[House Hearing, 108 Congress]
[From the U.S. Government Publishing Office]
CONQUERING OBESITY: THE U.S. APPROACH TO COMBATING THIS NATIONAL HEALTH
CRISIS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HUMAN RIGHTS AND WELLNESS
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 15, 2004
__________
Serial No. 108-268
__________
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
______
U.S. GOVERNMENT PRINTING OFFICE
98-212 WASHINGTON : 2004
____________________________________________________________________________
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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
TODD RUSSELL PLATTS, Pennsylvania JOHN F. TIERNEY, Massachusetts
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
ADAM H. PUTNAM, Florida DIANE E. WATSON, California
EDWARD L. SCHROCK, Virginia STEPHEN F. LYNCH, Massachusetts
JOHN J. DUNCAN, Jr., Tennessee CHRIS VAN HOLLEN, Maryland
NATHAN DEAL, Georgia LINDA T. SANCHEZ, California
CANDICE S. MILLER, Michigan C.A. ``DUTCH'' RUPPERSBERGER,
TIM MURPHY, Pennsylvania Maryland
MICHAEL R. TURNER, Ohio ELEANOR HOLMES NORTON, District of
JOHN R. CARTER, Texas Columbia
MARSHA BLACKBURN, Tennessee JIM COOPER, Tennessee
PATRICK J. TIBERI, Ohio BETTY McCOLLUM, Minnesota
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 Barnet, Minority Chief of Staff/Chief Counsel
Subcommittee on Human Rights and Wellness
DAN BURTON, Indiana, Chairman
CHRIS CANNON, Utah DIANE E. WATSON, California
CHRISTOPHER SHAYS, Connecticut BERNARD SANDERS, Vermont
ILEANA ROS-LEHTINEN, Florida (Independent)
ELIJAH E. CUMMINGS, Maryland
Ex Officio
TOM DAVIS, Virginia HENRY A. WAXMAN, California
Mark Walker, Chief of Staff
Mindi Walker, Professional Staff Member
Danielle Perraut, Clerk
Richard Butcher, Minority Professional Staff Member
C O N T E N T S
----------
Page
Hearing held on September 15, 2004............................... 1
Statement of:
Bost, Eric, Under Secretary for Food, Nutrition, and Consumer
Services, U.S. Department of Agriculture; and Ed Thompson,
M.D., M.P.H., Chief, Public Health Practice, Centers for
Disease Control and Prevention, U.S. Department of Health
and Human Services......................................... 11
Kretser, Alison, director of scientific nutrition policy,
Grocery Manufacturers of America; Hunt Shipman, executive
vice president, government affairs and communications,
National Food Processors Association; Morgan Downey,
executive director, American Obesity Association; Dr.
Daniel Spratt, director, reproductive endocrinology, Maine
Medical Center, Endocrine Society of America; and Dr.
Thomas Wadden, vice president, North American Association
for the Study of Obesity................................... 57
Letters, statements, etc., submitted for the record by:
Bost, Eric, Under Secretary for Food, Nutrition, and Consumer
Services, U.S. Department of Agriculture, prepared
statement of............................................... 14
Burton, Hon. Dan, a Representative in Congress from the State
of Indiana, prepared statement of.......................... 4
Cummings, Hon. Elijah E., a Representative in Congress from
the State of Maryland, prepared statement of............... 105
Downey, Morgan, executive director, American Obesity
Association, prepared statement of......................... 76
Kretser, Alison, director of scientific nutrition policy,
Grocery Manufacturers of America, prepared statement of.... 59
Shipman, Hunt, executive vice president, government affairs
and communications, National Food Processors Association,
prepared statement of...................................... 70
Spratt, Dr. Daniel, director, reproductive endocrinology,
Maine Medical Center, Endocrine Society of America,
prepared statement of...................................... 88
Thompson, Ed, M.D., M.P.H., Chief, Public Health Practice,
Centers for Disease Control and Prevention, U.S. Department
of Health and Human Services, prepared statement of........ 24
Wadden, Dr. Thomas, vice president, North American
Association for the Study of Obesity, prepared statement of 93
CONQUERING OBESITY: THE U.S. APPROACH TO COMBATING THIS NATIONAL HEALTH
CRISIS
----------
WEDNESDAY, SEPTEMBER 15, 2004
House of Representatives,
Subcommittee on Human Rights and Wellness,
Committee on Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:10 p.m., in
room 2154, Rayburn House Office Building, Hon. Dan Burton
(chairman of the subcommittee) presiding.
Present: Representatives Burton, Watson, and Waxman.
Staff present: Mark Walker, chief of staff; Mindi Walker,
Brian Fauls, and Dan Getz, professional staff members; Nick
Mutton, press secretary; Danielle Perraut, clerk; Kristin
Amerling, minority deputy chief counsel; Karen Lightfoot,
minority senior policy advisor and communications director;
Anna Laitin, minority communications and policy assistant; Josh
Sharfstein and Richard Butcher, minority professional staff
members; Earley Green, minority chief clerk; and Cecelia
Morton, minority office manager.
Mr. Burton. Good morning. A quorum being present, the
Subcommittee on Human Rights and Wellness will come to order.
I ask unanimous consent that all Members' and witnesses'
written and opening statements be included in the record.
Without objection, so ordered.
I ask unanimous consent that all articles, exhibits, and
extraneous or tabular material referred to be included in the
record. Without objection, so ordered.
In the event that other Members from Congress attend the
hearings today, I ask unanimous consent that they may be
permitted to serve as a member of the subcommittee for today's
hearing only. Without objection, so ordered.
The reason we are convening today is because we are going
to talk about a subject that is very, very important not only
to the people of this country, but to the Government of the
United States. Obesity is an ever-increasing concern of
everybody. We just found out recently, when we started looking
into this, that 31 percent of adults over the age of 20 in the
United States are considered obese. That is almost one out of
three. In addition, the data that we found also shows that 65
percent, almost two out of three people in this country, are
overweight.
Now, why is that important? The reason it is important is
because of the tremendous costs and burdens that it puts on the
health care system. Right now, 129.6 million adults who are
currently living here in the United States have an unhealthy
weight level, and that is an increase of 54.9 percent, almost
55 percent in the last decade alone. So we are eating ourselves
into the grave. That is a terrible thing to say, but it is the
truth.
The health concerns related to overweight and obesity: high
blood pressure, high cholesterol levels, diabetes, heart
disease, increased probability of having a stroke and certain
types of cancer such as breast, colon, and prostate cancer, not
to mention, as I said, premature death.
Now the Federal Government is classifying obesity not just
a behavioral problem, but a disease as well, and HHS is
conducting in-depth research into the underlying causation of
obesity, not discounting a genetic or predetermined basis for
the disease.
A study of the national costs attributed to both overweight
and obesity-related services specify that medical expenses
accounted for 9.1 percent of the total U.S. medical
expenditures in 1998, and that reached a total dollar amount of
roughly almost $79 billion. So we are not talking about chump
change here. That would equate today, in 2003 or 2004 dollars
to almost $95 billion. And approximately half of those costs
were compensated for by funds allocated to Medicare and
Medicaid. So the Government and the taxpayers have a vested
interest in finding solutions to this problem.
Now, this is very interesting. In Indiana, my home State,
according to information released by the Behavioral Risk
Factors Surveillance System at CDC, over $1.6 billion is spent
annually by the taxpayers of Indiana due to health implications
linked directly to obesity. Now, for my colleague from
California, Mr. Waxman, it is $7.7 billion, which is over 10
percent of the total obesity costs in the United States. So we
have a problem in Indiana; you have a bigger problem in
California.
Fortunately, the Federal Government and private
organizations have created several programs to combat and bring
awareness to obesity. The Division of Nutrition and Physical
Activity at the CDC has developed and designed a program to
help States improve their efforts to present obesity by
promoting good nutrition and more physical activity.
Currently, 20 States are involved in that program, but we
need to be more involved. And the people of this country need
to be aware that obesity is not only a burden to them, but a
burden to everybody, their neighbors and every taxpayer across
this country. And physical activity is really important to good
diet.
We need to also be talking to our fast food restaurants and
the people who package foods and put them in the supermarkets,
to make sure that they create food stuffs that we can consume
that are nutritious and taste good, but aren't going to kill
us. And that is one of the reasons why we are having this
hearing today.
To speak on these and other initiatives to prevent and
combat obesity, we will hear today testimony from Dr. Ed
Thompson, Chief of Public Health Practice at CDC. And as the
Federal agency charged with ensuring the safe production of
food and the management of Federal food assistance programs,
the U.S. Department of Agriculture is also concerned, and they
have one of their representatives here. We have the pleasure of
receiving testimony from Eric Bost, the Under Secretary for
Food, Nutrition, and Consumer Services at USDA. And he is going
to be testifying about the current USDA outreach programs.
As I said before, it is imperative that the Government of
the United States work with the private sector to find
solutions to this problem. I don't mean to be facetious, but it
is growing at a very rapid rate, and we have to do something
about it.
[The prepared statement of Hon. Dan Burton follows:]
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Mr. Burton. With that, I would like to yield to a gentleman
that really does watch his weight, and I go down to the gym and
I will see him on the workout equipment, working for hours at a
time; and his heart beat, I think, is three beats per minute,
so I know he is in good health, Henry Waxman, the ranking
member of the committee.
Mr. Waxman. Thank you, Mr. Chairman, for your kind words
and for holding this hearing.
Rising rates of obesity in the United States represent a
public health crisis. Obesity causes heart disease and
diabetes, it is associated with premature death, and it is
responsible for billions of dollars in health care costs.
The burden of obesity will affect every corner of our
society, but it will not be spread equally. Obesity harms the
poor more than the well-off, threatens certain racial and
ethnic groups more than others, and in any given area can be
concentrated among those who have fewer opportunities to
exercise and less access to nutritious food. It is a special
responsibility of Government to address disparities in health,
and today I would like to focus on Government's efforts to
address especially high rates of obesity among the
disadvantaged communities in our society.
We all know that the Food Stamp Program prevents
malnutrition and hunger for millions of Americans each year.
Food stamps also play an important role in promoting good
nutrition. Each year the Federal Government sends more than
$150 million to the States to provide nutritional education and
services that help to address obesity. In my home State of
California, these funds support more than 190 programs in 4,000
low-income schools and communities.
This spring the U.S. Department of Agriculture proposed
major changes in nutrition education funded through the Food
Stamp Program. Instead of encouraging community-wide education
in schools, churches, and other settings, USDA is now asking
that programs narrowly target women who are food stamp
participants and applicants. I also understand that USDA is
discouraging programs from focusing on the nutritional needs of
particular high-risk groups such as obese of individuals with
Type 2 diabetes.
California is objecting to USDA's proposal. According to
the State's leading public health officials, the planned
changes will reduce the number of Californians served by more
than 80 percent, will eliminate programs in churches and
community centers across the State, and will lead to a loss of
as much as $80 million in Federal funding. California's leading
public health official has stated that USDA's new strategy
would support ``inefficient approaches.'' He also told USDA
that, if enacted, the proposal would devastate the State's
successful efforts to provide nutrition education to poor and
minority communities.
I am pleased that Under Secretary Bost is here today to
discuss these issues with the committee. It is my hope that we
can have a productive conversation about how to resolve these
serious concerns about USDA's proposals.
I would also like to thank all of the witnesses for coming,
and I look forward to their testimony.
Thank you, Mr. Chairman.
Mr. Burton. Thank you, Congressman Waxman.
We will now hear from the Under Secretary for Food,
Nutrition, and Consumer Services at the USDA, the Honorable
Eric Bost; and also the Honorable Ed Thompson, M.D., M.P.H. He
is the Chief of Public Health Practice Centers for CDC, U.S.
Department of Health and Human Services.
As is our custom, would you please rise so you can be sworn
in?
[Witnesses sworn.]
Mr. Burton. We will start with Under Secretary Bost. And
what I would like, because we have another meeting at 4, I
would like to try to hold the opening statements, if possible
to 5 minutes. Thank you very much.
STATEMENTS OF ERIC BOST, UNDER SECRETARY FOR FOOD, NUTRITION,
AND CONSUMER SERVICES, U.S. DEPARTMENT OF AGRICULTURE; AND ED
THOMPSON, M.D., M.P.H., CHIEF, PUBLIC HEALTH PRACTICE, CENTERS
FOR DISEASE CONTROL AND PREVENTION, U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Mr. Bost. Good afternoon, Mr. Chairman and Congressman
Waxman. It is indeed a real pleasure for me to be here. For the
record, I am Eric Bost, Under Secretary for Food, Nutrition,
and Consumer Services at U.S. Department of Agriculture. I am
here today to speak about our efforts to combat the national
obesity crisis.
We currently administer 15 nutrition programs, serving one
out of every five Americans, including the Food Stamp Program,
the National School Lunch Program, Breakfast Program, and WIC--
Women, Infants and Children. We are also responsible for food
guidance, currently the Food Guide Pyramid and, in cooperation
with our colleagues at Health and Human Services, the Dietary
Guidelines for Americans.
I have two main points in my testimony that I would like to
share with you. One, as the chairman noted, we have a serious
obesity epidemic that is currently existing in this country in
both adults as well as children, and we have several
initiatives to combat it, but it is real important to know that
we cannot do it alone.
Just a couple of statistics. Over 400,000 deaths a year
related to poor diet and physical activity; it is, right now,
the second leading cause of preventable death, after smoking,
and soon will surpass deaths from smoking; diabetes has
increased by 49 percent in the last 10 years; one in three
persons born in 2000 will develop diabetes if there is no
change in the current health habits; alarming trends among
children in the past 20 years, the percentage of children who
are overweight has doubled and the percentage of adolescents
who are overweight has more than tripled. Most importantly,
this may be the first generation of children not to live as
long as their parents as a direct result of this issue.
You talked about the costs. I do want to note one thing:
$117 billion a year in 2000 in direct and indirect costs; also,
obesity as it relates to the individual.
If you are overweight, it will probably take 3 years off of
your life. Obese persons will probably take 7 years off of
their life. And if you are obese and smoke, you are shortening
your life by probably 13 years. Why? The immediate reasons
appear to be somewhat simple. We eat too much, we eat too many
of the wrong things, and we get too little physical activity.
It seems very simple, but in terms of addressing it, it is
really not because of a couple of things. One, we have some of
the best food in the entire world: the widest variety, the
highest quality, the most safe and most affordable food
anywhere. Also, as Americans, we love a good deal. Super-sizing
is just a few cents more; all-you-can-eat buffets. And, last
but not least, one of the struggles that we are having is it
has to be rooted in a behavior change and, as Americans, we
hate to have someone tell us what to do.
Children are a very special challenge for us. Kids' choices
are shaped by their surroundings: at home, in school, and in
the wider community. Also, television and computers draw
children away from sports and physical activity. In terms of
some of our efforts to address this issue at USDA, which we
believe is very important, first of all, there is a conference
that Health and Human Services will participate with us next
month to talk about the leading research regarding what we can
do to address this issue. As part of our nutrition promotion
and education, as a part of our WIC Program, we are currently
reviewing the WIC food package. Also, we have a breastfeeding
promotion, and breastfeeding is directly related to children
that are healthy and, for whatever reason, don't tend to be as
obese when they grow up.
Also, we have programs that are focusing on school-aged
children: our HealthierUS Initiative, in coordination with
Health and Human Services and also the Department of Education;
our Eat Smart. Play Hard. Campaign which is in school; also,
Changing the Scene, which is a nutrition education in the
school; also, our Team Nutrition Program; Fruits and Vegetables
Galore; Making it Happen; and also one of the things that we
are starting is HealthierUS Challenge, where we will identify
schools that have done an outstanding job in terms of providing
healthier alternatives to children in schools.
Across all of our populations, we have a 5 A Day Program,
in partnership with the National Cancer Institute and CDC; and
our Food Stamp Nutrition Education Program that Congressman
Waxman made note of. We are currently in a review of the Food
Guide Pyramid or Food Guide Guidance, and also the development
and review of the Dietary Guidelines.
Just recently, June 30th of this year, the President signed
the Child Nutrition bill, which was just reauthorized. Right
now almost 29 million children are served in the National
School Lunch Program and reauthorization in terms of working
with Congress, we were able to ensure that children have
improved access to school meals for eligible children by
requiring direct certification through the Food Stamp Program,
streamlining the process so that all children in households can
apply at one time, and making certification valid for the
entire year. Also, the act provides funding to work with
schools to establish their own health, nutrition education, and
physical activity goals and initiatives, and also it extends
and expands the Fresh Fruit and Vegetables pilots that
distributed free fruits and vegetables to schools to encourage
health alternatives to non-nutritious foods and snacks in eight
schools and on three Indian reservations.
Why are schools so important and why are our programs so
critical? The research indicates that kids who eat school lunch
eat nearly twice as many vegetables. Kids who eat school
breakfast eat twice as many servings of fruit. In terms of the
food that is provided in the National School Lunch Program, the
total fat has been reduced from 38 percent to 34 percent over
the last several years.
In conclusion, Government, we believe, has a critical role
to play in addressing the obesity issue in this country and in
promoting and moving Americans toward a healthier lifestyle,
and I think that is the issue for me that I really want to
stress. It is not only obesity that we are talking about, it is
the issue of ensuring that people make wise and informed
decisions about what they eat, how much they eat, some level of
physical activity.
It is also important, I believe, to realize too that we
cannot do this by ourselves. We need the partnership with
media, researchers, industry, teachers, administrators, and
especially with parents in terms of being role models for their
children. And last but not least, we need individuals to accept
some level of personal responsibility to make healthy choices.
Regardless of the information that we provide, regardless of
the changes that we make, it still comes down to a person and a
parent making an informed decision and choice for their
children, and I think that is very important.
Thank you very much. I would be happy to answer any
questions that you may have.
[The prepared statement of Mr. Bost follows:]
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Mr. Burton. Thank you, Mr. Secretary.
Dr. Thompson.
Dr. Thompson. Mr. Chairman, members of the committee and
committee staff, I thank you for the opportunity to participate
in today's hearing. I am Dr. Ed Thompson, Chief of Public
Health Practice at the Centers for Disease Control and
Prevention, an agency of the Department of Health and Human
Services. Today I will present an overview of the overweight
epidemic in our Nation and identify a number of Department of
Health and Human Services initiatives and programs designed to
combat these epidemics in poor nutrition, physical activity,
and obesity.
If you look at the chart to my left and to your right, you
see maps showing the percentage of the population of each State
in 1994, 1999, and 2003 who were obese as measured by our
behavioral risk factor surveillance system. Nearly two-thirds
of adults in this country are overweight or obese, with nearly
30 percent overall being obese, as you have correctly noted,
Mr. Chairman.
What you see there in lighter blue, that is 10 to 14
percent of the population being obese; not overweight, but
obese. And the lighter blue which appears in 1994 disappears
after 2001. The darker blue is 15 to 19 percent. Beginning in
1997 you see some red, and on that chart there you see it in
2003; it appears first several years before. That means that 20
percent of the adults in that State, one out of every five, are
obese.
Finally, in 2003 we have had to introduce a new color, and
that is gold. In 1999 it appears in many States. I am sorry,
the gold is 20 percent are obese; the red is the new color
introduced in 2003, and that represents 25 percent or more of
the population. One out of every four adults in those States is
obese, and in 2003, as you can see, five States had one in four
adults who were obese.
Overweight and obesity and associated risk factors of poor
diet, physical activity, and other contributing factors
contribute to chronic conditions such as heart disease, stroke,
diabetes, and certain cancers. A recent study estimates that
4,000 adult deaths each year in the United States are
associated with poor diet and physical inactivity. That is as
many Americans as died in all of World War II.
We have already begun to see the impact of the obesity
epidemic on the health of young people. Type 2 diabetes,
strongly associated with obesity, was virtually unknown in
children and adults 10 years ago. Today it accounts for almost
50 percent of new cases of diabetes among youth in some
communities.
A CDC report predicts that one in every three Americans
born in 2000, that is, the children now entering kindergarten,
will develop diabetes during his or her lifetime. Successfully
combating the overweight epidemic in our Nation requires the
involvement of many sectors and levels of society. Although
national initiatives can play an important role, they are not
sufficient by themselves; community-based initiatives are
critical for reaching Americans where they live, work, go to
school, and play. State level programs are critical for
supporting and disseminating community-based activities.
DHHS is implementing a comprehensive approach to reach the
American people through these various levels. CDC uses multiple
approaches to address obesity and its risk factors, including
funding State health departments, school-based programs, a
national media campaign, and community-based programs. The
Steps to a HealthierUS cooperative agreement program is
designed to promote programs that reduce the burden of chronic
disease and address the associated risk factors.
Steps targets diabetes, overweight, obesity, and asthma,
and addresses the associated risk factors of physical
inactivity, poor nutrition, and tobacco use. CDC funds 28 State
Health Departments to prevent and reduce obesity, and we fund
23 State Departments of Education to implement coordinated
school health programs to help ensure that students receive
instruction on nutrition, physical activity, and tobacco use
prevention.
CDC's youth media campaign, called ``VERB. It's what you
do,'' is the largest national multicultural campaign designed
to increase levels of physical activity among youth. After 1
year, the impact has been demonstrated by substantial
improvements, including the average 9 to 10-year-old American
child in the Nation, after the campaign, who was exposed to the
VERB campaign, engaged in 34 percent more sessions of free time
physical activity when compared with children who were unaware
of the VERB campaign.
Two recent major initiatives tied to obesity within the
Department of Health and Human Services are the Food and Drug
Administration's Obesity Working Group, which will advise the
agency on innovative ways to deal with the increase in obesity
and identify ways to help consumers lead healthier lives, and
the National Institutes of Health development of an Obesity
Research Task Force to develop a strategic plan for obesity
research.
In October DHHS and USDA will host a national obesity
prevention conference. The conference's objective is to learn
from past and current research, identifying steps we can take
to prevent further increases in the prevalence and severity of
obesity.
We are learning a great deal about effective strategies for
promoting physical activity and healthy eating. We know that no
one strategy alone will be sufficient. Our chances of success
will be greatest if we use multiple strategies to address
numerous factors that contribute to caloric imbalance. DHHS is
helping lead the national effort to combat the epidemic of
overweight and obesity through a comprehensive, multifaceted,
multilevel approach. We are committed to doing all we can to
help our Nation enjoy good health now and for a lifetime.
We thank you for your interest and for the opportunity to
share information about these strategies with you, and we will
be happy to answer your questions at the appropriate time.
[The prepared statement of Dr. Thompson follows:]
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Mr. Burton. Thank you very much, doctor.
We have been joined by the ranking member of the
subcommittee, Ms. Watson.
Did you have an opening you would like to make, Ms. Watson?
Ms. Watson. Yes. Thank you so much, Mr. Chairman. I
especially want to commend you because of your strong
leadership on the issue of America's health and well being time
and time again.
The prevalence of obesity in the United States in both
adults and children is increasing at an alarming rate.
Currently, about 127 million Americans are labeled overweight
and about 60 million of the population is considered obese. On
top of that, about 9 million individuals are considered
extremely obese. In addition, a 2004 study released by the
Department of Health and Human Services Centers for Disease
Control and Prevention shows that deaths due to poor diet and
physical inactivity rose by an astounding 33 percent over the
past decade. Several experts speculate that obesity may soon
overtake tobacco as the leading preventable cause of death.
Mr. Chairman, I must emphasize again that obesity in the
United States has reach epidemic proportions. The CDC has
ranked obesity as the No. 1 health threat facing America. In a
larger perspective, obesity is global, not just a problem of
the United States. Recent estimates are that about 300 million
worldwide are affected by obesity. Up to 20 percent of men and
25 percent of women in European countries are considered obese.
According to the National Institutes of Health, overweight
refers to increased body weight that is at least 10 percent
over a recommended weight relative to the individual.
These recommended weight standards are generated based on a
sampling of the U.S. population or by body mass index [BMI], a
calculation that assesses weight relative to height. The NIH
states that all adults age 18 or older who have a BMI of 25 or
greater are considered at risk for premature death and
disability as a consequence of their fat to lien muscle mass
ratio. Obese is commonly referred to as any individual with a
BMI greater than 30.
Mr. Chairman, there are two specific concerns that I would
like to highlight, in addition to those that our witnesses will
provide today. The areas are health and financial concerns
regarding obesity. First the health concerns. To name a few,
overweight and obese people are at an increased risk of
developing any of the following: cardiovascular disease,
diabetes, stroke, hypertension, angina, gout, fatty liver
disease, sleep apnea, fertility complications, psychological
disorders, cancer of the kidney, breast, colon cancer, rectum
cancer, esophagus, prostate cancer, and gallbladder.
Americans with low income levels and minorities are
disadvantaged in gaining treatment due to the disparities in
our health care system. More attention must be directed into
prevention and awareness of obesity long before related
illnesses and diseases attach.
In addition to the health impact of obesity, there are also
great economic consequences on the U.S. health care system.
Direct medical costs include preventative, diagnostic, and
treatment services relative to obesity. Indirect costs relate
to morbidity and mortality costs. There is an opportunity to
reduce costs because obesity is a preventative condition.
Socioeconomically, lower income groups and minorities tend to
be more obese.
Another economic situation that should be brought to the
subcommittee's attention may have serious consequences in my
State of California. In May, USDA proposed major changes to
nutrition education funded through the Food Stamp Program. This
program provides major funding to State public health efforts
to combat obesity. The proposed changes would dramatically
restrict what States can do with the money, forcing them to
abandon community-wide efforts to do targeted counseling to
women with children who are on food stamps.
On July 27, 2004, California strongly objected to the
proposed changes. The chief public health officer wrote: ``For
USDA to reserve directions contradicts all that we know about
effective strategies.'' California said the new proposal would
result in fewer low-income people being served and undermine
hunger prevention.
If this framework becomes effective in 2006, few of today's
in-kind contributions would continue to qualify for Federal
financing participation. California would lose most, if not
all, of its more than $80 million in Federal matching funds.
Financially, the $21.3 billion spent in 2000 on health care and
lost productivity attributable to physical inactivity, obesity,
and overweight, and the $1.7 billion attributable to obesity in
the Medi-Cal program would continue to rise unchecked. Rather
than being a partner with States, this framework would abandon
them, abdicating USDA's responsibility for good nutrition,
nutrition education of low-income Americans, and helping to
reverse the Nation's obesity epidemic.
So, Mr. Chairman, I look forward to the continuing
testimony of today's witnesses and the positive solutions that
our witnesses can provide.
I yield back the balance of my time. Thank you.
Mr. Burton. Thank you. It is nice to have you with us, as
usual. You look like a fashion plate that just stepped out of
one of the magazines.
Did I understand you to say that there were 400,000 deaths
that could be prevented a year if we watched our weight? Is
that correct?
Mr. Bost. Yes.
Mr. Burton. 400,00 a year.
Mr. Bost. That is correct.
Mr. Burton. I hope everybody who is paying attention to
this will listen; 400,000.
Mr. Bost. And increasing all the time.
Mr. Burton. Yes. And you said it is $117 billion in direct
or indirect costs?
Mr. Bost. That is correct. That is based on 2000 figures
that we got from CDC.
Mr. Burton. That is based on 2000 figures.
Mr. Bost. Yes.
Mr. Burton. So it is probably higher now.
Mr. Bost. Well, the most recent figures, if you
extrapolate, would indicate it is up to $123 billion.
Mr. Burton. $123 billion.
Mr. Bost. Yes. That is correct.
Mr. Burton. And a lot of that is paid through Medicare and
Medicaid.
Mr. Bost. Yes.
Mr. Burton. So the taxpayers are funding a lot of that.
Mr. Bost. Yes.
Mr. Burton. I am reiterating this because I think it is
very significant. You said children born today, one out of
three will get diabetes?
Mr. Bost. That is correct. If they keep eating like they
are eating, that is correct.
Mr. Burton. And that is preventable if they had a balanced
diet and watched their caloric intake and the fat intake.
Mr. Bost. That is correct, along with some level of
physical activity.
Mr. Burton. Right. You said something about sleep apnea.
Which one of you said that?
Ms. Watson. I did.
Mr. Burton. You did.
Mr. Bost. Congresswoman Watson said something about sleep
apnea.
Mr. Burton. As one of the causes. Well, the reason that
rang a bell with me is I have to tell you a story, and this
will be humorous, but it is true. When I was a boy, we lived
across the street from the schoolyard, and we didn't have much
money, so mom fixed foods that were quick and fast. She was a
waitress and she would come and fix dinner; a lot of them have
a lot of caloric problems and fat problems.
And my brother, who is 7 years my junior, I would say at
dinner, I am finished, can I go play basketball across the
street. And she would say, you eat like a bird; you are going
to die. And then she would say, OK, go ahead and play. And then
as I walked out the door, she would say, look at your little
brother. He was in a highchair and she was shoveling food into
him, saying, he is a good eater; he is going to be real
healthy.
Well, the reason I bring that up is because it is like a
record playing in people's head. And my brother today has a
very serious weight problem that he has to fight all the time,
as well as ancillary problems including sleep apnea. And the
reason I say that, because if anybody is paying attention
besides the people in this room, what parents teach their kids
in their formative years or very early years does stay with
them for a lifetime, and if you force-feed a child like my mom
did--and she was well intentioned, a wonderful lady--then what
you are doing is creating that record in their brain that is
going to be playing over and over again that they are going to
be using throughout their life, and it is going to cause them
to eat more than they should.
Now, that may seem like a very simple thing to state, but I
am absolutely convinced that is why my brother has had this
weight problem throughout his life. And I think that is why I
didn't, because I was fortunate enough to be a little older and
be able to run across the street without eating all that food
and play in the schoolyard. So I just thought I would throw
that out as an object lesson.
I don't have a lot of questions, but I think it is
extremely important, and I guess I would suggest this as a
charge to the health agencies, that the education of the
American people need to be increased through public service
announcements, through all kinds of ways that you can think of.
We need to be telling parents don't feed your kids too much.
When they are ready to quit eating, let them quit eating, like
they should have done with my brother. And, also, teach them,
like you said, that vegetables and fruits are not something
that you should just have as an ancillary part of the meal,
because they don't have a lot of calories and they won't put on
a lot of weight.
So I really appreciate your being here today. You guys have
a big job on your hands, especially when you look at the growth
in obesity in this country, but I do appreciate your hard work.
With that, I will yield to my colleague, Mr. Waxman.
Mr. Waxman. Thank you, Mr. Chairman.
Public health experts believe that social marketing
campaigns are a critical part of the efforts to reduce obesity.
These campaigns aim to change community norms about nutrition
and food. Yet USDA's proposal withdraws support from virtually
all social marketing efforts in favor of one-on-one counseling
sessions. California's leading public health official in the
Schwarzenegger administration has said that this proposal would
lead to the adoption of ineffective approaches.
Mr. Bost, do you disagree with public health experts who
say it is important to address obesity at a community level?
Mr. Bost. Well, Mr. Waxman, let me put my response in terms
of your question in some framework in terms of this issue of
the Food Stamp Nutrition Education Program, because I had the
opportunity last week of going to California and meeting with
the leadership there about this specific issue.
In May we issued a draft framework so that we could start a
dialog and seek public comment on what we believe we could do
with the States and our partners to improve the Food Stamp
Nutrition Education Program. We were looking at several things:
one, how to organize it more effectively and more efficiently
to maximize the outreach efforts and the impact it may have on
low-income people; and, also, how could it be better
coordinated, more effectively coordinated with all of the other
efforts that we were attempting to implement.
In addition to that, and with that in mind, this was not,
and I repeat, not an effort about reducing funding or nutrition
education, or reducing access to the Food Stamp Program, or
rejecting social marketing or eliminating school-based efforts.
For whatever reason, many of the folks in California took it to
mean that, but it wasn't that at all.
In addition to that, we had received over 1,000 comments.
The vast majority came from California, and they repeated many
of the things that you did say. However, we did have some
States who did not necessarily agree with the position that
California took. The point that we are interested in making is
that we have X amount of dollars to reach a targeted group of
people, those who participate in the Food Stamp Program, and we
sent the draft framework out to receive input how could we more
efficiently and effectively address this specific target
population. It was by no means to eliminate any of the things
that you noted in your comments, not at all.
Mr. Waxman. Since you sent it out and you are getting
comments, does that mean that you are open to hearing the
criticisms that we are hearing overwhelmingly from
Californians, democrat and republican people, in the
administration in Sacramento?
Mr. Bost. Absolutely. That is why I went to California, to
meet with the leadership to talk about it, because so many of
the comments did come from California. And the thing that I
would also like to leave you with is that no final decision has
been made, and I left it with the folks in California to
discuss it.
Mr. Waxman. Well, I am happy to hear that. Let me just ask
you some of the underlying philosophy that public health
experts are raising as you consider your proposal. Health
experts have argued that it is better to try to change the
culture of a community, how they look at nutrition, than just
one-on-one counseling. As I understand it, it is hard to
convince an individual to buck what the rest of the community
is doing, it is a difficult message to sell, and they believe
the most effective approach is to change the norm and improve
the health of the whole community. Do you see that as a
reasonable approach?
Mr. Bost. Oh, absolutely. However, with food stamp
nutrition education money, the money is specifically designated
to address those people who participate in the Food Stamp
Program. So for us to say or for me to say that I am going to
use that money and that we may, just by happenstance, address
people who participate in the program, but I am going to get
everybody else, I can't do that. Congress says I can't do that.
The statute is very clear about how I can use that money. What
we were interested in doing was to talk with the States about
we can more efficiently and effectively address that, and do it
without adversely affecting what California is doing.
Mr. Waxman. Well, that is the key, because California is
trying to take a much more broad approach than going
specifically to individuals, because the public health experts
there believe that is the only way you are going to really be
effective, and we want a program that is effective. USDA's
proposal prioritizes nutrition education for women with
children. California is concerned this priority would
jeopardize funding for many specific educational programs,
including those geared to children in the LA unified school
district and those geared to diabetics.
Does the USDA believe that a one-size-fits-all approach is
better than strategies designed at the community level?
Mr. Bost. No, absolutely; and the framework didn't say
that. In addition to that, when we looked at the approximately
24----
Mr. Waxman. Well, I am not arguing about what the framework
says, but these are the questions that are being raised as to
whether it fits in with that framework, and I suppose you are
going to evaluate it. Given the scientific evidence about
escalating rates of obesity in children, shouldn't USDA be
prioritizing children as well?
Mr. Bost. Well, we have, because if you look at the number
of people who participate in the national Food Stamp Program,
of the 24 million, over 50 percent are children.
Mr. Waxman. Given the tight link between obesity and Type 2
diabetes, is there anything wrong with States trying to reach
out to diabetics for nutrition education?
Mr. Bost. No, not at all.
Mr. Waxman. California has said it would lose up to $80
million in Federal funding because of the limitations on
nutrition education that they thought USDA is proposing. Yet
these limitations do not appear to be well justified. I think
what we are asking on a bipartisan basis in the congressional
delegation, what the people in California on a bipartisan basis
are also asking, is that you take a look at this, because they
feel that what is being suggested would undermine California's
efforts through these revisions. So I want to give you that
message; you got it in California. And as you look at the
revisions, please keep it in mind. Is that fair?
Mr. Bost. Absolutely. And we will do so and we have done
so.
Mr. Waxman. Good.
Could I just continue with one last question?
Mr. Burton. Sure.
Mr. Waxman. The new USDA guidance states that food stamp
nutrition education funds may not be used to convey negative
written, visual, or verbal expressions about any specific food,
beverage, or commodity. USDA staff has the right to review
educational campaigns to make sure that there is no
``belittlement or deregation'' of such items. Can either of you
explain the origin of this policy? What scientific evidence
supports this policy and how many educational campaigns have
been rejected because they belittled specific foods or
beverages?
Mr. Bost. One, that preceded me, and the only one that I
can think of was one that was using the money to talk about
soft drinks in a specific State. But it is also in statute. And
I think you read exactly from statute.
Mr. Waxman. And the statute says that you cannot belittle--
--
Mr. Bost. If it is, it is very close.
Mr. Waxman [continuing]. Or have deregation of a food
product?
Mr. Bost. If it is not, it is very close to that, if memory
serves me correct.
Mr. Waxman. Well, I would like to----
Ms. Watson. Can you yield?
Mr. Waxman. Sure.
Ms. Watson. On that very specific point, if we have a
particular cola drink that we know has caffeine in it, if that
is pointed out as a risk, is that considered--I don't know the
definitions of belittling.
What was the other word?
Mr. Waxman. Deregation.
Ms. Watson. Deregation. I don't know what the definitions
are. Is there a definition in the statute?
Mr. Bost. Congresswoman Watson, I don't know, I will have
to look at it and see. I think the issue is about being able to
target a particular food or food group. I think that is what
the issue is, especially with public funds.
Mr. Waxman. Well, let me ask you this, if you can get us
for the record a full explanation of how this provision was
developed. If it is our fault, let us know. And then a
correspondence with the food industry and all examples of State
educational programs that were rejected by USDA staff based on
this definition. So that will allow us to know how big a
problem this is in the States' efforts to deal with it.
Thank you, Mr. Chairman.
Mr. Burton. Let me, before I yield to Ms. Watson, just say
that I am one of the biggest free enterprise advocates that
there is in the Congress, I am sure, but if we are taking
exception and we are making exceptions to certain companies or
certain industries because we are afraid it will hurt their
sales, while at the same time it is hurting the American people
by creating more obesity and more health problems, then we have
our horses going backward here.
The fact of the matter is if there is something that is
causing a health problem, and it is in legislation that we
can't say anything about it because we might hurt in some way
that industry, then we need to re-evaluate that. I don't want
to hurt any industry because, as I said, I believe in free
enterprise, but, at the same time, if caffeine or if too much
sugar or too much fat in a product is going to be detrimental
to the American public and the taxpayers and the health of this
Nation, then we have to re-evaluate and start telling people,
hey, if it is this kind of a sandwich or this kind of a cola
that is causing a problem, then we have to have it changed. And
we need to attack that problem, because the growth of this
problem is unbelievable.
Ms. Watson.
Ms. Watson. I want to follow kind of in that train as well.
As a teacher and school psychologist and a member of the school
board, first thing I did is go into our kitchens and find out
what we were preparing for our youngsters to eat. We might have
found a product that we felt was detrimental to their health.
In describing the detriment, you have to describe the product
and what is in the product.
So what I would like to see is some definition of what you
mean by belittling or degrading. We need to have a definition,
because I am reminded of a bill--you know, California is
unique, we do it first--and we had a bill that would tax junk
food. It sunsetted because we could not decide what junk food
really was. You know, is caramel popcorn junk food or is there
a nutritional value?
So I don't know how we would really make this work if we
didn't have some definitions or some standards when we point
out the problems with a particular food. So can you respond to
that?
Mr. Bost. Yes. But, Congresswoman Watson, in terms of the
very specific example that you gave in terms of schools, the
foods that are reimbursable have to meet the dietary
guidelines, and other foods that are served that are a la carte
are determined by the schools. So the schools themselves can
make a determination of what they believe is appropriate or not
appropriate, and would not necessarily fall in our purview.
But, like I said, for those foods that are reimbursable on the
national school lunch program, they have to meet certain
guidelines. So the very specific example that you gave me is
not applicable in this specific instance.
Ms. Watson. But maybe you can clear it up for me. If the
schools determine, can they also point out a product that would
be injurious to someone's health? Would that fall under your
reference to belittling?
Mr. Bost. No. It is left to the discretion of the school.
There are two forms of food that are served in schools: one, a
la carte, that the school decides to serve, actually, maybe
three, those that are in the vending machines, and foods that
are reimbursable by us. There are three categories of foods.
Those foods that are reimbursable have to meet certain
guidelines that we spell out; the other two are left entirely
at the discretion of the schools.
Ms. Watson. Well, the reimbursable foods, can a school
district say these foods, and particularly some of them, are
detrimental, and would that be considered belittling?
Mr. Bost. Well, that is difficult for me to answer because
since I have been Under Secretary I don't think that has ever
occurred.
Ms. Watson. I said we do it first in California.
Mr. Bost. Well, no. The school has the discretion whether
they want to serve it or not. They don't have to say it is
detrimental. If it is a reimbursable food, then they have the
choice of whether they are interested in serving it or not. So
they don't have to say it is detrimental, because they can
choose not to serve it. They can do what they want.
Ms. Watson. OK, would you write me a letter as to what the
standards for belittling or detrimental, whatever the other
was?
Mr. Bost. Yes, we will.
Ms. Watson. So I will have a clear understanding. Thank you
very much.
Mr. Bost. You are quite welcome.
Mr. Burton. Before we let you go, it seems to me that maybe
your agencies could recommend to the Congress, after doing a
little bit of research, what we could do to better define what
is a food with too much fat, too much sugar, or too much
something else in it. No, I am serious. I am serious, because
we are not just talking about school foods here. You look at
the huge increase in the amount of obesity among adults and
huge increase in the amount of people who are overweight that
are not considered obese among adults, and you consider the
health risk factors connected with that, and we really need to
do a better job of educating in addition to just the schools in
this country.
I mean, I am not going to name products here because I will
be shot before I get out of the building, but the fact of the
matter is you go into a supermarket and you look at packages of
various products that you want to take home and eat while you
are watching a football game, and the fat content is huge. But
the people don't think about that because they haven't been
educated about that. And I think that we ought to be educating
them about that, and we need to have some kind of a definition
here in the Congress so that we can set the proper parameters
on how your agencies can illuminate the issue for the American
people. Right now it seems to me like you have all kinds of
restrictions on you, and we need to lift those restrictions so
we can better educate the American people.
Mr. Bost. Well, Mr. Chairman, to some extent we are in the
process of doing that. We are currently reviewing the dietary
guidelines for American, both USDA and Health and Human
Services, and also the Food Guide Pyramid is currently under
review. So to some extent we are in the process of doing that.
Mr. Burton. Well, manufacturers of these various products,
it seems to me, also ought to get the message, and maybe if we
eliminated some of the barriers that you have to deal with
legislatively, you could probably talk to them in a little
stronger way. Not that I like to see Government sticking its
nose into the private sector, but when you start talking about
these astronomical health care costs related to obesity, you
realize that something has to be done, especially when you are
talking about one out of every three kids born today are going
to have diabetes if we don't do something.
I just got back from Guam and Saipan not too long ago, and
they don't have enough dialysis machines to take care of the
population over there, American citizens who are dying from
diabetes. We don't need to have one out of three kids growing
up in the next 25 years that have diabetes; we won't have
enough money to buy dialysis machines and keep them alive. So
anything you can recommend that we can do legislatively to help
and to educate the American people, I am sure Representative
Watson and Waxman and myself would be happy to do.
Ms. Watson. Mr. Chairman, Representative Waxman wanted to
submit these two letters for the record.
Mr. Burton. Sure. Without objection, so ordered.
Thank you, gentlemen. We will go to our next panel now.
Our next panel consists of Ms. Alison Kretser, the director
of scientific nutrition policy at the Grocery Manufacturers of
America; Mr. Hunt Shipman, executive vice president, government
affairs and communications for the National Food Processors
Association; Mr. Morgan Downey, executive director of American
Obesity Association; Dr. Daniel Spratt, director of
reproductive endocrinology, Maine Medical Center, Endocrine
Society of America; and Dr. Thomas Wadden, vice president of
North American Association for the Study of Obesity.
Would you please stand so you can be sworn?
[Witnesses sworn.]
Mr. Burton. Let me just say it is 5 after 3, and I think
many of my colleagues have left because we have adjourned for
the week because of the religious holidays. I will probably be
the only one here for this panel, but I can assure you the rest
of the committee will be getting this information. The reason I
bring that up is we have another meeting that I have to go to
at 4, so I would like for you to limit your comments, if you
would, to 5 minutes so we can get to the questions.
Ms. Kretser.
STATEMENTS OF ALISON KRETSER, DIRECTOR OF SCIENTIFIC NUTRITION
POLICY, GROCERY MANUFACTURERS OF AMERICA; HUNT SHIPMAN,
EXECUTIVE VICE PRESIDENT, GOVERNMENT AFFAIRS AND
COMMUNICATIONS, NATIONAL FOOD PROCESSORS ASSOCIATION; MORGAN
DOWNEY, EXECUTIVE DIRECTOR, AMERICAN OBESITY ASSOCIATION; DR.
DANIEL SPRATT, DIRECTOR, REPRODUCTIVE ENDOCRINOLOGY, MAINE
MEDICAL CENTER, ENDOCRINE SOCIETY OF AMERICA; AND DR. THOMAS
WADDEN, VICE PRESIDENT, NORTH AMERICAN ASSOCIATION FOR THE
STUDY OF OBESITY
Ms. Kretser. Thank you for the opportunity to discuss the
efforts of the food and beverage industry to help combat
obesity in America. My name is Alison Kretser. I am a
registered dietician and I am the director of scientific and
nutrition policy for the Grocery Manufacturers of America.
As the leading voice of the food and beverage industry in
the obesity and nutrition debate GMA has established a long-
term commitment to arrest and reverse obesity in America, and
to provide consumers with the information and resources they
need to establish healthy dietary habits for life.
As the companies that make the foods Americans choose every
day, GMA member companies recognize their role in not only
offering choices that meet consumer demand for taste, quality,
and convenience, but also, just as importantly, health.
On GMA's commitment I can assure you that I am speaking for
the leadership of the industry. The CEOs on the GMA board have
adopted a global strategy on food and health that states our
resolve in no uncertain terms. As you know, we are supporting
the efforts that Congress has undertaken to combat obesity. GMA
was an original and enthusiastic supporter of Congressmen Wamp
and Udall's Congressional Fitness Caucus. We also support
passage of the Improved Nutrition and Physical Activity Act
[IMPACT], introduced by Congresswoman Mary Bono.
We applaud Congress for its initiatives, but there is a
great deal more that everyone, including the food industry, can
do. We recognize that food is the energy input side of the
healthy weight equation, and numerous efforts are underway to
help consumers better understand how they can balance what they
eat with what they do. For example, companies are formulating
products to meet the health demands of consumers. Efforts
include: reformulating products to reduce calories, fat, and
sugars; introducing new products with increased fiber and whole
grains; and offering new choices for smaller product serving
sizes.
However, one of our challenges is to provide and promote
products that make eating not only healthy, but enjoyable.
Having introduced numerous healthy products that do not pass
the consumer taste test, we know that people will not buy foods
they do not enjoy. In the coming months consumers will see many
more of these products that meet their demand for both health
and taste.
Just as importantly, GMA has provided USDA and HHS with
numerous recommendations on how to make the dietary guidelines
for Americans and the Food Guide Pyramid relevant and useful
for all consumers, while also incorporating the latest science.
Specifically, we have urged USDA to retain the shape of the
Pyramid, a well-recognized brand among consumers. However, to
increase its utility, we have recommended that USDA link both
the size and number of servings to the Nutrition Facts panel,
which is based on a 2,000 calorie diet. While a single image of
the Pyramid cannot educate consumers about all aspects of the
Government's dietary recommendations, it can, when used on food
labels and elsewhere, serve as a reminder of what a healthy
diet looks like.
However, the Nutrition Facts panel is not always a well
understood tool among consumers. For that reason, GMA and its
member companies are funding research regarding consumer
perception about calories and serving sizes on the Nutrition
Facts panel. The goal is not just to educate consumers, but to
improve the labels to meet their needs.
In addition to offering new products and improved nutrition
information, GMA and many of our member companies founded the
American Council for Fitness and Nutrition to promote the
critical balance between nutrition and physical activity for a
healthy lifestyle. Now representing 91 companies and
organizations, the Council's work is guided by an advisory
board of 27 experts in the fields of nutrition, physical
activity, and behavior change.
This year the Council launched two pilot programs targeting
the specific needs of the Hispanic and African-American
populations, which are disproportionately impacted by obesity
and related diseases. One of this subcommittee's members,
Congressman Cummings, was at the launch of the Council's Summer
Fun Food and Fitness Program in Baltimore and is familiar with
its goals and the children's achievements. Both programs
incorporated healthy eating and cooking segments, and an
emphasis on making physical activity a daily habit.
In conclusion, with the intense public focus on obesity,
healthy, and nutrition, we have an unprecedented opportunity to
combat obesity and to improve public health. Through improved
nutrition information and product innovation, we can give
consumers the tools they need to build healthy diets and to
maintain a healthy weight. Thank you.
[The prepared statement of Ms. Kretser follows:]
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Mr. Burton. Thank you.
Mr. Shipman.
Mr. Shipman. Thank you, Mr. Chairman. I am Hunt Shipman,
executive vice president of government affairs and
communications for the National Food Processors Association
located here in Washington.
NFPA is the voice of the $500 billion food processing
industry, and our three scientific centers, our scientists, and
professional staff represent food industry interests on
government and regulatory affairs and provide research,
technical services, education, communications, and crisis
management support for our U.S. and international members.
Obesity is a multi-faceted issue and requires a multi-
disciplined approach. I would like to briefly discuss efforts
now underway that we believe can be successful in helping to
combat obesity.
The food industry has a long history of providing consumers
with safe, affordable, and nutritious foods that meet their
expectations for taste, value, and convenience. Innovation and
reformulation are key tenets for our industry. Food companies
have responded to consumer demand by creating a variety of
reduced, low and non-fat food products, reduced and low-calorie
foods, and foods modified for specific dietary and medical
needs. Such foods help ensure that all consumers can find
products they need to create their own healthful diet.
An important fact to remember is that the greatest source
of nutrition information for most consumers is the Nutrition
Facts panel found on the foods they purchase every day. The
Nutrition Facts panel was developed and designed to help make
consumers aware of the various nutritional components in food,
and it also can be an excellent weight management tool.
NFPA is now preparing a consumer-friendly brochure on
following food labels for healthy weight management, featuring
easy-to-understand information on food labels and how labels
can help them attain or maintain a healthy weight by making
wise food choices. This consumer information will be on NFPA's
Web site, where it can be downloaded by consumers and health
experts, or anyone who communicates to consumers about how to
better understand food labels.
Because of the importance of physical activity in combating
obesity, the food industry sponsors a number of programs
designed to encourage children's physical activity and
nutrition education, such as the University of North Carolina's
Get Kids in Action program and Triple Play, the Boys and Girls
Club of America's new health and wellness initiative, to
promote healthy lifestyles.
As Ms. Kretser noted, the food industry has also endorsed
legislation designed to provide more Government support for
school physical activity programs, such as the Impact bill. We
believe that Federal support for in-school physical activity
programs is important to the success of such efforts. And the
food industry has actively participated in numerous conferences
and other public events to discuss various approaches to
combating obesity.
As I noted at the beginning of our remarks, obesity is a
multi-faceted issue, and no one approach or activity will solve
this situation. Clearly, labeling alone will not bring about
the behavioral changes needed to reduce obesity in this
country. We need to ensure that the information we provide to
consumers is linked to both motivational and actionable
education messages so that consumers will use nutrition
information to create healthful diets. Such messages need to be
thoroughly researched and consumer-tested.
In 2004, both USDA and HHS have been active participants in
the process of reviewing the Dietary Guidelines for Americans,
as well as the Food Guide Pyramid. Revised versions of both the
Dietary Guidelines and the Pyramid are scheduled to be released
in early 2005. Throughout the review process for the Dietary
Guidelines and Pyramid, NFPA has strongly advocated that these
nutrition education tools must be easily understood and must
trigger the behavioral change by the public. Attention to
positive dietary guidance messages, coupled with consumer
research to evaluate their effectiveness in motivating
behavioral change is essential. federally funded biomedical and
behavioral research related to health promotion and disease
prevention is also needed.
Food companies succeed by meeting consumer demand, and
clearly the consumer demand for both a wide variety of food
products to meet varying dietary needs and the demand for more
information on how to attain or maintain a healthy wealth is
strong. Labeling flexibility will help to create incentives for
products designed to meet consumers' needs and demands.
Government's role should be to ensure that labeling and claims
that can help consumers to better understand the role that
various foods can play in healthful diets is both truthful and
non-misleading.
In closing, stakeholders, including the food industry,
Government, and the medical and public health communities will
have to work together. Without cooperative efforts, we will
make no progress in this issue. Dedicated collaboration,
energy, and resources will make a difference in the classroom,
on the playground, in the home, and throughout our Nation.
Thank you for the opportunity to appear before the
committee.
[The prepared statement of Mr. Shipman follows:]
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Mr. Burton. Thank you, Mr. Shipman.
Mr. Downey.
Mr. Downey. Thank you, Mr. Chairman, and I want to thank
you for convening this hearing. I hope it is the first of
several on this topic, because it is very complicated and
complex.
I also would like to take this opportunity to applaud the
work of Secretary of Health and Human Services, Tommy Thompson,
over his tenure. He has taken on obesity as a major issue. He
has led the components of HHS to develop comprehensive and
sound plans for attacking this problem. We also hail his
decision in July for Medicare to recognize that obesity is a
disease and to open the door to developing appropriate
treatment strategies for treating it.
In the opinion of the American Obesity Association, obesity
is the most fatal, chronic, prevalent disease of the 21st
century. No other human condition combines obesity's prevalence
and prejudice, sickness and stigma, death and discrimination.
We believe that the full weight of the Federal Government's
capacities be brought to bear on the problems of obesity in the
same way we have tackled other challenging health problems like
cancer, heart disease, smoking, teen pregnancy, HIV-AIDS, and
bioterrorism. All such efforts have involved a commitment of
leadership, time, and resources across a spectrum of
activities, including education, research, prevention,
treatment, consumer protection, and discrimination.
I would like to briefly touch on each of these areas and
what the Federal Government may be doing.
On the educational front, although we have had a spate of
information and features on obesity, it is still largely
misunderstood in many corners, and this is true in the policy
area as well. One of the things that we have overlooked, as you
saw earlier the slides from the CDC, is that while the
population has doubled over 30 years who had a BMI of 30, the
population with a BMI of 40, morbidly obese, has tripled during
that period of time, and the population with a BMI of 50 has
increased some 400 percent.
The problems of obesity--mortality, morbidity, sickness,
health care costs, health care utilization--scale up, so those
increasing levels of severe morbid obesity, where people are
100 pounds or more overweight, is really where a large part of
the problem is. We have tended to think of this as a
statistically small part of the population. It is not. If all
of the persons in the United States with morbid obesity live
together, it would basically be the 12th largest State in the
country, roughly the size of Illinois. It would encompass, as
my crude estimates take it, 29 congressional districts. The
population with morbid obesity, just morbid obesity alone, is
over two and a half times the size of our entire Alzheimer's
population. This population receives nothing in the way of
research or many of the programs and policies that have been
discussed to attack their problems at that level.
We have important educational messages that we think need
to be brought out. Obesity is not a behavior; obesity is excess
adipose tissue. It is a disease because it meets every
rationale definition of disease. It is a chronic, fatal,
relapsing disease that is at least as complicated to treat as
heart disease or cancer. It is a problem that is largely going
to be solved by more research. And while diet and exercise are
intrinsic to discussions of obesity prevention and treatment,
much more is needed as the long-term effects of these
interventions are poor.
Obesity is a global problem arising from a combination of
genetic, environmental, and behavioral factors. We don't know
how to effectively prevent and treat obesity over the long
term, with the exception of bariatric surgery for persons with
morbid obesity. If we do not drastically and quickly expand the
research base of obesity, new treatments and new prevention
strategies are likely to fail, and it will sink the entire U.S.
health care system, which simply cannot absorb millions of new
cases of diabetes, heart disease, stroke, and the other
conditions you have mentioned. Simplistic assertions that
obesity is easily prevented or easily remedied do a disservice
to persons with obesity and inhibit the discovery of effective
solutions.
We believe that one of the areas that is most important to
address is this area of research. I have provided the committee
with three graphs I will briefly describe. One depicts the
growth in the NIH budget since 1998, roughly doubling from
$13.6 billion to $28.8. And yet you will see although there has
been a dollar increase in the obesity budget it has basically
been a straight line as the funding has increased so
dramatically.
Second, the obesity budget at NIH is far behind that of the
conditions caused by obesity, such as diabetes, cardiovascular
disease and, in comparison to some areas like HIV-AIDS and
smoking, receive a very small portion of the funding.
And, finally, we have a graph here depicting the prevalence
of various conditions and comparing that to NIH levels of
funding. It is hard for us to imagine how we are going to get
out of the problem with this insufficient attention to our
research base to give us the information to get there.
So for that reason, as well as some others, we are calling
on Congress to look at establishing a National Institute of
Obesity research at NIH which would focus and concentrate
attention on the various problems such as basic research,
epidemiology, genetics, neuroscience, prevention, therapeutic
development, economics, health policy, etc.
Mr. Chairman, I have more to say, but I see my time is out.
I would be glad to address some areas if you would like me to.
[The prepared statement of Mr. Downey follows:]
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Mr. Burton. Thank you, Mr. Downey.
Dr. Spratt.
Dr. Spratt. Thank you. Chairman Burton, I would like to
begin by thanking you for the opportunity to testify here
today. I am director of reproductive endocrinology and
endocrine research at Maine Medical Center. In my clinical
practice I deal every day with both adolescents and adults with
obesity-related problems. I am here today as Chair of the
Government Relations Committee for Endocrine Society.
The Endocrine Society is the world's largest and most
active professional organization of endocrinologists,
representing over 12,000 members worldwide. We are dedicated to
quality research, patient care, and education.
I will be primarily addressing issues of research in
obesity today. In the other presentations you have heard the
magnitude of the obesity problem in the United States. Our
Society has provided to your committee our Obesity Handbook
that provides additional details. This Handbook is part of a
major effort of the Endocrine Society that has been undertaken
over the past 2 years to increase scientific and public
awareness of the obesity crisis.
As you have noted and other panel members, the Federal
Government has also set in motions efforts to begin to tackle
the obesity problem. In addition to those measures noted
before, NIH Director Dr. Zerhouni has created the NIH Obesity
Research Task Force. Its strategic plan for obesity research,
which was released in February of this year, calls for the NIH
to undertake research exploring, preventing, and treating
obesity through lifestyle modification, pharmacological, and
surgical approaches, and research that further examines the
link between obesity and its associated health conditions, such
as metabolic syndrome.
Several important questions confront us. What is the cause
of obesity? Is it genetic, cultural, environmental? Well, the
truth is there may be no one cause of obesity, but, rather, a
combination of many, with different combinations in different
individuals. Why are more than 65 percent of Americans
overweight or obese?
And even more alarming, why has childhood obesity tripled
since 1970? Why are racial and ethnic minorities
disproportionately affected by obesity and related ailments
such as diabetes and cardiovascular disease? While we should
not single out one cause or one issue for obesity, I have been
asked today to update the committee on current research being
conducted by those in the field of endocrinology.
What role can our Society play in helping you address these
problems? Well, as you know, endocrinologists work with
hormones and metabolism. Hormones are substances that are
secreted by glands that regulate body functions. For instance,
the thyroid gland secrets thyroid hormone, which regulates
general body metabolism. Well, researchers have recently
discovered that adipose, fat tissue, actively secretes hormones
that influence many body functions, and that the adipose is in
turn regulated by hormones from other glands.
As metabolic specialists, endocrinologists are actively
engaged in the study, management, and treatment of obesity and
related diseases. In both the clinical and basic research
setting, we evaluate the hormones that regulate appetite,
metabolism, and energy balance. Endocrine researchers are
attempting to determine the root causes of obesity and to find
the most effective measure to prevent, as well as combat, this
condition.
One recent endeavor resulted in the discovery of the
hormone leptin by Jeff Friedman at the Rockefeller Institute,
and this opened a whole new dimension in the field of obesity.
Leptin is a hormone produced by fat cells that travels in the
blood stream to the brain to influence appetite. It also
influences body temperature, reproductive function, and the
speed at which calories are burned.
This important discovery established the principle that fat
cells can communicate with the brain and influence metabolic
processes. Since this discovery, there have been many more
discoveries demonstrating that other organs, like the pancreas
and the GI tract, can produce substances that control appetite
and metabolism.
It is also worth noting that breakthroughs in obesity
research have resulted from what we call ``broad-based''
research. This is research that is conducted without a
particular clinical goal established at the onset of the
research. For example, scientists at Mass General Hospital have
recently evaluated thousands of genes from the C. elegans worm.
Among other discoveries, they found hundreds of promising genes
that may help determine how fat is stored and used in a variety
of animals, including us.
This new information can be used to find similar genes in
humans and then assess their significance for the control of
obesity. The decision to characterize this worm genome was not
made with obesity in mind, but more for the general belief that
deciphering this genome would have some payoff down the road.
So we must continue to support broad-based research in science,
as some of the most important breakthroughs have been
serendipitous.
This basic information lays the foundation for clinical
research. For instance, currently there are only two FDA
approved drugs for long-term treatment of obesity, and neither
is fully effective. Clinicians routinely prescribe medications
to treat the complications of obesity that have been listed
here, but we only have these two pharmaceutical options to
treat obesity before it results in co-morbidities. Better
knowledge of the physiology and pathophysiology of obesity can
lead to development of more effective drugs, as well as more
effective nutritional, surgical, and other approaches. We, as
doctors, and the American public as patients, need better
medications based on the knowledge we will gain from basic and
clinical research.
We believe, finally, that obesity research should be
continued on three levels. First, basic research should
continue to better understand the body's complex mechanisms of
storing and utilizing energy. Second, transitional research
should be moving these basic discoveries into trials of
clinical treatments. Our evolving knowledge will provide
numerous opportunities for better diagnostic, pharmaceutical,
surgical, nutritional, and behavioral approaches.
Third, as these approaches are implemented, outcome or
impact research should be designed and put in place to assess
efficacy, as mentioned in part of the Impact bill. Finally, we
should pay particular attention, as has been noted here, to the
disproportionate occurrence of obesity and its related health
problems in our childhood and minority populations.
So I want to thank you for inviting me to testify here
today, and thank your committee for furthering the public
discourse on this growing problem of obesity.
[The prepared statement of Dr. Spratt follows:]
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Mr. Burton. Thank you, Dr. Spratt.
Dr. Wadden.
Mr. Wadden. Mr. Chairman, Ms. Watson, thank you for the
opportunity to testify on behalf of NAASO, the North American
Association for the Study of Obesity. NAASO's members include
more than 1,800 scientists, practitioners, and educators who
are dedicated to improving the prevention and treatment of
obesity in the lives of those affected by this condition.
I am Tom Wadden, the vice president of NAASO and professor
of psychology at the University of Pennsylvania in
Philadelphia.
We have heard today that the United States is experiencing
an epidemic of obesity. What can we do to control this public
health crisis that threatens the lives and well-being of so
many of our citizens? NAASO offers three recommendations today:
first, increase the availability of treatment for people who
are already obese; second, substantially strengthen efforts to
prevent the development of obesity, particularly in children;
and, third, double NIH funding for obesity research from its
current level of $400 million. Let me briefly discuss each of
these.
In 2002, a landmark study supported by the NIH showed that
a 15-pound weight loss reduced the odds of developing Type 2
diabetes by more than half in overweight persons who were at
risk of developing this illness. To meet their treatment goals,
study participants received frequent individual counseling from
dieticians and other health professionals.
Remarkably, such treatment, though clearly effective, is
not covered by most insurance plans today. Ironically,
insurance companies pay to treat the complications of obesity,
including high blood pressure, Type 2 diabetes, and heart
disease, but they do not cover obesity itself. These serious
medical problems could be prevented, or at least alleviated, if
patients could obtain help in managing their weight.
NAASO believes that the treatment of obesity should be
reimbursed when provided by appropriately trained health
professionals. NAASO met this morning with officials from the
Centers for Medicare and Medicaid Services. We strongly urge
Congress to direct CMS, in collaboration with private insurers,
to develop guidelines for covering weight management services,
including diet and exercise counseling, medications, and
surgical interventions. We also urge Congress to assist
universities, as well as State Departments of Health, in
training more health professionals to provide weight management
services.
While we must treat obesity to prevent the development of
health complications, our greater need is to prevent the
development of obesity itself. As we have heard, America's
children are of paramount concern. Fifteen percent of our youth
are now overweight. An additional 15 percent are at risk of
overweight; they are just a few pounds away. And we have heard
about the explosion of Type 2 diabetes in pediatric clinics.
NAASO urges Congress to provide greater support for obesity
prevention programs. The Centers for Disease Control and
Prevention, as we heard from Dr. Thompson, are playing a
crucial role through their Division of Nutrition and Physical
Activity, which administers the State-based Nutrition and
Physical Activity Program.
But only 28 States are currently supported by CDC, and of
these only 5 are funded at an adequate level, the basic
implementation level. Those States receive $750 million to $1.5
billion per year. The United States needs this program in all
50 States funded at adequate levels. NAASO urges Congress to
strengthen support for this and other CDC initiatives,
including its Division of Adolescent School Health and its VERB
campaign that Dr. Thompson spoke of.
The solution to our Nation's obesity epidemic seems so
simple: people need to eat less and exercise more. And yet the
solution could not be more complex, because so many factors
influence our daily eating and activity habits, as you have
already told us, Congressman Burton. Children today see 10,000
food-related commercials on TV each year. Most are for sweet or
fatty foods. How do these ads influence children's eating
behavior and body weight at the age of 4 or 14 or later at 40?
Think what your brother's weight would be today if he had seen
10,000 food ads per year.
How do TV and video games affect children's daily physical
activity? We know it decreases it, but by how much? How does
the design of a neighborhood, including the need to drive to
school and to shopping centers, affect weight and well-being of
children and their parents?
Answers to such questions are urgently needed in order to
develop the most effective prevention programs. We cannot
expect children to make better food and activity choices long-
term until we create environments at home and at school that
support better choices. Willpower is just not the answer for
pediatric obesity.
This past August the NIH published its Strategic Plan for
Obesity Research, as Dr. Thompson said. This document
identifies short and long-term research goals to improve
obesity prevention and treatment, and to advance understanding
of the multiple causes of this condition. As we heard, this
includes groundbreaking research in genetics and
neuroendocrinology that is identifying basic biological
mechanisms for controlling eating, energy expenditure, and body
weight. This research will further prevention and treatment
efforts.
NAASO urges Congress to double NIH's funding for obesity
research from its current level of $400 million. Mr. Downey has
told you how little support there is for obesity compared to
other disorders. The NIH has a comprehensive program, but it
will only succeed if sufficient resources are provided as have
been provided in the fights against cancer, heart disease, and
AIDS.
Funds invested in obesity research will yield multiple
benefits: as we reduce the number of Americans who are
overweight and obese, we will dramatically reduce the many
complications, including Type 2 diabetes, heart disease, and
several cancers; and as important, we will reduce the personal
suffering of the millions of Americans affected by obesity.
Thank you for this opportunity to testify.
[The prepared statement of Mr. Wadden follows:]
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Mr. Burton. Well, thank you, doctors, ladies and gentlemen.
We really appreciate the testimony. It was very enlightening,
because I have always been of the opinion if you just ate less
and exercise more, you would stay thin. But you have convinced
me today that is not the only solution to the problem, although
I think it is a big one.
You said labels help. I think it was you, Ms. Kretser, who
said that, I believe. And I think they do, but most people,
when they are going to the store to get something for a
basketball or football game, where they kick their feet up and
you see these advertisements on TV where some guy is overweight
and he is sitting in a big chair popping all this stuff, they
don't read those things.
Can't the food industry do something to educate the people
through public service announcements in addition to those kinds
of commercials? It just seems like to me, as the doctor just
said, they see 10,000 food commercials per year, a child, and
an awful lot of those are these junk food ads that lead to
obesity. It seems to me, in addition to trying to find better
foods with lower caloric intake and fat intake and so forth,
that the food industry could, in their advertising or through
public service announcements, educate the public as to what
they should be eating. It would also help them in sales of the
products that aren't so fattening.
Is there any thought about that?
Ms. Kretser. In response to your question, food advertising
has the potential and it will play an important role in the
battle against obesity. And I can tell you there is a sea
change in the type of advertising that is done in the food and
beverage industry. They are looking at how, within advertising,
we can communicate healthy lifestyles so that if a food such as
advertising a cookie, you show a child coming in from outdoors,
being physically active, and then having the correct amount of
a snack. We are very committed to advertising responsibly and
portraying the correct way to use a food, and how much and the
amount of the food. And if it is a snack food, that it isn't
portrayed as replacing an entire meal. That is inappropriate.
Mr. Burton. Well, all I can say is that I have never seen a
commercial for a junk food or a fast food that said don't eat
too much of this, now. They never say that; they always say--
and I don't want to get into specific products----
Ms. Kretser. Well, we have in this country a self-
regulatory mechanism that is under the National Advertising
Review Unit that CARU, which is the Children's Advertising
Review Unit that has a set of principles that all of our
companies adhere to in adveritising to children, and they
review commercials for children under the age of 12, and we
have a very high compliance rate if in fact they have an issue
with how a food is----
Mr. Burton. Well, pardon my English, but it apparently
ain't working, because you have one in three kids that are
being born today that are going to be a diabetic if we don't
change things, and kids are getting fatter all the time, and
the message----
Ms. Kretser. Well, I think you have heard today that it is
not just one single issue, such as advertising. There are many
multiple factors that have changed as far as our lifestyle.
Within the last 10 years our lifestyle is very, very different.
Mr. Burton. No, I understand that. I understand that. But
that is one part of the solution, and that is to educate. You
know, I watch television like everybody else, and I see beer
and alcohol commercials where they say drink responsibly.
But with fast foods and things like that, I never hear them
say eat responsibly. I am not saying that is the solution, it
just seems to me that the industry, while developing foods that
are better for us that still taste good, that they can also do
something to talk about caloric intake and fat intake. We don't
want to discuss this ad infinitum, but I just hope that maybe--
--
Ms. Kretser. We do communicate. We have a great deal of
information on nutrition on company Web sites, and I encourage
you to look at major manufacturers' Web sites, all of the
information that they have available for consumers.
Mr. Burton. I would be happy to look at those Web sites,
but that is not what I am talking about. We are talking about
10,000 commercials a child sees in a year, not their Web site.
A lot of kids are very, very good with computers, but they
don't rush to the computer to look at what kind of things they
should eat; they see that coming into the television when they
watch a movie or watch some kind of other thing.
Ms. Kretser. I understand what you are saying, but I will
say that parents are a tremendous role model, and Government,
as far as schools as well, but parents, you teach how you eat.
I have two children, and they have watched me for years.
Mr. Burton. I want to ask some other questions. Let me just
tell you we have latchkey kids now. More husbands and wives are
working than ever before. When I was a boy, my mom worked and
my stepfather worked, and my dad went to the slammer because he
was a bad apple. But the fact of the matter is today probably
60, 70 percent of the families, both parents work, and the kids
come home and they spend time watching television, and the
parents don't have the opportunity, as they did in the past, to
go into these things in detail.
I am a free enterprise advocate, as I said, and I don't
like to mess around with the private sector. Let me just
finish. I just think that the industry would be well served not
only to come up with new products that taste good, that people
can consume in a way that will be safer, but also so that they
can help educate the kids, because the parents, in many cases,
aren't there to do it.
I have a couple of other questions I would like to ask
before my time runs out.
You said, Dr. Wadden, that we ought to double the amount
for research for obesity from $400 million to $800 million a
year. I don't disagree that is probably a good goal. We have
severe budgetary constraints right now. Is there any other way,
other than spending another $400 or doubling the amount of
money being spent on research, to help solve these problems for
things other than just advertising and caloric intake?
Mr. Wadden. Well, I think that we are going to have more
dialog between the private sector and industry, academia and
Government and the public sector, because I do agree we are
going to have to have multiple sources coming together to work
on this problem. I think the NIH plays such an important role
in terms of trying to figure out what are the causes, where are
the most productive avenues to intervene.
Your State is ahead on things. In Los Angeles you have
decided to take sugared sodas out of vending machines, which I
highly applaud. We would like to be able to say is that a good
decision, does that in fact reduce obesity? So those are the
kinds of grassroots movements that we could provide funding for
from NIH to see if that is a good target. It is a better target
to do what you are thinking about, going more after maybe
television advertising aimed at children or at the food
industry.
So we do need money for basic research at NIH that can
address these issues, as well as the types of issues you raise,
but the partnership has to be with industry, with State
government, as well as the Federal Government doing its part.
Mr. Burton. Let me just ask Dr. Spratt a question real
quick. You said we need more research for drugs to help combat
obesity. It seems like we have a pill for everything. And you
may be correct, I don't know. Do we really need more
prescription type drugs to deal with the obesity problem? Would
our money be better spent in education and that sort of thing,
rather than, after the fact, giving people pills to control
their appetite?
Dr. Spratt. Well, I personally agree with you, and I think
our community would too, that the knowledge that we are gaining
can lead to many approaches besides just some medicines that
will help control obesity. However, for a subset of patients
with morbid obesity, where nothing else is working, that is at
great risk, these effective medicines are a great benefit in
reducing the problems of diabetes and cardiovascular disease.
So it is one part, I believe, of the solution, certainly not
the whole solution.
Mr. Burton. Ms. Watson, I will yield to you. I am sure my
time has expired.
Ms. Watson. These are issues that we have been dealing with
for decades, and I am looking at the industries that produce
these foods, fast foods in particular, and in certain areas in
my district you can go into one block and you could find five
or six fast foods, particularly fried chicken. We have new
donut shops now, nothing but oil, dough, carbohydrates. And our
kids whose parents are not in the home, homes most often are
dysfunctional, will have breakfast in the morning, a donut and
a Pepsi, a donut and a Coke. That is their breakfast. So what I
see is a partnership.
At least we have labeling now, and in a lot of the
restaurants they tell you what is in the food and how it is
prepared somewhat. But they are, I think, attractive nuisances.
What can we do to bring the food production industry, our
educational services, our health services together on this and
not appear too heavy-handed with it?
But we are going to have to do a better job somewhere along
this way of educating people, and I don't think a pill is the
answer, because naturally our body will digest and use the fats
it needs and get rid of the others. But the problem is how do
our children in today's world really know how to use that
Pyramid. I remember, and I am talking about another life when I
went to school, that it was emphasized; now we hardly mention
it. So anyone want to speak to that?
Mr. Downey. If I could. I think we have to take drug
development as a serious tool here. We are accustomed to using
this to control things like cholesterol, to control
hypertension. And if we did have an array of several, five or
six kinds of medications like we have for diabetes,
hypertension and the like, we could get a lot of these problems
under control and not have the higher expenses that come from
leaving it untreated. So I look at this as just another chronic
disease. Drug medications are a common way that we approach
these.
And while the environmental activities, areas like you have
touched on, are extremely interesting, we have around the world
really kind of natural experiments going on, countries that are
changing from one kind of lifestyle more to a western
lifestyle; maybe they don't have television advertising, maybe
they don't have vending machines. We really don't know what is
happening there in terms of whether those are influencers,
controllers on obesity or not.
Since you raised it, I will mention about the fast food
franchises in particularly low-income minority areas. I don't
have the figures in front of me, but I came across information
a few years ago that for the Small Business Administration this
is a major part of their whole economic development program in
many minority areas. So the article I read indicated that this
is what the SBA was largely doing with its minority economic
development program, was supporting these franchises in these
economically depressed communities that provided a lot of jobs
and income.
So the issues become a lot tougher to tease out. And while
we talk about food advertising, we also have a situation that
Congress, as is true in virtually every western democracy,
heavily subsidizes the agricultural industry. We produce twice
as many calories per person per day as we need in this country.
This creates great demands. We can increase portion sizes
without really taking in the cost of food very much; it puts a
premium on advertising and marketing to get market share, etc.
I know Dr. Wadden and I have talked about these a lot, and
he is an expert in these. These are tradeoffs. These things
were developed to create obesity, but our whole society is
really geared to reducing physical activity. We have engineered
physical activity out of our time. We are trying to increase
production so American workers are now working longer, harder,
more productively than ever before. We are using technology
where we didn't just 5 or 10 years ago. And these are all
creating this environment or lifestyle. It is very hard for an
individual to change that; that is the environment that we are
all in.
Ms. Watson. Well, we sit here and we talk about the
problem, and I kind of hear an acceptance of the problem. I am
hoping from you to hear more about how we then resolve these
problems for the future. The free market is going to continue
to produce its goods as long as they are meeting a profit;
however, we worry about the physical health of Americans and
what we can do and what policies we can set, and I do hope that
we can hear back from you as to how you can help us guide
policy that would improve the health of Americans.
Mr. Burton. Thank you, Ms. Watson.
Well, let me just say you have been a very interesting
panel. I really appreciate the illumination of a lot of the
issues that I wasn't familiar with. One thing that I noticed,
Mr. Shipman, I didn't ask you a question, but you and the young
lady next to you there, Ms. Kretser--is it Kreetser?
Ms. Kretser. Kretser.
Mr. Burton. Kretser. Excuse me, I am sorry.
I think one of you indicated that the Food Processors
Association produces about $500 billion a year in product. So
it is a very, very large industry in this country. I don't know
how much of that they utilize for advertising or for public
service announcements, but I would just like to suggest that
maybe in the process of developing new and better foods that
will help solve this problem, that they might be able to do
some advertising which will help in that direction and use just
a few of those dollars to educate the public so that we can
maybe enlist their help to solve the problem. Government can't
do it all.
Dr. Wadden asked for $400 million more. We have a huge
budget deficit right now. We have a war we are fighting in
Iraq. We have the war against terrorism. We have to increase
our intelligence activities, the CIA and FBI, to protect the
American people against an attack by terrorists.
So we don't have the luxury of being able to put an extra
$400 million or $500 million here or $5 billion there, or
whatever it happens to be. But the industry that produces these
products, and does in a way contribute to the problem, could be
a big help to us by educating the public through their
advertising and through public services announcements, as well
as coming up with new products that taste good.
I would love to sit down and watch a football game where I
could eat to my heart's content and not get fat. Right now I
can't do that. But if you guys come up with something, I will
buy that product day and night.
With that, thank you very much for being here. We really,
really appreciate it.
We stand adjourned. We will have another hearing on this in
the future.
[Whereupon, at 3:55 p.m., the subcommittee was adjourned.]
[The prepared statement of Hon. Elijah E. Cummings and
additional information submitted for the hearing record
follow:]
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