[House Hearing, 108 Congress]
[From the U.S. Government Publishing Office]
THE SUPERSIZING OF AMERICA: THE FEDERAL GOVERNMENT'S ROLE IN COMBATING
OBESITY AND PROMOTING HEALTHY LIVING
=======================================================================
HEARING
before the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTH CONGRESS
SECOND SESSION
__________
JUNE 3, 2004
__________
Serial No. 108-201
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpo.gov/congress/house
http://www.house.gov/reform
______
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COMMITTEE ON GOVERNMENT REFORM
TOM DAVIS, Virginia, Chairman
DAN BURTON, Indiana HENRY A. WAXMAN, California
CHRISTOPHER SHAYS, Connecticut TOM LANTOS, California
ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
JOHN L. MICA, Florida PAUL E. KANJORSKI, Pennsylvania
MARK E. SOUDER, Indiana CAROLYN B. MALONEY, New York
STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland
DOUG OSE, California DENNIS J. KUCINICH, Ohio
RON LEWIS, Kentucky DANNY K. DAVIS, Illinois
JO ANN DAVIS, Virginia JOHN F. TIERNEY, Massachusetts
TODD RUSSELL PLATTS, Pennsylvania WM. LACY CLAY, Missouri
CHRIS CANNON, Utah DIANE E. WATSON, California
ADAM H. PUTNAM, Florida STEPHEN F. LYNCH, Massachusetts
EDWARD L. SCHROCK, Virginia CHRIS VAN HOLLEN, Maryland
JOHN J. DUNCAN, Jr., Tennessee LINDA T. SANCHEZ, California
NATHAN DEAL, Georgia C.A. ``DUTCH'' RUPPERSBERGER,
CANDICE S. MILLER, Michigan Maryland
TIM MURPHY, Pennsylvania ELEANOR HOLMES NORTON, District of
MICHAEL R. TURNER, Ohio Columbia
JOHN R. CARTER, Texas JIM COOPER, Tennessee
MARSHA BLACKBURN, Tennessee ------ ------
PATRICK J. TIBERI, Ohio ------
KATHERINE HARRIS, Florida BERNARD SANDERS, Vermont
(Independent)
Melissa Wojciak, Staff Director
David Marin, Deputy Staff Director/Communications Director
Rob Borden, Parliamentarian
Teresa Austin, Chief Clerk
Phil Barnett, Minority Chief of Staff/Chief Counsel
C O N T E N T S
----------
Page
Hearing held on June 3, 2004..................................... 1
Statement of:
Agatston, Dr. Arthur, cardiologist and author, the South
Beach Diet; Dr. G. Harvey Anderson, professor, Department
of Nutritional Sciences, University of Toronto; Dr. Susan
Finn, chair, American Council for Fitness and Nutrition;
and Bruce Silverglade, director, legal affairs, Center for
Science in the Public Interest............................. 95
Crawford, Dr. Lester M., Acting Commissioner, Food and Drug
Administration; Lynn Swann, chairman, President's Council
on Physical Fitness and Sports; and Eric Hentges, Executive
Director, U.S. Department of Agriculture, Center for
Nutrition Policy and Promotion............................. 15
Trager, Dr. Stuart, chairman, Atkins Physicians Council...... 71
Letters, statements, etc., submitted for the record by:
Agatston, Dr. Arthur, cardiologist and author, the South
Beach Diet, prepared statement of.......................... 98
Anderson, Dr. G. Harvey, professor, Department of Nutritional
Sciences, University of Toronto, prepared statement of..... 107
Crawford, Dr. Lester M., Acting Commissioner, Food and Drug
Administration, prepared statement of...................... 17
Cummings, Hon. Elijah E., a Representative in Congress from
the State of Maryland, prepared statement of............... 155
Davis, Chairman Tom, a Representative in Congress from the
State of Virginia, prepared statement of................... 4
Finn, Dr. Susan, chair, American Council for Fitness and
Nutrition, prepared statement of........................... 112
Hentges, Eric, Executive Director, U.S. Department of
Agriculture, Center for Nutrition Policy and Promotion,
prepared statement of...................................... 56
Putnam, Hon. Adam H., a Representative in Congress from the
State of Florida, prepared statement of.................... 157
Silverglade, Bruce, director, legal affairs, Center for
Science in the Public Interest:
Information on global strategy on diet, physical activity
and health............................................. 123
Prepared statement of.................................... 144
Swann, Lynn, chairman, President's Council on Physical
Fitness and Sports, prepared statement of.................. 46
Towns, Hon. Edolphus, a Representative in Congress from the
State of New York, information concerning children's diets. 68
Trager, Dr. Stuart, chairman, Atkins Physicians Council,
prepared statement of...................................... 74
Waxman, Hon. Henry A., a Representative in Congress from the
State of California, prepared statement of................. 9
THE SUPERSIZING OF AMERICA: THE FEDERAL GOVERNMENT'S ROLE IN COMBATING
OBESITY AND PROMOTING HEALTHY LIVING
----------
THURSDAY, JUNE 3, 2004
House of Representatives,
Committee on Government Reform,
Washington, DC.
The committee met, pursuant to notice, at 11:37 a.m., in
room 2154, Rayburn House Office Building, Hon. Tom Davis of
Virginia (chairman of the committee) presiding.
Present: Representatives Tom Davis of Virginia, Shays, Ros-
Lehtinen, Ose, Lewis, Putnam, Schrock, Duncan, Murphy, Carter,
Blackburn, Harris, Waxman, Towns, Maloney, Cummings, Tierney,
Clay, Watson, Van Hollen, and Ruppersberger.
Staff present: David Marin, deputy staff director and
communications director; Keith Ausbrook, chief counsel; Ellen
Brown, legislative director and senior policy counsel; Anne
Marie Turner, counsel; Robert Borden, counsel and
parliamentarian; Rob White, press secretary; Drew Crockett,
deputy director of communications; Mason Alinger, Brian Stout,
Susie Schulte, Michael Layman, and Shalley Kim, professional
staff members; Teresa Austin, chief clerk; Brien Beattie,
deputy clerk; Allyson Blandford, office manager; Leneal Scott,
computer systems manager; Phil Barnett, minority staff
director; Kristin Amerling, minority deputy chief counsel; Josh
Sharfstein, minority professional staff member; Earley Green,
minority chief clerk; Jean Gosa, minority assistant clerk; and
Naomi Seiler, minority staff assistant.
Chairman Tom Davis. I want to welcome everyone to today's
hearing. I would note a quorum is here.
The hearing is on the Federal Government's role in fighting
obesity in the United States. Today we will examine the
increasing threat obesity poses to all Americans, what
government is going to do to help people lead healthier lives
and how the government can provide greater health leadership
for the public.
As obesity will soon pass smoking as the No. 1 avoidable
cause of death among Americans, a reexamination of our national
health policy is more than warranted. Mr. Waxman, it took us a
long time to get together on a smoking bill and FDA regulation.
Maybe we can work on an obesity bill once we get that through.
The facts are, quite frankly, frightening. Obesity-related
disease kills 400,000 Americans each year. Medical treatment of
obesity and its more than two dozen associated conditions costs
nearly $100 billion annually according to some estimates with
about half paid by taxpayers through Medicare and Medicaid.
In 2001, obesity was a primary factor in five of the six
leading causes of death among Americans: heart disease, cancer,
stroke, Chronic Obstructive Pulmonary disease and diabetes.
One-third of all Americans are considered obese; another third
are overweight and the trend line is only getting worse.
Clearly, all Americans aren't eating wisely, they are not
exercising enough, but that is too simple. The root causes of
obesity are far too many in number to adequately address here
today. We are a Nation consumed by work, spending long hours
behind desks, favoring fast food meals and cramming in exercise
when we are able, if at all.
While heredity largely determines how a person burns
calories and retains fat, the person's behavior unquestionably
has a greater impact on weight gain. In the year 2000, women
consumed 335 more calories per day than they ate in 1971. Men
eat 168 more calories today than they did 30 years ago. At the
same time, nearly half of all American adults reported they
engaged in no physical activity at all.
During its meeting last week, the U.S. Dietary Guidelines
Advisory Committee declared that most adults need 30 minutes of
moderate physical activity nearly every day. Some require 60
minutes a day to avoid weight gain. Yet, while there may be
consensus that all Americans should be more physically active
and make better eating decisions, there are numerous and
conflicting views on how to reach those goals.
People are confused. Should they follow the same food
pyramid we all learned in school a long time ago? Is the answer
a low carb or no carb diet? How much daily exercise is enough
to make a difference? Today's hearing will focus on how the
Government should and perhaps should not respond to the obesity
epidemic. It is especially timely because several executive
branch agencies and departments are reassessing their roles in
the fight against obesity. For example, the Department of
Health and Human Services and the Department of Agriculture are
working together on revisions to the Federal Dietary Guidelines
and its well known visual aid, the Food Pyramid.
The Food and Drug Administration's Obesity Working Group
released a report entitled, ``Calories Count,'' to reexamine
FDA's responsibilities for reducing obesity. Also, HHS is
overseeing the President's ``Healthier U.S.'' Initiative to
emphasize the importance of physical activity, a nutritious
diet and making smart health choices.
All of these programs are thoughtful and well intentioned
steps in the fight against obesity but as officials at all
levels of Government contemplate what message to convey to an
increasingly overweight U.S. population and how to convey it,
the questions we want to ask today are many and complex. What
should Government's role be in fighting obesity? If we agree
the Government should have a role in advocating healthy living,
what should that role look like? To what degree should we act
and at what cost to our pocketbooks and quality of life? Some
favor significantly enhancing Federal regulation to food, diet
and consumer choice. Proposals ranging from the ``Twinkie tax''
to federally mandated labeling of restaurant menus begs a
larger debate on the appropriate role of Government in our
lives.
The question becomes, how do we reconcile the need for
Government to participate in the campaign against obesity
without implying that Americans should be able to make
decisions about what to eat and drink on their own? To help
answer these questions, we have two panels of distinguished
witnesses from the fields of Government, academia, science and
law.
I look forward to our discussion today and I again want to
welcome our witnesses and their important testimony.
[The prepared statement of Chairman Tom Davis follows:]
[GRAPHIC] [TIFF OMITTED] T5914.001
[GRAPHIC] [TIFF OMITTED] T5914.002
Chairman Tom Davis. I would ask unanimous consent that the
written statement of Marshall Manson, vice president of public
affairs, Center for Individual Freedom, be submitted for the
record. Without objection, so ordered.
I would now yield to Mr. Waxman for an opening statement.
Mr. Waxman. Thank you, Mr. Chairman, for holding this
hearing on obesity today.
Obesity rates in the United States and abroad are rising at
an alarming rate and a key question is what can the Government
do to fight this epidemic? I believe the Government's role is
to create opportunities for individuals and communities to
address obesity. Americans need to access meaningful
nutritional information about foods and effective messages
about how to maintain healthy weight. Communities need safe
places to exercise, inviting places to walk and recreational
opportunities so that the young and old can be active.
Ultimately, of course, the decisions are going to be up to
the individuals and communities, but let us get as much correct
information to people as possible. That is why I was pleased to
have been the author of the ``Nutrition Labeling and Education
Act,'' which provides the ingredient labeling information on
every food product available for sale that tells people about
calories, carbohydrates, cholesterol and other ingredients.
Many public policies on obesity make a difference. For
example, HHS established the Steps Cooperative Agreement
Program to fund community-based programs that have been
effective in controlling chronic illnesses associated with
obesity. There are other cases, however, where Government,
especially under the Bush administration, where the priorities
seem to be promoting the interests of the food industry over
the protection of the public health. I want to set out some
examples of that.
On the food labeling bill that I authored, the ``Nutrition
Labeling and Education Act,'' the law provided that claims
couldn't be made on food products about protecting people
against disease unless there was a clear scientific consensus.
The FDA now has reinterpreted the law and decided that they are
not going to force this legal requirement about a significant
scientific agreement before the companies can make the health
claims about foods. They are going to let the companies go out
and make these claims because they now know they won't be
called to task by the FDA.
In one of the first decisions under this new policy, the
FDA announced it would let companies claim that ``Supportive
but not conclusive research shows that eating 1.5 ounces per
day of walnuts as part of a low saturated fat and low
cholesterol diet and not resulting in increased caloric intake,
may reduce the risk of coronary heart disease.'' I don't know
what that means. There may be experts here today who can
understand what this message means in just one reading but for
the rest of us, it is quite complex. Maybe what they expect the
bottom line to be is that people should think eating walnuts
may prevent heart disease. That conclusion doesn't have
scientific agreement behind it and it may be wrong.
The FDA found all the studies submitted to support the
claim to be either irrelevant or of poor to moderate scientific
quality and the FDA's independent reviewers agreed it is
uncertain from the publicly available scientific evidence
increasing consumption of walnuts will reduce coronary heart
disease. So this claim for walnuts may help sell more walnuts.
The manufacturers and those in the processing of walnuts can
make some more money but I think it is misleading and confusing
for consumers and undermines the intent of Congress in terms of
giving accurate information to consumers.
There has been a recent policy action on soft drinks that
also exemplifies this administration's approach. The Department
of Health and Human Services has repeatedly tried to block the
World Health Organization from concluding that there is
evidence linking sugar containing beverages with weight gain.
This position may please the soft drink manufacturers but it
certainly contradicts the scientific opinion of the Surgeon
General, the Centers for Disease Control, the U.S. Department
of Agriculture as well as the findings of a number of
scientific studies. In effect, we have the administration
putting the interest of the soft drink manufacturers over the
scientific consensus that there is this link.
On nutrition education, the Department of Agriculture
decided that public campaigns funded through food stamp
programs may not be used to convey negative written, visual or
verbal expressions about any specific foods, beverage or
commodities. The Department of Agriculture staff has even been
given the right to review the content of each educational
campaign to ensure there is no belittlement or derogation of
food items. This is a Twinkie protection provision that does
not appear to have any scientific justification. The Department
of Agriculture appears to be prohibiting States from saying
anything bad about junk foods, this despite a recent study
showing that junk foods constitute almost one-third of
Americans diets.
What we see, I think, is a troubling patter emerging. When
the manufacturer wants to make misleading health claims, the
administration says yes. When public health agencies want to
educate the public about well established health risks of
certain foods, the administration says no, don't tell the
consumers. There is a lot at stake for food companies. As one
investment report concluded, any restrictions on advertising
more comprehensible labeling, warnings that clearly highlight
the risk of overindulgence in snacks, soft drinks and fast
food, can only be negative for the industries that sell those
food items.
However, the purpose of Government is not to protect the
short term profits of the food industry, it is to support the
health of individuals and communities. Ultimately, healthy
eating will provide many opportunities for companies to provide
and market foods, but we shouldn't try to keep the consumers
from knowing the facts.
I hope as we move forward on the battle against obesity,
that our health agencies will remember that obesity and
overweight are public health issues with public health
consequences. People need to be guided by the best science and
must advance the goal of improving health.
I thank the witnesses and look forward to hearing what they
have to say today as we try to think through what to do about
what some are describing as an epidemic, particularly among our
children.
[The prepared statement of Hon. Henry A. Waxman follows:]
[GRAPHIC] [TIFF OMITTED] T5914.003
[GRAPHIC] [TIFF OMITTED] T5914.004
Chairman Tom Davis. Thank you very much.
Members will have 10 days to make opening statements. Does
anyone really wish to make a statement?
Ms. Ros-Lehtinen. Mr. Chairman.
Chairman Tom Davis. You have an introduction and I know Mr.
Murphy has an introduction. You are recognized.
Ms. Ros-Lehtinen. Thank you so much, Chairman Davis.
I would like to congratulate you for your outstanding
leadership for holding this timely hearing and my good friend
from California, Mr. Waxman, as well.
I would like to especially thank one panelist for being
here today because he is one of my congressional constituents.
That is Dr. Arthur Agatston, right there in the front row. He
is going to be bringing his expertise to this vital hearing.
Dr. Agatston will speak on the second panel as you pointed
out, Mr. Chairman. The Doctor, as all of us know, is the author
of the best selling book, ``The South Beach Diet,'' the best-
selling liftestyle book that has been on the New York Times
Bestseller List now for over a year.
Dr. Agatston brings with him a wealth of experience
providing the public with information about the connection
between a good diet, safe weight loss and disease prevention.
He has authored more than 100 scientific publications as well
as reviewed for major medical and cardiology journals. He is a
cardiologist with Mt. Sinai Hospital located in my
congressional district in Miami Beach.
As you pointed out, Mr. Chairman, America's obesity problem
has reached a critical level. Obesity rates have increased
dramatically over the past two decades and the National Center
for Health Statistics estimated that 64 percent of American
adults were considered overweight or obese in the years 1990
and 2000 when they did the study. The physical and economic
costs of obesity are astounding. Obesity, as you pointed out,
Mr. Chairman, will surpass smoking as the leading avoidable
cause of death among Americans. It has been linked to cause
diseases such as cancer, heart disease, diabetes, stroke and
illnesses that account for over two-thirds of all deaths in the
United States. Since obesity is caused by multiple large scale
factors, no one solution will adequately help Americans control
their weight. Nevertheless, the Federal Government is currently
reexamining many of our health and nutrition policies and I
commend your committee, Mr. Chairman, for examining these
critical Government initiatives. It is imperative to assess
their impact on whether the Federal Government can or should do
more and I hope we will continue to work together to eradicate
this disease.
Thank you again for inviting my congressional constituent,
Dr. Arthur Agatston, to be a witness here today. He is joined
by his wonderful powerhouse of a wife as well.
Thank you.
Chairman Tom Davis. Thank you very much.
Mr. Murphy.
Mr. Murphy. Thank you, Mr. Chairman, for convening this
hearing on this important aspect of public health and one that
is really a killer of our children and adults.
I would like to take a minute to recognize one of the
witnesses testifying before us, Lynn Swann, chairman of the
President's Council on Physical Fitness and Sports. Lynn, a
Pittsburgher now, although originally from Tennessee, I
believe, and spent some time at a place called USC where he
became an All-American, we still see as one of the best
football players the game has ever seen.
With the Pittsburgh Steelers, No. 88 played in four Super
Bowl games in 6 years, was named MPV in Super Bowl X and is in
the Pro Football Hall of Fame. Their Web site says, ``He is
blessed with gazelle-like speed, fluid movements and a
tremendous leaping ability which caused him to become a regular
wide receiver in his second year.''
However, football is not Lynn's only passion. Lynn also has
a heart for helping people reach personal milestones
physically, mentally and emotionally. In addition to promoting
healthy living through the President's Council on Physical
Fitness and Sports, Lynn has also been the National Spokesman
and is on the Board of Directors for the mentoring program, Big
Brothers/Big Sisters of America. Lynn brings a lot of
experience to the table. I am glad he is able to be with us
today to discuss the concerns of obesity and its impact on
health in America and it is because of this broad range of
concern, we recognize him as an All-American in every way.
Thank you, Mr. Chairman.
Chairman Tom Davis. Thank you.
Mr. Towns.
Mr. Towns. Thank you very much, Mr. Chairman.
Let me also thank you first for having the hearing and I
also thank the witnesses for coming.
We are here at a very crucial point in the stability of our
country's health and well-being. It is time to take a very hard
look at what we plan to do to reverse this terrible trend. Our
Nation's lack of nutritional conscience is staggering. If we
don't act now, our children and grandchildren are going to
continue to eat poorly, exercise less and suffer adverse health
consequences, resulting in premature death and reduced quality
of life.
Americans are suffering from a multitude of preventible
illnesses that are a direct result of bad eating habits and a
sedentary lifestyle which can lead to diabetes, heart disease,
asthma, stroke, gall bladder disease, osteoarthritis, pregnancy
complications, increased surgical risk, depression and certain
types of cancer associated with obesity.
Over 8 million children and teenagers in the United States
are overweight. Obesity is not just a vanity issue for adults
and it is time to confront that reality. Children have the
immediate risk of Type 2 Diabetes, hypertension, orthopedic
problems and psycho-social implications such as discrimination,
alienation and bullying. Moreover, obese children and
adolescents are more likely to become obese adults.
I direct your attention to a graph on the easel. Mr.
Chairman, ladies and gentlemen, this I is why we are here
today. This is embarrassing. This chart shows precisely what we
are talking about. We owe our children more than this. It is
bad enough that we as adults are eating this way but our kids
don't deserve this. Take a long look at the numbers. Over 20
percent of babies aged 19 to 24 months have never consumed any
food except for soft drinks, bacon and french fries. That is
almost unbelievable but ladies and gentlemen, it is true.
We need to address the economic circumstances affecting
food choice. Disadvantaged, inner city families are surrounded
by fast food restaurants and stores carrying snack foods with
little nutritional value. Young Americans need to be able to
exercise and play in safe parks and neighborhoods. They need to
have access to regular physical education and schools that not
only teach them the R's, but teach them nutrition and healthy
choices. Employees must implement work site healthy promotion
programs that allow employees a small amount of time each day
to participate in physical activity.
Healthy food needs to be readily accessible to every
citizen. We cannot afford to wait, Mr. Chairman, for our
quality of life and for our children, we must act now. Failure
to do so will result in a Nation too overweight and too sick to
sustain.
Thank you again for having this hearing. I think the timing
is right.
With that, I yield back.
Chairman Tom Davis. Thank you.
Mr. Schrock.
Mr. Schrock. Thank you, Mr. Chairman.
I wasn't going to make any comments but I think I will make
a brief opening statement and then I have a couple comments on
things I have heard here already.
The current health debates are clearly focusing on health
coverage benefits, malpractice and payment levels but one of
the most important health issues cannot be overlooked and that
is the actual health of the American people. Obesity in the
U.S. population has been increasing steadily over the past two
decades and unfortunately, plays a major role in disability at
all ages. I am delighted the gazelle and others are here today
to discuss this with us.
Until a few minutes ago, I thought I heard everything
during the business meeting, we were having and some of the
things I heard President Bush being blamed for I leaned to Mr.
Putnam and said jokingly, before long, Mr. Bush will be blamed
for the Civil War. Well, I am not far off because a few minutes
ago, now he is being blamed for obesity. How ridiculous does
this get? What about personal responsibility? What about
families taking control of the eating habits of their families
and making sure children stay at home at night and eat and that
dad doesn't stop by a fast food restaurant on the way home and
pick up junk for them to eat?
That doesn't mean all fast food is junk because some of
these people are getting their act together and there are
healthier things in the fast food restaurants, but it boils
down to personal responsibility. I go into middle schools and
high schools and there are ``gedunk machines'', that is what we
used to call them in the Navy, that is where they can sell
Cokes or candy bars or chips. That is nonsense if we really
care about the health of our kids, why are we allowing that to
happen.
Frankly, family oversight I think has to factor into this
very well. My family, my son, my wife and I live in Virginia
Beach so we each have a South Beach book that we have been
using and it does work and that is what it is going to take.
Chairman Tom Davis. South Beach means South Virginia Beach
where we are from.
Mr. Schrock. That is right. That is what I thought it meant
when I bought it.
Let me tell you something that really baffles me around
here. There are a lot of young people that work on a lot of
staffs around here. I think the thing that upsets me more than
anything else is I see some overweight young staffers in their
twenties carrying globs of food from the restaurants around
here and they get on an elevator to go down one floor so they
can go to their offices and eat it. That is nonsense. We ought
to lock the elevators and make these folks walk up and down the
steps, walk and do what they are supposed to do. I know there
are some members who have cars take them from their offices to
vote. Let them walk. It is all about personal responsibility.
It is good we are having this hearing but when Government
gets involved, it is going to get screwed up. Frankly, I think
Government ought to keep their hands out of this and make it
the responsibility of the people who are eating the food and
their children. This chart that was just handed to us, this is
outrageous when you think about kids at this age eating bacon,
hot dogs and sausage. No wonder we have this problem. Frankly,
it is about personal responsibility and I am very anxious to
hear what the witnesses say today and maybe what they say here
today can help the American people get their act together with
their diet and not Government.
Thank you.
Chairman Tom Davis. Thank you.
We have a great panel here. We have: Dr. Lester M.
Crawford, Acting Commissioner, Food and Drug Administration;
Mr. Lynn Swann, already introduced by Mr. Murphy, the chairman
of the President's Council on Physical Fitness and Sports; Dr.
Eric Hentges, Executive Director, U.S. Department of
Agriculture, Center for Nutrition Policy and Promotion. They
will provide the committee with an overview of the Federal
Government's initiatives to combat obesity and promote health
living. Additionally, these witnesses will offer an update on
the process to revise and modernize the Federal Dietary
Guidelines and the Food Pyramid.
[Witnesses sworn.]
Chairman Tom Davis. Dr. Crawford, I will start with you and
move straight down.
When the light in front of you turns orange, it means 4
minutes are up and you have 1 minute and the red is 5 minutes
and move to summary after that but we won't hold you strictly
accountable.
Thank you.
STATEMENTS OF DR. LESTER M. CRAWFORD, ACTING COMMISSIONER, FOOD
AND DRUG ADMINISTRATION; LYNN SWANN, CHAIRMAN, PRESIDENT'S
COUNCIL ON PHYSICAL FITNESS AND SPORTS; AND ERIC HENTGES,
EXECUTIVE DIRECTOR, U.S. DEPARTMENT OF AGRICULTURE, CENTER FOR
NUTRITION POLICY AND PROMOTION
Dr. Crawford. Thank you very much for having us here. I am
delighted to be with Dr. Hentges and also Mr. Swann.
As you know, obesity and weight management has for sometime
been one of the top public health stories in the media. This
hearing is extremely timely in providing a forum to raise
awareness not only of the problem but also of the many
initiatives of the Federal Government to address this epidemic.
Today I will cover the Department of Health and Human Services'
initiatives and programs designed to assist Americans with
maintaining a healthy weight.
Obesity has risen at an epidemic rate during the past 20
years. Nearly two-thirds of adults in the United States are
overweight and 31 percent are obese according to the Centers
for Disease Control and Prevention. The prevalence of
overweight and obesity varies by gender, age, socioeconomic
status, race and ethnicity. Overweight and obesity are
associated with increased morbidity and mortality.
Approximately 400,000 adult deaths in the United States each
year are attributable to unhealthy dietary habits, coupled with
physical inactivity.
The Government's role in combating the obesity epidemic I
think is as follows: eating a healthy diet and increasing
physical activity reduces weight which is shown to reduce the
risk for many chronic diseases. Often small changes such as
physical activity for 30 minutes a day or consuming 100 fewer
calories a day can result in large health benefits. However,
individuals must have the right information to make healthy
lifestyle choices.
In June 2002, President Bush launched the healthier U.S.
initiatives designed to help Americans, especially children,
live longer, better and healthier lives. HHS Secretary Tommy
Thompson built on President Bush's Healthier U.S. Initiative to
create the Steps to a Healthier U.S. Program which provides the
overall framework for HHS initiatives addressing obesity and
overweight. These initiatives target a variety of populations
and include programs in education, communication and outreach,
intervention, diet and nutrition, physical activity and
fitness, disease surveillance, research, clinical preventive
services and therapeutics, and policy and Web-based tools.
Two major initiatives I would like to highlight today are
the FDA's Obesity Working Group and NIH's development of an
Obesity Research Strategic Plan. In August 2003, we at the FDA
established an Obesity Working Group to determine how the
agency could address this problem. In March 2004, the FDA
released its comprehensive report to combat obesity with a
focus on the message, ``Calories Count.'' The agency's
proposals are based on the scientific fact that weight control
is mainly a function of the balance between calories consumed
and calories expended. For example, the report recommends FDA
reexamine the food label to determine how the label can better
assist consumers in making weight management decisions.
The following items are highlighted. We will consider
changes to the Nutrition Facts panel that will further
emphasize the focus on calories. We will encourage food
manufacturers to revise certain labels as single servings, a
voluntary action they can already take to help consumers make
more informed choices about their diet. As an example, earlier
this week, Kraft Foods reported on a range of initiatives with
regard to packaging and labeling helping consumers make
informed choices by adding the amount of calories for total
packages. We encourage other companies to move in the same
direction.
Third is to encourage the use of comparative labeling
statements to make it easier for consumers to compare different
types of foods and make healthier substitutions and then
finally to evaluate the nutrient content claims for the
carbohydrate content of foods.
FDA has filed three petitions from manufacturers in March
of this year and plans to enter into rulemaking to define terms
such as ``low'' and ``reduced'' so that consumers are armed
with better and more accurate information. FDA will conduct
consumer studies this summer and we will publish a document by
the end of the year.
Other major recommendations from this working group include
initiating a Calories County Education Program and encouraging
restaurants to provide nutrition information to consumers. I
would like to express appreciation for the work of the National
Restaurant Association and those restaurants that have acted to
provide this information at this point.
Strengthening enforcement activities to ensure the accuracy
of the information in the nutrition facts panel is another
item. Revising FDA's 1996 draft guidance for the clinical
evaluation of weight control drugs and increasing collaboration
on obesity research are other items.
With regard to research, the second major initiative, I
would like to mention the NIH Obesity Research Task Force. As
the problems of overweight and obesity have grown, the need for
new action and research has become more evident. In response,
NIH assembled a task force to identify areas for new research
across its institutes and in March of this year, the agency
released the draft of its strategic plan. That plan does the
following things.
Research will be stimulated toward preventing and treating
obesity through lifestyle modification, preventing and treating
obesity through pharmacologic, surgical and other medical
approaches, breaking the link between obesity and its
associated health conditions, and cross-cutting topics such as
decreasing health disparities and encouraging technology,
fostering inter-disciplinary research teams, investigative
training, translational research and education outreach.
The last area I would like to mention is HHS' efforts to
work with the international community are continuing. The World
Health Organization's global strategy on diet, physical
activity and health holds much promise in the fight against the
global epidemic of overweight and we support that.
Mr. Chairman, these are my remarks. I appreciate the time
very much.
[The prepared statement of Mr. Crawford follows:]
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Chairman Tom Davis. Thank you very much.
Mr. Swann, thank you for being with us.
Mr. Swann. Thank you very much for having me here.
I would be remiss if I didn't first pay my respects to Ms.
Blackburn from Tennessee. As I was born in Alcoa, TN, the first
organized sports team I played on was a Little League baseball
team in Alcoa.
Also, Mr. Waxman, having grown up in California, the first
football team I ever played on was a team called the Peninsula
Jets and the next year, the San Bruno Rams as I was growing up
there and graduating from and playing football for the
University of Southern California before as Mr. Murphy said I
went to Pennsylvania and there played for the Steelers for 9
years and having some success.
Mr. Waxman. Have you lived anywhere a member of this
committee did not reside?
Mr. Swann. I should apologize to all members of the
committee that I defeated their teams. It was a paid job and as
a professional, I had to do my duty. [Laughter.]
I would like to say that throughout my life there have
always been opportunities for physical activity, to be a member
of a team, to participate, to be out, to walk eight blocks to a
park and play until the lights went out, to walk to school, to
ride my bike to school. As we canvas our Nation today, we see
there are fewer and fewer opportunities for children to
participate. Yes, the better athletes have a chance to be on
the varsity football team and basketball team and baseball team
but my oldest brother, who is a dentist, 5' 6'' and about 135
pounds, kids do not have the opportunity to do as he did when
he was in high school which was play on the B or C basketball
team for those who weren't the biggest, the tallest and the
most talented but still provide an opportunity for them to
participate and play and learn from sports and gain the
benefits.
We have seen and heard all the information of obesity
rising in our Nation. We also have probably looked at the
numbers and where they will head in the next 10 years. The
numbers are just ugly. They are preventible. The key word when
we look at obesity and obesity-related illnesses and diseases
is preventible and they are preventible through activity,
through more physical activity. We have to now make physical
activity a priority. It is not an elective in our lives. If we
are going to establish the well being of a nation, we have to
establish physical activity as a priority, as well as our
intellectual and spiritual well being, we have to make sure
there is a higher level of physical activity so that we can
grow, focus, concentrate and have the endurance to do the jobs
we need to do.
Obesity has come not because people are lazy but because
for many reasons, our own innovation and advances in technology
and growth, the Internet, robotics, we don't need that large
labor force. Parents are concerned about their children's
safety, so they walk them to school or they drive them to
school more likely, the kids don't ride their bicycles. There
are ways around this. There are community organizations that
have grants that will put their kids together and create safe
walking paths for them to get to school or riding paths for
them to ride their bicycles to school. That labor force we no
longer need is going to have to step up in terms of their own
individual choices and how they lead a physical, active life.
The food, the balance is very important. It is all about
balance. It is not just about physical activity, it is about
the caloric intake. I did an interview with a nutritionist at
Virginia Tech. She is the nutritionist for the football team at
Virginia Tech, so I asked her, how many calories a day do the
offensive and defensive linemen eat during a football year to
be physically capable of getting the job done? The bigger guys
on the team are eating 6,000 calories a day. That is a huge
amount of food but look at the activity level of these young
men. One hour a day of weight lifting, a 3-hour football
practice, walking back and forth across campus to get to
classes. It is unbelievable. There is a balance there.
If you are only exercising up to a point or getting the
kind of activity where you are burning up 2,000 calories a day,
anything over that means you are going to increase your weight.
It is an individual responsibility to understand this and if
Secretary Paige doesn't mind if I stick my toe a little bit in
his water, if we want our children to understand the proper way
to eat, the proper way to exercise, then we have to have better
education on the physical fitness side and that does mean
physical education. If we are not going to have it in the
schools, then it is absolutely the priority of our parents, of
adults to set the better example. Yes, our children learn in
school but our children learn by example first. If the adults
aren't taking their kids out for physical activity, then who
is. If we don't set a better example, then we are all going to
lose in the end.
I carry with me a medallion that was given to me by the
Surgeon General of the Air Force. The back of it says,
``Execution is the chariot of genius.'' It was written by
William Blake. We understand what we have to do. Now it is time
to execute a plan. The plan simply is to get active. You don't
need the best or the most perfect plan, you just need to get
going. I would ask that all of you whenever you go home to your
States and your districts, whenever you are making a speech, as
a bipartisan issue, if you would recommend to your
constituency, to your followers, to get out and start
exercising, every speech you make will go a long way toward
getting America a little healthier, a little stronger and much
more active.
Thank you.
[The prepared statement of Mr. Swann follows:]
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Chairman Tom Davis. Thank you very much.
Dr. Hentges.
Mr. Hentges. Thank you, Mr. Chairman.
I am pleased to be here this morning to speak about the
efforts of the Department of Agriculture to combat overweight
and obesity. Helping Americans live longer, better and
healthier lives is a top priority of the President's Healthier
U.S. Initiative. In support of the President's initiative, we
at USDA are in the midst of updating the Dietary Guidelines for
Americans and the Food Guide Pyramid, our current food guided
system.
The National Nutrition Monitoring and Related Research Act
of 1990 requires the Secretaries of Agriculture and Health and
Human Services to jointly publish the Dietary Guidelines for
Americans at least every 5 years. The guidelines form Federal
nutrition policy, they set standards for nutrition assistance
programs, they guide nutrition education programs and provide
dietary advice for consumers.
Through the Dietary Guidelines, the Federal Government
speaks with one voice on nutrition issues. The Dietary
Guidelines Advisory Committee, comprised of 13 nationally
recognized experts, were appointed last year to review the
latest scientific and medical research. We expect to receive
the committee's report later this summer. From this report,
USDA and the Department of Health and Human Services will
publish the 6th edition of the Dietary Guidelines for
Americans. The newly revised guidelines will be released in
early 2005.
On a separate but parallel track, we are in the middle of
updating the Food Guide Pyramid. The Food Guide Pyramid was
created as a teaching tool to assist the public in interpreting
the Dietary Guidelines in eating a healthful diet. We placed a
notice in the Federal Register last year asking the public for
comment on the technical underpinnings of the Food Guide
Pyramid. Use of the Federal Register system opened up the
process to the public for the first time. USDA received
widespread support for its scientific base of these revisions,
the comments supported using calorie levels for sedentary
individuals as the basis for assessing nutrition adequacy.
Using RDAs and other standards from the National Academy of
Sciences Dietary Reference Intake reports as the nutritional
goals, using common household measures such as cups and ounces
rather than servings and emphasizing increased intake in
unsaturated fats and oils, whole grains, legumes and dark green
vegetables. A second Federal Register notice will be published
this summer to obtain public comment on the graphic image and
the education messages for the new food guidance system.
The last and most critical stage of the revision process is
implementation. That is, the plan to inform and educate
Americans. Research tells us that people recognize the pyramid
image but don't follow it. That is why we are so committed to
full implementation and exploring new and effective ways to
reach the public. USDA's Food and Nutrition Services also plays
a critical role in promoting healthy diets and lifestyles for
the Federal Nutrition Assistant Program participants. These
programs touch the lives of 1 in 5 people in the United States
each year. They represent a prime opportunity to help low
income people change their eating and physical activity
practices to achieve a healthy weight.
Mr. Chairman, I would ask the committee to refer to my
prepared remarks for a list of examples of how the Food and
Nutrition Consumer Service mission area is supporting the
President's Healthier U.S. Initiative by promoting healthier
eating and physical activity throughout our nutrition
assistance programs.
In conclusion, we appreciate the committee's interest in
nutrition and its critical role in overall healthy lifestyles.
Government has an essential role in helping Americans adopt a
healthy lifestyle. That includes eating a nutritious diet,
being physically active and achieving and maintaining a healthy
weight. We know the Government alone cannot reverse the growing
trend in obesity. Meeting this challenge requires partnerships.
These partners include policymakers at Federal, State and local
levels, industry, health and advocacy organizations, schools,
the media and of course, the American public. USDA is fully
committed to doing all it can to address this issue.
I want to thank the committee for the opportunity to share
our efforts with you.
[The prepared statement of Dr. Hentges follows:]
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Chairman Tom Davis. Thank you very much.
I could ask you 2 hours of questions. I have 5 minutes and
I want to do a few. First of all, we are updating the Food
Guide Pyramid. Is there any evidence that what we have been
told the last 40 years may not have been exactly the right
pyramid for a generation of kids who have turned out to be
obese?
Mr. Hentges. Mr. Chairman, I believe the science behind the
Food Guide Pyramid is based upon authoritative consensus
science such as the National Academy of Science reports on the
recommended dietary allowances.
Chairman Tom Davis. Do the consensuses change over time?
Mr. Hentges. It is evolutionary. If we look at the last 60
years, there is new data and one of the reasons for our current
revision is because the National Academy of Science has just
gone through a major revision of the dietary reference intakes,
so we need to come up to stay in touch with where the science
is bringing us.
Chairman Tom Davis. This has to be lobbied heavily behind
the scenes. You talk about interest groups up here on Capital
Hill, you talk about the sugar lobby, the milk producers, these
are well funded groups. How you put together that food pyramid
can be devastating to their bottom line. Are you listening to
those groups? Are they having any influence in this or are you
just going strictly on scientific consensus?
Mr. Hentges. It is scientific, but Under Secretary Boss has
definitely set an open door policy for anybody coming in,
whether it is American Dietetic Association or a commodity
group or the Institute of Food Technologists, all of them, but
indeed, if you look at the basis for the Dietary Guidelines
Advisory Committee and that Federal policy, everything that
comes out in the revision of a Food Guide Pyramid will be in
total harmony with the nutrition policy.
Chairman Tom Davis. Mr. Swann you stayed in shape after
your playing days, you look in pretty good shape. The exercise
is obviously a critical component, but you can't exercise your
way out of obesity if you continue to gorge. What is your
analysis of that and how do you stay in shape and what do you
counsel others to do?
Mr. Swann. What I do is I monitor how I eat, when I eat and
I also try and get exercise on a regular basis. That is really
an important factor. You have meetings scheduled here, we all
schedule the things that are important to us and we say we
don't have time for exercise. That is because we don't schedule
it. If you are not exercising, you are not considering it
important enough to do it. It is not an elective. For me it is
not an elective not because I want to be a professional
athlete, that is not what it is about. I exercise more now than
I ever did before because I want to have a good quality of
life. If I reach the age of 80 or 90 years of age, I want those
years to be good years. I don't want them to be feeble, I don't
want to be frail and fall down and have it be the cause of my
death because I am not physically capable. That is what I do.
We have a Web site, the presidentschallenge.org. It is set
up and designed to give people tools to be physically active,
to motivate and incentivize them to have some kind of workout
program. It is a non-competitive program because we have to be
mindful of the kids who are not athletic and who don't have the
ability to run, jump and do all those things. There over 100
different forms of physical activity on this list where you can
get points toward Presidential awards. So we encourage people
to go there. It is at that site, fitness.gov, you can get a
tremendous amount of information and then you can act on it but
it has to be in harmony. There has to be a level of activity
and a level of nutrition that goes along with it. Keep in mind,
I have friends and we all have friends who probably eat
extremely well or might be vegans or vegetarians. If you eat 10
times the amount of food you should eat and it is all good for
you, then you have consumed a bad quantity of food and it is
going to have adverse effects, so you have to be mindful of the
quantity and quality and making good individual decisions.
Chairman Tom Davis. I think there is universal agreement in
the testimony of the three of you that childhood is really the
best chance to slow the obesity epidemic through food but also
through exercise. Lynn, what are you seeing in the school
systems? Are they promoting physical fitness or do you see
mixed results around the country? Any thoughts on that?
Mr. Swann. We see very mixed results around the country.
Before taking this job, I had an opportunity to talk to
Governor Schwarzeneggar of California about his role. He spent
part of his term when he was chairman of the President's
Council on Physical Fitness and Sports trying to reach out to
every Governor in America to put physical education in the
schools. When he started, there was one State, IL, that
mandated physical education as a part of their educational
program. Today there is only one State in the Nation that
mandates physical education as a part of the basic curricula,
the State of Illinois. It is not California, not Pennsylvania,
not Florida, not Texas, just Illinois.
So when you go around schools you see a variety of
programs, some are very, very good, some are not being taught
by physical education teachers because there isn't a physical
education teacher on staff but there are programs you can
implement. So we have a variety of programs around the Nation
but nothing consistent for a nation.
Chairman Tom Davis. Thank you very much.
Mr. Waxman.
Mr. Waxman. I want to thank the three witnesses here today
to help us understand what approaches we can take to be
effective in dealing with obesity. I appreciate your testimony.
Dr. Hentges, let me start with you. Nutritional education
through the Food Stamp Program is an important way to reach a
lot of people. There have been new guidelines by USDA saying
that funds ``may not be used to convey negative, written,
visual or verbal expression about any specific foods, beverages
or commodities.'' It also provides under these guidance that
the USDA staff has the right to review educational campaigns to
make sure there is no belittlement or derogation of such items.
Can you explain whether there is any scientific evidence
justifying this provision?
Mr. Hentges. I am not real familiar with the issue but I
know specifically that one. I know that in the revisions in the
current activities, on the Food Stamp Nutrition Education
Program, they are trying to focus more sharply on these current
issues. I know within the review of education materials that
are used throughout the Government for communication, there is
a cross agency committee that looks for this speaking with one
voice and making sure we are unified in sticking with nutrition
policy.
Mr. Waxman. Let me ask you, would you be willing to share
with this committee a full explanation of how this provision
was developed including all correspondence with the food
industry, all examples of State educational programs that were
rejected by USDA staff?
Mr. Hentges. I would be very glad to provide written
comments on what has occurred on this issue.
Mr. Waxman. We want your written comments and also
documents and letters as it was developed. I think that would
be helpful for us to understand it further.
There is another issue as well I want to ask you about.
There is a framework for nutrition education that was published
in May 2004 requiring educational efforts be narrowly targeted
at food stamp recipients. It appears to prohibit States from
using the funds as part of a broad social marketing campaign
designed to change the eating patterns of the entire community.
I would like to find out what evidence justifies this approach
and perhaps you can also submit to us all the information on
how that was developed?
Mr. Hentges. I am vaguely familiar with this and I know
from a regulatory standpoint, there are restrictions on using
these funds with participants, but where there is an overlap of
public service or community announcement aimed at the food
assistance participants, there is a broader range of reach to
the communit--and I will provide you the specifics on that.
Mr. Waxman. I am concerned about what evidence would
justify this kind of restriction because it would seem that if
obesity is a public health program, we wouldn't want to say you
can only talk about the obesity issues to the food stamp
recipients if a State wanted to go broader than that and talk
about all kids, not just kids on food stamps. You would agree
with that?
Mr. Hentges. Yes, and I would say our programs at the
Center for Nutrition Policy and Promotion are aimed at the
general public and we work with the Food and Nutrition Service
for their specific programs and what they are allowed to do
with the recipients of food assistance.
Mr. Waxman. I find the restrictions about belittling food
troubling because, for example, you might say to eat an apple a
day is a good healthy thing to do but you would be prohibited
from saying, don't eat more junk food, isn't that correct,
because that might be belittling junk food?
Mr. Hentges. I will have to get back to you on exactly what
those regulations are.
Mr. Waxman. Dr. Crawford, I mentioned in my opening
comments the false and misleading information that I think may
be made available to the consumers inappropriately under the
LEA. I would like to know how the FDA could say they are not
going to enforce the law on information that doesn't have a
scientific consensus behind it and how the FDA would allow
scientists, even when there is an extremely low level of
comfort about the claim, to be permitted to go ahead and make
these claims. Are you familiar with this provision by the FDA
and can the FDA justify taking this action even though it is
inconsistent with the law?
Dr. Crawford. Yes, I am familiar. The concept is this. We
had some adverse court rulings with some positions we had taken
on health claims, so we developed the idea of growing out of
that with some internal consideration of allowing qualified
health claims. Basically, this means although scientific
consensus might not be 100 percent, it is enough to where we
are able to say if the company or if the organization applying
for the health claim would be willing to qualify honestly and
directly in terms of how strong the evidence is, we would
consider what is called a qualified health claim.
On the walnut issue you mentioned, that grows out of the
fact that walnuts were determined to have Omega 3 fatty acids
and also it was determined that the Omega 3 fatty acids in
walnuts were bioavailable. So it followed that they could get a
qualified health claim if they intended to. There was also some
talk earlier, I am not sure if it was you or someone else
talking about what does this will do for competition? Actually,
when a qualified health claim is granted, any company that
produces, sells, or markets walnuts in this case may use it.
Mr. Waxman. It allows more than one manufacturer to make
claims that are qualified, but in reality, could be
scientifically inaccurate, maybe even misleading, and when the
law says proscriptively you ought to have scientific consensus
before you could go out and make these kinds of claims, it
seems to me the FDA is rewriting the law. I think one of the
dangers is it could start to be a Tower of Babel of misleading
information and the public is going to doubt the credibility of
any of these labels, especially if it is an FDA label because
they will know that it is not based on good science. Qualified
answers may not be based on good science and may not represent
what Congress spoke to, which is there really is a scientific
consensus before these kinds of claims can be made. It is
obviously the advantage of the manufacturer to make claims that
are misleading. We don't want that to happen. We didn't want
that to happen when we passed the law. I am afraid the FDA
policy undermines that provision.
Dr. Crawford. If I could followup? We don't think it
undermines the policy. What we find is that there rarely is 100
percent scientific consensus, so the question is whether you
allow any exposition of what the health advantages of a food
might be in a way that is qualified so that it is honest and is
not misleading. That is what we are attempting to do.
Chairman Tom Davis. Thank you very much.
Mr. Shays.
Mr. Shays. Thank you for conducting this hearing and I
would like to put on the record that Mr. Ose would tempt us to
take some of the snacks he has stacked up at his desk and I had
a Heath bar crunch and one Oreo cookie but turned down a lot of
other things.
I would like to ask each of you whether you think there is
logic to companies being sued because they offer a menu that
people don't eat in moderation, blaming the companies instead
of their own children or their own oversight of their own
children and so on? I would like you to speak to that issue.
Dr. Crawford. I do not think that is logic and I think what
we have to do is inculcate individual responsibility, I think
the Government has a role and I believe all three agencies
represented here have a big part of that role to try to get
things back on course. I also think supporting mandatory
physical education programs as Mr. Swann has mentioned is also
important but I do not see the logic of that. If someone wants
to sue a fast food company or something like that because of
their abrogation of individual responsibility, I don't think
that follows.
Mr. Swann. I would simply state that I agree. We have to
make sure people are educated to make good individual choices
and decisions. I think all of us who are sitting in this room
have the foods we would put in the junk food category that we
like to eat and we enjoy, but it is the decision not to eat the
whole bag if you are going to have a few potato chips, not to
eat a dozen doughnuts if you want to have one and have a proper
amount of physical activity to balance it out, and it is
individual responsibility. Certainly we want to make sure the
individual knows what he or she is consuming, so labeling
becomes very important. I do not see the logic in suing a
company for what we individually decide to eat.
Mr. Hentges. I would say the challenge before us is really
more effective implementation, whether it is through our food
label, through our dietary guidance, or through our guide
system, whether it be a pyramid or whatever and to be able to
do that, we need to have partnerships, not only partnerships
amongst the academic and health organizations, but we need the
industry to partner with us to be able to get this information
out so that we avoid some of these other alternatives.
Mr. Shays. I thank all three witnesses. I also want to
thank Mr. Waxman who is not here because in years past he was
very involved in labeling issues. I think they are absolutely
essential to provide all the information we can possibly have.
I think the FDA can continue to do a better job. I think you
can continue, Doctor, to find different ways to help educate
people.
The bottom line for me is I am absolutely amazed that
parents would have their kids sue someone. They just need to
look at themselves and their own responsibilities. I hope our
country doesn't go down the route of blaming someone else for
the responsibility of the individual.
With that, Mr. Chairman, I thank you for this hearing. I
think it is very important. I appreciate all the witnesses and
our second panel as well.
Chairman Tom Davis. Thank you very much.
Mr. Towns.
Mr. Towns. Thank you very much, Mr. Chairman. Again, let me
thank you for holding this hearing. I think this is a very
important hearing.
Before I start, I would like to ask, Mr. Chairman, if I
could put the High Calorie, Low Nutrient Children's Diet in the
record?
Chairman Tom Davis. Without objection, it will be put in
the record at this point.
[The information referred to follows:]
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Mr. Towns. Thank you.
Dr. Crawford, does your department collaborate with the
Department of Education?
Dr. Crawford. Yes, sir, we do. With respect to obesity, we
have worked out an agreement with Secretary Paige so that we
will partner with them in terms of the education message
because obviously he has more access to the target audiences in
the education message, particularly in the schools. So yes,
when we had the Obesity Working Group, he designated a contact
person and I designated one and the two of them have been
working together. So we do partner with them, yes.
Mr. Towns. Do you have an opportunity to ever look at the
school lunch program?
Dr. Crawford. That is in the Department of Agriculture.
Mr. Towns. Yes, but have you ever had the opportunity to
look at them?
Dr. Crawford. I have eaten some of them, yes, sir, but not
in a long time.
Mr. Towns. The reason I asked that is when you look at some
of the things they are serving young people today in some of
the schools, I think it is a shame. Nobody is saying anything.
That is the reason I raised this issue. I know it is not
directly your jurisdiction but I think when it comes to
guidelines and getting out information, it seems to me you
would sort of convey to the Department, and we would also raise
this issue with the Department of Agriculture as well, but I
think that is the basis. If you start in the kindergarten and
first grade serving these kinds of things to kids and they
think it is OK because after all, the school is doing it.
Dr. Crawford. I take your point. I think you are exactly
right. What we need to do is start early, as you said, but we
also need to give them a few more tools to work with. For
example, if you look on the nutrition label now, we hope the
nutrition label will be under our agreement with the Department
of Education, a mechanism by which young children are trained
to take this individual responsibility at an early age. On the
label now, it says what an item's calorie content is but it
doesn't relate that to the amount of calories you are allowed
to consume in 1 day on average and maintain your weight.
We are moving toward having on the label, if you drink a
milkshake that is 1,000 calories, it now will say in bigger
letters that it is 1,000 calories but in the future it will
also say you have just now eaten 50 percent of what you can eat
today and maintain your weight and not increase weight. You
could say it is a simple message but the science of it is
elegant really and I think we can use that as a means to
educate students.
I remember in my own case when I was consuming those school
lunch programs, we had mandatory in the State where I grew up
what was called a health book in the third grade. In the third
grade we were taught the basic food groups, we would talk about
calorie dense foods, talk about junk foods and I think it did
instill individual responsibility but we didn't have many tools
in those days, we didn't have a nutrition label. It is up to us
at FDA and the rest of the Government to make it work and also
to make it work for all of the people in America, including the
children.
Mr. Towns. Thank you.
Would you like to answer that?
Mr. Hentges. Regarding the school lunch program, by statute
it is required that the School Lunch Program comply with the
dietary guidelines and other criteria set by the Secretary.
Those include the school lunch program not be more than 30
percent of calories from fat, no more than 10 percent of
calories from saturated fat, that they meet one-third of the
RDAs for protein, calcium, iron, Vitamin A and Vitamin C.
I think part of the issue here is that as a local decision,
schools can decide to include competitive foods but when the
child gets the school lunch program meal, it does comply with
the dietary guidelines established but there is the issue of
competing foods which is a local level decision.
Mr. Towns. Mr. Chairman, just give me a second. I want to
ask Mr. Swann one question.
First of all, thank you for the work that you are doing.
How do we deal with the situation where there are budget cuts
and as soon as you cut the budget, the first thing that goes
out is the extracurricular activities such as intramural
sports. That is the first thing they eliminate. How do we get
around that because that is the real problem.
Mr. Swann. It is a real problem. Mr. Schrock earlier had
talked about individual responsibility and not having too much
government but the reality is on our Web site, the
presidentschallenge.org, the President's Physical Fitness
Program is one that can be implemented in schools and does not
require necessarily a physical education teacher. So there are
programs that teachers and school districts can implement. They
may not be an organized sports team that would be competitive
in some nature but they can organize those intramural sports
teams on their own, they can implement a physical education
program within their classroom whatever their curriculum might
be. It could be as simple as saying instead of you sitting in
this classroom for an hour, we provide 10 minutes that you get
up and stretch, walk around and move your legs so that you are
not sedentary for the entire school day, any particular age.
I agree with you that when money is tight, the sports
programs, the physical education programs and even the art and
music programs are the first to go because they are not
mandated by a particular State's educational program but there
are other ways to get that exercise and we have to seek those
other ways because it should not be an elective, it should be a
priority in their lives.
Chairman Tom Davis. Thank you.
We have other Members who want to ask questions but we have
a vote and in addition, one of our witnesses on the next panel
has to catch a helicopter and I want to get his testimony
before he has to go.
I would like to call Dr. Stuart Trager from Atkins. Dr.
Trager, if you could give your testimony now?
Mr. Ose. Mr. Chairman, while Dr. Trager is preparing could
I?
Chairman Tom Davis. Go ahead.
Mr. Ose. In southern California, for 31\1/2\ years, this
issue has existed and we have in front of us a witness today
who can finally put to rest the truth about what happened on
December 23, 1972 when the Oakland Raiders were robbed in
Pittsburgh. [Laughter.]
Chairman Tom Davis. Well, you have him under oath. This is
your shot.
Mr. Ose. I understand. That is exactly my point. Before I
get an answer to that, I also want to examine this. This
witness went to USC and there were a number of occasions in the
early 1970's when his college team came to the University of
California and attempted, attempted I say, to defeat the Cal
Bears. I just want to get on the record some answers to some
questions if I could, Mr. Chairman.
Chairman Tom Davis. Quickly.
Mr. Ose. Swanee.
Mr. Swann. As quickly as possible.
Mr. Ose. Let me ask the question first.
Mr. Swann. I thought you did. I was going to say we made no
attempt to beat the Cal Bears, we did beat them. [Laughter.]
Mr. Ose. I remind the witness he is under oath.
Chairman Tom Davis. Mr. Ose, I would quit while I am ahead
here.
Mr. Swann. And in 1972 when Franco Harris made his now
famous immaculate reception, the official said it was a
completed pass, it was good, it was a touchdown and I, myself
being so much younger, was just a junior at USC playing on the
national championship team, so I can't give you any eye witness
testimony.
Mr. Ose. Mr. Chairman, let the record show that the witness
had no knowledge whatsoever of what occurred in Pittsburgh
Stadium that day. [Laughter.]
Chairman Tom Davis. Thank you.
Dr. Trager.
[Witness sworn.]
Chairman Tom Davis. Thank you for being with us. This is
important testimony. Mr. Swann, I think you and Dr. Crawford or
Dr. Hentges are going later but he is going to give a keynote
speech so he has to catch a helicopter ride down there. We
would have moved him up to the panel had I known we would be
delayed this long with the markup but this is important
testimony as well because Atkins has revolutionized the way a
lot of us look at food and food products.
Dr. Trager, thank you.
STATEMENT OF DR. STUART TRAGER, CHAIRMAN, ATKINS PHYSICIANS
COUNCIL
Dr. Trager. Mr. Chairman, thank you very much for
accommodating my schedule.
Members of the committee, I thank you all for asking me to
appear today and commend you for addressing the Government's
role in combating the obesity epidemic and promoting healthy
ways for individuals to fight this critical public health
issue.
By way of introduction, my name is Stuart Trager. I am
medical director of Atkins Nutritionals. I too am an avid
Atkins adherent following this approach for the last 4 years of
my life. I practice orthopedic surgery and I am an eight time
Iron Man finisher. Sitting next to the panel today, it is tough
to get much out of that Iron Man finisher, however, at the time
it seemed pretty difficult.
Taken together, this rather unique combination of
experiences has given me great insight into the challenges
presented to those fighting to maintain healthy weight, to
those living with medical complications of obesity and to those
frustrated by their own inability to achieve weight loss
through exercise. Though the banner at the finish of the Iron
Man says ``Anything is possible,'' I am afraid for many running
35 miles to burn the 3,500 calories necessary to shed 1 pound
of body weight is just too great an obstacle to overcome.
To create strategy for success, it is critical that we
appreciate the factors that have resulted in the current
epidemic of obesity. Surely schedules are more hectic than
ever, portion sizes are expanding as rapidly as our waistlines
and highly processed, convenient foods are omnipresent. These
circumstances have created a real challenge to the Nation. To
begin, we must be willing to move beyond the one size fits all
approach that has dominated the nutritional dogma for the last
three decades.
As we address the challenges of the Nation associated with
this current epidemic, it is worth recalling the words of Dr.
Walter Willett from the Harvard School of Public Health who
stated, ``Mainstream nutritional science has demonized dietary
fat, yet 50 years and hundreds of millions of dollars of
research have failed to prove that eating a low fat diet will
help you live longer.'' Facing hard truths is never easy.
However, the current obesity crisis is currently estimated at
taking 400,000 lives each year. The dietary guidelines are
clearly not working and prospects for inclusion of alternatives
in the rewrite are not entirely promising. There is a clear
need to challenge the status quo and to continue to fight the
nutritional establishment and conventional wisdom if we are
going to stem this epidemic.
When USDA's survey showed that while 80 percent of
Americans recognize the Food Pyramid, very few heed its advice,
it is clear that we need alternatives. As we move forward, our
strategy must provide real life tools that work in the current
environment. For an increasing number of people, it is becoming
clear that controlling carbohydrates is one such option.
Because promising magic is no more beneficial than
prescribing strategies that are unobtainable, we must always
remember that solutions to this epidemic have to be supported
by evidence based science. Increasing public awareness about
the importance of scientific validation of safety and efficacy
is important and with Atkins, it is clear this has helped many
recognize the benefits of the strategy.
The consistent stream of supportive clinical research
including these two independently funded studies, one from the
American Heart Association and the other from the National
Institute of Health, have opened many eyes to the safety and
efficacy of controlling carbohydrates as an alternative to
traditional dietary recommendations.
The recent publication of two additional studies, one from
Duke, the other from the Philadelphia Veterans Hospital, have
lent further support. Simply put, for many, weight loss occurs
more rapidly when following Atkins, more calories can be
consumed while on Atkins, compliance is enhanced on Atkins and
risk factors as well as diabetic control improved while on
Atkins.
With recent editorials in the annals of Internal Medicine
and the American Journal of Cardiology, it is clear we are
making much progress in changing opinions. It is at times easy
to forget that despite the critical importance of science in
this debate and that we must never rely on anecdotal reporting,
that this is about helping people. To that end, I thought it
worthwhile reminding everyone why we are really here. The
individuals losing weight and improving risk factors in these
studies on Atkins have names and faces. Real people in the real
world are losing weight and improving their cardiac risk
factors by following the Atkins approach, something Dr. Atkins
fought for 30 years to make the establishment pay attention to.
Counting carbohydrates is simply more palatable for many
than eating smaller portions of less satisfying foods. At
Atkins Nutritionals, we feel a tremendous sense of
responsibility to assure that this powerful tool is used
correctly, that people obtain the best possible results and
that we truly impact the epidemic of obesity. We have helped
develop the Atkins Food Guide Pyramid to address the myths and
misconceptions put forth by the low fat advocates, the animal
rights activists and the copycats who would have you believe
that Atkins is just about red meat and bacon.
If you look at the Food Guide Pyramid we have distributed,
you see there are lots of fruits, vegetables and the right
carbohydrates. This was Dr. Atkins' effort put forth in January
of last year before he died. We are actively reaching out to
decisionmakers here in Washington and we are committed to
helping to spread our message of carbohydrate awareness to our
education and youth initiatives. We are committed to ensure
that the public knows the correct way to control carbohydrates,
the time tested way that science has repeatedly validated.
In conclusion, I would like to thank the committee for
taking the time to discuss this very important matter. To make
a difference, we believe Congress should invest in more science
and provide additional information regarding this alternative
to the low fat, low calorie dogma of the last three decades and
continue to scrutinize guideline revisions and allow for more
seats at this very important table.
Thank you.
[The prepared statement of Dr. Trager follows:]
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Chairman Tom Davis. Dr. Trager, thank you.
We are here at the mercy of the congressional schedule and
they have votes scheduled right now, a series of three votes.
One of them is on anabolic steroids and stopping their use and
proliferation, so it is relevant to what we are doing. We will
come back in a half hour.
I would like to dismiss this panel so that you all can get
on with your business. I just want to ask one last question.
You heard Dr. Trager talk about more investment in scientific
research. I know Dr. Atkins always said, it wasn't hand to
mouth but he didn't have the millions to invest. Is that a good
idea? From an Agricultural point of view and the FDA, are we
putting in enough or could you use more resources if Congress
provided them?
Mr. Hentges. I would definitely support the
administration's budget request on research and it is an area
that we can't let fall behind for sure.
Chairman Tom Davis. Thank you.
Dr. Trager. Mr. Chairman, there are tens of millions of
people who are choosing this controlled carbohydrate approach
that are following the Atkins' strategy.
Chairman Tom Davis. You see it everywhere you go. The
marketplace will overwhelm government if government doesn't
react.
Dr. Trager. What we are looking for is more research
dollars so that this can be studied so that we can have the
long term studies. Because we know that it works, we now need
to add the science to it to help these people to make sure the
message is clear so they get the information to do it
correctly.
Chairman Tom Davis. Thank you.
Dr. Crawford. I agree that we do need the kind of targeted
research that this new road map that the National Institutes of
Health has put together because of the funding that Congress
has been able to provide them and we need targeted basic
research to know some of these things, like why does obesity do
what it does? We still don't really know that.
Chairman Tom Davis. Thank you. I know Mr. Swann would say
more research is fine but don't cut out the PE programs?
Mr. Swann. Yes.
Chairman Tom Davis. This has been great. As I said, I wish
we could go on all day, I could go 2 hours just with my own
questions. I know Mr. Ose has his major question out of the way
for this but we will come back with the next panel. Thank you
all very much.
We will recess for half an hour and come back with the next
panel.
[Recess.]
Chairman Tom Davis. We have everyone here. The committee
will come back to order.
If you would rise for the oath?
[Witnesses sworn.]
Chairman Tom Davis. Thank you very much for being here. We
will have Members drifting back from a series of votes. We will
have another series of votes probably in about an hour, maybe a
little before, so I want to move through the testimony quickly
so we can get to questions.
I can't tell you how excited we are about the panel we have
here today, the expertise and the opinions that you bring to
this. What I think I will do, we have Dr. Agatston who had
already been introduced by Ms. Ros-Lehtinen; we have Dr. G.
Harvey Anderson, professor, Department of Nutritional Sciences,
University of Toronto; Dr. Susan Finn, Chair, American Council
for Fitness and Nutrition; and Bruce Silverglade, director,
Legal Affairs, Center for Science in the Public Interest.
Doctor, why don't we start with you and we will move down the
line. Thanks so much for being with us.
I will just say I had a hot dog and tuna fish for lunch. I
don't know if it is good or bad.
Dr. Agatston. No comment.
STATEMENTS OF DR. ARTHUR AGATSTON, CARDIOLOGIST AND AUTHOR, THE
SOUTH BEACH DIET; DR. G. HARVEY ANDERSON, PROFESSOR, DEPARTMENT
OF NUTRITIONAL SCIENCES, UNIVERSITY OF TORONTO; DR. SUSAN FINN,
CHAIR, AMERICAN COUNCIL FOR FITNESS AND NUTRITION; AND BRUCE
SILVERGLADE, DIRECTOR, LEGAL AFFAIRS, CENTER FOR SCIENCE IN THE
PUBLIC INTEREST
Dr. Agatston. Thank you, Chairman Davis. I would like to
thank Representative Ros-Lehtinen for her very kind words.
There is a major untold story currently unfolding in
America. Cardiologists and internists across the country who
are practicing aggressive prevention have largely stopped
seeing heart attacks and strokes in their practices. They just
don't get called to the emergency room for these events like
they used to. The factor that is changing the cardiac
prevention paradigm include non-invasive imaging to detect and
track early, pre-clinical arteriosclerosis, advanced blood
testing to determine the cause of pre-clinical disease, new
medications that target causes of disease like laser beams and
finally, a growing consensus on the nutritional factors
associated with the epidemic of obesity.
I am a cardiologist, not a diet doctor. My journey to
author a diet book occurred somewhat accidentally. Until 10
years ago, my primary research interest was in non-invasive
imaging of the coronary arteries. Around that time, it became
more and more apparent that my patients, the country and
frankly, me, were rapidly gaining weight on the nationally
recommended low fat, high carbohydrate guidelines. In fact,
there had become a disconnect between the practical day to day
experience of clinicians and the national guidelines. In
America, low fat, high carb diets just didn't work and this was
actually documented in the medical literature again and again.
The low fat, high carb recommendations were made primarily
on the basis of population studies that demonstrated that
societies that consume low fat diets had lower rates of heart
attack and obesity than high fat societies. There were
exceptions such as Mediterranean populations where high fat
intake was associated with low heart attack and obesity rates.
In the past 5 to 15 years, research has gone a long way to
explain what went wrong with our low fat experiment. In
particular, three new perspectives have become widely accepted.
First came understanding of the importance of fiber and
glycemic index in our diet. The glycemic index is a measure
actually pioneered by my colleague, Dr. Anderson and his group
at the University of Toronto. It is a measure of how fast a
food causes swings in blood sugar. Rapid swings in blood sugar
cause food cravings soon after a meal, high fiber foods tend to
be low on the glycemic index.
Second came the concept of prediabetes in 1989. We learned
that low fiber, high glycemic diets often resulted in obesity,
pre-diabetes and then diabetes by amplifying those swings in
blood sugar. Third, new research demonstrated that not all fats
are equal. Mediterranean oils, particularly olive and Omega 3
oils, have favorable effects on both cardiovascular and general
health.
With this important new information, the causes of our
epidemic of obesity became apparent. No. 1, the type of
carbohydrates consumed in the low fat countries was high in
fiber and low in glycemic index. That adopted in the United
States was low in fiber and high in glycemic index. The
consumption of unprecedented amounts of high glycemic processed
carbohydrates produced swings in our blood sugar that resulted
in frequent cravings and increased caloric intake leading to
the obesity epidemic. Secretary Tommy Thompson announced
recently that over 40 percent of Americans over the age of 40
are pre-diabetic.
No. 3 was because animal protein in our diets is from corn-
fed cattle and poultry that do not run free and have high
levels of saturated fat and insignificant levels of health
Omega 3 oils. No. 4, in an attempt to lessen our intake of
saturated fats, trans fats were introduced and became
ubiquitous in our commercial baked goods and fast foods. We now
know that trans fats are worse than saturated fats for both our
waistlines and our blood vessels.
In response to my own frustration with the low fat diet, in
1995 I decided to try a different approach. I was also
influenced by the beginning of the low carb diet trend
pioneered by Dr. Atkins. While I found the low carb diet
approach fascinating, I felt the scientific evidence pointed in
a slightly different direction. My patients had already had
heart problems and/or were at high risk for heart disease.
There was too much evidence that saturated fat was associated
with coronary disease. On the other hand, evidence was growing
that the healthy Mediterranean oils had favorable effects on
our lipids and on our cardiovascular health.
As far as carbohydrates, it became clear that what was
causing our epidemic of obesity was not carbohydrates per se
but the processed rapidly digested high glycemic carbohydrates.
The good, non-processed carbohydrates were too rich in vitamins
and nutrients to restrict. We developed a simple and flexible
diet plan for our patients that followed the principles of good
nutrition, dense carbohydrates, healthy fats and lean proteins.
There was no counting calories, grams of fats or grams of
carbohydrates.
While calories definitely count, it was our observation
that counting calories alone did not work. Carbohydrate choices
were made on the basic of glycemic index. We found that when
proper food choices were made, hunger and cravings diminished
and fewer calories were consumed. We also strongly encouraged
exercise throughout for burning calories, for building and
maintaining lean body mass and for cardiovascular health.
After years of frustration, I was amazed and gratified by
our patients' response to our program. They lost weight, their
blood chemistries improved, and they found the diet easy to
follow. We began reporting our findings at national meetings in
1997. Our clinical experience indicated the diet could truly
become a lifestyle. Weight loss was usually sustained and the
manifestations of pre-diabetes and often of Type 2 diabetes
were reversed. In 1999, local TV asked us to put south Florida
on what is now called the South Beach Diet which we did very
successfully for 3 years. This led us from the clinical and
academic realm to the public sector.
The success of South Beach Diet has given me a unique
opportunity to help change the way America eats. We have
recently established a non-profit research institute to study
nutrition and cardiac prevention and are planning a study of
school children where bad eating habits begin.
The following are my recommendations for incorporating the
South Beach Diet principles into the Federal guidelines. The
diet pyramid should be updated as planned; the base should be
occupied by the good carbohydrates, vegetables, whole fruits
and whole grains. The next level should include lean proteins,
low fat dairy products, and good fats. Above the good fats
should be saturated fats and above that, processed
carbohydrates and at the apex, trans fats which we should be
absolutely restricting. The benefits of proper diet and
vigorous exercise must become part of school curricula.
Continued efforts are necessary to educate the public regarding
healthy food choices.
I believe that the principles of nutrient dense, good
carbohydrates, good fats, lean protein and plenty of exercise
have recently become the consensus of scientific opinion. If
applied successfully to the American lifestyle, our epidemic of
obesity and diabetes can be reversed.
Thank you.
[The prepared statement of Dr. Agatston follows:]
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Chairman Tom Davis. Thank you very much.
Doctor Anderson.
Dr. Anderson. Thank you, Chairman Davis, and thank you for
the opportunity to address your committee on the obesity
epidemic.
We all agree that the increase in the prevalence of obesity
in the past 25-30 years is both startling and alarming but the
question is, what is its origin and we don't have an origin to
that question, or we don't have a simple answer. Therefore, my
message to government is their role must be to keep a steady
hand on the helm and stay the course until we have both
evidence for and agreement on a solution or solutions.
Obesity arises from both environmental and genetic factors,
but it is agreed that the rapid increase in the prevalence of
obesity is primarily environmental. Americans at all
socioeconomic levels are getting fatter and some have
attributed this to the toxic environment of inexpensive,
readily available food, reduced activity, increased wealth,
longevity, stress in the workplace, advertising and even
mother's diet, just to name a few of the potential factors. The
point is the origins of this obesity epidemic are not defined
and are complex. So how can we offer short term solutions?
In my opinion, the role of Government at the present time
is to stay the established course of providing dietary guidance
to the public and to avoid any dramatic changes in the current
dietary guidelines and food guides. Some argue for change but
where is the evidence? Change in dietary guidance must be based
on what we describe in medicine as evidence-based
decisionmaking. This is a systematic approach to categorizing
quality of evidence that is available. It does not give equal
weight to each piece of evidence and does not arrive at simply
a consensus solution. In other words, the loudest and most
articulate speaker does not sway the evidence and the final
decision. Government should have, as a policy, assurance that
the principles of evidence-based decisionmaking, is applied to
all forms of dietary guides. Current practice is to base
dietary guidelines on evidence and consensus, but does not
apply evidence-based systems.
I would also like to remind you that dietary guidance is
for the maintenance of health and prevention of disease.
Dietary guidelines are guidance statements for government
policy and provide the basis for consumer messages. Food-based
guidance to the public is provided by both dietary guidelines
and food guidance, that is the Pyramid, and if followed by the
individual, this guidance will lead to food choices providing
nutrient, adequate diets and will reduce the risk of chronic
disease. Of course modification of this general guidance is
appropriate for some populations of different cultures or
genetic makeup as well as those who develop markers to the
disease process, for example, high blood cholesterol.
I don't think there is anything fundamentally wrong with
current dietary guidance. The question is why don't people
follow our guidance and select healthier diets, eat less and
exercise more? We do not have the answer but it seems to me we
need to make greater effort to communicate our existing dietary
guidance in more effective ways. Shifting dietary guidance
without scientific evidence is irresponsible and will only add
to more confusion.
Because of the presence of the other speakers, I know you
know that the carbohydrate, the base of the pyramid, has been
brought into question. I want to address that specific issue.
Many hypotheses have advanced suggesting carbohydrates are the
cause of obesity and one suggests that sugars and processed
carbohydrates bypass food intake regulatory systems thereby
causing obesity. The evidence is to the contrary and this is my
area of expertise. My research shows that all sources of energy
and diet contribute. Carbohydrates, including sugars, are
satiating. Carbohydrates are more satiating than fats and less
so than proteins, although I must note that the ranking amongst
these depends on quantity and source.
The real question is what is in the environment that causes
people to eat too much food and ignore basic physiological
signals? Why don't people eat more fruits and vegetables and
whole grain cereals and whole grain products as described in
the base of the pyramid. Why don't they make the right choices?
Hypotheses on the role of the food supply and obesity
epidemic are abundant and require testing and the application
of evidence-based decisionmaking before we are in a position to
suggest food-based solutions that are effective. However, I am
convinced that food-based solutions will not be effective
unless we also tackle other environmental factors contributing
to obesity including the low level of activity associated with
our current lifestyles. In the meantime, let us find ways to be
more effective in empowering individuals to follow the current
dietary guidance.
In closing, I would like to draw your attention to a recent
publication on ``Dietary Guidelines: Past Experience and New
Approaches,'' published in the Journal of the American Dietetic
Association in December 2003. It was my privilege to serve as
co-organizer of that meeting and co-editor of the publication.
This international conference strongly advocated the
application of an evidence-based approach to modification of
food-based guidance for the public.
Thank you.
[The prepared statement of Dr. Anderson follows:]
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Chairman Tom Davis. Thank you very much.
Dr. Finn.
Dr. Finn. Good afternoon, Chairman Davis. Thank you for the
opportunity to discuss the Federal Government's role in
addressing the Nation's obesity epidemic.
I chair the American Council for Fitness and Nutrition
[ACFN]. I am also the past-President of the American Dietetic
Association.
As you have heard this morning, we all agree that obesity
is a growing concern for all Americans. Recognizing the serious
nature of this issue, in January of last year a coalition of
food and beverage companies, restaurants and related trade
associations founded the American Council for Fitness and
Nutrition to work toward comprehensive and achievable solutions
to the Nation's obesity epidemic. Today, ACFN represents more
than 65 diverse organizations and our work is guided by an
advisory board of 27 distinguished experts in nutrition,
physical activity and behavioral change.
The epidemic of obesity did not occur overnight or even
within the last decade. Understanding the contributing factors
and the fundamental driving forces provides a key to solving
this complex and multifaceted challenge. ACFN believes, as do
most experts in the field, that the ultimate solution to
obesity is about energy balance, matching calories burned with
calories consumed. In order to accomplish this seemingly simple
objective, people must moderate their calorie intake to match
their energy expenditure by eating less, being more physically
active, or ideally doing both.
The Federal Government has an important role to play in
helping to solve the Nation's battle with weight but we
recognize the Federal Government cannot fight this battle
alone. It requires the action of all sectors of society. Toward
that end, ACFN is working with health professionals, educators,
policymakers and consumers to develop lasting approaches to
combat obesity. These approaches focus on improving
communication to Americans about the need to balance nutrition
with physical activity.
While it is clear that the problem of obesity is
widespread, its impact on America's youth deserves special
attention. We know, for example, that children who participate
in physical education programs fare better academically,
personally and physically than those who are inactive. However,
physical education requirements in our public schools have been
declining dramatically over the last 20 years and in only about
half of our elementary schools do they have PE teachers on
staff.
ACFN applauds Congress and the Federal Government for
numerous important initiatives that seek to address these
objectives. For example, the Improved Nutrition and Physical
Activity Act passed by the Senate last December would provide
much needed funding to develop community-based programs. We
urge the House of Representatives to pass companion legislation
sponsored by Representative Mary Bono and 77 other Members of
Congress.
ACFN has touted the benefit of PIP grants distributed by
the U.S. Department of Education. PIP grants provide local
communities with funding to improve existing physical education
programs or launch new youth-focused initiatives. We hope
Congress will continue to fully fund this critical program.
The Department of Health and Human Services programs
including Healthier U.S. and the Small Steps to Better Health
campaigns, focus on health, prevention by encouraging Americans
to improve their lifestyles while eating a balanced diet and
increasing their physical activity.
Earlier this year, ACFN responded to HHS's request for
partners to promote Healthier U.S. initiatives. In a recent
report, the Food and Drug Administration Obesity Task Force
proposed a calorie count campaign and made several
recommendations to improve consumer understanding of
appropriate serving sizes. Through the Grocery Manufacturers of
America, the food and beverage industry is responding to the
FDA's work by conducting consumer research to better understand
how to communicate caloric content, especially for single
servings.
Under the auspices of HHS and USDA revisions to the Dietary
Guidelines for America and the Food Guide Pyramid present an
important opportunity to formulate guidelines that can help
people of all socioeconomic and cultural backgrounds improve
their health. While the existing pyramid has recently become
the subject of some debate, one thing is clear, it is one of
the most widely recognized nutrition education tools in the
marketplace. ACFN members are committed to promoting the new
guidelines when they are released next years.
The Five A Day Better Health Program Partnership between
the National Cancer Institute and the Produce for Better Health
Foundation showcases the scope and reach of public education
programs can achieve with private sector involvement. In
addition, ACFN strongly encourages the Government to assess
what gaps in research exist regarding obesity's causes and
solutions, either through projects of its own or by partnering
with agencies or private sector organizations like ACFN.
In conclusion, the food and beverage industry acknowledges
the role it plays in providing consumers with many foods and
beverages that they enjoy every day and is committed to doing
its part to help consumers better understand how they must
balance what they eat with what they do. Clearly, all sectors
of society, including the food industry, must work together to
combat obesity. Ultimately, individuals have to make a choice
about the foods they eat and the level of physical activity
they engage in. Government can and should provide information
to help consumers make informed choices. Congress must embrace
proposals that are positive, comprehensive and address obesity
as an issue rooted in improper energy balance. After all, this
discussion is not simply about weight gain, it is about the
health of our Nation.
Thank you.
[The prepared statement of Dr. Finn follows:]
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Chairman Tom Davis. Thank you very much.
Mr. Silverglade.
Mr. Silverglade. Thank you, Mr. Chairman, for this
opportunity to testify and I commend you for holding these
hearings on this vitally important issue.
The committee has asked us to address several specific
questions. I will address each of them in turn. The first and
most important question is what is our view of Government's
role in shaping health policy, especially on the subject of
controlling weight? We believe the answer to that is simple.
Federal, State and local public health agencies have a major
role to play in ensuring that the food industry provides
consumers with a healthy food environment. This is perhaps a
new term but I am going to use it several times in my
testimony. We need a healthy food environment, at the
supermarket, in schools, at the workplace and in public
settings.
Presently, consumers face a very hostile food environment.
By this I mean fast food outlets across America heavily promote
high fat, hight salt and high sugar foods and beverages.
Vending machines in schools, hospitals and airports offer
mostly high fat, high salt and high sugar snack foods and soft
drinks. Food companies fill the airwaves, magazines and
Internet sites with more than $7 billion worth of marketing
messages for mostly high fat, high sugar, high salt foods,
often consumed by children. That $7 billion figure contrasts
sharply with the meager $4-$5 million spent by the U.S.
Government on its ``5 fruits and vegetables a day'' program.
Government is also partly to blame for the hostile food
environment. Several members of the committee this morning
raised the question whether Government should be involved in
this area. Well, Government is part of the problem, so it must
be part of the solution. For example, Congress requires that
full fat, whole milk be offered at schools participating in the
National School Lunch Program. This was a requirement passed at
the behest of the dairy industry which lobbied Congress.
Congress also passed legislation at the behest of the beef
and pork industries to enable USDA to operate advertising and
promotional campaigns for those industries that are designed to
increase consumption of beef and pork products, many of which
are high in fat. Mr. Waxman earlier this morning mentioned
congressional meddling with the Food Stamp Program, that limits
the ability of States to communicate to food stamp recipients
what foods they should be eating for a healthier diet.
Congress has failed to provide the Department of
Agriculture with authority to regulate so-called
``competitive'' foods, foods not part of the official School
Lunch Program but that are nonetheless sold in schools. As we
have heard from USDA this morning, competitive foods are not as
nutritious as the official School Lunch Program. Congress has
failed to provide USDA with authority to control sale of those
foods and to add insult to injury, the Federal Trade Commission
has developed an extensive legal and economic rationale, or
apology I should say, for why it should not regulate
advertising of less healthful foods to children.
In such a food environment, it is no wonder that more than
60 percent of adults are overweight or obese. Obesity is not
merely a matter of personal responsibility. Let us think about
it. Obesity rates have climbed greatly in the last decade or
so. Did all of these Americans suddenly become irresponsible
over the last 10-15 years? That would be quite a social
phenomenon to say the least. No, Americans have not suddenly
and inexplicably become irresponsible on a societal level.
What has occurred in the last 10-15 years is changes in the
way foods are marketed, changes in the proliferation of less
healthful processed foods, often packaged in huge single serve
portions. What has changed is not a massive social phenomena of
where Americans have become socially irresponsible but what has
the huge amount of money spent by the food industry to increase
to promote unhealthful food products.
While individuals are ultimately responsible for what they
put in their mouths, the World Health Organization, the world's
leading public health agency, has stated in a new global
strategy on diet, physical activity and health, just issued 2
weeks ago, that it is Government's role to make the healthy
choice the easy choice. I will repeat that because it is really
a key element. Government's role is to make the healthy choice
the easy choice. We are pleased to see that Dr. Crawford
representing the administration who was at the Geneva,
Switzerland meeting of the WHO, said that the administration
supports the WHO's global strategy. Let us see how that
statement compares to what the Federal Government is really
doing.
I think the global strategy is so important that I would
like it considered as an annex to my written statement and
incorporated in the hearing record if possible.
Chairman Tom Davis. Without objection, it will be.
[The information referred to follows:]
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Mr. Silverglade. Not surprisingly, the WHO calls for
educational programs. That is no surprise, but in addition, the
WHO states that food advertising affects food choices and
influences dietary habits and that messages that encourage
unhealthy dietary practices should be discouraged. We,
therefore, request Congress hold hearings on ways to protect
consumers, especially children, and reduce the prevalence of
advertising of less healthful foods.
The WHO calls for an examination of food and agriculture
policies for their potential health effects on the food supply.
In response, for example, USDA could develop policies to reduce
the average saturated fat content of beef, pork and dairy
products instead of being mandated by Congress to run
promotional campaigns for the current product lines.
The WHO's global strategy recommends that governments adopt
policies that support healthy diets at school and limit the
availability of products high in salt, sugar and fat in
schools. Congress should take a look at the competitive foods
sold in schools that compete with the school lunch program and
give USDA the authority it needs to take the measures
recommended by the WHO.
Perhaps most controversial, the WHO report states that
prices influence consumption choices and that public policies
can influence prices through taxation, subsidies or direct
pricing in ways that encourage healthy eating and physical
activity. The WHO noted that some countries successfully use
fiscal measures including taxes to influence the availability
and access to a consumption of various foods.
No one is calling for a Twinkie tax. My organization has
called for a 1 cent tax on each can of soft drinks sold, that
could hardly be called regressive and certainly would not have
an effect on low income consumers but it would raise hundreds
of millions of dollars for nutrition education campaigns we all
agree are necessary. In fact, more than a dozen States in the
United States already tax soft drinks. It is not a radical
proposition.
The gist of the World Health Organization's strategy is
that Government must take a proactive role and not merely act
as a passive information provider. Neither I nor anyone in my
organization is advocating that Government regulate what
consumers eat, but Government must regulate business practices
that create hostile food environment.
In sum, the blueprint has been offered to us by the World
Health Organization. I am glad that the administration has
supported it. It is now time that they take steps to implement
it. So far the Small Steps Program by the Department of Health
and Human Services which includes such recommendations to
consumers as to ask their doctor about taking a multivitamin
supplement, to running errands and to drink lite beer--if they
drink beer--instead of regular beer really doesn't pass the
laugh test.
There is legislation pending in Congress that would
implement some of the WHO's recommendations and we urge this
committee to take a serious look at those bills.
Thank you.
[The prepared statement of Mr. Silverglade follows:]
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Chairman Tom Davis. Thank you very much. Thank all of you.
I am going to go to questions. We have a couple of votes
and instead of going over and trying to come back, I want to
try to get through.
Dr. Agatston, just explain to me briefly the difference
between good carbohydrates and bad carbohydrates and how they
affect the body?
Dr. Agatston. We have evolved for millions of years as
hunter gathers and what we gathered was a great variety of
vegetables and whole fruits, very nutrient rich. Early
agriculture was whole grains, slowly digested. Those are
basically the good carbs. We can describe them as nutrient
rich, high fiber is low on the glycemic index.
When the national recommendations came for low fat, we
didn't have understanding of those concepts.
Chairman Tom Davis. They didn't take into account the
differences?
Dr. Agatston. Yes, but the science really wasn't there and
so what the food industry produced was all the great tasting,
zero cholesterol, zero fat processed goodies, big swings in
blood sugar, obesity and the timing coincides with our obesity
epidemic.
Chairman Tom Davis. Dr. Anderson, would you concur with
that?
Dr. Anderson. I think you have to be careful about
simplistic categorization of good and bad.
Chairman Tom Davis. That was my categorization.
Dr. Anderson. The point is that even in my own studies,
rapid release carbohydrates may be perfectly appropriate if you
want a satiety effect, short term, immediately. You feel
better, you are hungry. The question is why do people eat too
much of anything, including the rapid release carbohydrates as
well as you can over eat on a high fat, high other type of
carbohydrate as well. I think there are benefits to all forms
of carbohydrates. An athlete at a certain time will need a
rapid release, you don't want a slow release under those
circumstances. Why don't people make the choices appropriate to
their circumstances and empowering people to understand that
and make those choices, I believe is important.
Chairman Tom Davis. Dr. Agatston, again, in your book you
disparage the Heart Association's high carbohydrate, low fat
eating pattern that is intended to prevent heart disease. Can
you elaborate on that?
Dr. Agatston. The actual studies of low fat, high carb,
when the Heart Association came out with those recommendations,
they did not do a large prospective study because of the
expense. They made the decision on the best available evidence
and long term diet studies are every expensive and very
difficult to do. The new Heart Association guidelines are much
better than the ones we talked about in the book. They
acknowledge whole grains and what I call the good
carbohydrates. I agree there are times when you want fast
release carbohydrates, but for the majority of the population
in most situations, it has been a disaster.
Chairman Tom Davis. Professor Anderson, your colleague,
Professor David Jenkins, developed the glycemic index concept
something like 30 years ago. As the Government reexamines many
aspects of national dietary policy, what do we need to keep in
mind about glycemic index?
Dr. Anderson. It is premature to put it into a public
health mode and please make a distinction between diets that
are geared for the South Beach or the Atkins Diet or whatever
it might be, not criticizing them, but they are a diet aimed at
weight loss and not aimed at prevention. We have to think about
prevention.
Low glycemic index diet will assist in the control of blood
glucose excursions and are appropriate for a diabetic but the
question that we have is where do these changes in diet
potentially apply for the prevention of disease? Also, you have
to remember the food guide and the dietary guidance that we
give is aimed at making sure people get a nutrient adequate
diet as well as select the right foods to prevent chronic
disease. So it has to get both across. That is where we are
failing, in that educational program.
Dr. Agatston. Now we are looking at over the age of 40 of
40 percent prevalence of pre-diabetes and obesity, so what we
are talking about, lower glycemic foods and there is a wealth
of information on the effect on blood sugar, pre-diabetes and
diabetes, we are talking about a large percent of the
population. There are relatively few people who have chosen the
right parents and can eat anything and get away with it but we
are really talking about I think a rather big percentage of the
population.
Chairman Tom Davis. Dr. Finn.
Dr. Finn. I have been in the field a long time. I have been
in the field of dietetics a long time and our dieticians that
are representative of the Dietetic Association, 70,000 of them,
battled back and forth and have for many, many years about what
is the best way to help people or to help patients that have
disease. I think the consensus is pretty much around the idea
that we are not going to come out with one way but some people
do better on a South Beach Diet for prevention, others do
better on something that might be higher in protein and we are
coming full circle to say, it is based pretty much on where
that individual is. It is about calories and how we balance
those and help people really develop a healthy lifestyle that
is permanent. Losing weight isn't the problem, keeping it off
is the problem.
Chairman Tom Davis. So you don't think Government should
advocate a target diet for all people? We need to give them the
information.
Dr. Finn. I think, as Dr. Anderson said, we have to inform
people and I think we have to do everything we can as
professionals to empower people to make those choices and that
comes from all sectors of society and Government is a piece of
that.
Chairman Tom Davis. Thank you.
Mr. Silverglade, twice in your testimony you criticized the
schools for serving 2 percent milk or whole milk which is I
guess only 3.5 percent fat. Because of the satiating nature of
milk based on its protein fat ratio, do you have evidence that
the children are gaining weight from drinking milk?
Mr. Silverglade. All I could say is that the American
Pediatric Association recommends that children older than 2
years of age drink low fat or skim milk and there is a
consensus recommendation among public health professionals in
the United States, medical professionals, that children drink
low fat or skim dairy products that provide all the vitamins
and minerals that whole milk provides without the unnecessary
fat, calories and saturated fat.
Chairman Tom Davis. CSPI has a boatload of recommendations
about eating and what you shouldn't eat but through the 1980's,
they waged a campaign to force fast food companies to stop
using natural and tropical oils for frying and instead switch
to vegetable oil. I am not sure in retrospect, did they stand
by that or did they have a correction in that area?
Mr. Silverglade. I think you raise a good point. We did
urge the fast food industry to stop the use of tropical oils
such as coconut oil and palm oil that are more highly saturated
in fat than lard or beef fat. What we didn't know at that time
is they were going to move to vegetable oils and then
hydrogenate them which essentially thickened them to make them
work like lard or beef fat. We didn't know that. It was
unfortunate but those are the steps they took to respond to our
campaign to drop the use of tropical oils. Now we know that
these hydrogenated oils are high in trans fatty acids and we
are urging the fast food industry to come up with safer
ingredients to use. French fries can be fried many ways and in
fact in Europe, the European Union, McDonald's has stopped the
use of oils that are high in trans fatty acids. Why don't they
stop the use of them here in this country?
Chairman Tom Davis. A lot of this is market driven now. If
you go into restaurants around the country, you go to
McDonald's around the world and they are giving people what
they want. You have the bunless burgers in a lot of places as
you walk in now, you have a kosher McDonald's, I have been to
it in Tel Aviv, you have a meatless McDonald's in India, but
consumers drive a lot of this as well. South Beach and Atkins
have revolutionized what a lot of restaurants are offering.
I would love to spend the afternoon but we have votes. Your
entire testimony is in the record. I can't thank you enough for
being with us and sharing this. As we digest it through the
committee and make our reports, I want to reserve the right to
get back to you because I think what you all have contributed
is very, very important to us as we formulate policy at this
level. Thank you all for being with us. I will let you go and
we will adjourn the hearing.
[Whereupon, at 1:37 p.m., the committee was adjourned, to
reconvene at the call of the Chair.]
[The prepared statement of Hon. Elijah E. Cummings and
additional information submitted for the hearing record
follows:]
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