U.S.
sales of more than $460 billion, GMA members employ more than 2.5
million workers in all 50 States. The organization applies legal,
scientific and political expertise from its member companies to vital
food, nutrition and public policy issues affecting the industry. Led by
a Board of 42 Chief Executive Officers, GMA speaks for food and
consumer product manufacturers at the State, Federal and international
levels on legislative and regulatory issues.
GMA and its member companies believe the topic for today's hearing
is critically important. The food and beverage industry we represent
has long advocated for comprehensive, long-term strategies for
improving the health and wellness of all Americans by promoting
science-based solutions focused on the critical balance between fitness
and nutrition. We have done so as individual companies and trade
associations and, more recently, in cooperation with other industry
allies, not-for-profit organizations, public health professionals and
others who are committed to promoting the balance between fitness and
nutrition. Many of these groups and individuals have joined with GMA to
form the American Council for Fitness and Nutrition, an organization
dedicated to these ideals.
GMA thinks the ``Improved Nutrition and Physical Activity Act'' is
the perfect title for the legislation being developed by Members of
this Committee because it sets the right framework for this discussion.
The lack of a balanced diet coupled with the lack of regular, daily
physical activity can lead to many physical and mental conditions--
including depression, heart disease, diabetes and overweight.
These conditions emerge because of a complex combination of factors
and cannot be solved solely by blaming individuals, food companies or
societal trends and events. It is well documented that people become
overweight from a variety of dietary, socio-economic, genetic and life-
style risk factors. Therefore, finding effective, long-term solutions
requires (1) a thorough understanding of the science of fitness and
nutrition, (2) a recognition of the benefits of a well portioned and
balanced diet, and (3) a commitment to promoting physical activity.
I would like to discuss these three topics in turn and then offer
some insights into the contributions the food and beverage industry is
making to help improve general wellness. Finally, I will close with
observations on the draft legislation and what more can be done by
individuals, the food and beverage companies and Government entities to
improve nutrition and physical activity for all Americans.
I. The Science of Fitness and Nutrition
History has taught us that there can be no single solution to
improving our children's nutrition and fitness. Although our need for
food is basic, the interaction between nutrition, exercise and health
is complex. To help our kids lose weight and get in shape, we must
understand the evolution of food and the latest developments in
nutrition science to avoid repeating past mistakes in nutrition advice
offered by Government, health professionals or the media.
As a nutritionist, I can tell you that there is a consensus that at
its core, this issue is about calories in versus calories out. In
scientific terms, obesity is a disease with a multifactorial etiology.
In addition to diet and physical activity, incidence of overweight and
obesity are also affected by sociocultural factors, socioeconomic
status, and an individual's unique genetics and physiology. To
understand how a poor diet and the lack of physical activity in
particular contribute to overweight and obesity, the fundamentals of
thermodynamics must be understood and applied: calories consumed =
calories expended. The source of calories consumed does not affect the
equation. Total diet (calories in) and physical activity (calories
out), therefore, are the critical controllable factors in today's
weight loss and in weight maintenance.
Overweight and obesity among Americans are linked to several major
chronic diseases affecting Americans, such as cardiovascular disease,
cancer, and diabetes. Overweight children are more likely to become
overweight adults, and, therefore, they may be at increased risk of
developing these chronic diseases later in life. There is general
scientific agreement that parents and healthcare professionals should
stress to adolescents the benefits of eating a healthy diet, as
outlined in the U.S. Department of Agriculture's Food Guide Pyramid.
The American Dietetic Association has stated that the entire diet,
rather than specific foods, should be scrutinized. Identifying the
extra calories that might be contributing to an adolescent being
overweight or obese will probably be more effective in changing his or
her diet than portraying individual foods as good or bad.
Simply put, the science is too much in flux to declare a final
answer today. For instance, we have been told to monitor cholesterol to
prevent coronary heart disease, which is the leading cause of death in
the United States. More recent studies have identified homocysteine,
not cholesterol, as a culprit in producing arteriosclerosis. Scientists
are also now divided on the role of saturated fats in causing coronary
heart disease. That linkage, once thought ironclad, is now being
reassessed. Retrospective epidemiological studies are now calling into
question the practical benefits of avoiding saturated fats for an
entire lifetime. What is clear is that the keys to a healthy lifestyle
involve following the American Dietetic Association's (ADA) guidance on
a well proportioned, balanced diet and physical activity. Doing just
one is not enough: we need to do both.
In addition to scientific research, the amount of general nutrition
information available to the public is at an all time high. However,
consumers are potentially more confused about food and its role in
enhancing health than ever before. This is especially true when it
comes to losing or maintaining weight.
With every passing decade, there seems to be a new ``diet'' that
focuses on a single food group or nutrient, such as carbohydrates,
proteins and fats, and professes to be the answer to all our weight
gain woes. The Atkins diet was popular in the 1970s, developed in
response to the targeting of sugar and carbohydrates. In the 1980s, the
nutrient culprit of the decade was fat. Now, in the new millennium,
obesity rates are rising and, once again, many Americans are turning to
the anti-sugar and anti-carbohydrate diets of the past and consumers
are as confused as ever.
My point is that none of these fads worked in the past and, as a
nutritionist I can tell you, they will not work this time either. We
have an opportunity to get it right this time. Consumers need
consistent and understandable messages about food and health based on
the best available science--not quick fixes that promise to deliver
unrealistic benefits. We must take a total diet approach and forever
abandon blaming one nutrient or food as the cause of America's weight
gain.
II. A Well Proportioned and Balanced Diet
The Government has recognized that a balanced approach to diet is
the right approach, as opposed to characterizing certain foods as
``good'' or ``bad.'' In the preambles to the proposed and final
regulations implementing the 1990 Nutrition Labeling and Education Act
(NLEA), FDA emphasized that there is no such thing as a good food or a
bad food. Similarly, the USDA Food Guide Pyramid focuses on a well
portioned and balanced diet. This is the same approach embraced by one
of the most successful diet-assistance groups, Weight Watchers.
The Weight Watchers POINTs program uses a positive system that
allows consumers to build their own diet, complete with ample food
choices, including ice cream, pizza and ``fast food.'' The program does
not prohibit any food or nutrient; it just teaches people to balance
the amounts of their consumption. It doesn't mandate, tax or prohibit,
it measures and recommends. Since introducing the points program,
Weight Watchers members have lost a combined 79.9 million pounds.
Other examples support that position. Although the number and type
of reduced-fat, low-fat, and non-fat foods has increased dramatically
over the last twenty years, more Americans are overweight today than in
1990. We know that people are buying and reading the labels on low-fat
foods; but we are still gaining weight as a population. Some non-fat
and low-fat foods may have as many calories as their regular variety.
Other studies have demonstrated that both obese and non-obese
adolescents who exercise consume similar amounts of calorie-dense snack
foods, items of minimal nutritional value, and food with highly
saturated fat. So simply avoiding fat or sugar is not the magic some
think. We have lost sight of the simple fact that calories still count.
Moreover, if Congress focuses on ``bad'' foods, it will find that
opinions about those foods change radically over time. Ten years ago,
we were most concerned about the propensity of dietary cholesterol to
raise serum triglyceride levels. Accordingly, people were advised not
to consume animal fats. Today, scientists have uncovered some
components found in animal products called conjugated linoleic acids
that may provide exciting health benefits. We also now know that
calcium, which is abundant in dairy products, can deliver health
benefits beyond building strong bones. Calcium is now linked to
providing potential protective effects against colon cancer and may
help those with diabetes.
In looking at the total diet, we should identify the amount of
excess calories in an individual's diet, rather than declaring
individual foods are ``good'' or ``bad.'' Restricting, taxing or
prohibiting certain foods will almost certainly not work. In fact, a
study published in the Journal of the American Dietetic Association
states that overly restrictive diets may lead to enhanced food
cravings, overindulgence, eating disorders or a preoccupation with food
and eating. Moreover, selective food taxes are arbitrary,
discriminatory and regressive. Such taxes hinder free choice by
consumers and disproportionately affect households with lower incomes
that may have fewer affordable snack options.
Some studies have been completed which develop this point, but more
research needs to be done, especially with children. Many of the
existing studies have focused on the role of exercise and diet in
extending an adult's life. We need to review existing studies and
determine what additional studies might be helpful in focusing on
childhood and adolescent nutrition and fitness. For example, we should
be looking at the role of nutrition and fitness in the development of
diabetes, respiratory or skeletal problems and other conditions that
are problematic for children, pre-teens and adolescents. Similarly, we
should focus on the balance between fitness and nutrition to promote
overall wellness--instead of focusing too much attention on weight
loss.
III. The Benefits of Physical Activity
Many people came to this hearing today with many competing
perspectives, but no one disagrees that physical activity is the
leading cause of health in America.
According to the American Heart Association, daily physical
activity helps reduce the risk of heart disease by improving blood
circulation throughout the body, keep weight under control, improve
blood cholesterol levels, prevent and manage high blood pressure,
prevent bone loss, boost energy level, manage stress, improve the
ability to fall asleep quickly and sleep well, improve self-esteem,
counter anxiety and depression, increase muscle strength, provide a way
to share activity with family and friends, establish good heart-healthy
habits in children.
Physical activity among children is especially important. Studies
have also shown that children who participate in quality physical
education programs fare better physically and mentally than children
who are not physically active. The National Association for Sport and
Physical Education reported that a quality physical education program
will help children improve self-esteem and interpersonal skills, gain a
sense of belonging through teamwork, handle adversity through winning
and losing, learn discipline, improve problem solving skills and
increase creativity.
But it is clear that fitness is becoming less of a personal issue
and more of a societal concern. It is important to stress individual
solutions toward fitness but at the same time we need to examine all
the environmental changes in our lives that have reduced fitness.
Time spent on computers and televisions have overtaken sports;
driving has overtaken walking; technology and automation reduce on-the-
job activity--and people around the world are becoming more sedentary.
More alarming is the lack of quality daily physical activity in our
Nation's schools. According to a report issued by the International
Life Sciences Institute (ILSI), about one in four children do not get
any physical education in school. Physical education requirements in
our public schools have been declining over the last twenty years.
Today, only the State of Illinois has a daily physical education
requirement for grade K-12, but it allows schools to be exempted from
this requirement. During the 1990s, the percentage of high school
students enrolled in daily gym classes dropped from 42 percent to 29
percent and only 19 percent of those high school students taking daily
physical education courses are physically active for 20 minutes or more
a day. Outside of school, the statistics are equally concerning.
According to ILSI, fewer than one in four children get 20 minutes of
vigorous activity every day of the week and fewer than one in four get
at least half an hour of any type of physical activity every single
day.
The Surgeon General, many leading researchers and well-respected
health organizations, the FDA and USDA have all said the risks of
inactivity are too great regardless of your diet. Mr. Chairman, it is
time to get Americans moving again.
Last year, Congress approved $50 million in funding for the
Physical Education for Progress (PEP) program. The PEP Act authorizes
the U.S. Department of Education to award grants to help initiate,
expand and improve physical education programs in schools. Funds
awarded under PEP can be used for a variety of purposes including the
purchasing of equipment, hiring of staff and developing curriculum. The
PEP program provides vitally needed funds to local communities and
schools and can serve as a catalyst for communities across America to
address physical activity issues. GMA supports the PEP program and
urges you to encourage your constituents to apply for grants. We would
also urge Congress to support full funding for PEP in the FY2003
appropriations process and beyond.
For children, we agree with the standards set by the Surgeon
General: at least 30 minutes of physical activity for all grades K-12.
The goal here, Mr. Chairman, should be to make physical fitness a
cultural habit that catches on early. Like all habits, the ones that
start early tend to stay with us for a long time. Quite simply, to make
physical fitness a habit for life it will need to become part of
American culture.
IV. Industry's Contributions
GMA believes the food and beverage industry has a very important
role to play in helping to improve fitness and nutrition. The industry
has introduced tens of thousands of products that provide options for
consumers looking for ways to incorporate variety, balance and
moderation in their diets. Food and beverage companies also place a
high priority on researching and developing new ways to make people's
favorite foods even healthier without sacrificing taste. For example,
large numbers of products are fortified with calcium and other
essential vitamins and minerals and many items have been reformulated
to provide reduced or lower calorie, fat or salt content while
delivering good taste.
What is done in the home and in the community is also important to
combating this problem. GMA members and many other companies in the
industry support a wide variety of nutrition education and physical
activity programs designed to help individuals and their communities.
Here are just a few examples:
TAKE 10! is a classroom-based program focused on the promotion of
physical activity designed to reduce periods of inactivity during the
school day. The program integrates 10-minute intervals of physical
activity into the school day combined with age-appropriate lessons of
math, science, language and arts.
The 5 A Day Better Health Program is a national program to
encourage all Americans to eat 5 to 9 servings of fruits and vegetables
every day for good health. The national 5 A Day for Better Health
Program, established in 1991 as a partnership between the National
Cancer Institute and the Produce for Better Health Foundation, is the
largest public-private partnership for nutrition and health in the
United States and in the world.
ACTIVATE--a communications and web-based program designed to
provide important nutrition and physical activity information for
children and their families.
Colorado on the Move is a new program developed by the University
of Colorado's Center for Human Nutrition in response to the national
obesity epidemic. The program proposes easy to implement strategies to
increase physical activity in the population that will be sufficient
enough to prevent positive energy balance and weight gain.
GMA and its member companies have also been long-standing promoters
of health and wellness in the communities in which we operate. Many
companies have provided financial, technical and personnel support for
local food banks, community-based wellness programs (e.g. diabetes
prevention programs, ``heart healthy'' education programs) and school-
based nutrition education and physical activity programs.
Closer to home, the GMA Board of Directors recently approved a set
of corporate wellness principles to promote the creation of prevention-
based initiatives at our companies that are designed to improve the
health and wellness of our workforce.
V. Observations and Suggestions
There is a growing understanding in Congress and across the United
States that food, itself, is not the problem. It is the lack of a
balanced diet and not enough exercise that is the root cause of today's
concern.
Imprecise solutions and unfounded rhetoric have sent many consumers
down the wrong paths. Punitive measures and quick fixes such as snack
taxes, advertising and sales restrictions are unproductive and
potentially dangerous. Such proposals lull people into thinking that
these complex problems can be solved with one simple measure. As a
dietitian, I feel compelled to reinforce the need for measured,
balanced approaches to this complicated issue. This is not just my
opinion, but a position supported by many clinical and dietary science
professionals. Congress should not criticize people's willpower or food
choices; instead it should promote positive program focused on the
balance between diet and exercise. This is nothing new. Most leading
health associations, well-respected weight loss programs and fitness
experts support this philosophy.
GMA believes the legislation is heading in the right direction by
focusing on improving nutrition education, increasing physical
activity, and calling for additional research. We strongly support the
provisions calling for a cataloguing of existing research to better
understand what is currently being done and in which areas additional
research may be necessary. In addition, we encourage the Committee to
look at existing programs that might be able to accomplish some of
these activities without having to create new organizations and
bureaucracies. As with any piece of legislation, it is important that
all definitions be precise, and that grants are well tailored to their
purpose and given to the most meritorious applicants. We have some
additional suggestions that we look forward to working on with you as
this proposal progresses.
In the area of research, I cannot emphasize enough the importance
of quality research on behavioral factors. Currently, the research that
is available is inadequate. We need to investigate more fully what
actions change behavior so that we can develop programs that actually
work.
Another area that must be improved is nutrition education. GMA
supports the professional guidance of the American Dietetic
Association, which states all foods fit within the U.S. Dietary
Guidelines. We support additional research to determine the best way to
introduce and teach these concepts to parents and their children. While
tremendous amounts of information currently exists, much of it is not
produced or distributed in a way that gets it into the hands of those
who need it most--parents, their children, educators and community
leaders. We also need a better commitment to provide up-to-date
nutrition education programs that are culturally appropriate. These
nutrition education programs should build on the ADA's recommendations
and teach our children the value of variety, moderation and balance.
Much more research is needed to enable us to do so effectively.
Speaking broadly, we must empower individuals through education and
awareness. We need to improve the public's understanding of the
consequences of too little exercise and unbalanced diets and urge
Americans to view obesity as more than a cosmetic issue. After we raise
awareness, we must offer access to effective programs and educational
tools that people can actually use. These programs should embrace the
science of fitness and nutrition mentioned earlier and identify ways to
achieve a balanced diet and quality daily physical activity in the
workplace, our community, home and school environments.
On the public policy front, we pledge to work with Congress to look
for additional ways to adopt the Surgeon General's recommendation for
physical activity for all school aged children, K-12 and find ways to
improve the quality and accessibility of nutrition education
underscoring how all foods eaten in moderation can fit into a healthy
diet. In addition, we look forward to working with you to increase
funding for research on the behavioral factors that contribute to
America's weight gain; identify and support effective and culturally
appropriate health interventions to reach at-risk and minority
populations; and provide incentives for schools, communities and
companies to develop and adopt physical fitness and general wellness
programs.
Finally, a discussion on fitness and nutrition would not be
complete without mentioning the critical role individuals and families
play in combating obesity. Ultimately, individuals have to make a
choice about the foods they eat and the level of physical activity they
engage in. Governments can and should provide information to help
consumers make informed choices. The food and beverage industry also
plays an important role in providing choice and variety and promoting
its products in a truthful and non-misleading fashion. None of these
actions are as important, however, as the role parents play in
establishing food eating patterns and preferences for their children.
Parents must set a good example of eating a moderate amount of a
wide variety of foods. Most weight management experts agree that food
should not be withheld or used as a reward. At the same time, foods
should not be forced on children. Children need to see their parents
setting a good example by enjoying and engaging regularly in physical
activity. As studies have shown, people who learn appropriate eating
habits early in life continue to eat responsibly throughout their
lifetime and pass these good habits onto their children.
The ability for individuals to exercise choice and make responsible
decisions will be aided or hindered by the outcomes of this hearing and
the actions taken by Congress from this point forward. Let me reiterate
the importance of endorsing policy proposals that are positive,
comprehensive and address the problems surrounding the fitness and
nutrition debate in a responsible manner.
GMA is very pleased by the willingness of the Senate, and
particularly the Members and staff of this Committee to engage in a
dialogue with the food industry. We believe our expertise can be an
asset in this on-going effort. We look forward to working with the
Committee on this important subject, and thank the Committee for its
constructive and positive approach to this matter.
Senator Bingaman. Dr. Dickey, please go ahead.
STATEMENT OF RICHARD A. DICKEY, M.D., WAKE FOREST UNIVERSITY
SCHOOL OF MEDICINE, ON BEHALF OF THE ENDOCRINE SOCIETY
Dr. Dickey. Thank you, Mr. Chairman, and good afternoon.
My name is Richard Dickey, and I am a newly-retired
physician. I practiced endocrinology for over 30 years and
still practice as a volunteer at an indigent clinic in North
Carolina. I also continue to teach at Wake Forest University
School of Medicine and have participated in People-to-People
Ambassadors programs leading endocrinologists to China and Cuba
to study problems with obesity and metabolic syndrome in those
cultures.
I am pleased to testify before you today on behalf of the
Endocrine Society, where I serve on the Clinical Affairs
Committee. We commend the Members of the HELP Committee for
their leadership and support in bringing the issue of obesity
to the attention of both the Congress and the American public.
The Endocrine Society, founded in 1916, consists of over
10,000 physicians and scientists who are dedicated to the study
of endocrinology. Endocrinology is the study of hormone
disorders including diabetes, obesity, thyroid disease,
osteoporosis, infertility, menopause, pituitary tumors, and
hypertension.
I am also here as a representative of the Hormone
Foundation, the Endocrine Society's patient education
organization. This foundation plans to launch a major
initiative over the next year to address the growing epidemic
of obesity and help educate patients and physicians on the
metabolic syndrome.
The Endocrine Society strongly supports the Senate HELP
Committee's development of the Improved Nutrition and Physical
Activity Act. The efforts of this Senate Committee to address
and raise the visibility of obesity and its negative impact on
the health of our Nation is truly commendable. As an
organization dedicated to the advancement of research and
knowledge and the care of patients, the Endocrine Society urges
the Committee to take this opportunity to address the impact of
research and the mechanisms responsible for the diagnosis and
treatment of obesity and its complications, including the
metabolic syndrome.
In 2002, obesity is a national epidemic, as we have heard,
with the number of obese and overweight Americans nearly
doubling over the past 10 years. Estimates from the U.S.
Surgeon General indicate that over half of all Americans are
now overweight. Adipose tissue, or fat, hunger, weight, and
metabolism are all regulated by hormones. Research by
endocrinologists has shown that obesity, especially in
children, can lead to numerous medical problems later in life,
including diabetes, heart disease, and infertility.
You have identified a number of excellent programs to
address this epidemic. I would like to expand on several areas
that the Endocrine Society believes to be imperative. The first
is to recognize the medical risks of obesity. We define the
most debilitating and costly complications of obesity as the
metabolic syndrome.
The Centers for Disease Control estimates that a decade
ago, approximately one in five United States adults had the
metabolic syndrome, which is defined as a person having three
or more of the following: abdominal or visceral central
obesity, high blood fat levels, low HDL or so-called ``good''
cholesterol, high blood pressure, or high blood sugar or
glucose.
The NCEP expert panel concluded, because the root causes of
the metabolic syndrome for the overwhelming majority of
patients are improper nutrition and inadequate physical
activity, that the high prevalence of this syndrome underscores
the urgent need to develop comprehensive efforts directed at
controlling the obesity epidemic and improving physical
activity levels in the United States.
But besides the American adult population, obesity,
diabetes, and the metabolic syndrome also affect American
children. Our health care system is simply not prepared for the
epidemic explosion of diabetes and other metabolic
complications of obesity in our younger generation of
Americans. The costs to the American public of the medical
complications of obesity are substantial and may increase
health care costs to a greater extent than tobacco use and
smoking.
Annual health care costs of diabetes alone are
approximately $100 billion now and are expected to double over
the next 10 to 20 years. The costs of medical complications of
obesity and the metabolic syndrome in terms of pain, suffering,
and loss of productivity are also important and include
blindness, kidney failure, limb amputations, stroke, heart
attack, cancer, and death.
To address the medical complications and health care costs
of an epidemic of this proportion, we will need a new arsenal
of tools and new therapies to supplement the nutritional and
exercise approaches. The internal signals that control body
weight and metabolism are very complex and need much more
study. Research to determine the mechanisms responsible for
obesity and the metabolic syndrome, as well as for the
prevention of and treatment for obesity and related clinical
conditions such as diabetes and cardiovascular disease is
essential. Research also should include funding for a
significant genomics component to expedite the identification
of genes with mutations or polymorphisms linked to obesity and
the metabolic syndrome, to expedite the development of more
effective therapies.
The Endocrine Society appreciates this opportunity to
testify before the Senate HELP Committee on the very important
issue of obesity. It is not a simple problem with a simple
answer. Obesity is a devastating and extremely costly epidemic,
an epidemic which is robbing and ruining the lives and health
of millions. We must confront it, and we must stop it. To date,
we have failed to fully acknowledge, to understand, to develop
and implement, effective and adequate means to prevent and
treat the cancer of obesity in our Nation. The Endocrine
Society believes that the Committee is headed in the right
direction by focusing on improving nutrition education and
increasing physical activity. In addition, significant progress
can be achieved toward preventing obesity through research to
better determine and understand the mechanisms responsible for
this national and, in fact, international problem.
The Society looks forward to continuing to work closely
with the Senate and particularly the Members and staff of this
Committee to achieve meaningful progress in the battle against
obesity.
Thank you.
[The prepared statement of Dr. Dickey follows:]
Prepared Statement of Richard A. Dickey, M.D.
Good afternoon Mr. Chairman and Members of the Committee. My name
is Richard Dickey and I am a newly retired physician. I practiced
endocrinology for over 30 years, and still practice as a volunteer at a
local indigent clinic. I also continue to teach at Wake Forest
University. I participated in the People to People Ambassador program,
and have led groups of physicians to China and to Cuba to study obesity
and metabolic syndrome in these cultures.
I am pleased to testify before you today on behalf of The Endocrine
Society, where I serve on the Clinical Affairs Committee. We commend
the Members of this Committee for their leadership and support in
bringing the issue of obesity to the attention of both the Congress and
the American public.
The Endocrine Society, founded in 1916, consists of over 10,000
physicians and scientists who are dedicated to the advancement,
promulgation, and clinical application of knowledge related to
endocrinology. Our members include academic researchers and educators
as well as clinicians involved in the daily treatment of patients with
hormone disorders including diabetes, obesity, hyperthyroidism,
hypothyroidism, osteoporosis, infertility, menopause, pituitary tumors,
hypertension and other endocrine disorders. We publish four peer-
reviewed journals: Endocrinology, Endocrine Reviews, The Journal of
Clinical Endocrinology and Metabolism, and Molecular Endocrinology.
I am also here as a representative of The Hormone Foundation, The
Endocrine Society's patient education organization. The Hormone
Foundation is dedicated to improving the quality of life by promoting
the prevention, diagnosis, and treatment of human disease in which
hormones play a role. The Hormone Foundation plans to launch a major
initiative over the next year to address the growing epidemic of
obesity, and educate patients and physicians on the metabolic syndrome.
The Endocrine Society strongly supports the Senate HELP Committee's
development of the ``Improved Nutrition and Physical Activity Act.''
The efforts of this Senate Committee to address and raise the
visibility of obesity and its negative impact on the health of our
Nation is truly commendable. As an organization dedicated to the
advancement of research and knowledge and the care of patients, The
Endocrine Society urges the Committee to take this opportunity to
address the impact of research in the mechanisms responsible for the
diagnosis and the treatment of obesity and its complications, including
the metabolic syndrome.
In 2002 obesity is a national epidemic with the number of obese and
overweight Americans nearly doubling over the last 10 years. Estimates
from the U.S. Surgeon General indicate that over one-half of all
Americans are overweight. Adipose tissue or fat, hunger, weight, and
metabolism are all regulated by hormones. Research by endocrinologists
has shown that obesity, especially in children, can lead to numerous
medical problems later in life, including diabetes, heart disease, and
infertility.
You have identified a number of excellent programs to address this
epidemic. I would like to expand on several areas that The Endocrine
Society believes to be imperative. The first is to recognize the
medical risks of obesity. We define the most debilitating and costly
complications of obesity as the metabolic syndrome.
Metabolic Syndrome: The Center for Disease Control estimates that
approximately one in five U.S. adults have the metabolic syndrome. The
Third Report of the National Cholesterol Education Program (NCEP)
Expert Panel on Detection, Evaluation and Treatment of High Blood
Cholesterol in Adults (ATPIII) defined individuals with the metabolic
syndrome as having 3 or more of the following:
Abdominal obesity (waist circumference >102 cm, or 40 inches,
in men, >88 cm, or 35 inches, in women)
High blood fat levels (triglyceridemia > 150 mg/dl)
Low HDL cholesterol (<40 mg/dl in men, <50 mg/dl in women)
High blood pressure (>130/85 mm Hg)
High blood sugar (fasting glucose >110 mg/dl).
The researchers concluded, ``Because the root causes of the
metabolic syndrome for the overwhelming majority of patients are
improper nutrition and inadequate physical activity, the high
prevalence of this syndrome underscores the urgent need to develop
comprehensive efforts directed at controlling the obesity epidemic and
improving the physical activity levels in the United States.'' The
problem of improper nutrition is related to the ``Western Diet'',
characterized by higher consumption of red meat, processed meat, french
fries, high-fat dairy products, refined grains, and sweets and
desserts; the ``Prudent Diet'', a far healthier choice, is
characterized by higher consumption of vegetables, fruit, fish, poultry
and whole grains. According to a new study from the Harvard School of
Public Health that followed more than 42,000 male health professionals
for 12 years, men who consumed a typical ``Western Diet'' were 60
percent more likely to develop diabetes than those whose diets center
on vegetables, fruits, whole grains, fish and poultry. Besides the
American adult population, the metabolic syndrome also affects American
children. A recent estimate revealed that 1 in 4 obese children may
show signs of pre-diabetes (NEJM ref). Our health care system is not
prepared for the epidemic explosion of diabetes and metabolic
complications of obesity in our younger generations of Americans.
The costs to the American public of the medical complications of
obesity are substantial. Obesity may increase health care costs to a
greater extent than smoking. Annual health care costs of diabetes alone
are approximately $98 billion now and are expected to double over the
next 10-20 years. The costs of the medical complications of obesity in
terms of pain, suffering, and loss of productivity also are important.
Medical complications of obesity and the metabolic syndrome include
blindness, kidney failure, amputations, strokes, heart attacks, and
death.
Funding for basic and clinical research: To address the medical
complications and health care costs of an epidemic of this proportion
we will need a new arsenal of tools and new therapies to supplement the
nutritional and exercise approaches. The internal signals that control
body weight and metabolism are very complex and need much more study.
Research to determine the mechanisms responsible for obesity and the
metabolic syndrome as well as for the prevention of and the treatment
for obesity and related clinical conditions, such as diabetes and
cardiovascular disease, is essential. Research also should include
funding for a significant genomics component to expedite the
identification of genes with mutations or polymorphisms linked to
obesity and the metabolic syndrome to expedite the development of more
effective therapies.
Clinical Funding: In the long term, to address this epidemic, we
will also need to develop creative new strategies to ensure funding for
the clinical care of obesity, including expanding multidisciplinary
clinical obesity centers, and assuring access to medical care for the
prevention and treatment of obesity prevention and the metabolic
syndrome.
Funding for and development of public school-based educational
programs in nutrition and exercise targeted at children and adolescents
and funding for and development of community-based educational programs
in nutrition and exercise: This needs to go a step further than issuing
block grants. The development of web-based educational tools marketed
and made available to schools would ensure a consistent message, and
provide all educators the opportunity to work these issues into their
curriculum.
CONCLUSION
The Endocrine Society appreciates this opportunity to testify
before the Senate HELP Committee on the very important issue of
obesity. It is not a simple problem with a simple answer. The Endocrine
Society believes that the Committee is headed in the right direction by
focusing on improving nutritional education and increasing physical
activity. In addition, significant progress can be achieved toward
preventing obesity through research to better determine and understand
the mechanisms responsible for this national problem.
The Society looks forward to continuing to work closely with the
Senate, and particularly the Members and staff of this Committee to
achieve meaningful progress in the battle against obesity.
Senator Bingaman. I thank all of you very much for your
testimony. Let me ask a few questions about trying to zero in
on some practical steps that could be taken and that Congress
could assist with.
Obviously, this problem is societal, the problem of
inadequate activity and poor diet. But it seems to me that the
portion of that that is actually most susceptible to change
would be in the school setting. It seems like you could have a
big impact there, because you are dealing with young people.
Clearly, we have had a lot of testimony this afternoon about
physical activity and the need to get physical education back
into our schools and the right kind of physical education, and
I certainly agree with that.
On the issue of diet in the schools, it would seem that two
fairly straightforward approaches, if they are done in
parallel, would make a lot of sense. One is to substantially
improve school lunches so that they are better and more
appealing to kids. I think a lot of kids look at the school
lunch and figure this is a loss and go to the vending machines
or outside, across the street, to the burger joint. So one is
improved school lunches, but at the same time to get the junk
foods out of the schools so that kids really do have an option
of eating good food while they are being kept in the school.
Do you agree with that approach, Dr. Brownell? Is that a
good place for us to concentrate our efforts so as to really be
able to have a measurable impact?
Mr. Brownell. That would be an absolutely wonderful place
to start. As long as the bad foods are present, there are
biological and, of course, social reasons why kids will eat
them, so the more you can minimize the presence of unhealthy
foods and maximize the presence of healthy ones, the better you
will do.
I would take what you said one stop further and somehow
develop the philosophy that what the kids are eating and their
physical activity gets integrated with the educational mission
of the school. Right now, food service in most schools is sort
of a stand-alone operation, like custodial services, where you
just do not want them to lose money, keep the customers happy,
get them to buy as much of whatever as you can just so you do
not lose money.
If all of these things get integrated, and health
education, physical education and the school lunch program all
go together because the schools believe this will ultimately be
in the best interests of their children--even their academic
performance--I think you will have more hope.
Senator Bingaman. Thank you.
Do any of the rest of you have a comment on that?
Ms. Katic, did you have a view on that?
Ms. Katic. Absolutely. I really want to emphasize first of
all that there has been an attempt to improve the school lunch
program over the last several years. USDA has a program in
place called Team Nutrition that has been implemented in many
schools across the country. It meets the dietary guidelines for
Americans--for instance, 30 percent of calories from fat, and
so forth. They are still trying to implement that program
across the country. It has been effective in a lot of schools.
At the same time, they have tried to market the school lunch
program to make it appealing for kids, because historically,
that has really been a challenge and a problem.
I want to say something obviously about the junk foods in
schools. I feel very strongly that ``just saying no'' to these
kinds of foods in schools does not give children the tools they
need to make choices throughout their lives. It is something
that they really need to be educated about, and that needs to
start in the classroom.
If you take foods away--you heard it said earlier in the
New York Times article--they are going to go somewhere else and
get it. These foods are available all the time, and they are
going to be available for the rest of their lives. So if they
do not learn how to include it in the diet, they never learn.
They have to learn when, how much, when it is appropriate, and
if that is not offered in the schools, they do not have the
right tools to navigate the food environment as they get older.
Senator Bingaman. I would certainly agree that teaching
kids to ``just say no'' is not the solution, but it would seem
to me that if you have a good nutrition education program in
the school, it would make sense to complement that by not
having a vending machine right outside the door that is selling
junk food.
Ms. Katic. Sixty percent of schools today offer water and
100 percent juice as options in vending machines. All soft
drink companies provide diet soft drinks.
Senator Bingaman. But there is not the kind of advertising
campaign directed at kids saying go out and buy yourself a
bottle of water that there is to buy Coke or Pepsi.
Ms. Katic. Water is the fastest-growing item in the
beverage category. It is being driven by consumer demand. And
yes, we do see advertising for water.
Senator Bingaman. Well, maybe you will solve the problem
for us, and we will not have the problem of kids drinking too
many sodas.
Dr. Dickey.
Dr. Dickey. Yes, I would agree that the education of the
kids is important, but I think the education of the parents and
the education of medical professionals, as well as the
teachers, is important. It has to be a comprehensive program,
and it has to be integrated with the physical activity and the
nutrition program.
We tend to eat what tastes good. We tend to choose what
tastes good, what we like, not necessarily what is healthy for
us, and that behavior is very difficult to change. It has been
mentioned earlier that changing behavior takes a lot longer and
a lot more persistence than just educating.
So I think that we need an educational program to help make
better choices and then provide those better choices is the
key.
Senator Bingaman. Thank you.
Ms. Davis.
Ms. Davis. In Pathways, we actually worked with the school
food service personnel, and I will mention three things that
they were eager to learn and did in their school breakfast and
lunch programs. Those were offering choices to the kids as they
came through the lunch line. It made it much more appealing if
they had several different vegetables or fruits to choose from
in the lunch line. Second was working with them in their food
preparation to prepare the food in a more healthy way, with
less saturated fat, less fat, and in a more appealing way to
the children as well, and sharing that from school to school
what the school lunch workers were learning. We found it to be
extremely successful, they enjoyed doing it, and the children
liked it as well.
The other problem that we worked with them on is that they
were giving seconds of the main course rather than seconds of
the fruits and vegetables, so we worked with them on that. So
they were small changes, but they were important changes, and
they were changes in the whole lunch program.
Senator Bingaman. Let me ask about one other subject and
that is the contracts that many schools and school districts
have entered into with various food vendors to provide
exclusive rights to sell a particular soft drink. I do not know
how extensive those are, but I have spoken with people in
school administration in my State, and they say we need those
funds. We have gotten a deal here where we have become addicted
to having the fast food vending machines in the schools because
the schools get a cut of everything that is sold.
How do we unscramble that egg and get to a situation where
we are not hamstrung in our ability to make rational policy
judgments because of some contractual agreement that we have
entered into?
Dr. Dickey, do you have a point of view on that?
Dr. Dickey. I was shocked to learn about these contracts
within the past year and the great impact that they have. I
think the answer is that we have to find some way to provide
the funds that are being supplied by those alternatives,
because that is not the way we should be deciding what our
choices are.
So providing an alternative source of funds and in an
incremental fashion, withdrawing those, or providing
alternative choices, even under contract, which are healthier
choices--that is a choice that we can make--whether we are
going to continue to sign contracts to fund schools and
education by forcing changes in the offerings that we think or
healthier choices, or whether we are simply going to replace
those funds with other funds which are already short. But that
is a hard choice to make, and it is one of the choices we are
going to have to make.
Senator Bingaman. Ms. Katic, did you have a point of view?
Ms. Katic. Absolutely. I think Dr. Dietz said it best
earlier when you asked him the same question. I support what he
said. He inferred, as Dr. Dickey just mentioned, that offering
choice is very important and then backing up with nutrition
education in the classroom what the proper choices are that
should be made is extremely important.
So that instead of taking those kinds of foods away, I
think it is really important to add alternatives, as was just
suggested. And I mentioned earlier and will say it again that
water and juice are definitely sold in the schools, and like I
said, water is the fastest growing category. Diet drinks are
offered as well. So there are already existing choices in
vending machines, and I think we need to highlight the ones
that we want our children to choose.
Senator Bingaman. Dr. Brownell.
Mr. Brownell. I think these contracts are quite pernicious.
There is a famous case in Colorado Springs where the school
district there was given millions of dollars, not just hundreds
of thousands, to sign a 10-year contract with Coca-Cola. If I
remember the numbers right, the contract stipulated that the
school system would sell 70,000 cases of Coke products in one
of the first 3 years of the contract. In the year prior to the
contract, they had sold 21,000 cases of Coke products. So the
school system basically entered into a contract agreeing to
triple the sales of Coca-Cola products in their school system
in order to get this many millions of dollars. It is hard to
argue that that is good.
And the issue about choices sound like ``mom and apple
pie,'' but you would not want to put cigarette machines in the
schools so kids can get real world experience in making
choices.
The sad fact is that the way America is now, if the bad
food is there, kids are going to eat it. Some kids will go next
door to the 7-Eleven, some will go to the Burger King down the
street, but this will have enough of a public health impact
that it would really make a significant dent, I think, in the
weight problem, and then, at least the schools become an
opportunity for the kids to learn positive things rather than
to walk past the soft drink machines, the vending machines, and
go into a cafeteria that either has a fast food franchise in
it, which is the case with thousands of schools, or basically
makes the same foods themselves.
Senator Bingaman. Dr. Davis, do you have any comment on
this?
Ms. Davis. No, but I agree with Dr. Brownell.
Senator Bingaman. Thank you all very much. It has been
useful testimony and a very useful hearing, and we will
continue to work on this legislation and refine it and
hopefully introduce it in a couple of weeks.
Thank you all very much.
[Whereupon, at 4:35 p.m., the hearing was adjourned.]
[Additional material follows.]
ADDITIONAL MATERIAL
Prepared Statement of Senator Enzi
Thank you Mr. Chairman. I join you in welcoming the witnesses in
our panels today. I look forward to listening to your comments and
proposals for a strategy to improve physical activity and nutritional
practices in America.
On the surface, getting fit and maintaining a healthy body seems
like a simple issue. Our bodies run on a simple equation; when energy
intake is greater than energy expenditure, the object gains mass. When
energy expenditure is greater than energy intake, the object, our body,
loses mass. However, the equation in the American culture is
complicated by recliners and king-sized snack packs.
Our mission today is very serious. We will seek information from
you to form strategies that encourage healthier eating and exercising,
but more importantly, we will discuss how to change our culture.
Throughout these discussions, we must not villainize the wrong actor.
In recent years, sugar has been booed off the stage of our national
diet. Sugar-free diets are marketed as the best way to lose weight. We
need to consider scientific evidence before we suggest limiting access
to a food which, in moderation, has no negative health implications.
A recently published U.S. Department of Agriculture (USDA) research
brief on current scientific knowledge concluded that intake of added
sugars is not associated with diabetes, heart disease, obesity and
hyperactivity. First of all, sugars are not ``empty calories.'' Humans
transform all digestible carbohydrates into the simple sugars the body
needs. All simple sugars are chemically identical. It follows that the
body does not distinguish sugars added to foods from the same naturally
occurring sugars or sugars broken down from complex carbohydrates.
The report indicated that Food and Drug Administration's Sugars
Task Force and the National Research Council concur: there is no
conclusive evidence citing sugar consumption as an independent risk
factor for coronary artery disease in the general population.
Evidence does not single out dietary sugar as the cause of obesity;
many factors contribute to this disease. A number of studies actually
show an inverse relationship between reported sugar consumption and
overweight. Mr. Chairman, I would like to request that a copy of this
report from the USDA Center for Nutrition Policy and Promotion be
included in the record.
As the Committee considers today what strategies we should initiate
to increase the health of the American people, I suggest we evaluate
all factors that contribute to obesity and adopt a well-rounded
approach to our health.
Thank you Mr. Chairman.
______
Prepared Statement of Senator Clinton
For years, we have listed chronic diseases like heart
disease, cancer, stroke, diabetes as some of the leading causes
of mortality, yet we have not done enough to address the causes
of these chronic conditions. It is now recognized that
individual behaviors and environmental factors are responsible
for 70 percent of all premature deaths in the United States.
While we must learn more about the other factors that
contribute to these diseases, there are some factors that we
clearly know to target. Physical inactivity, poor diet, tobacco
use are at the top of the list. These behaviors lead to the
diseases that ultimately kill us. We don't have to sit idly by
waiting for some deadly disease to strike. Our own behavior can
help protect us or put us at increased risk.
Unfortunately we have not always done a good job educating
ourselves and the public about the importance of our own health
behaviors. We have begun to tackle the problem with smoking,
but still have a long way to go. American diet and exercise
habits have deteriorated to a record low. Obesity is reaching
epidemic proportions: 27 percent of U.S. adults are obese and
13 percent of children and 14 percent of adolescents are
seriously overweight. Daily physical activity has declined for
both children and adults. After school sports are reserved for
the elite athlete and physical education (PE) is no longer
required. Even when youngsters take P.E., they rarely actively
participate. The consequence of this sedentary behavior is
taking its toll. Type II diabetes is increasing at an alarming
rate. Type II diabetes used to be a disease of older overweight
adults. It is now being diagnosed in children.
It is time that we recognize the cost of poor dietary
behaviors and physical inactivity to our own health and the
health of our Nation. Studies have shown that Type II diabetes
is preventable in both children and adults by careful attention
to diet and exercise. We need to help our young people develop
healthy eating and exercise behaviors that they can carry with
them though out their lives. Fad diets and simple messages to
be thin will not work and have unintended consequences of their
own.
Recent data from the 1999 Youth Risk Behavior Survey
indicated that 7 percent of young women who were very thin
(body mass index < 15 percentile) reported taking laxatives or
vomiting to lose weight or to avoid gaining weight. An even
larger percentage (9 percent) of these very thin young women
reported using diet pills.
Poor eating habits have also led to a ``calcium crisis''
among American youth. Very few adolescent girls (14 percent)
get the recommended daily amount of calcium, placing them at
serious risk for osteoporosis and other bone diseases. Because
nearly 90 percent of adult bone mass is established by the end
of adolescent growth period, the Nation's youth's insufficient
calcium intake is truly a calcium crisis. The consequence of
this crisis will be seen years later, when we are likely to
face an unprecedented incidence of osteoporosis in women.
We need a comprehensive approach to promoting healthy
eating habits and regular exercise. Senator Bingaman and I have
introduced S. 2249, Promoting Healthy Eating Behaviors in
Youth, that would attempt to prevent the serious array of
eating-related health problems now common in our Nation, by
supporting research to identify the best ways to help young
people develop healthy eating habits. However, this bill is
just a small beginning. We need more research to guide both
prevention and treatment efforts and we need communities of all
types--families, schools, work settings--to create the
supportive environments necessary to make a real change in what
we eat and how often we exercise.
------
Response to Written Questions of Senator Clinton from Kelley Brownell
Question 1: Do we know the best ways to help children develop
healthy eating habits?
Answer 1. Biology drives most people toward a diet high in fat,
calories, and variety. This would be adaptive if food was scarce, but
this drive intersects with a food environment that is relentless in
making problem foods accessible, cheap, good tasting, and ubiquitous.
It will take powerful efforts to reverse this situation.
Children are a logical place to begin. Eating habits are
established early, so programs in elementary schools would be helpful,
and Government programs such as WIC, Head Start, and food stamps could
be central to the effort. The object would be to offer children healthy
and attractive food, integrate eating with education (so children are
learning about good nutrition), and to create programs that make the
material fun and educational. Research shows that children can learn to
like healthy foods when presented in the right context.
Another key issue with children is learning about portion sizes.
The ``more is better'' philosophy is ingrained in American consumer
habits. Words like big, super, and mega describe serving sizes of many
foods. What was once the large soft drink is now the small (16 oz.),
the large fries of yesterday are now the small size, and things like
``value meals'' may be teaching children that large sizes are good,
even necessary. ``Supersize'' is now a verb. Eating to the point where
hunger is satisfied, understanding reasonable portions, and avoiding
inducements to eat large sizes must be taught to children.
Physical activity is also important. The activity itself will help
with weight control and overall health, but can also lead to healthier
eating. The food industry is pushing hard to focus the spotlight on
physical activity, saying consensus exists on the importance of
exercise. It would be a mistake to leave activity out of the picture,
but it would be grave mistake also to let attention be diverted from
food.
Question 2: Are eating disorders and obesity related?
Answer 2. There is fear among eating disorders specialists that
increased focus on weight and obesity will drive more people toward
disordered eating (pressure to be thin would be even more intense).
This would be a special concern in children, who are developing their
adult body image and can fall into unhealthy dieting practices.
Eating disorders can be crippling, and should not be ignored, but
because obesity dwarfs these disorders in public health significance,
the obesity effort should not get hamstrung by critics in the eating
disorders field. Perhaps the way to be sensitive to this constituency
is to address the issue in legislation or other places, perhaps with
language like:
``Obesity prevention programs should be implemented in ways to
prevent the onset or exacerbation of disordered eating and body image
problems. Focusing on nutrition and physical activity in the service of
health, vitality, and well-being, educating children on natural
variations in body size, and avoiding images of thin ideals such as
models is essential.''
______
Response to Written Questions of Senator Clinton from Lisa Katic
Question 1. You mentioned in your testimony that ``overly
restrictive diets may lead to enhanced food cravings, overindulgence,
eating disorders or a preoccupation with foods and eating.'' I have
heard from many young women who have started diets to lose weight and
``be healthy'' only to develop an eating disorder. How can we
discourage obesity and not encourage eating disorders?
Answer 1. Your first question about how to address obesity without
encouraging eating disorders is a critical one. The best way to do this
with a young population is to be positive about food and nutrition
education in the school and home environments. Some schools have
attempted to implement eating disorder prevention programs only to find
they were more harmful than helpful. Programs that introduce young
people to disordered eating may inadvertently create negative outcomes
by raising awareness about weight issues among this vulnerable
population who may have been otherwise uninterested in losing weight.
Education programs then show young people new and suggestive weight
control methods such as laxative use, diuretics, smoking, or binging.
Students may become more aware about the need to diet and now know how
to achieve a result. Some other potential adverse effects of eating
disorder prevention programs are: glamorization of eating disorders
often depicted in the media by highlighting famous people who have
suffered from eating problems; prevention programs can give children
the idea that everybody is doing it, therefore it is socially
acceptable; and negative messages about ``bad'' foods such as sugar or
fat contribute to fear of food.
The first step in establishing positive nutrition messages in
school-based education is to change the focus from highlighting
negative, problem-based approaches to focusing on building self-esteem
and showing children how to enjoy food and regular physical activity
without developing a fear of food. This can be achieved by conducting
cooking classes where children learn about all of the ingredients that
go into certain foods. Supermarket tours can provide practical
application of nutrition information, as can visits to students'
favorite restaurants.
Also, nutrition educators, teachers and parents must examine the
important role they play in modeling positive eating behavior. Those
that interact with young people on food and nutrition issues must
consider their own body image and self-esteem. Specialized training for
teachers, health educators and dietitians is needed in this area and
should not only provide factual information about food and nutrition,
but must also provide information and activities that focus on healthy
body image, shape and normal growth patterns throughout the lifespan.
The primary focus of this training should be to encourage educators to
abandon the common negative approach to food, which uses terms like
``junk food'' or ``bad food'' and not use terms such as overweight and
obesity. Children and adolescents must learn how to fit their favorite
foods into an overall balanced diet and feel good about doing so in the
process.
Question 2. I know many young women who have given up milk products
entirely in order to avoid the calories and stay thin. Many of these
women have successfully avoided the effects of obesity but will end up
with a different health problem: osteoporosis. What kind of media
campaign should be direct at our youth? I am concerned that a campaign
that emphasizes the importance of being thin may have some unintended
consequences.
Answer 2. If the approach outlined above were successfully
incorporated into a school's curriculum, then your second question
would not be an issue. The same positive approach to food is needed in
this case as well.
If young women perceive milk products as being ``bad'' because they
contribute to weight gain, then young women have a constant uphill
battle with food. They will potentially struggle for a lifetime to
achieve a happy medium between consuming foods with the nutrients they
need to maintain health and desiring to meet an unrealistic set of
goals for their weight. Unfortunately, the unrealistic set of weight
goals usually wins in the end. Nutrition is compromised and women or
men will suffer health consequences if a negative approach to food and
nutrition is adopted.
Any campaign targeted at this population must be positive and focus
on health not the importance of being thin. Messages delivered to a
target audience in any campaign must be tested with that audience first
to determine their impact and acceptability.
I hope this helps answer your questions, I would be happy to
provide additional information if needed on any of your food or
nutrition questions.
______
Prepared Statement of John McCarthy
Mr. Chairman and Members of the Committee: On behalf of the
International Health, Racquet & Sportsclub Association (IHRSA), I want
to commend the Committee for focusing legislative attention on the
major public health problem of obesity in the United States today. Two
of the largest contributing factors to obesity are poor nutrition and
inadequate physical activity. IHRSA, representing 5,000 of our Nation's
health and fitness facilities, is dedicated to improving the public's
health through physical activity, and we strongly support legislative
focus on this problem.
It is important to note that framing this issue as a public health
problem is correct and essential. Almost \2/3\ of all adults are
seriously overweight or obese and the percentage of obese children has
doubled in the last two decades. The World Health Organization has
declared that obesity is set to become the largest disease of the
century. It is appropriate for the Government to carefully examine the
causes of the problem, and to enact programs and incentives which will
encourage healthy eating and healthy levels of physical activity. To do
otherwise is to tolerate the continuing increases, in heart disease,
cancer, stroke, and diabetes, as well as the associated fiscal costs of
obesity.
We cite two of the many recent research reports which document the
problem of obesity. In June 2001, RAND issued a report analyzing the
costs and scope of obesity. It concluded that obesity was now the
number one public health problem in the United States, even greater
than the health effects of smoking, poverty, or problem drinking. The
RAND study demonstrated how obesity is linked to very high rates of
chronic illness. Not surprisingly, obese individuals spend 36 percent
more on health services and 77 percent more on medications. In
addition, the March 14, 2002 issue of the New England Journal of
Medicine reports that physical fitness is the single most important
factor, aside from age, which predicts life expectancy. The New England
Journal of Medicine authors explicitly call upon physicians to
encourage their patients to improve their exercise capacity.
Obesity costs are estimated at $117 billion annually. The Committee
and Congress should be aware that these costs represent direct costs of
medical care and loss of income to our citizens who suffer from obesity
and related medical conditions. There are further losses to the
employer community which supports most health insurance costs for their
employees as well as the cost of turnover and lack of productivity
accompanying significant illnesses. There is, of course, a loss to the
Federal and State governments, whose Medicare and Medicaid programs
will increasingly be taxed by the costs of these disease conditions
which are a consequence of obesity.
To allow our citizens to enjoy long and productive lives, to avoid
the drag of immense and preventable obesity-related health costs on our
economy, and to focus our scarce Government health resources on the
most intractable health problems, we should as a Nation make every
effort to improve our nutrition and fitness.
ROLE OF HEALTH AND FITNESS FACILITIES
Health and fitness facilities have become critically important
players in the national effort to promote health and prevent disease.
Approximately 34 million Americans utilize the Nation's health,
sports and fitness clubs. They range in age from youth to senior
citizens, with particularly strong growth in participation in the 55+
age group over the past few years. In the whole population, only about
10 percent judge their health to be ``excellent,'' but one third of
fitness club members believe they have excellent health.
The health and fitness clubs of today are a long way from the old
gym. There have been genuine advances in understanding exercise
physiology and development of equipment which efficiently aids exercise
and fitness development. More importantly, most private health clubs
have been developing ongoing relations with health care industry
professionals. To cite a few relevant developments:
89 percent of IHRSA members offer initial fitness assessments.
73 percent offer body composition analysis.
66 percent offer nutritional counseling.
63 percent offer weight management programs.
61 percent offer exercise prescriptions.
55 percent offer wellness education.
Health and fitness facilities play an essential role for millions
of Americans who are interested in fitness and maintaining a healthy
lifestyle. In doing so, they also are an essential resource in
controlling the costs of poor nutrition and fitness.
ROLE OF EMPLOYERS
The key question is what motivates a person to exercise and
maintain a healthy level of physical activity. Although there are many
factors, it is IHRSA member experience that the involvement of an
employer through programs centered at or sponsored through the
workplace are successful. Just as most private health insurance is
provided through the employer, we need to create a system in which
fitness benefits and services may be promoted through the employer.
This connection may be direct, with facilities located on site. It may
be through an employer offering a health plan in which a fitness
program is an available benefit. Or it may be through an employer
contributing to or subsidizing employee utilization of health club
facilities.
The Healthy People 2010 report from the Department of Health and
Human Services details how obesity and the resulting chronic conditions
cost employers more than 39 million days of work time annually. At the
top of employers' worries are the controlling health care costs,
gaining efficient employee performance, and recruiting and retaining
qualified workers. These issues are all the more intense for small
employers, which often cannot afford large health insurance premiums,
or afford to lose proven and productive employees.
Most adults spend half or more of their waking hours at worksites.
Both from the standpoint of the costs to employers, and the healthy
impact on employees, connecting employees with concepts of health and
fitness at the worksite is essential.
Just as the schools are the logical starting point for
encouragement of healthy lifestyles and nutrition habits for children,
the worksite is the most logical platform from which to build more
effective programs and personal activity habits.
ENCOURAGING ACTIVITY AND SOUND NUTRITION
We know that Senator Frist and others are preparing proposals which
can focus resources on these important priorities. The schools have an
essential role to play, given their prominence in our children's lives
and their educational responsibilities. Governmental and local entities
should be encouraged to grant tax relief and incentivize physical
activity and nutrition counseling activities at the local level,
including activities sponsored by business.
Yet we believe it is essential to enlist the five million small
employers who employ 70 percent of the private workforce with fitness
programs which can be clearly and easily used by employers and
employees. The Surgeon General's Call to Action to Prevent and Decrease
Overweight and Obesity 2001 cited that ``the worksite provides the many
opportunities to reinforce the adoption and maintenance of healthy
lifestyle behaviors.'' Furthermore, the report recommends creating
incentives for employees to join local fitness centers. Accordingly, we
suggest that the Congress include in any legislation the ``Healthy
Workforce Incentive'' concept.
In 1984, the Congress enacted Internal Revenue Code Section 132,
relating to the non-taxation to employees of certain fringe benefits
received from employers. That section allows employers to maintain on-
premises health and fitness facilities, and allow employee use of such
facilities without additional income or tax consequences to the
employee receiving the benefit of these services. This tax incentive,
however, is of no use to those millions of businesses which do not have
the resources (space and/or capital) to create and maintain fitness
facilities for their employees.
To encourage health and fitness and control the costs associated
with the chronic conditions arising out of obesity, the Congress can
make a very simple modification of IRC Section 132. By simply removing
the ``onsite'' requirement, employers, especially small employers,
would be encouraged to contribute to their employee use of fitness
facilities, regardless of the location of the employee or the
availability of a ``company gym.'' Smaller employers, in particular,
for the first time would be able to incentivize employee physical
activity with no negative tax consequences to the employee. The change
would require no additional bureaucracy, no detailed rulemaking, no
complicated tax accounting.
This change would give employers a very important additional
technique to work with their employees on healthy lifestyle and
nutrition habits. We firmly believe that whatever the minor cost of
this program in non-taxed benefits would be more than made up by
increased productivity, lowered health insurance premiums, and lowered
medical expenditures for employees, employers and ultimately the
Government.
Summary
IHRSA commends the Committee, Senator Frist, and those other
Senators who will join him on his legislative proposal. Obesity and
lack of physical activity are truly national problems. There is no one
solution to the problem. Focusing on schools and workplaces may provide
efficient and effective platforms from which to improve child and adult
health status. Legislation should also provide the simple healthy
workforce incentive of tax free employer provision of fitness benefits.
These steps would be modest, but would result in real and successful
progress in our fight against the Nation's number one public health
problem.
______
Prepared Statement of Katherine E. Tallmadge
The devastating problem of childhood obesity shatters lives,
diverts scarce public resources and causes heartbreaking suffering to
millions of our Nation's youth.
It has become an epidemic that demands careful study and urgent
action. As a nutritionist in private practice in Washington, D.C. for
20 years I have seen obesity in our youth evolve into something
approaching a national tragedy.
As a health care professional I have seen this problem up close.
I. BIOGRAPHICAL SKETCH
I first started thinking about weight problems when I was a child
in Ohio. A vivid memory from childhood was finding my mother weighing
peas at the kitchen counter before dinner. The peas were scattering all
over the counter and floor and I helped her pick them up.
``Mom, what are you doing?'' I asked. Weighing peas, after all,
seemed like a very strange thing to do.
``I'm fat,'' she replied. ``I'm on a diet and I have to lose
weight.''
Now, you have to understand that my mother was--and is--a beautiful
Swedish woman. She is artistic, funny and has always had tons of
friends.
But all she could think about was how fat she was. She hid behind
us kids in photographs and always put off doing things for herself,
like buying new dresses, until she would ``lose weight''--which she
never seemed to do. The shame and disappointment she felt was something
that stayed deep inside me.
Years later, when faced with choosing a major in college, I picked
nutrition in undergraduate school and behavioral sciences in graduate
school. I wasn't even aware of the inner voices affecting my decisions
at the time. It's only now, after years of reflection, that I realize
why I'm so passionate about my work. I chose this as my life's vocation
so that I could help people like my mother.
When my own weight problem developed and caught me by surprise in
college, and it eventually turned into an eating disorder, I was
determined to solve my own problem so that I could help myself avoid
the pain my mother experienced and be a better counselor in my career.
My professional career has evolved in response to my desire to make
a real difference in people's lives. While studying nutrition in
college, I was dismayed at the overwhelmingly negative results in
weight loss studies. People who went on diets gained their weight back
95 percent of the time. I thought, what good is all this nutrition
knowledge if people aren't benefiting?
I was determined to make a difference, so I decided to study
behavioral sciences in graduate school to help me figure out what makes
people tick and how to best help them change. My graduate studies also
helped me become a better counselor which, I believe, has been
necessary for my clients' success.
But the real reason I've been able to help so many people over the
years is the time I've spent listening to and understanding my clients,
becoming intimately involved in their day to day routines, and
analyzing their many successes and failures. Solving my own eating
disorder and weight problem has also given me empathy and insight into
their unique needs and has convinced me that anyone can conquer this
problem.
The bottom line is that I'm no sanctimonious preacher looking down
at a congregation of sinners. I've been there! And I know what it takes
to come back from those depths of despair.
I'm passionate about helping people solve their weight problems,
which, I believe, saps them of health, energy and happiness. Let alone
all of the horrible and preventable diseases which inevitably occur.
When I learned how easy and positive weight loss could be and how
it could transform lives, I wanted to scream it from the rooftops. Diet
Simple is my way of screaming from the rooftops!
II. SCOPE OF THE PROBLEM
One out of every five children in this country is overweight or
obese, resulting in severe social, emotional, and medical problems for
these youngsters. And 70 percent of overweight children between 10 and
13 will go on to become obese as adults, leading to skyrocketing health
costs, misery, and early death for many.
This is expected to further burden a health care system already
spending, some recent studies have concluded, as much as $293 billion
annually on obesity and its related diseases. This is particularly
startling when one realizes the overweight and obese adults of today
most likely were not overweight as children. This new generation of
overweight children promises a record number going into adulthood with
skyrocketing health care costs.
``The greatest health risk of childhood obesity is the risk of
becoming an overweight adult,'' argued Dr. Thomas Robinson, Assistant
Professor of Pediatrics and Medicine at Stanford University School of
Medicine at the Washington, D.C. conference.
But whether or not obesity continues into adulthood, childhood
obesity presents many serious health risks to the child. Type II
diabetes, for instance, which is normally diagnosed in obese adults, is
becoming increasingly evident in children.
A study of children aged 19 and under in Cincinnati showed that
prior to 1982, 4 percent of all cases of diabetes diagnosed were Type
II or non-insulin-dependent. However, by 1996, that rate jumped to 16
percent, a 10-fold increase in little over 10 years. Obesity and
inactivity were major risk factors for this diagnosis in children which
occurred at a mean body mass index of 37 (higher than 25 is
overweight). The highest prevalence was in African American females.
Overweight children are not immune from other adult-style diseases
either. Cardiovascular risk factors such as elevated triglycerides and
LDL cholesterol, along with lowered HDL cholesterol are often observed
in overweight children. These children also suffer from higher rates of
hypertension, sleep apnea, liver and gallbladder disease, and even
orthopedic complications including Blount disease, characterized by
bowed legs.
Because of these potentially serious health complications,
overweight children should be routinely screened for levels of fasting
insulin and glucose, and a fasting lipoprotein profile should be
obtained regularly, according to Dr. William Dietz of the Centers for
Disease Control and Prevention in the March 1998 issue of Pediatrics.
But experts believe the social consequences of childhood obesity
are just as serious as the physical. Obese children become targets of
early and systematic discrimination. By the time they are teens, a
negative self image is developed, and increased behavioral and learning
difficulties are observed, according to Dr. Dietz at the conference in
Washington, D.C.
The National Longitudinal Survey of Youth, designed to examine the
effects of obesity in adolescence on social achievement in early
adulthood, found women who were obese in late adolescence and early
adulthood achieved less years of advanced education, had lower family
incomes, lower rates of marriage, and higher rates of poverty. These
effects were found only in women, and even when controlled for the
income and education of the family of origin.
``These results suggest that obesity was a cause rather than a
consequence of socioeconomic status,'' said Dr. Dietz, in Pediatrics.
``Adolescent obesity may be the worst socioeconomic handicap that women
can suffer,'' he added.
Studies demonstrate clearly that obesity can ravage a life from
youth to death. There are complex factors that interact to cause poor
nutrition and limited physical activity which lead to obesity in young
people.
The problem of obesity effects children of all races and economic
backgrounds, however a disproportionate number of overweight or obese
children come from low income Caucasian families, or African American,
Mexican American, and Native American families of all income levels.
Although genetic factors play a role in obesity development,
researchers are skeptical that this explains the current problem. Human
genetics have probably not altered in the last several decades while
the incidence of obesity has risen dramatically.
Childhood obesity is obviously a result of the consumption of too
much high calorie, low nutrient foods and too little physical activity.
But why children are eating too much and exercising too little is
multifaceted.
III. FAMILY AND SOCIETAL INFLUENCES
One of the most influential factors is the parenting the youngster
receives, and the family environment in which he or she develops.
For many reasons, today's parents are less able or available for
effective guidance. Often parents are struggling to deal with increased
economic pressures. Many households are headed by single women. Or if
there are two parents, they both likely work and have less time to
guide their children's lifestyles and food choices. Several studies
show parental neglect is a strong predictor of the development of
childhood obesity.
The care givers are so overburdened with work responsibilities that
they don't have time for the kids. The children fend for themselves
with food. Television becomes the child care provider.
In recent decades, family meal times have changed in quality and
quantity. Parents have become less likely to prepare all meals for
their children and are resorting more to the purchase of fast foods or
the use of frozen foods that children can choose and microwave
themselves. Often families aren't eating meals together, which means
children may be grazing on their favorite high calorie snack foods all
afternoon while skipping family dinners and breakfasts. In fact,
missing breakfast is a key risk factor for obesity in children. Nearly
80 percent of heavier girls fail to eat breakfast regularly, studies
show. Also, families who eat dinner together are less likely to have
obese children.
This suggests that the initial focus of preventive efforts should
be on the obese parents of the young child, regardless of the weight
status of the child.
When parents of overweight children were treated for obesity, the
children were more likely to lose weight than if the children were
directly treated, in a study published in the American Journal of
Clinical Nutrition in 1998. Other studies show positive long term
effects of treating the whole family.
What the parent eats and makes available in the house profoundly
effects what the child eats and prefers.
Studies show that children will develop food preferences based on
what is provided in the home by their parents. In studies conducted at
Pennsylvania State University, kids' fat preferences and fat intakes
were linked to parental fatness, so the heavier parents had kids who
were preferring and eating diets that were higher in fat, said Dr.
Leann Birch, Professor and Head of the Department of Human Development
and Family Studies at Pennsylvania State University at the Washington,
D.C. conference.
``Kids learn to prefer calorie-dense foods, and this could, in
fact, be one of the factors that contributes to diets that are too high
in calories and too high in fat,'' said Dr. Birch.
Birch's studies demonstrate that parents can teach children to love
healthy food if it is presented positively.
``If we work at it, we should be able to help children to learn to
eat what we think is good for them,'' says Birch. But, she warns,
children naturally reject new foods, so parents must be patient,
positive and vigilant and may need to present a new food at least 10
times before the child accepts it. Children have a natural love for
sweets, so introducing sweets takes little or no effort.
Studies show that providing information that new foods taste good
(not that it's ``good for you!''), opportunities to sample good-tasting
novel foods, or observing others enjoy foods can increase acceptance
for both adults and children. Children's preferences for ``disliked''
vegetables were enhanced when they had opportunities to observe peers
and parents selecting and eating those vegetables. But it may take up
to twenty exposures to the foods for a child to prefer them.
Food preferences are learned and modifiable. Children eat what is
available to them and learn to prefer vegetables and healthy foods if
they are frequently and positively offered.
The level of a child's physical activity is also influenced by
parents in many ways.
Without parental supervision, today it often isn't safe for
children to be outdoors playing with friends or walking to and from
school. Even when there is adequate supervision for children, today's
youth are inclined toward more sedentary activities, such as watching
television and playing on computers or video games.
Studies have shown clearly that there is a direct relationship
between hours of television watched and obesity levels in children.
It's up to families and care givers to encourage children to be active
and to be role models for regular physical activity.
Most children are very receptive to going on walks, going hiking or
swimming, or simply shooting some hoops with Mom or Dad. With strong
family connections, these activities are more likely to be perceived as
positive and valuable to the child and those values can be carried over
into habits as an adult.
But as children move into their teenage years, parental influence
over their behavior diminishes and they are more deeply influenced by
peers and other broader societal factors. Even the best of parents are
given little assistance by the larger culture which influences the
behaviors and attitudes of the children, especially as they become
teens.
Unfortunately, the environment of many of our teenagers reinforces
the over consumption of calorie-dense foods, snacks, and sodas, and
doesn't encourage physical activity.
Schools are increasingly relying on selling calorie-dense sodas,
snack foods, and fast foods to children to increase school revenues.
Portion sizes for many foods and beverages have grown to absurdly large
proportions. For example, she notes, the 7-11 ``Big Gulp'' contains 64
ounces and 600-800 calories. A bottle of soda now contains up to 20
ounces, when 20 years ago, the standard Coke was 6 oz.
In the past 20 years, teens' milk consumption has decreased while
soda consumption has increased. Two-thirds of teenage boys are drinking
3 sodas per day, with two-thirds of girls drinking 2 sodas per day,
according to the USDA. Studies have shown a link between soft drink
consumption and obesity in teenagers.
Children are less active because of safety concerns, particularly
low income children in urban areas. In some communities, there are no
sidewalks to walk on, just roads to drive on. And to make matters
worse, schools are offering and requiring less gym classes with recess
quickly disappearing.
The 1997 Youth Risk Behavior Surveillance study administered by the
Centers for Disease Control and Prevention found that half of all U.S.
high school students did not meet basic exercise needs. It also found
that substantially fewer girls exercised on a regular basis. Another
trend is the decline in physical activity with increasing age. Between
the 9th and 12th grades, boys exercised 10 percent less, while girls
exercised 23 percent less. Black girls exercised even less than their
white counterparts.
The report goes on to say that children have a natural need for
more daily physical activity than adults. Elementary school children
should be encouraged to accumulate more than 60 minutes and up to
several hours per day of age- and developmentally-appropriate activity.
The report emphasizes the importance of variety and that the majority
of activity should be in play that is intermittent in nature. It adds
that ``extended periods of inactivity are inappropriate for children.''
For adolescents, the guidelines are similar to those for adults.
The report recommends that adolescents engage in three or more sessions
per week of activities that last 20 minutes or more at a time and
require moderate to vigorous levels of exertion.
SUMMARY
If parents don't eat vegetables and fruits, kids don't
If parents don't drink milk, kids don't
Kids can't lose weight unless their parents are eating healthy or
are also on a weight loss program
Badgering the kids doesn't work.
Telling kids one thing and doing another is not working. Parents
must model what they want their kids to do
Kids eat and learn to prefer the foods which are available in their
homes. Hence, overweight parents have children who prefer fatty foods
When parents skip breakfast, kids skip breakfast--putting them at
risk for poor school performance and obesity
When parents over-emphasize sodas, sweets and desserts, their
children are more likely to develop sweet addictions. And even if the
children don't have weight problems now, they will later
When parents don't exercise, kids don't do it or value it--and this
stays with them for a life time
If parents don't teach their kids to cook, their children will rely
on high calorie/low nutrient junk food and take-out
Studies demonstrate 50 percent of 5-year-old girls know what
dieting is. And this is related to if their parents are dieting. This
puts these children at risk of developing eating disorders and weight
problems later.
Even though kids are overweight, they're nutritionally deficient
and malnourished because of the poor quality of food they're eating.
Being overweight is causing serious self-image problems, lack of
confidence in children, which will have profound effects on them their
whole lives.
Overweight girls achieve less later in life.
IV. SOLUTIONS
The solution to solving the childhood obesity problem is complex.
Where parents are having problems providing appropriate role modeling,
society and schools may have to step in.
Increasing youngsters' physical activity levels may need to be
addressed in society so children have safe environments in which to
play and get around. Schools are a part of the answer as they need to
place a higher value on time for physical activity and presenting
nutritious foods in positive ways. And families need to understand the
important role they play by setting better examples for their children
and being physically fit and enjoying eating healthy together.
In my private nutritional counseling practice in Washington, DC, I
have helped many overweight children gain control over their bodies by
advocating a whole-family approach.
My own personal story illustrates how adult modeling affected my
own body image, eating and weight problems later in life. But also how
these problems can be overcome.
______
Prepared Statement of Myrna Johnson
On behalf of the Outdoor Industry Association, I want to thank the
bipartisan leadership of the Health, Education, Labor and Pensions
Committee for your commitment to addressing our Nation's obesity
epidemic. Data compiled by the Center for Disease Control points to
obesity as one of the single greatest health challenges facing our
Nation. Today, 50 percent of adults, 16 percent of children aged 6-11
and 14 percent of adolescents are overweight and are at increased risk
of chronic diseases such as diabetes, heart disease and cancer.
However, there is reason for great hope on the obesity front.
Studies have also shown that regular exercise and a healthy diet can
dramatically reduce obesity.
The time has come to get America's youth off the couch and
outdoors. As an industry, we have identified educating young Americans
on the physical and mental health benefits of outdoor recreation as one
of our top public policy objectives. Specifically, we are supporting:
1. Legislation that ensures physical education in schools--full
funding for the PEP initiative.
2. Greater outdoor recreation activities in schools.
3. Greater access to affordable recreation.
Outdoor recreation is one of the most effective tools we have in
combating childhood obesity and we are committed to making this tool
available to more Americans.
Upon careful review of ``Improved Nutrition and Physical Activity
Act,'' the Outdoor Industry Association is prepared to offer its strong
and enthusiastic support for this legislation. This measure represents
a thoughtful and comprehensive approach to addressing an enormously
complex societal health problem. As one of America's fastest growing
industries, we look forward to working with this Committee at each step
of the legislative process.
The Outdoor Industry Association
The Outdoor Industry Association is the trade association of the
$18 billion human-powered outdoor recreation industry. Our members
include 1,100 manufacturers, retailers, and distributors of outdoor
products associated with hiking, backpacking, climbing, canoeing,
kayaking, fly fishing, and backcountry skiing. In 2000, Outdoor
Industry Association's Participation Study found that hiking and
mountain biking each had over 70 million participants and that 149
million Americans participated in basic outdoor recreation activities.
The events and aftermath of September 11th have also brought
renewed focus on outdoor recreation. According to the Outdoor Industry
Association Special Report: ``The effects of September 1lth on
Recreation, Travel and Leisure,'' 29 percent of Americans changed their
travel plans for the 6 months following September 11th. When exploring
the types of vacations or activities that Americans will take in future
months, 91 percent of Americans say they would feel safest visiting
national parks. Clearly, Americans are seeking outdoor experiences in
these uncertain times.
Combating Obesity Through Outdoor Recreation
The ``Improved Nutritional and Physical Activity Act'' recognizes
and emphasizes the critical nexus between recreation and reducing the
prevalence of obesity. The Outdoor Industry Association is very
supportive of Title II of this Act, ``Community Demonstration Grants,''
which authorizes $40 million in fiscal year 1903 for an array of
community-based recreation initiatives.
We would recommend language be included in Section 201 (b) that
recognizes the potential to significantly leverage Federal dollars for
recreation through community/business partnerships. We look forward to
working with you and your staff on this potential win-win measure.
The Outdoor Industry Association is also embarking on a health
oriented campaign similar to that described in Title X, ``Youth Media
Campaign.'' During June of 2003, the Outdoor Industry Association will
be launching a campaign highlighting the health benefits of outdoor
recreation. Themes the industry will be emphasizing include: Eat
Healthy, Play Healthy (the importance of diet and exercise) and
Thinking Outside the School (motivational posters and or learning
modules to encourage the discovery of nearby outdoor resources).
Again, our industry believes there is an opportunity for real
synergy between our efforts and those policies being advanced in the
``Improved Nutrition and Physical Activity Act.'' The American public
will frequently pursue the physical activities that provide the most
enjoyment. Human-powered outdoor recreation offers a myriad of funds
and affordable sports activities for persons of all ages, and any
fitness level. We look forward to working with you and your staff on
this important component of the legislation.
Support for Obesity Legislation
The Outdoor Industry Association greatly appreciates the
opportunity to work with this Committee in crafting and advancing
meaningful obesity legislation. We stand ready to support your efforts
with both technical drafting suggestions and the development of
nationwide support for your legislation.
Outdoor Industry Association was founded in 1989 and provides trade
services for over 4,000 manufacturers, distributors, suppliers,
retailers, sales representatives and climbing gyms in the outdoor
industry. Outdoor Industry Association programs include: industry
research; representation in Washington, D.C.; educational programs and
cost-saving benefits. OIA (www.outdoorindustry.org) is headquartered in
Boulder, Colorado.
______
Prepared Statement of Connie Tipton
These comments are submitted on behalf of the member companies of
the International Dairy Foods Association (IDFA) and its three
constituent organizations, the Milk Industry Foundation, National
Cheese Institute, and International Ice Cream Association. Members
range from large multi-national corporations to single plant
operations, and represent more than 85 percent of the total volume of
milk, cultured products, cheese, and ice cream and frozen desserts
produced in the United States. IDFA represents more than 600 dairy food
manufacturers, marketers, distributors and industry suppliers across
the United States and Canada, and in 20 other countries.
The dairy industry in the U.S. has made a significant investment
and commitment over many years to research and fact development about
the role of dairy products in diet and health. There also has been a
major commitment by the dairy industry to educating consumers about the
importance of a balanced, nutritious diet along with exercise to
maintain good health. Long-standing alliances between the dairy
industry and a broad range of recognized medical and scientific
professionals and related organizations have provided the research and
confirmation of dairy's key role in a healthy lifestyle. The IDFA
organizations are committed to continuing and expanding these efforts.
As the Committee embarks on an exploration of issues related to
improved nutrition and fitness, the dairy foods industry seeks to be a
partner in providing existing information and research that may be
helpful to your consideration.
The following messages about dairy products and their role in a
nutritious diet provide an overview of some of the existing information
that may be of interest. We would be happy to provide more detailed
information about any of the research related to these messages, if the
Committee is interested.
The Good News About Milk & Dairy
General Milk Statements
Dairy products are available in a wide range of varieties
to suit consumers' individual tastes and nutrition needs.
People choose different milks for different reasons, and
the different varieties of milk--fat-free, lowfat, whole, flavored and
lactose-free--all deliver the same powerful package of nine essential
nutrients: calcium, vitamin D, potassium, phosphorus, protein, vitamin
B-12, vitamin A, riboflavin and carbohydrates.
Dairy's role in a nutritious diet has been established and
lauded by the nutrition and science community, including the American
Dietetic Association, the National Institutes of Health, the U.S.
Department of Agriculture, the National Osteoporosis Foundation, the
American Academy of Pediatrics and many other reputable health
organizations.
Milk is doctor recommended. The American Academy of
Pediatrics recognizes widespread low calcium intake among children,
which remains one of the most pressing public health problems. The AAP
notes that because of these low intakes, pediatricians should recommend
a daily diet that includes milk and other calcium-rich dairy foods.
Further, children are more likely to consume more milk in place of soft
drinks or other beverages if they have the option of flavored milk.\1\
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\1\ American Academy of Pediatrics. Calcium requirements of
infants, children, and adolescents. Pediatrics. 1999; 104(5):1152.
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Studies show that many who are lactose intolerant,
regardless of ethnic background, can drink up to two 8-ounce glasses of
milk with food or in small quantities throughout the day without side
effects. For those who cannot, lactose-free milk is widely
available.\2\
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\2\ Inman-Felton, AE. Overview of lactose maldigestion (lactase
non-persistence). Journal of American Dietetic Association.1999;
99:481.
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Weight Loss/Weight Management
Emerging studies suggest that dairy products may play a
role in maintaining a healthy weight. Researchers have found that those
individuals who consumed more milk and milk products were least likely
to be overweight.\3\ \8\
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\3\ Zemel, MB et al. Regulation of adiposity by dietary calcium.
FASEB J. 2000; 14:1132.
\8\ Davies, KM et al. Calcium intake and body weight. Journal of
Clinical Endocrinology & Metabolism. 2000; 85:4635.
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This protection from obesity found with increasing
calcium/dairy intakes was not limited to fat-free or lowfat dairy
products. The reported weight control benefits may be associated with a
variety of dairy products.\3\ \8\
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\3\ Zemel, MB et al. Regulation of adiposity by dietary calcium.
FASEB J. 2000; 14:1132.
\8\ Davies, KM et al. Calcium intake and body weight. Journal of
Clinical Endocrinology & Metabolism. 2000; 85:4635.
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Milk may also play a role in reducing the risk of obesity
in children.\5\ Researchers analyzed the diets of preschool children
and found that those consuming four servings of a variety of dairy
products per day was associated with less body weight compared to
children who consumed the same number of calories but fewer servings of
dairy products.\6\
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\5\ Chan, GM et al. Journal of the American College of Nutrition,
2001.
\6\ Carruth, BR and Skinner, JD. The role of dietary calcium and
other nutrients in moderating body fat in preschool children.
International Journal of Obesity. 2001; 25:559.
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Compelling evidence found in animal studies suggest that
the calcium from dairy is more effective in weight control than non-
dairy sources or calcium supplements.\3\ To date, emerging research in
human subjects has shown similar results.
---------------------------------------------------------------------------
\3\ Zemel, MB et al. Regulation of adiposity by dietary calcium.
FASEB J. 2000; 14:1132.
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Research in animal studies indicates those with a high
calcium intake had an increase in the breakdown of fat, thereby burning
more fat for energy, and required the use of less insulin.\3\
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\3\ Zemel, MB et al. Regulation of adiposity by dietary calcium.
FASEB J. 2000; 14:1132.
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Researchers at the University of Tennessee analyzed the
diets of Americans using Government food consumption surveys (NHANES
III) and found that body fat was significantly lower in people who
consumed more dairy (after controlling for calorie intake, physical
activity and other factors.)\3\
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\3\ Zemel, MB et al. Regulation of adiposity by dietary calcium.
FASEB J. 2000; 14:1132.
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Researchers at Purdue University found in women ages 18 to
31 years who consumed a diet containing at least 780 mg of calcium and
1,900 calories or less per day lost, or had less of an increase in,
body weight over a 2-year period, compared to women who consumed the
same number of calories but less calcium.\7\
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\7\ Teegarden, D et al. Calcium related to change in body weight in
young women. Federation of American Societies of Experimental Biology
Journal.1999; 13:A873.
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Researchers at Creighton University in Omaha found that
women who consumed 1,000 mg of calcium (the amount in at least three 8-
ounce glasses of milk) weighed about 18 pounds less than those who
didn't. The researchers speculate that calcium may help turn off one of
the mechanisms responsible for storing fat.
A recent study published in JAMA found that overweight
young adults who consume more dairy products--such as milk, yogurt and
cheese--may be less likely to become obese and develop insulin
resistance syndrome, a key risk factor for Type II diabetes and heart
disease.\9\
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\9\ Pereira, MA et al. Dairy consumption, obesity, and the insulin
resistance syndrome in young adults: The CARDIA study. Journal of the
American Medical Association. 2002; 287:2081.
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A number of studies have shown that the intake of calcium
(particularly from dairy products) is inversely associated with body
weight in children, adult men and women, Caucasians and African
Americans.\9\
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\9\ Pereira, MA et al. Dairy consumption, obesity, and the insulin
resistance syndrome in young adults: The CARDIA study. Journal of the
American Medical Association. 2002; 287:2081.
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Milk & Kids
A growing body of evidence suggests that a decline in milk
consumption may have serious, long-term detrimental effects on the bone
health of today's youth.
Milk consumption in school lunch increases when chocolate
or other flavored milk is offered, significantly increasing calcium and
riboflavin intakes. \10\
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\10\ Guthrie, HA. Effect of a flavored milk option in a school
lunch program. Journal of American Dietetic Association. 1977; 71:35.
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Flavored milks also offer a way to satisfy cravings without the
guilt.
Chocolate milk is a great way to satisfy chocolate
cravings.
Additional flavors found in dairy cases across the country
include Caramel, Mocha Cappuccino, Vanilla, Banana, Orange, Strawberry
and Cookies and Cream. Besides tasting great, the new milk flavors have
the same amount of calcium and the eight other essential nutrients.
Children and adolescents who are high consumers of soft
drinks have lower intakes of riboflavin, folate, vitamins A and C,
calcium and phosphorus.
______
Prepared Statement of the American Dietetic Association
Lifestyles that support and sustain the maintenance of a healthy
weight, for both individuals and the population as a whole, are a major
focus of the American Dietetic Association and its members. The rapid
rise in the prevalence of overweight and obesity among all segments of
the U.S. population is of grave concern as the health and quality of
life of those afflicted plummets and health care costs and societal
burdens continue to soar.
Dietetic professionals translate complex nutrition principles into
a vast array of healthful and appealing food options for millions of
Americans daily. Our unique education, supervised pre-practice
experience, and mandated continuing professional education equip us to
identify and address overweight, obesity and its health consequences at
all stages of the life cycle and in a myriad of educational, community,
medical, commercial, and research environments. We commend the
Committee's pursuit of legislation that represents a community-based,
thoughtful approach to the prevention and treatment of obesity for the
American public. Federal legislation should focus on strategies to
encourage local screening and intervention programs, and encompass the
consensus achieved through the Surgeon General's ``Call to Action''
related to obesity and overweight. The public health focus of
legislative proposals is extremely important. We recommend it be paired
with a number of additional elements that will maximize its success.
Obesity is a complex disease state. Its definition must be
evidence-based and appropriate to each segment of the population
characterized. Modifiers such as age and ethnicity must be considered
as general parameters for the U.S. population are established.
Not everyone who falls outside the upper limit of normal for
defined parameters is obese even though their body weight may be higher
than is recommended. We must be sure that weight reduction is promoted
for those in whom weight loss would be of benefit. Individuals who make
healthful food choices the majority of the time, who are physically
active/physically fit, and at low risk for the development of diet-
related disease should be urged to maintain the weight and lifestyle
that is best for them.
The American Dietetic Association urges that obesity be designated
a disease by Federal agencies and institutions (i.e., Centers for
Medicare & Medicaid Services, Social Security Administration, Centers
for Disease Control and Prevention, etc.) with all of the attendant
ramifications that such a designation implies--including sanctioned
insurance coverage for obesity treatment. Coverage will facilitate the
timely provision of health services to treat obesity and its attendant
commodities; i.e., hypertension, lipid abnormalities, diabetes
mellitus. As interventions are implemented, parameters, in addition to
weight change, must be identified as outcomes to be assessed. Examples
include but are not limited to:
Normalization of blood pressure, blood sugar, lipid
parameters
Normalization of respiratory rate, improved exercise
tolerance
Reduced rates of admission or length of stay in
institutional settings
Reductions in medications use
Reductions in frequency of visits to health care providers
Decreased incidence of obesity-related comorbidities.
Our knowledge of the genetic, environmental, cultural, behavioral,
and emotional contributors to overweight and obesity is limited;
current approaches to prevent or treat overweight and obesity are
simplistic at best. An evidence-based approach to the development and
implementation of strategies to prevent and treat overweight and
obesity is necessary. Further, adequate annual appropriation of funds
must accompany any demonstration project or research authorizations
that are legislated.
Coordination among the numerous stakeholders--government, academia,
medicine, industry and others---is vital if rapid progress is to be
made. Within Government institutions, we recommend strengthening the
network of public officials who design and implement Federal, State and
local projects and programs so that nutrition and physical activity are
fully integrated within them. The Secretaries of Agriculture and Health
and Human Services would benefit from having senior advisors on
nutrition and health involved in the design and review of broad array
of agency programs--not just those programs traditionally viewed as
food, nutrition and health related. A deputy level position within the
Surgeon General's office should ensure that nutrition and physical
activity are fully integrated into Federal health and research agendas.
Within the States, individuals with expertise in food, nutrition, and/
or physical activity, are needed at top levels with the authority to
coordinate information and resources and make public health initiatives
in nutrition and physical activity effective.
Losing weight and maintaining a healthy weight in our American
society is difficult, and ADA has several science-based positions on
healthful eating, the balance between energy intake and expenditure,
weight management, and medical nutrition therapy for diet-related
medical conditions.
While a number of individuals with moderate to morbid obesity
studied in clinical research settings are able to loose weight, few--
perhaps only 5 percent of those studied--maintain their weight loss
over time. A recent University of Pittsburgh study suggests that in the
general adult population, planned modest weight loss of 10 percent or
more maintained for at least 5 years occurs at a rate of approximately
25-27 percent. Data such as this are promising, but our ability to
replicate them will depend on our willingness to understand and then
act individually and as a Nation.
The best way to combat overweight and obesity is to prevent it. We
support efforts to prevent or to reduce the incidence of childhood
obesity, and in fact, have directed the ADA Foundation to turn its
attention toward this issue. When working with children, we also must
work with their families. Family members, of all ages, must become
involved and must practice the dogmas that they preach.
Prevention and intervention modalities targeted to children must
incorporate the development of healthful eating practices and daily
physical activity. As promising programs or programmatic elements are
identified, school and community-based nutrition and physical education
initiatives can be tested and those that are effective expanded through
grants and appropriations. A preventive approach, rather than an
approach that targets weight management only after one or more disease-
specific consequences have become established, offers the opportunity
for restoration of a healthy weight before the comorbidities associated
with obesity become entrenched and target organ damage occurs.
ADA urges the Committee to emphasize the importance of innovative
approaches to the prevention and treatment of obesity throughout the
lifecycle. This includes proactive work with adolescents and women of
childbearing age to maintain a healthy weight prior to conception. It
encompasses the promotion of weight gain during pregnancy according to
established guidelines, and encourages breastfeeding during the first
year of the infant's life. This type of approach should help to stem
the tide of increased incidence gestational diabetes and Type II
diabetes in our Nation's mothers and children.
Finally, we want to emphasize that increased awareness, education
and action are needed to ensure positive health outcomes. Opportunity
and incentives to pursue a healthy lifestyle must be supported with
Reasonable access to a variety of low-cost nutritious
foods for all Americans but especially for its children
Nutrition education and/or behavioral counseling to
facilitate food choices that support optimal weight maintenance and
life-long healthful eating habits
Physical activity curricula, programs and facilities that
accommodate a broad range of individual interests and abilities and
that are part of the established curriculum in elementary and secondary
schools.
Public and private insurance coverage for weight
management programs initiated prior to the development of diet-related
disease.
The emphasis on the identification of individuals who would benefit
from prevention and/or treatment must be matched with a comparable
effort to ensure that there is adequate funding to support sufficient
numbers of sound, multidisciplinary weight management options once
obesity has been diagnosed. Obesity is multifactorial by nature; its
management will require a team approach. Registered dietitians and
dietetic technicians, physicians, nurses, psychologists, exercise
physiologists, pharmacists and others will need to work collaboratively
to ensure success. The nature and depth of counseling required to
effectively intervene in youth and adults with moderate to morbid
obesity greatly exceeds that which can be provided in the context of
the routine office visit.
As a society, we must acknowledge the effect that our national
``culture'' has on the food and activity choices of the individual. We
must collectively seek to improve it and to shift toward it toward
health.
In summary, ADA and its members are uniquely positioned to assist
in the development and delivery of individualized prevention and
treatment programs, to participate in community and school-based
programs, and to conduct basic and applied research related to
overweight and obesity.
Federal legislation to address overweight, obesity, nutrition and
physical activity must have a public health focus at the community,
school, family and individual levels; promote research to better
understand contributing factors and solutions; and create opportunities
for education and behavioral counseling for weight management,
prevention, and treatment. Further, Federal and private health programs
should provide coverage for medical nutrition therapy and behavior
modification to reduce obesity and diet-related disease.
We commend the Committee for its work in bringing this issue to the
forefront. Thank you, Mr. Chairman and Members of the Committee, for
giving the American Dietetic Association the opportunity to share our
views toward seeking and defining solutions to the epidemic of obesity
that jeopardizes the health and well being of all.
______
Prepared Statement of the National Soft Drink Association
NSDA is pleased to submit a statement to the Committee today to
share our views on the issue of fitness and nutrition, and in
particular, its role in combating child overweight and obesity. NSDA is
the major trade association representing the United States soft drink
industry. Our members produce a wide array of beverage products
including carbonated soft drinks, fruit juices, fruit drinks, bottled
waters, iced teas and coffees, sports drinks and herbal and energy
drinks. The U.S. soft drink industry has sales of over $72 billion a
year and employs more than 183,000 workers in all fifty States.
NSDA and its member companies commend the Committee for exploring
ways to reverse rising obesity rates. Today's hearing is an important
first step in understanding a very complex public health problem. There
are three important components of any effort to reverse current obesity
trends. First, Congress should take steps to implement the Surgeon
General's most recent recommendation that all school-aged children
receive 30 minutes of physical activity each day. We strongly believe
that without this first critical step, any approach is likely to fail.
Second, we need to improve the level and quality of nutrition
education. Nutrition information used for education purposes should be
based on fact, not emotion. There is a great deal of misinformation
masquerading as evidence regarding soft drink consumption and soft
drinks and health. For example, teen soft drink consumption is often
misrepresented. An analysis of Federal Government data by researchers
at Virginia Tech shows the average adolescent consumes about a can of
soda a day, nearly one-fourth of teens do not drink regular carbonated
soft drinks and only 5 percent consumed more than three per day. This
level of consumption falls within the USDA/HHS Dietary Guidelines for
Americans and the dietary advice of the American Dietetic Association.
And third, the Committee should reject any recommendation to ban,
tax, restrict or forbid the consumption of any particular food or
beverage. Weight management professionals who work with patients know
that efforts to prohibit foods in diet do not work, and may reinforce
the negative behaviors they are trying to change.
With regard to the Surgeon General's recommendation about daily
physical activity, we note with dismay that the physical education
requirements in our public schools have been declining over the last 20
years. During the 1990s, the percentage of high school students
enrolled in daily gym classes dropped from 42 percent to 29 percent and
only one State today requires daily physical education for grades K-12.
There are many reasons for this decline including new mandates on
schools like standardized testing, time constraints, liability
concerns, and lack of adequate financial resources. NSDA believes that
the ``Improved Nutrition and Physical Activity Act (IMPACT)'' being
developed by the Committee is a step in the right direction toward the
successful implementation of the Surgeon General's recommendation. We
also believe that the Committee should urge the Congress to support
full funding for the Physical Education for Progress (PEP) program in
the FY2003 appropriations process and beyond.
NSDA believes however, that the private sector can also help
schools address their revenue problems. Soft drink companies have had a
strong and long-lasting commitment to America's education process for
more than fifty years. Like many local businesses, beverage companies
have developed successful partnerships with schools that provide value
in the form of grants, scholarships and employee volunteer programs.
These partnerships also generate revenue from the sale of beverages
that help fund important educational programming, such as sports and
physical education equipment, arts and theater programs, foreign
language classes and computers and other technology.
These business partnerships are a ``win-win.'' Beverage companies,
schools, students and taxpayers all benefit. Educators are empowered to
make decisions that best benefit their schools, students and
communities. In fact, local control is the key to making these public-
private partnerships work for schools. That is why the soft drink
industry opposes further Federal legislative intervention in the issue.
The revenue generated from the sale of beverages in schools in an
important part of the education funding equation in the United States.
According to a March 2001 Survey by the National Association of
Secondary School Principals (NASSP), 30 percent of schools report that
their funding situation is worse than it was 5 years ago. The need for
additional revenue is greater among the Nation's rural and urban
schools.
In 1996, the Carnegie Foundation for the Advancement of Teaching
and NASSP produced a report evaluation America's school entitled,
``Breaking Ranks, Changing an American Institution.'' The report
recommended that schools reach out to the business community to form
alliances that enhance academic programs on behalf of students. The
March 2001 NASSP survey on business relationships with schools shows
that educators have embraced the recommendation, as over 90 percent of
school principals support public-private partnerships with soft drink
companies to improve education. Other key findings from the study show:
1. Over 60 percent of schools offer a wide variety of beverages in
their vending machines, including water, 100 percent juice, sports
drinks and juice drinks.
2. The number one use of the revenue generated by the sale of
beverages in schools is to purchase sports and physical education
equipment (66 percent of schools), followed by after-school student
activities (59 percent), instructional materials (48 percent) field
trips (46 percent) arts and theater programs (44 percent) and computers
and other technology (42 percent).
It is important to remember the basic elements of achieving and
maintaining a healthy lifestyle:
1. Establish a daily diet that is balanced and has variety and
moderation for all foods and beverages consumed.
2. Engage in 30 minutes of physical activity daily.
Too many calories consumed from all sources, combined with a lack
of physical activity are fueling rising obesity rates. The American
Dietetic Association (ADA) counsels that there are no ``good foods'' or
``bad foods'' just good diet and bad diets. In addition, ADA says all
foods have a place in a balanced diet.
Opponents to beverage sales in schools base their objections on
their own allegations that consumption of soft drinks and other foods
of minimal nutritional value are causing obesity and other health
problems. Not only do these allegations ignore an ever-growing body of
scientific evidence (see attachment) but they also defy logic and
common sense. NSDA knows of no data or evidence that suggests that
children and teenagers in States, cities, or school districts that
restrict the sale of soft drinks in their schools are any less
overweight or obese then those in states that allow the sales of
competitive foods like soft drinks.
In closing, NSDA again commends the Committee for its efforts in
developing legislation intended to evaluate the success of existing
Federal nutrition programs and to encourage the development of physical
fitness programs and education at the local level. We stand ready to
work with the Committee in furtherance of these goals.
ATTACHMENT TO THE STATEMENT OF THE NATIONAL SOFT DRINK ASSOCIATION
RECENT ADVANCES IN SCIENTIFIC KNOWLEDGE CHALLENGE MANY COMMON VIEWS
ABOUT SOFT DRINKS AND HEALTH
There is one simple truth in all the data about rates of overweight
and obesity--if we consume more calories than we expend, we will gain
weight.\1\ Rising rates of obesity, especially pediatric obesity,
present the Nation with a serious health challenge. As parents,
educators, Government officials and healthcare professionals look for
answers, accurate information is critical. In many instances, the facts
challenge common misperceptions.
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\1\ ``Straight Facts About Beverage Choices,'' Journal of the
American Dietetic Association, September, 2001.
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Did you know that a November 2001 journal article by a
leading researcher at the United States Department of Agriculture
Center for Nutrition Policy and Promotion stated that sugar consumption
is not associated with chronic diseases such as diabetes, obesity and
hyperactivity in children? The author, Dr. Anne Mardis, MD currently at
the National Institute for Occupational Safety and Health, Centers for
Disease Control and Prevention advises that the ``focus on sugar as an
independent risk factor for chronic disease and hyperactivity should be
de-emphasized.'' \2\
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\2\ Mardis, Anne, ``Current Knowledge of the Health Effects of
Sugar Intake,'' Family Economics and Nutrition Review, United States
Department of Agriculture, Center for Nutrition Policy and Promotion,
volume 13, number 1, 2001.
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Did you know that according to research conducted by the Georgetown
University Center for Food & Nutrition Policy, presented at a major
scientific conference in April 2001, 20 percent of teens 12 to 16 years
of age do not consume regular carbonated soft drinks, 67 percent
consume one 12-ounce can of regular carbonated soft drink per day or
less and only 5 percent consume three or more cans per day. The simple
message here is that most children are not ``guzzling'' soft drinks.
Rather, they are finding a way to fit soda, milk, juice, water and
sports drinks into their diets.\3\
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\3\ Storey, M. & Forshee, R., ``Relationship Between Soft Drink
Consumption and BMI Among Teens,'' Experimental Biology 2001.
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Did you know that according to research using the very
latest Federal Government health data, conducted by Virginia Tech and
presented to the American College of Nutrition annual conference in
October 2001, soft drink consumption does not contribute to increases
in dental cavities in children? \4\ A recent University of Michigan
study showed that soft drinks do not cause increased cavities in people
under the age of 25.\5\ Also, according to the National Institutes of
Health, the number of dental cavities continues to decline and dental
health has been improving for years, due to many factors, including
water fluoridation and better oral hygiene.\6\
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\4\ Storey, M. & Forshee, R., ``Beverage Consumption and Dental
Caries,'' American College of Nutrition, 2001.
\5\ Burt, B.A., ``Is Sugar Consumption Still A Major Determinant of
Dental Caries? A Systematic Review,'' www.lib.umich.edu/dentlib/nihcdc/
abstracts burt2.html 2001.
\6\ National Institutes of Health Consensus Development Conference
Statement, ``Diagnosis and Management of Dental Caries Throughout
Life,'' March 26-28, 2001.
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Did you know that a recent study, funded by the dairy
industry and published in the American Journal of Clinical Nutrition,
showed that neither the caffeine nor the phosphorus found in some soft
drinks contributes to poor bone health? \7\
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\7\ Heaney, R. & Rafferty, K., ``Carbonated Beverages and Urinary
Calcium Excretion,'' American Journal of Clinical Nutrition, 2001,
74:343-7
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Did you know that the September 2001 Journal of the
American Dietetic Association contains an official Nutrition Fact Sheet
stating, ``Regular carbonated soft drinks contain calories; milk and
juice contain calories, vitamins and minerals--all beverages can have a
place in a well-balanced eating pattern''? Further, the American
Dietetic Association counsels that restricting foods or food
ingredients is not a viable strategy for weight management.\8\
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\8\ ``Straight Facts About Beverage Choices,'' Journal of the
American Dietetic Association, September 2001.
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Did you know that virtually no school system in the
country provides daily physical activity for its students\9\ despite
the fact that the rate of pediatric and childhood obesity in this
country has reached an alarming level? Today's school children receive
less physical activity today than their counterparts did 5 years
ago.\10\
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\9\ ``Shape of the Nation Report,'' National Association for Sport
& Physical Education, pp. 3-5.
\10\ National Association for Sport & Physical Education, ``Public
Attitudes Toward Physical Education,'' March 22, 2000.
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Did you know that low physical activity levels are
associated with increasing obesity? According to a new study conducted
by the National Public Health institute in Helsinki and published in
the American Journal of Clinical Nutrition,\11\ among various
behaviors, low levels of leisure exercise over time have the strongest
relationship with obesity. The authors conclude that a physically
active lifestyle, together with abstention from smoking, moderate
alcohol consumption and a variety of healthy foods, provide the
greatest likelihood of avoiding obesity. The results of the study of
24,604 Finnish men and women underscore the importance of regular
exercise in maximizing the chances of maintaining a normal weight.
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\11\ Am J Clin Nutr 2002: 5,809-817
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Did you know that a National Institutes of Health (NIH)
analysis of daily calorie consumption, published in the American
Journal of Clinical Nutrition \12\ concludes, ``The lack of evidence of
a general increase in energy intake among youths despite an increase in
the prevalence of overweight suggests that physical inactivity is a
major public health challenge for this group?'' The study suggests that
although some have tried to blame the over-consumption of food for
rising obesity rates, the evidence does not support that position. The
study suggests lack of exercise is a major contributor to obesity.
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\12\ Am J Clin Nutr 2000:72(suppl):1343S-53S.
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Did you know that a new study from the University of
Washington presented at the Experimental Biology 2002 Annual Meeting in
April 2002 demonstrates that cola soft drinks have the same effect on
satisfying hunger and thirst as orange juice and 1 percent milk? Adam
Drewnowski, Ph.D., Professor of Epidemiology and Medicine and Director
of the University of Washington's Nutritional Science Program said,
``Some nutritionists believe that colas act only as thirst quenching
liquids and have no influence on hunger or fullness, and that fruit
juices and milk are said to be foods that you drink. In our study with
healthy college-age men and women, we found nothing of the sort.''