[Senate Hearing 110-447]
[From the U.S. Government Publishing Office]
S. Hrg. 110-447
CHILDHOOD OBESITY: THE DECLINING HEALTH OF AMERICA'S NEXT GENERATION--
PART II
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON CHILDREN AND FAMILIES
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
ON
EXAMINING CHILDHOOD OBESITY, FOCUSING ON THE DECLINING HEALTH OF
AMERICA'S NEXT GENERATION NATIONAL PROBLEM, SOUTHERN CRISIS
__________
JULY 23, 2008
__________
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
EDWARD M. KENNEDY, Massachusetts, Chairman
CHRISTOPHER J. DODD, Connecticut MICHAEL B. ENZI, Wyoming
TOM HARKIN, Iowa JUDD GREGG, New Hampshire
BARBARA A. MIKULSKI, Maryland LAMAR ALEXANDER, Tennessee
JEFF BINGAMAN, New Mexico RICHARD BURR, North Carolina
PATTY MURRAY, Washington JOHNNY ISAKSON, Georgia
JACK REED, Rhode Island LISA MURKOWSKI, Alaska
HILLARY RODHAM CLINTON, New York ORRIN G. HATCH, Utah
BARACK OBAMA, Illinois PAT ROBERTS, Kansas
BERNARD SANDERS (I), Vermont WAYNE ALLARD, Colorado
SHERROD BROWN, Ohio TOM COBURN, M.D., Oklahoma
J. Michael Myers, Staff Director and Chief Counsel
Ilyse Schuman, Minority Staff Director
______
Subcommittee on Children and Families
CHRISTOPHER J. DODD, Connecticut, Chairman
JEFF BINGAMAN, New Mexico LAMAR, ALEXANDER, Tennessee
PATTY MURRAY, Washington JUDD GREGG, New Hampshire
JACK REED, Rhode Island LISA MURKOWSKI, Alaska
HILLARY RODHAM CLINTON, New York ORRIN G. HATCH, Utah
BARACK OBAMA, Illinois PAT ROBERTS, Kansas
BERNARD SANDERS (I), Vermont WAYNE ALLARD, Colorado
EDWARD M. KENNEDY, Massachusetts MICHAEL B. ENZI, Wyoming (ex
(ex officio) officio)
MaryEllen McGuire, Staff Director
David P. Cleary, Minority Staff Director
(ii)
C O N T E N T S
__________
STATEMENTS
WEDNESDAY, JULY 23, 2008
Page
Dodd, Hon. Christopher J., Chairman, Subcommittee on Children and
Families, opening statement.................................... 1
Prepared statement........................................... 3
Bingaman, Hon. Jeff, a U.S. Senator from the State of New Mexico,
statement...................................................... 5
Thompson, Joseph, M.D., MPH, Surgeon General, State of Arkansas;
Director, Arkansas Center for Health Improvement, Little Rock,
AR............................................................. 7
Prepared statement........................................... 9
Miller, Jonathan, Healthplace participant representative,
University of Michigan, Regional Alliance for Healthy Schools
(RAHS), Ypsilanti, MI.......................................... 15
Prepared statement........................................... 17
Dwyer, Philip J., President and CEO, Central Connecticut Coast
YMCA, New Haven, CT............................................ 18
Prepared statement........................................... 20
Neely, Susan K., President and CEO, American Beverage
Association, Washington, DC.................................... 35
Prepared statement........................................... 36
Murkowski, Hon. Lisa, a U.S. Senator from the State of Alaska.... 45
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
Mikulski, Hon. Barbara A., a U.S. Senator from the State of
Maryland, prepared statement............................... 69
Alexander, Hon, Lamar, a U.S. Senator from the State of
Tennessee.................................................. 69
van Helden, Bethany, MS, RD, University of Michigan, Regional
Alliance for Healthy Schools (RAHS), prepared statement.... 70
American Psychological Association (APA), prepared statement. 71
National Assembly on School-based Health Care (NASHBC),
prepared statement......................................... 72
Joseph W. Thompson, M.D., MPH, letter........................ 73
(iii)
CHILDHOOD OBESITY:
THE DECLINING HEALTH OF AMERICA'S
NEXT GENERATION--PART II
----------
WEDNESDAY, JULY 23, 2008
U.S. Senate,
Subcommittee on Children and Families Committee on Health,
Education, Labor, and Pensions,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:33 p.m. in
Room SD-430, Dirksen Senate Office Building, Hon. Christopher
Dodd, chairman of the subcommittee, presiding.
Present: Senators Dodd, Bingaman, and Murkowski.
Opening Statement of Senator Dodd
Senator Dodd. The committee will come to order.
Let me apologize to our witnesses and guests who were here.
We are a couple of minutes late in starting, but we are
delighted that you are all here. I am particularly grateful to
our witnesses for making the effort to be a part of this
important discussion and debate, and I want to welcome my
constituent, Mr. Dwyer. It's nice to have you here with us, as
well as our other guests.
Let me take a couple of minutes and share some opening
thoughts with you. Then I will turn to Senator Bingaman for any
opening comments he may have. My friend and colleague from
Tennessee, the Ranking Republican member of this committee,
Senator Lamar Alexander, will be joining us at some point. I
know Senator Harkin, who has been a leader along with Senator
Bingaman on this issue of the medical emergency of obesity,
will also be joining us at some point. I know his plans are,
anyway, to be with us.
I thank all of the audience. We have a very packed crowd
again. Last week, we had the first hearing on this issue, and
we had a packed audience as well that came to be a part of it,
and we will see how things go.
A week ago, we did something a little different that I
hadn't done in 27 years. I turned to the audience after we
heard the panel and got the audience involved. A lot of you
bring unique background and experience, and if you hang around
long enough, we may ask you to be involved and share some
thoughts and ideas you have as well. I have never done that
before, Jeff. It was an interesting----
Senator Bingaman. Pretty dangerous.
Senator Dodd. Pretty dangerous stuff, I know, we are doing.
Well, thank you all for being here. First, let me welcome
my colleagues and distinguished witnesses and thank them for
their presence to discuss what is now being recognized as a
medical emergency, the childhood obesity epidemic.
Last week, we began our series of hearings on this urgent
problem, and we heard from experts who have concluded that our
children's generation may be the very first generation in
American history to live shorter, less healthy lives than their
parents. We heard some very startling facts as part of that
hearing.
Nearly a third of our Nation's children are obese or at
risk of becoming obese. That is roughly 25 million of our
younger Americans, with those in minority families and poor
families at even a greater risk than other parts of the
population.
We heard about the dramatic increase in children diagnosed
with diseases that had previously only been seen in adults,
such as type 2 diabetes, high blood pressure, and high
cholesterol. We heard some of the reasons behind the epidemic
as well--the prevalence of junk food and soda in our schools
and advertised on our televisions, which is a big reason why we
consume more calories per day than ever before in our history.
We discussed how Americans are less active and how the
environment in which our children are growing up has made it
increasingly difficult for children to be physically active.
They don't walk to school because we don't build safe paths.
Even when they are at school, only 8 percent, only 8 percent of
middle schools require daily physical activity.
The sad truth is that when it comes to physical activity,
it is much easier for children to play video games at home than
a game of hide-and-seek outside with their friends.
So, it is time to call this what it is, a medical
emergency. We are not talking about a few children who eat too
many sweets and don't exercise. We are talking about an entire
Nation that needs help getting back on the right track, and it
starts with our children.
It starts with making sure the public understands just how
much of a threat this obesity epidemic poses to all of us,
whether we have children or not. That is why in the past week,
my wife, Jackie, and I have been visiting schools, camps, and
hospitals in our home State of Connecticut to raise the
visibility of this problem and help highlight the efforts
underway to solve it.
We have both been talking about a new report that says a
mere $10 per person per year in proven community-based programs
could save the country more than $16 billion annually within 5
years. We should be supporting those efforts, all of us should.
The Institute of Medicine released a report in 2005 that
laid out recommendations and action plans for all sectors of
our society from government to healthcare professionals to
schools and families. Yet despite the efforts of some States to
get tougher nutritional standards for school lunches and more
rigid physical activity for students, the institute also found
``substantial underinvestment of resources to adequately
address the scope of the obesity crisis.'' That is a quote.
Others have highlighted how jumbled and disorganized
Federal standards are. As Senator Tom Harkin of Iowa has
pointed out, USDA regulations allow children to buy donuts and
Snickers bars at their school, but not breath mints or cough
drops. It makes no sense at all, and he is right.
In any emergency, you need an effective, coordinated
response. That is why I am proud to announce today that on
behalf of Senator Harkin, Senator Jeff Bingaman, who is here
with us, and myself, we are introducing the Federal Obesity
Prevention Act, which will marshal the resources and manpower
of the Federal Government to tackle the obesity problem head
on.
Our piece of legislation creates a Federal interagency task
force to review what the Federal Government is already doing,
coordinate its efforts, and establish a Government-wide
strategy for preventing and reducing obesity. In the near
future, we will be working with Senator Bingaman on other
complementary legislation.
Childhood obesity is a medical emergency of hurricane-like
proportions. We know the storm is coming. We know how strong it
is going to be. We know the havoc it is going to wreak on our
families, our society, and our healthcare system, which is
already strained to the breaking point. It is time we used the
tools to fight it. What is missing is the political will and
leadership to take that fight on.
I am delighted to be joining my friends, Senator Harkin and
Senator Bingaman, who have championed these issues for many,
many years to do just that. I also want to thank the Ranking
Member, Senator Alexander, who has also been very concerned
about these issues.
I also want to take a moment to recognize my staff
director, by the way, on this subcommittee. Is she here? There
you are, right behind me. Hiding behind me. MaryEllen McGuire.
For many years, she has helped make this subcommittee work, and
this is the last hearing that she will be with us.
I couldn't let this moment pass without saying a huge thank
you to MaryEllen McGuire. We wish you the very best. And if
they are not nice to you, you come right back home to us, here,
from wherever you are heading off to. But thank you, MaryEllen,
for everything you have done.
With that, let me turn to my colleague from New Mexico,
Senator Bingaman, for any opening comments he has, and then we
will introduce our witnesses and get on with the hearing.
[The prepared statement of Senator Dodd follows:]
Prepared Statement of Senator Dodd
Thank you all for coming. First, allow me to welcome my
colleagues and our distinguished witnesses, and thank them for
being here today to discuss what is now being recognized as a
medical emergency--the childhood obesity epidemic.
Last week, we began our series of hearings on this urgent
problem, and we heard from experts who have concluded our
children's generation may be the first in the modern era to
live shorter, less healthy lives than their parents. We heard
some startling facts. Nearly a third of our Nation's children
are obese or at risk of becoming obese--that's 25 million
children, with those in minority families and poor families at
an even greater risk. We heard about the dramatic increase in
children diagnosed with diseases that were previously only seen
in adults, such as type 2 diabetes, high blood pressure and
high cholesterol. We heard some of the reasons behind the
epidemic--the prevalence of junk food and soda in our schools
and on our televisions, which is a big reason why we consume
more calories per day than ever before. We discussed how
Americans are less active, and how the environment in which our
children are growing up has made it increasingly difficult for
children to be physically active. They can't walk to school
because we don't build safe paths. And even when they're at
school, only 8 percent of middle schools require daily physical
activity. The sad truth is that when it comes to physical
activity, it's much easier for kids to play video games at home
than a game of hide and seek outside with their friends.
And so, it is time to call this what it is--a medical
emergency. We are not talking about a few kids that eat too
many sweets and don't exercise. We are talking about an entire
nation that needs help getting back on the right track. And it
starts with our children. It starts with making sure the public
understands just how much of a threat this obesity epidemic
poses to all of us, whether we have children or not. That is
why in the past week, my wife Jackie and I have been visiting
schools, camps and hospitals throughout Connecticut to raise
the visibility of this problem and help highlight efforts
underway to solve it. We have both been talking about a new
report that says $10 per person per year in proven community-
based programs could save the country more than $16 billion
annually within 5 years. We should be supporting these efforts.
The Institute of Medicine released a report in 2005 that
laid out recommendations and action plans for all sectors of
our society--from government to health care professionals to
schools and families. Yet despite the efforts of some States to
set tougher nutritional standards for school lunches and more
rigid physical activity for students, the Institute also found
``substantial underinvestment of resources to adequately
address the scope of the obesity crisis.'' Others have
highlighted how jumbled and disorganized Federal standards
are--as Senator Harkin has pointed out, USDA regulations allow
children to buy doughnuts and Snickers bars at their school but
not breath mints or cough drops. It makes no sense at all. In
any emergency, you need an effective, coordinated response.
That is why I am proud to announce today on behalf of
Senators Harkin, Bingaman and myself that we are introducing
the ``Federal Obesity Prevention Act'' that will marshal the
resources and manpower of the Federal Government to tackle the
obesity problem head on. Our bill will create a Federal
interagency task force to review what the Federal Government is
already doing, coordinate its efforts, and establish a
government-wide strategy for preventing and reducing obesity.
In the near future we'll be working with Senator Bingaman on
other complimentary legislation.
Childhood Obesity is a medical emergency of hurricane-like
proportions. We know this storm is coming--we know how strong
it is going to be. And we know the havoc it is going to wreak--
on our families, our society and on our healthcare system,
which is already strained to the breaking point. It's time we
use the tools to fight it. What's missing is the political will
and leadership to take that fight on. And so, I am delighted to
be joining my friends Senator Harkin and Senator Bingaman who
have championed these issues for many years, to do just that. I
also want to thank the Ranking Member of the subcommittee,
Senator Alexander, who also has a very real concern about these
issues. And with that, I would like to turn this over to my
colleague for his opening statement.
Senator Dodd. Senator Bingaman
Statement of Senator Bingaman
Senator Bingaman. Senator Dodd, thank you for your
leadership on this very important issue.
There are an awful lot of issues competing for attention
around the Congress at all times, and there are just a limited
number of days and hours and hearings that can be held. The
fact that you have devoted two hearings in the last week or so
to this subject is a real sign of commitment on your part; as
is the legislation that you referred to and are introducing
today. I am honored to join you as a co-sponsor.
The issue is a real one, and I see it all around my State
and hear about it from educators, from healthcare
professionals, and from parents. It is a serious problem that
we need to address. We are not doing right by the young people
in this country by leaving the issue unattended.
I very much appreciate what you are trying to do, and I
would just point out something that is fairly obvious, I am
sure, to you and to most people, and that is that the problem
afflicts particular segments of our population more than
others. In my State, we have a large Native-American
population. The percentage of Native-American high school
students who are overweight or obese is substantially higher
than in the rest of our State.
This is a result of a variety of factors, some of which you
referred to, but this hearing, as I understand it, is to focus
on solutions.
Senator Dodd. Right.
Senator Bingaman. That is exactly why I came, to try to
hear from our experts about what they think we can do.
So, thank you.
Senator Dodd. Thank you, Senator, very, very much.
Let me take a couple of minutes to introduce our witnesses
and thank them again for being with us.
Dr. Joseph Thompson has many titles that speaks volumes
about your expertise and your background. Dr. Thompson has
served as the first-ever surgeon general of the State of
Arkansas. He has had that post for the last 3 years, I believe.
He is also director of the Robert Wood Johnson Foundation
Center to Prevent Childhood Obesity and director of the
Arkansas Center for Health Improvement.
He is an associate professor of pediatrics in the College
of Medicine and Public Health at the University of Arkansas for
Medical Sciences. Board-certified in both pediatrics and
preventive medicine, Dr. Thompson practices as a hospital
generalist at the Arkansas Children's Hospital in Little Rock.
Doctor, we thank you very, very much for being with us.
Jonathan Miller, we are delighted you are here. You are a
brave and courageous soul to come before a congressional
committee, but we are very honored by your willingness to do
this. I want to extend our thanks to you, for sharing your
personal story with us. It takes a lot of courage to come into
a public setting and share a personal story.
But it is a very successful one and a courageous one, and
so we hope you will offer a lot of inspiration to others out
there who wonder at how hard it is to do this and whether or
not it can be done at all. So we thank you very, very much for
being with us.
Jonathan participated in a nutrition and physical activity
program offered by a school-based health center at his high
school, and this program helped him to be successful at losing
weight and adopting a far healthier lifestyle. I congratulate
you on your tremendous success. Again, thanks for coming
forward.
Jonathan is from--am I going to pronounce this right?--
Ypsilanti? Ypsilanti, MI, and is now in college. We thank you
again.
Phil Dwyer is from my home State of Connecticut, and one of
my favorite uncles was Phil Dwyer. So not this Phil Dwyer, but
a Phil Dwyer from Mansfield, CT.
Anyway, I am pleased to welcome Phil Dwyer, who is
president and CEO of the Central Connecticut Coast YMCA, which
is helping people in 25 Connecticut communities to live
healthier lives. He has been with the YMCA for 39 years, where
he has overseen many cross-cutting initiatives that support
children and families.
Currently, he serves as the vice chairman of the
Connecticut State Alliance Public Policy Committee, supporting
public policy efforts to improve health and well-being of young
people in our home State. He is a graduate of Springfield
College and has a master's in government from Lehigh
University. We thank you for your years of service to a
wonderful, wonderful organization.
Susan Neely is with us as well. She is the president and
CEO of the American Beverage Association, the trade association
representing the nonalcoholic beverage industry. Previously,
Ms. Neely was the Assistant Secretary for Public Affairs at the
U.S. Department of Homeland Security.
She has also served as an executive of the Association of
American Medical Colleges and the Health Insurance Association
of America and holds a B.A. degree from Iowa University and
from Drake.
I spent a little bit of time at Iowa University and Drake
over the last year or so. We are interested in hearing about
the work that you are doing, and we thank you as well, Susan,
for joining us today.
What I would like to ask you to do, if you would, is each
take 5 to 7 minutes. Let me inform all of you, as I will say to
my other committee members, that any opening statements,
comments, additional material that you think would be helpful
for the committee to have will be included as part of the
record.
So even if you don't get through all you wanted to share
with us, your full statements and any documentation you think
would be relevant we will include as part of the record. That
goes for members as well.
Dr. Thompson, we will begin with you, if we can, and then
go right down the line as you have been introduced. So, again,
thank you all for being with us.
STATEMENT OF JOSEPH THOMPSON, M.D., MPH, SURGEON GENERAL, STATE
OF ARKANSAS; DIRECTOR, ARKANSAS
CENTER FOR HEALTH IMPROVEMENT, LITTLE ROCK, AR
Dr. Thompson. Thank you, Senator Dodd.
I want to thank Chairman Dodd, Senator Bingaman, the staff,
and the audience for being here, and I want to lend my voice to
your warning siren of what portends on the horizon. I am here,
in addition to being the surgeon general and the leading health
advisor to now Governor Beebe--former Republican Governor
Huckabee used my advice on occasion also. I am here, most
importantly, as a pediatrician and a father of a 16-year-old
girl and a 13-year-old boy, and what is on the horizon is not a
pretty picture.
We have not intentionally drawn the lot that we have. There
is no malice. There is no intent of any organization, any
governmental entity, any family, to get to the point of risk
that we have in this Nation, but we must very intentionally get
out of this or the future portends a very dismal outlook.
We have over a third of our children in the Nation now that
are either obese or overweight. Three decades ago, that number
was 5 percent. The impact on the health consequences we are now
seeing in the clinical arena, where we have adult-onset
diabetes in teenagers, where we have hypertension and cardiac
disease starting in the late teens and 20s, where we are having
leg injuries that we didn't used to see because the weight is
so great on our young people's bones.
These issues are clinical realities. We have measured their
impact, and they are costing the State, through our Medicaid
and State Children's Health Insurance Program, a significant
amount of both utilization cost as well as indirect program
support cost.
As you mentioned, Senator Bingaman, this epidemic cuts
across whole communities, all categories of race, ethnicity,
family income levels, and locales. But it especially hard hits
low-income individuals, minorities in the southern region of
the United States that bears a disproportionate burden of the
obesity risk.
Finally, as we found in our State, the business sector has
a direct interest in this, too, because the healthcare costs
are large--$14 billion estimated to be the impact on the U.S.
healthcare system--but the lost productivity and the future
workforce issues are even greater. The business community has a
vested interest here also.
I won't go over some of the history of how we have gotten
here, except just to highlight. Three decades ago, a kid went
to school after they ate breakfast at home. They had a
nutritious cafeteria meal. They came home in the afternoon,
played outside. They had a home-cooked meal at night. They had
a safe park to play in. They did not have cartoons 24 hours a
day as they do now on cable TV. They didn't have fast food as
readily available.
The products that they ate did not come prepackaged,
prepro-
cessed in cellophane wrappers. We didn't have agricultural
subsidies making corn syrup be excessively inexpensive and,
therefore, having an impact on the food products that families
were offered. Dramatic changes have happened over the last
three decades that have caused us to unintentionally contribute
to this life-threatening epidemic that we are in now.
Our State, 5 years ago, recognized this and undertook the
first and largest major comprehensive strategy to combat
childhood obesity. Passed in 2003, our Act 1220 attempted to
change everything we could think about that could be
contributing to this. Primarily in the school setting--changing
vending options, eliminating vending machines for elementary
school students. Restricting access to vending machines until
after the lunch period.
Changing what was offered in the cafeterias. Educating
cafeteria workers about how to cook nutritious meals. Adding
health education. Adding physical activity requirements in
every grade. Changing the way our Medicaid and our SCHIP
program reimbursed clinicians for support. Supporting community
programs, as you will hear about later, to give after school
program support so the kids didn't go home, lock the door, turn
on the television, and start munching.
Importantly, we measured in every student, kindergarten
through 12th grade, the body mass index so that we have a
baseline in 2003, and we have continued that each year so we
can track progress. We provide to the parent a confidential
health report that says what their child's health risk is.
In 2003, the Centers for Disease Control had said
nationwide 30 percent of children were obese or at risk. The
first time we measured it in our State, it approached 40
percent. So almost 33 percent more than the Nation's burden.
We mobilized our communities. We mobilized our State
government. We mobilized our industry to try to make that
change, and I am confident to say here before you today, as we
announced last year, that we have halted the childhood obesity
epidemic in Arkansas through this multifactorial approach.
But I want to draw to your attention, every level of
government, every sector of industry has a responsibility here.
Most control of local development ordinances and so forth are
at the local community level. States have an incredible amount
of influence on State Medicaid and SCHIP programs and on
educational rules and regulations, but there are some specific
issues where we need help from the Federal Government.
First, we need to address the child nutrition and WIC bills
that are coming up before the Department of Agriculture to make
sure that they are reinforcing good nutrition and that we are
supplying, through federally funded programs that States
administer--school breakfast programs, school lunch programs,
summer programs--support for nutrition. We need increased
reimbursement rates for school meals. We need help for schools
to make stronger nutrition statements.
In the schools, the reauthorization of No Child Left Behind
represents an opportunity. Currently, there are no physical
performance standards in No Child Left Behind. It is all
focused on academic performance. What gets sacrificed is
physical education, physical activity time during the school
day. We send a mixed message to our student when we don't
provide them an environment.
The reauthorization of the transportation bill. We have
done an excellent job building highways and ways to transport
people in motorized vehicles. We have not adequately addressed
the needs of those who are on bicycles, those who are
pedestrians, those safe routes to schools for kids to be able
to walk to school each day, as they did three decades ago. Now
you have to stand in line behind the row of SUVs to drop your
kid off because it is not safe to walk in the neighborhood.
The television airways that allow the advertising now on
24-hour-a-day channels, 50-some odd in our locale when you have
the basic package, are filled with advertising for recruiting
youngsters, which frequently use the TV of which we have too
many TVs in the bedrooms. These are issues that the Federal
Trade Commission and Congress should work on together to try to
find ways to better protect that home environment from the
penetration of advertising.
You have two Federal agencies, both the Centers for Disease
Control, which is charged in providing support to the amount
their limited resources allow to States for both school and
public health programs, and you have the National Institutes of
Health, which I would ask you to help prioritize research on
how to create more healthful environments and prevent childhood
obesity so that we don't have to pay for the treatment of
childhood obesity and its adult onset of diseases downstream.
We need to support them with the fiscal resources to achieve
this changed goal to promote health, not just treat disease.
I would like to thank you. I am here. The experiences we
have are very similar to the challenges faced by all of the 50
States in the United States and the territories. Our State has
had some luck and leadership available that lets us portend the
future. We have stepped on some land mines that I don't mind
sharing with you, but we have also had some advances that we
didn't expect, and I look forward to sharing that with you
today.
Thank you.
[The prepared statement of Dr. Thompson follows:]
Prepared Statement of Joseph W. Thompson, M.D., MPH
Chairman Dodd, Ranking Member Alexander, Senator Harkin, members of
the subcommittee, thank you for this opportunity to testify about the
No. 1 health threat facing our children today and generations to come--
obesity.
I am Dr. Joe Thompson, a father, a pediatrician, the Surgeon
General of the State of Arkansas and the Director of the Robert Wood
Johnson Foundation Center to Prevent Childhood Obesity.
First, I would like to thank all of you for your dedication to this
issue. The recently enacted Farm bill contains some very promising
provisions to improve our children's nutrition--specifically the
expansion of the Fresh Fruit and Vegetable Program into every State and
the Food Stamp Electronic Benefit Transfer demonstration project that
will automatically give extra benefits to participants who purchase
fruits, vegetables and other healthy foods. All who care about the
future of our children and this country are grateful for your
leadership on this issue.
However, considering the scope of the childhood obesity epidemic,
we must do more.
We did not get here through the malicious actions of industry or
government. But, we must intentionally reverse our path, or our
families, our communities, our States and the Nation will face a future
of deteriorating health, lower worker productivity, and an increasing
need for social services and health care support.
Many have made investments in this issue. The Robert Wood Johnson
Foundation has dedicated $500 million specifically to reverse the
epidemic by 2015, and it is working with nonprofits and communities
across the Nation to support State and local efforts to effect change.
States like Arkansas are making substantive changes not only in their
programs but also in their strategic planning. Industry also has a role
to play, and we are beginning to see both innovative and promising
changes come from that arena. Most important, every level of
government--including Congress--has a responsibility to contribute to a
solution and support communities and States as they strive to prevent
and reverse the childhood obesity epidemic.
It is worth repeating the statistics to help frame the discussion:
Today, almost 32 percent of children and adolescents--more
than 23 million--ages 2 to 19 years are obese or overweight.\1\
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\1\ Ogden C.L., Carroll M.D., Flegal K.M. High Body Mass Index for
Age Among US Children and Adolescents, 2003-2006. Journal of the
American Medical Association 2008;299(20):2401-2405.
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Even more startling are the health consequences that
follow. Obesity increases the risk for type 2 diabetes, hypertension,
osteoarthritis, stroke, certain kinds of cancer and many other
debilitating diseases.\2\
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\2\ Health Consequences. Centers for Disease Control and
Prevention, 2007. Available at www.cdc.gov/nccdphp/dnpa/obesity/
consequences.htm. Accessed 19 Jul 2008.
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The childhood obesity epidemic cuts across all categories
of race, ethnicity, family income and locale, but some populations are
at higher risk than others. Low-income individuals, African-Americans,
Latinos and those living in the southern part of the United States are
impacted more than their peers.
For example, African-American girls are more likely to be
obese or overweight than white and Mexican-American girls. Among
African-American girls, 39 percent are obese or overweight, compared
with 35 percent of Mexican-American girls and 30 percent of white
girls.\1\
Obviously the health consequences are dire, but so are the
health care costs to this Nation. Childhood obesity alone is estimated
to cost $14 billion annually in direct health expenses. Children
covered by Medicaid account for $3 billion of those expenses.\3\
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\3\ Childhood Obesity: Costs, Treatment Patterns, Disparities in
Care, and Prevalent Medical Conditions. Thomson Medstat Research Brief,
2006. Available at www.medstat.com/pdfs/childhood_obesity.pdf. Accessed
19 Jul 2008.
How did we get here? There is no single answer. The dramatic
increase in obesity that both adults and children in the Nation have
experienced over the past three decades is caused by a confluence of
movements, changing influences, daily realities and the economic
climate. Consider some of the macro and micro shifts in our culture and
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daily lives that shape our children's health:
Many supermarkets have moved out of both rural areas and
blighted urban areas, leaving residents without access to healthy,
affordable foods. Food deserts are spreading across the Nation.
Children living in these deserts do not get to eat many fresh fruits
and vegetables, but they are certain to know who Ronald McDonald is.
Similarly, there are recreation deserts, because parks are
much less common in low-income and minority neighborhoods. And even
when they do exist, lack of safety and perceptions about safety are
critical barriers that impact children's ability to play and be active
on a daily basis.
Because of urban sprawl, communities are becoming less and
less livable. Increasingly designed with cars in mind, our
neighborhoods are frequently not walkable or safe places for kids to
play. Consequently, fewer than 15 percent of kids walk or bike to
school, in part because street designs and traffic make it unpractical
and unsafe.
And when kids get to school, they'll find that
requirements in No Child Left Behind to meet annual yearly progress in
reading and math have squeezed out time for recess and physical
education, despite evidence that active kids perform better
academically.\4\
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\4\ Trudeau F, Shephard RJ. Physical education, school physical
activity, school sports and academic performance. International Journal
of Behavioral Nutrition and Physical Activity. 2008;5:10.
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Despite the 2004 Child Nutrition Reauthorization Act
requiring that each school district have a school wellness policy that
addresses physical activity and nutrition standards for foods in
schools, implementation of these policies is far from universal.
Furthermore, in many cases, the relationship between
schools and vending machines presents a conflict of interest. While
many schools have become dependent upon even limited revenue from
vending machines to supplement stretched budgets, we should not be
surprised when this and the next generation of young adults get a non-
nutritious, unhealthy breakfast and lunch from vending machines.
After school, kids spend too much of their time watching
television or playing video games--in fact, 50 percent of all 3-year-
olds have a television in their bedrooms.
Through television, schools and, increasingly, through
digital media, the food industry spends millions of dollars each year
marketing high-calorie foods and beverages that have poor nutritional
value to children and adolescents.
Most schools lock their gates at the end of the day,
preventing students and the broader community from using these public
facilities, that are in every neighborhood, for recreation purposes.
Community-based youth programs, like Little League, that
encourage sports have declined, and they are less available to the low-
income children at highest risk for obesity.
All of these changes have created an environment that makes it
difficult, inconvenient, expensive, dangerous or even impossible for
most families and many children and teens to eat healthy foods and be
active. This will not change if we do not act quickly and deliberately
at the community, State and Federal levels to create healthy
environments where we live, learn, work and play.
Today, I want to talk to you about the success we are having in
Arkansas in halting this epidemic as a result of comprehensive landmark
legislation addressing healthy eating and active living; the type of
resources and support State and local communities need to fight this
epidemic; and evidence-based recommendations on how Congress can help
States and local communities prevent and reverse the childhood obesity
epidemic.
Arkansas is similar to many other southern States--at risk for and
paying the price for poor health. Compared with the Nation as a whole,
we have disproportionately high rates of disease and infant mortality,
low-life expectancy and low-economic status. Like other southern
States, Arkansas is also disproportionately burdened by obesity risks
in both adults and children. Almost one out of every three adults in
Arkansas is obese.\5\
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\5\ Centers for Disease Control and Prevention (CDC). Behavioral
Risk Factor Surveillance System Survey Data. Atlanta, GA: U.S.
Department of Health and Human Services, CDC; 2007. Available at
apps.nccd.cdc.gov/brfss/index.asp. Accessed 12 May 2008.
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However, in many ways Arkansas is different because we do not
accept the status quo and are doing something about childhood obesity.
In 2003 we passed Act 1220, which led to the first and most
comprehensive legislatively mandated childhood obesity prevention
program in the country. We had three goals:
change the environment within which children go to school
and learn health habits every day;
engage the community to support parents and build a system
that encourages health; and
enhance awareness of child and adolescent obesity to
mobilize resources and establish support structures.
Specifically the law included provisions aimed at:
improving access to healthier foods in schools, including
changing access to and contents of vending machines;
establishing physical activity requirements;
creating local parent advisory committees for all schools;
publicly disclosing so-called pouring contracts; and
reporting each student's body mass index (BMI) to his or
her parents in the form of a confidential health report.
As the Director of the Arkansas Center for Health Improvement, I
led the implementation of the BMI assessment program, and I am proud to
say that we have halted the epidemic in Arkansas. It took the work of
the schools, the community, parents, teachers and kids alike to commit
to this system-wide change for the good of their own health and the
future of our State and our country. We changed the environment through
policies and programs that now support a healthier and more active
lifestyle.
When we began measuring our kids' BMIs in school year 2003/2004,
nationally a little less than 34 percent of children ages 2 to 19 were
either overweight or obese.\6\ Based on statewide evaluations of
virtually all public school students in Arkansas, more than 38 percent
of our children and teens were in the two highest weight categories.
However, during the next 3 years (2005-2007) we found that we had
stopped progression of the epidemic--the rate of overweight and obesity
remained virtually unchanged at 38 percent per year.\7\ While the rate
of childhood obesity in Arkansas is still too high, we are encouraged
that our efforts have been successful and that the epidemic has been
halted in our State. Now, we can turn our efforts to reversing the
trend in our State and sharing lessons learned to inform national
efforts.
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\6\ Ogden C.L., Carroll M.D., Curtin L.R., McDowell MA, Tabak CJ,
Flegal KM. Prevalence of overweight and obesity in the United States,
1999-2004. Journal of the American Medical Association
2006;295(13):1549-55.
\7\ Arkansas Center for Health Improvement. Year Four Assessment of
Childhood and Adolescent Obesity in Arkansas (Fall 2006-Spring 2007),
Little Rock, AR: ACHI, September 2007.
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The most recent evaluation by the Fay W. Boozman College of Public
Health at the University of Arkansas for Medical Sciences \8\ shows
that Arkansas's law is working to create a healthier environment in
schools across the State. Some of the key findings of the report
include the following:
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\8\ Fay W. Boozman College of Public Health. Year Four Evaluation:
Arkansas Act 1220 of 2003 to Combat Childhood Obesity. Little Rock, AR:
University of Arkansas for Medical Sciences; 2008. Available at
www.uams.edu/coph/reports/#Obesity. Accessed Jun 30 2008.
The BMI assessments have been accepted and found helpful
by parents--recognition of obesity risk by parents of overweight
children has doubled in the first 3 years.
Sixty-one percent of school districts in Arkansas have
policies requiring nutritious foods be available in vending machines,
up from just 18 percent in 2004.
Twenty-six percent of vending items at schools are in a
healthy category, up from 18 percent four years ago.\1\
Seventy-two percent of students increased their physical
activity, up 10 percent from the previous year's study.
Parents are making efforts to create healthier
environments at home by limiting the time their children spend in front
of a television or video game screen and by encouraging more physical
activity.
Beyond the statistics, the positive impact that our policy changes
are having on individual kids like ``Samantha'' has been one of the
most encouraging success stories. Samantha was 10 years old when a
routine screening at her school showed that she was at serious risk for
obesity. Her mother, who thought Samantha was going through a harmless
phase she'd outgrow, got the message. In addition to embracing changes
made at school, Samantha's family also took steps to improve their
health at home: eating better, reducing TV time and becoming more
physically active. Samantha's BMI percentile dropped, and her weight
classification changed from the highest category to a healthy weight.
She's kept extra weight off and feels better than ever before.
This is what has worked for Arkansas. In order to help other States
model this program and the changes we made in our State, we need to
identify and disseminate best practices. I want to ask the U.S.
Congress for help in sustaining our State-based effort and expanding it
to the Nation.
Beyond what is happening in my home State, there is a real
opportunity for every level of government to play a role in reversing
this epidemic. I will touch on the local and State roles only briefly
and then discuss the areas where I believe Congress can make a real
difference across multiple programs and agencies.
Clearly State and local leadership is key to transforming
communities into healthy, supportive environments. Communities need to
be walkable and livable, and that means we need to make transportation
investments with pedestrians and cyclists in mind. More sidewalks and
bike lanes would make it easier for children to walk to school safely.
We also need to maintain parks and play spaces, and make sure these
areas are safe so parents will feel comfortable letting their children
play outside.
Our cities and urban areas should not be food deserts. We need to
attract supermarkets back to these areas through financial incentives
so residents don't have to make a choice between purchasing healthy
foods or making their rent and paying for gas.
Schools need to be havens of health, not contributors to the
problem. We need to implement school wellness policies, make vending
contracts public, improve the content of school breakfasts and lunches,
and get high-sugar, high-calorie drinks and junk food out of the
vending machines. States can improve physical activity requirements,
provide teacher training and ensure accountability. We need to take a
similar track in the community by expanding and promoting opportunities
for physical activity through capital improvement programs and
planning.
States face challenges, too, and the very real burden of balancing
their budgets every fiscal year. Whether it is transportation,
education, health care, economic development, or critical capital
investments, States work to implement many programs in collaboration
and partnership with the Federal Government and in support of local
communities. We need all levels of government to work together and we
need some changes.
While changes at the community level are essential, there is also a
strong role for the Federal Government to play in reversing this
epidemic, and the upcoming 111th Congress is ripe with opportunity. Not
only is health care reform going to be a top priority in both
chambers--and we cannot have true health care reform without shifting
our focus to prevention--there is a perfect confluence of opportunities
through reauthorization of existing programs that can positively
influence the trajectory of childhood obesity in this country.
Based on the evidence about what works, the Robert Wood Johnson
Foundation has identified five areas for policy change aimed at
increasing physical activity and healthy eating among children and
adolescents, decreasing sedentary behavior and, ultimately, preventing
obesity. They include: providing healthier foods to students at school;
improving the availability of healthy foods in all households;
increasing the frequency, intensity and duration of physical activity
at school; improving access to safe places where children can play; and
limiting screen time.
As Congress looks ahead to these reauthorization bills, your goal
should be to include specific policy pathways, developed from these
evidence-based strategies, in key pieces of legislation.
First, for the reauthorization of the Child Nutrition and Women,
Infants, and Children Program, I recommend the following:
Give the U.S. Department of Agriculture broader authority
to require nutrition standards for all foods and beverages sold during
the school day and regulate the content and sale of competitive foods,
including those sold in vending machines and school stores.
Increase Federal reimbursement rates for school meals to
help offset the rising cost of food.
Help schools meet stronger national nutritional guidelines
by providing grants for upgrades to cafeterias and kitchen facilities
so healthier food may be cooked and served.
Second, Congress is planning to reauthorize the landmark No Child
Left Behind law, which has made important strides in improving academic
achievement in this country and has the noble goal of all ensuring all
students have access to high-quality education regardless of their
socioeconomic status.
I recognize the critical importance of academic achievement, but I
also embrace recent studies that have shown the active child is the
child more ready to learn and may have greater academic success. At the
very least, we know that taking time out for physical education does
not negatively impact academic success. You do not have to sacrifice
children's health for academic achievement.
As Congress considers this important reauthorization, you should
incorporate a physical fitness index or physical education quality
score in school performance ratings. Schools do not have to require
physical education, but rather could establish a performance indicator
that places physical health on the map with academic achievement.
I've never heard a mom say she wanted an educated, unhealthy child
OR a healthy, uneducated child--she wants both for her child. We can do
this by making achievement goals within No Child Left Behind work
together.
Third, Congress has the opportunity to reauthorize the Federal
surface transportation bill, known as SAFETEA-LU. While this bill is
typically thought of as a highway funding bill, Congress should
recognize the even larger scope of the bill, which impacts
opportunities for regular physical activity. Specifically, Congress
should:
Ensure that children can walk and bicycle safely to school
by increasing funding for the Safe Routes to School programs.
Implement Complete Streets that are designed and operated
to enable the safe and convenient travel of all users of the roadway,
including pedestrians, bicyclists, users of public transit, motorists,
children, the elderly and people with disabilities.
Provide incentives to use transportation funds linked with
land use decisions that create walkable and bikeable communities where
people can get where they need go to without having to drive.
Finally, as Congress debates the reauthorization of the children's
health bill, you should include obesity as a treatable condition in the
State Children's Health Insurance Program (SCHIP) reauthorization and
Medicaid rules and regulations, which would establish childhood obesity
as a precursor to adult obesity-related conditions that threaten
individual life expectancy and the vitality of our workforce. Neither
Medicaid nor most private insurance plans provide coverage for obesity-
related services. Thus, these benefits may not be part of the plans
from which SCHIP coverage is developed. To more effectively address
rising childhood obesity rates, obesity needs to be considered not just
a risk factor, but a condition that requires medical attention.
In addition to the reauthorization of these major laws, Congress
has the opportunity to help shore up program and research funding at
the U.S. Centers for Disease Control and Prevention (CDC) and the
National Institutes of Health (NIH) during the annual appropriations
process. Specifically, Congress should fully fund and increase funding
for the CDC's Division of Nutrition, Physical Activity and Obesity,
which provides grants to States for obesity control and prevention.
Currently only half of the States are receiving such funding, putting
unfunded States at a substantive disadvantage and their children at
dire risk. In addition, I encourage you to charge NIH to prioritize
research on how to create more healthful environments that help prevent
childhood obesity and support them with fiscal resources to achieve
this goal.
The Federal Trade Commission, the Federal Communications Commission
and Congress should work together with the food and beverage industry
to develop a new set of rules governing the marketing of food and
beverages to children. The new rules should apply to all children and
adolescents and account for the full spectrum of advertising and
marketing practices across all media. If voluntary efforts are
unsuccessful in shifting the emphasis away from advertising high-
calorie and low-nutrient foods and beverages to advertising of
healthful foods and beverages, Congress should enact legislation
mandating the shift on both broadcast and cable TV. Congress could also
act to require warnings on all non-nutritious food and beverage
advertisements.
This list of recommendations is not exhaustive, but I hope it will
serve as a good springboard for Congress to consider as you make a
commitment to preventing childhood obesity. I would also point your
attention to the comprehensive recommendations made by the Institute of
Medicine in a series of reports it has authored on this critically
important issue. \9\ \10\ \11\ \12\
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\9\ Committee on Prevention of Obesity in Children and Youth.
Preventing Childhood Obesity: Health in the Balance. JP Koplan, CT
Liverman, VA Kraak (eds).Washington, DC: The National Academies Press;
2005.
\10\ Committee on Progress in Preventing Childhood Obesity.
Progress in Preventing Childhood Obesity: How Do We Measure Up?
Washington, DC: National Academies Press; Sept 2006.
\11\ Committee on Food Marketing and the Diets of Children and
Youth. Food Marketing to Children and Youth: Threat or Opportunity. JM
McGinnis, JA Gootman, V. Kraak (eds). Washington, DC: National
Academies Press, 2006.
\12\ Committee on Nutrition Standards for Foods in Schools.
Nutrition Standards for Foods in Schools: Leading the Way Toward
Healthier Youth. VA Stallings AL Yaktine (eds). Washington, DC:
National Academies Press, 2007.
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One thing is certain: There has never been a more clear set of
opportunities for Congress to make a difference across multiple
programs to support States and assist communities across the Nation
than right now. As I suggested, small changes to these laws and
programs can stimulate and reinforce huge changes under way at the
State and local levels.
Failure to make these changes will continue to contribute to a
toxic environment that unwittingly reinforces poor nutrition and
sedentary lifestyles and exacerbates health conditions that threaten
the future of our children and our Nation.
As a nation, we did not intentionally choose this course, but we
must intentionally and immediately work to reverse it.
Speaking for all States, we look forward to working with you, but
we need your help and we need it now. Thank you.
Senator Dodd. Thank you, Doctor. Congratulations on what
you have been able to achieve in Arkansas. Where was Arkansas
on that list, by the way, in terms of States? Do you have any
idea? Do you recall where it was when you started?
Dr. Thompson. Arkansas is always in the bottom tier of
States with respect to health issues. We are frequently in the
bottom tier of States as linked to economic issues. Income and
health go hand-in-hand. So, currently, Governor Beebe is
critically targeted on economic development and ways to raise
the family incomes. But he recognizes that we have got to have
an educated, healthy workforce or we are not going to be able
to support industry.
This is actually a new marriage between the industry and
the health communities that we have not had before. Very
powerful, very future-oriented, but critically important for
the health of not only our communities and our State, but I
believe the Nation, too.
Senator Dodd. Well, thanks very much.
Jonathan, we thank you for being here. You have got a good
story to tell, so we are all anxious to hear what you have to
say.
STATEMENT OF JONATHAN MILLER, HEALTHPLACE PARTICIPANT
REPRESENTATIVE, UNIVERSITY OF MICHIGAN, REGIONAL ALLIANCE FOR
HEALTHY SCHOOLS (RAHS), YPSILANTI, MI
Mr. Miller. Thank you for having me here.
Good afternoon, everyone. My name is Jonathan Miller. I am
currently a college student exploring my options. Two years
ago, my life was very different. I weighed 385 pounds. I was
quiet. I never thought about my weight or the risk or dangers
of being obese.
I remember one day in class, I actually had to sit in the
back of the room because I couldn't fit in the desk. It didn't
really faze me until one day actually I found out through my
high school, which was Stone High School in Ann Arbor, MI, that
there was a nutrition and physical activity group brought to us
by HealthPlace 101, which is a school-based health center.
After finding out about that, I decided to sign up for the
group. It turned out the group was separated into two different
categories. There was an individual meeting, where you actually
met with a dietician who worked for the school-based health
center. Basically, with the dietician, I would set my own
personal goals, whether it would be to exercise 20, 30 minutes
3 days a week or to make a small change in my diet, my eating
habits.
The one switch that I remember making was switching from
drinking so much soda to drinking water and milk. That had a
profound change in my life. I ended up losing somewhere around
90 to 100 pounds within a year and a half of taking that
program. I remember graduating and finding out that I weighed
295 pounds.
The second part of the group actually consisted of a group
meeting, where we would actually take exercise classes that
would consist of two classes within a week. We would meet
during the school day. We would actually have to take one
period of class off, but we would talk to our teachers and get
the OK with that.
So the exercise classes actually had a variety of choices
to choose from. We had Pilates. We had yoga, aerobics,
kickboxing, and belly dancing. I know, a variety. Yes.
[Laughter.]
Mr. Miller. I actually ended up taking classes that I never
thought I would take. I ended up taking a yoga class, and that
is something I never thought I would do, and that ended up
becoming the saving grace for me personally.
I remember there was a wonderful amount of peer support
within the nutrition and physical activity group at my high
school. We would basically just support each other because the
whole challenge of taking on losing weight is not an easy
battle to take on, and any support you can get is amazing and
needed, and we need more support every time we take on this
challenge.
Another thing that the nutrition and physical activity
group at my high school also provided me with was actually a
scholarship to my local YMCA in Ann Arbor, which provided me
with the teen scholarship that paid for my entire membership
for an entire year.
I remember spending many, many miles, walking many miles on
the treadmill there, which was a great thing for me because it
gave me a place to exercise outside of school, because the only
place I could exercise was school. Thanks to having the
scholarship to the local YMCA, it gave me a second place to go
to when I was outside of school.
Another thing that really helped for me with the nutrition
group was the fact that it was in school. The fact that I had a
nutrition group that I could go to--my second home away from
home, which was my high school--was the most important thing
for me because had it not been for the school-based nutrition
health center, I honestly don't know where I would be in the
whole battle of losing weight.
I am really thankful and appreciative for the fact that
this started in my school, and I knew there was a place that I
could go to to talk about any problems that I was dealing with,
whether they were personal or just trying to find ways to
actually press on with my goals and actually achieve them,
whether it be exercising 20 to 30 minutes 3 days a week or just
changing my eating habits.
For me, that was the best thing because I had the mindset
that in order to lose weight, one would have to take extreme
measures, which would basically be shakes, pills, bars,
exercise equipment that you would see on infomercials on TV. To
actually see that there was another way to do this and it
didn't take so much energy or so much thought process because,
I mean, let us be honest, being a high school student, you want
to use the least thought process as usual because you are
already doing it on a daily basis to get your classwork done.
So anything that deals with thinking and losing weight at the
same time, you usually want to avoid.
[Laughter.]
Mr. Miller. So to see that I could actually lose weight
without thinking so much about making sure I was eating the
right thing every single day or I was taking a particular pill
or making sure I was using this equipment 5 days a week or
anything of that nature was an amazing thing for me personally.
Today, I am still practicing these things that I have
learned from the nutrition and physical activity group. I still
exercise. I actually exercise more than 3 days a week. I
actually exercise around 4 to 5 days a week.
I still watch what I eat. Today, I have been successful in
losing weight. I have actually lost a total of 137 pounds,
which I am very proud of. So I am just very appreciative of the
fact that I had a school-based health center that helped me,
personally, lose weight.
So I am very thankful that I am here to tell my story. I am
honored to speak to your committee about this, but it is not
just my story. It is a lot of people's stories, sadly, and I am
very concerned about what is going to happen to my generation
if this problem is not addressed. This generation has to break
the cycle of childhood obesity, but we can't do it alone.
Thank you.
[The prepared statement of Mr. Miller follows:]
Prepared Statement of Jonathan Miller
Good afternoon. My name is Jonathan Miller. I am currently a
college student exploring my options. Two years ago, my life was very
different. At 385 lbs, I was quiet, I never thought about my weight,
the risks or dangers of obesity. Nor did I see the potential risk to my
health. I remember in one class I had to sit in the back of the room on
a bench, because I couldn't fit in the desk. I was living in a cycle I
did not know how to break.
Today, I am self confident and outgoing. So far, I have lost 137
lbs. I have more choices now. I can go to an event and not worry about
fitting in the seats; I can buy clothes at more than one store. I have
broken the cycle of obesity, but I did not do it alone.
Two years ago, when I was a senior at Stone High School in Ann
Arbor, MI, I signed up for the nutrition group on a dare with a friend.
The Nutrition and Physical Activity Program was offered by HealthPlace.
HealthPlace is the school-based health center. I remember being weighed
before the group began and told that I weighed more than the scale
could actually measure. The scale could only go up to 350 lbs. I was
shocked, surprised and scared.
The program consisted of weekly group meetings and 2 exercise
classes every week. There were a variety of exercise classes. From
Pilates to yoga, kickboxing aerobics and belly dancing, we had many
options to choose from. These were activities I had never thought I
would try, and the next thing I knew, I was taking a yoga class! Having
the class in the school, at the SBHC, made a big difference. While I
had to make adjustments with my classes and assignments, I found that I
was more energetic and willing to do the work. Having more energy and
using the endorphin rush from the exercise made me more productive and
the day more enjoyable. As we all know, it's easy to do things when you
feel good.
The group meetings provided peer support. We could discuss
nutrition, try new foods, and explore our personal strengths.
HealthPlace is a place of trust, where I felt safe enough to delve into
uncomfortable issues. Having this resource available in the school was
instrumental--it was a vital first step in getting me to understand the
health implications of my weight. We also discussed different community
exercise options. In fact, based on this information, I applied for and
received a scholarship from the local YMCA. This scholarship provided
me with a teen membership which allowed me to use the YMCA for
exercise. I spent many miles on the treadmill.
I stayed with the nutrition group for the entire year and also
started meeting individually with staff at the SBHC for nutrition
counseling. This one-on-one counseling helped me track my progress.
Personally, weighing in only once a month or every other month was most
helpful, because I didn't want to become obsessed with weighing myself.
I wanted to feel the difference in my being--my body and my health. The
counseling also helped with teaching me about the principle of ``small
changes.'' I used to believe in order to lose weight, one would have to
take extreme measures (for example; extreme dieting, exercise machines
from TV commercials, shakes, pills, and things of that nature). These
are also known as quick fixes. Instead, I learned a metaphor for taking
life one step at a time. I made my first change by switching from soda
to water, without changing everything in my diet. Later, I started
bringing my own lunches to school; this was my own way of practicing
portion control.
I am still practicing these main exercise and nutrition principles
today. I continue to make small changes towards a healthier lifestyle.
I am more loving to myself. I am not criticizing myself as often as I
used to. When I make choices, I think about what will take me in a
positive direction, instead of a negative one. I've learned I have the
power to make good things happen. Thanks to HealthPlace I realized the
amazing potential that was in me this entire time.
Thank you for having me here to tell my story. I am honored to
speak to your committee. But it's not just my story; I'm very concerned
about what's going to happen to my generation if this problem is not
addressed. This generation must break the cycle of childhood obesity,
but we can't do it alone. If every student had access to a SBHC, like I
did, they too could have a safe place to begin this life
transformation. I was able to address my nutrition and the mental
barriers to losing weight simultaneously. I'm not sure I could have
been as successful in my efforts without having these services offered
in the same place, where I spend the majority of my time--at school.
Thank you.
Senator Dodd. Thank you very, very much. Eloquent
testimony. Great job. We're very proud of you, thanks.
Mr. Dwyer, thank you.
STATEMENT OF PHILIP J. DWYER, PRESIDENT AND CEO, CENTRAL
CONNECTICUT COAST YMCA, NEW HAVEN, CT
Mr. Dwyer. Senator Dodd, Senator Bingaman, thank you for
inviting me.
I will tell you that I am honored, after 39 years of
working for the YMCA and trying to put into practical solutions
the ideas that people might have and have programs that people
will participate in and make healthy choices for themselves,
the YMCA for 160 years--I have only served a portion of that
time--has tried to have kids and families grow up and have
healthy, strong lives, and we work very hard to accomplish
that.
We believe in three things. One is that every child should
have access to healthy eating, and we offer programs to try and
encourage that. Every child should have 60 minutes of daily
physical activity. Yes, physical activity and physical
education classes are being pushed out of the school day.
But as a school board member, there was a time when we put
in the requirement for graduation of community service. But we
allowed that community service to be made outside the school
hours at different agencies around town.
The same concept would work for physical activity being a
requirement of graduation, but be more flexible in how children
can attain those hours of physical activity because time is
precious during a school day. Yet on their own freedom of how
they accomplish that, they could accomplish that during
nonschool hours as well. If you made it a part of graduation
requirements, just allow more flexibility as to how they
accomplish it.
And third, we believe that children need a supportive
relationship with a caring adult in order to accomplish their
pursuit of physical and health throughout their life. We call
people ``health seekers'' that come into the YMCA. They are
people who want to be healthy. They try to be healthy, but
often society gets in their way. The way in which we live our
lives, the way in which we build our streets make it more
difficult.
I know with my own two children going through school that
the requirements to get this AP course and that AP course
suddenly pushed lunch out of the day, and they would eat their
sandwiches during some class. As a society, we are not making
it possible as much as we could to support and have an
environment that allows people to be healthy.
Through the YMCA, we are trying to do two things. One is to
look inward. Look internally and say how do we change the way
we are doing things? We talk about health, and then we have a
staff meeting with donuts. That doesn't make sense. I think
that is true in every institution. What are you doing
internally to change the message to your staff and the people
who you serve?
We have been fortunate as a YMCA to be a pioneering
healthier community YMCA, and so the YMCAs across the country
are also trying to be facilitators of groups in our local
communities who want to engage on this issue. They just need a
little bit of support and help facilitating themselves.
You just look at the people who are in this room and you
know that there is a groundswell of support, whether it is from
State government or local government, school boards, parents,
citizen groups, traditional institutions, who want to be
engaged on this subject.
Talking about practical solutions, the Pittsburgh YMCAs put
a kiosk in their lobbies at about nine of their branches where
low-income people can come in and order fresh fruit and have it
delivered the next day at a savings of about 40 percent off the
retail price as a way of having access to that.
The Quad Cities--YMCA was able to influence a grocery store
to put in a teaching kitchen to help parents and adults find
that you can cook low-cost healthy meals. Rapid City was able
to convince their leadership that in all new developments, they
put in properly designed streets with sidewalks.
Clearwater, FL, was able to restore physical education in
schools and to require licensed childcare centers to have 30
minutes of physical activity each day.
So there are solutions out there. This is not rocket
scientist work. People want to be healthier, and they need the
support of their local institutions as well as the Federal
Government to help encourage that.
Our grandmothers and our mothers are right. An ounce of
prevention is worth a pound of cure. Now, thanks to the Trust
for America's Health, we have the research proof that dollars
spent on prevention give a huge return in future costs. If we
think that the costs of medical services today are taking too
much of our Federal and State budgets, can you imagine what
will happen if we do not address this problem today? Forty
years from now, we will not be able to sustain the cost
increase.
Back in college, I took a health course, and some professor
said, ``So what is health?'' The answer from one of the
students in the back--I wasn't smart enough to give this
answer--was ``freedom.'' Think of the costs that chronic
diseases bring to a family, to a community and the lack of
freedom they have, therefore, as a family or individuals or
whole communities to do different things.
This is a real crisis that we need to address. Clearly,
continuing to support the community health and Steps Program.
Clearly, continuing to help support the 21st Century Community
Learning Centers Program. Our Y offers that at elementary
schools, but also two high schools, and it is a vital way for
us to interact with kids.
At the end of the day, it is working with teens and youth
as ambassadors to their fellow teens in telling the story that
health is important and health is vital. Therefore, improving
their nutrition and increasing their physical activity will
have payback for a long, long time to come.
I want to thank you for inviting me here. I will tell you
that not only at YMCAs, but at not-for-profit institutions
throughout this country, we are looking for leadership to bring
us all together so that we can share the solutions that we
found, see what works, see what doesn't work and where it
works, in what kind of community.
We are anxious for that leadership. The Y is able to give
that leadership in some respects, but at the same time, we need
firm support from the Federal Government.
Thank you.
[The prepared statement of Mr. Dwyer follows:]
Prepared Statement of Philip J. Dwyer
i. introduction
Chairman Dodd, Ranking Member Alexander and members of the
subcommittee, good afternoon. My name is Philip J. Dwyer, President/CEO
of the Central Connecticut Coast YMCA. I led my first fitness class as
a YMCA youth volunteer and for the past 39 years I have been a YMCA
professional. Today I'm honored to speak on behalf of my local YMCA,
but also as a representative of the more than 2,600 YMCAs across the
country who for nearly 160 years have been dedicated to the health of
youth and families in America. All are welcome at their neighborhood
YMCA, regardless of age, race, sex, faith, background, ability or
income. Thank you for giving me this opportunity to share some
practical solutions to the obesity epidemic among youth. While my focus
is on efforts of the YMCA and our many community-based partnerships,
there are many government entities, foundations, and private
institutions dedicated to reversing our current youth obesity trends
and today we are seeking leadership from the Federal Government.
ii. nationally: overview of america's 2,686 ymcas
America's 2,686 YMCAs, at more than 10,000 sites, serve 21 million
people each year--more than half of which are children. From cities to
small towns YMCAs serve nearly 10 million children by building healthy
spirit, mind and body for all. We believe that the lifestyle health
crisis--including childhood obesity is a defining issue of this next
generation. Few organizations are in a better position than the YMCA to
support change in children and their families. We have the knowledge,
expertise, network and reach to succeed. At my local YMCA in Central
Connecticut we serve 71,000 people each year and 40,000 children and
youth.
How YMCAs Serve Children
The YMCA movement believes that all of our support to children and
youth must be based on three foundational pillars: (1) All children
must have access to healthy eating; (2) All children must engage in
physical activity--preferably 60 minutes each day; and (3) All children
must have strong relationships that support them in their pursuit of a
healthy life. It is on these three pillars--and a fundamental belief
that children are exposed to healthy living in a developmentally
appropriate manner that emphasizes fun and play--letting kids be kids--
that we base our myriad of programs and other opportunities.
Children: YMCAs serve nearly 10 million children age 17
and under through a variety of activities all of which focus on
building healthy spirit, mind and body for all. Nationally, 32 million
children live within 3 miles of a YMCA. Almost 70 million households
are within 3 miles of a YMCA. In Connecticut, my YMCA serves 40,000
children and youth which is one out of every six children in our
service area.
Serving Children and Youth: Programs focused specifically
on children and youth who are being challenged with overweight issues
at YMCAs grew by almost 50 percent during 2005 and 2006, and programs
for overweight adults jumped almost 70 percent. Nutrition programs
increased almost 30 percent, and weight management programs increased
165 percent. Broader community health and well-being coalitions grew 30
percent.
Camps: YMCAs are the largest provider of camps in the
United States.
Child Care: YMCAs are the Nation 's largest non-profit
provider of child care, with nearly 10,000 child care sites across the
country.
Youth Sports: YMCAs are the Nation 's largest non-profit
provider of youth sports.
Collaborations with Schools: Most YMCAs collaborate with
their local schools to improve physical activity and nutrition for
children and provide afterschool child care. In 2006, YMCAs
collaborated with 1,746 elementary schools, 1,363 high schools, 1,379
middle schools, 966 colleges, 866 home school programs and 447 charter
schools.
All YMCA programs are offered to and accessible to all,
regardless of ability to pay. YMCAs work hard day in and day out to
ensure no child is left out due to the families' inability to pay.
YMCA's Answer to the Health Crisis: ``Activate America''
Activate America is the YMCA's response to our Nation 's growing
health crisis. With Activate America, the YMCA is redefining itself and
engaging communities across the country to provide better opportunities
for people of all ages in their pursuit of health and well-being in
spirit, mind and body. YMCAs are changing the way they work inside
their facilities to make them more supportive for people who need help
adopting and maintaining a healthier lifestyle, and they are moving
outside of their facilities to act as a catalyst to improve community
health. YMCA Healthy Kids Day is the Nation 's largest event designed
to support the healthy living for kids and families.
For the last few years, the YMCA has incorporated the vision
reflected in Activate America into more and more aspects of our work.
For example, we're transforming YMCA child care sites into environments
where our three pillars of success--(1) physical activity, (2) healthy
eating and (3) relationship building--are the norm. As you will see
later, these three pillars of our evidence-based methods are integral
to what we are doing in Connecticut as well as what we are doing in
YMCAs across the Nation.
Academic Partners
To ensure that the YMCA's work is grounded in the latest science,
YMCA of the USA has worked with academic partners on Activate America.
Harvard University School of Public Health has helped YMCA of the USA
better understand how to design assessment tools for measuring healthy
eating and physical activity across all YMCA sites and programs.
Stanford University School of Medicine's Prevention Research Center has
provided expertise on several important projects, including two
assessments--one that allows communities to assess how supportive their
environments are for healthy living and one that allows individuals to
assess their own lifestyle behaviors and risk factors. These and other
academic partnerships will allow YMCAs to spread evidence-based best
practices nationwide.
Community Collaboration
Some of the greatest lessons in successfully addressing childhood
obesity have come from our community-based partnerships. At the YMCA,
there are three programs that have the same goals and similar
strategies funded by the Centers for Disease Control and Prevention--we
like to refer to them as our ``Healthy Communities'' initiatives--
Pioneering Healthier Communities, Steps to a Healthier US and ACHIEVE--
all focus on collaborative engagement with community leaders, how
environments influence health and well-being, and the role public
policy plays in sustaining change. A total of 116 communities across
the Nation participate in these initiatives and 20 new communities will
be launched later this month.
Our signature program, Pioneering Healthier Communities, or PHC for
short, is led by our National Chairman, Senator Tom Harkin, a member of
this committee. Through Pioneering Healthier Communities, YMCAs in 64
selected communities across the country have convened teams represented
by key community stakeholders (including hospitals, public health
departments, schools, local businesses, public officials and
foundations) to develop strategies, including policy and environmental
change approaches, that reduce barriers and increase support for
healthy living in local communities. Twenty new PHC communities will be
launched this year. I will explore some of our success on this in
Connecticut and then describe other successes nationwide.
iii. how the central connecticut coast ymca works locally on this issue
More Than Eating Less and Exercising More
The YMCA has learned that the majority of kids and families need
support in achieving their health and well-being goals. We call these
individuals ``health seekers''--they want to improve, but making
everyday healthy choices to be healthy and live well is frequently a
struggle, even when it has obvious advantages. Health Seekers, whether
children or adult are different from the ``already active''--those who
have and will stay active. Convincing Health Seekers to adopt healthier
lifestyles, even when it has obvious advantages, is often difficult.
Changing lifestyles of youth and families requires a lengthy period,
sometimes many years, from the time new ideas are first presented to
the time they are widely adopted.
For the ``health seekers,'' this journey to better health is
strengthened when they have supportive relationships and environments
that allow them to make more consistent healthy choices. This is what
the YMCA does everyday--provides the knowledge and supports that
encourage healthy living by allowing kids and families to find the joy
in living healthy lives through the support of family, friends, and the
community at large. More kids and families need these supports. This
epidemic of youth obesity will only be addressed by teaching and
persuading youth that increased physical activity and improved
nutrition is in their best interest. Helping them make this decision
and then implementing it over a lifetime and confirming the benefits of
this changed behavior. And this journey will only happen through
relationship building.
Therefore, the key question for this committee, our society and
especially for those of us committed to tackling the youth obesity
issue: How do we provide more supports and healthier environments to
speed up the rate in which youth and families begin to make everyday
healthy choices and begin living healthier lives?
From our work in Connecticut, I can tell you that the solution is
more than just telling kids to eat less and exercise more. Yes, people
are responsible for their own behavior but too often society creates
barriers, or at the least does not provide enough support, to help kids
and families realize their health goals. So, at our YMCA we sought out
community partners and created the Central Connecticut Coast Pioneering
Healthy Communities Team and together we have agreed to lead our
communities' journey to wellness by changing the behaviors and
environment impacting active lifestyles and healthy nutrition. We set
three goals:
The Food Systems Vision: The Central Connecticut Coast
(CCC) PHC Team works with partners to empower children and people who
care about children within our service area to adopt healthier eating
habits and improved nutrition, through nutrition education and access
to wholesome foods.
The Built Environment Vision: The CCC PHC works with the
Connecticut Governor's office and other regional partners to increase
physical activity among youth, families and adults through increased
use of the outdoors including: local, regional and State park systems,
YMCA facilities, and school physical education programs to insure
people engage in the recommended amount on a daily basis.
The Live, Work, Play Vision: The CCC PHC Team works with local
community agencies to advocate for equitable policies and resources to
improve access related to both nutrition education and opportunities
for physical activity among children and their families. We need to
remember there are many in our communities for whom healthy living may
not even be a choice. Whether it be ``food deserts'' (lack of access to
healthy food options), unsafe neighborhoods (where physical activity
may not be an option), or decreased ``walkability'' (where zoning laws
and the built environment discourage rather than encourage physical
activity), the YMCA insists we must also address these barriers.
Furthermore, research shows there is a correlation between lower income
and increased risk of obesity. Being that 1,518 YMCAs serve communities
where the median family income is below the U.S. average, we know we
have a unique opportunity, and responsibility, to address these
environmental barriers that cause health disparities.
So, what have we done by becoming involved in Activate America
through our Pioneering Healthier Communities initiative, with help from
CDC Funding and our own resources? We gathered together a team of
individuals interested in this issue from a local hospital, the New
Haven-based Family Health Alliance, officials from the Fairfield and
Milford Health Departments, a State representative, and local YMCA
volunteers started to talk about the issue and seek practical
solutions. All of our programs help youth go through the cycle of
adapting behaviors--teach, persuade, decide, implement and confirm. Let
me describe some of them:
First is to Teach
Milford PHC Team: Immediately following participation in
the YMCA of the USA's Washington, DC, PHC Conference, Dr. Dennis
McBride, Director of Public Health for the city of Milford, recommended
that the Mayor form a new committee comprised of community leaders to
``identify practical and sustainable solutions and tools for healthier
living within the city of Milford.'' The PHC initiative through
education, information, tools, resources, and access to best practices
has given them a belief that their small efforts will grow as the
combined PHC Team identifies best practices for adoption and potential
funding sources for program expansion. The idea of advocating with the
Milford Oyster Festival to include healthy food options came from these
PHC Team discussions. To date the Milford PHC Team has initiated a
Walking School Bus program at one elementary school and established a
``Friday is Fruit Day'' at three elementary schools. Their goal is to
expand both programs.
Friday is Fruit Day in Milford: In partnership with the
Milford board of Health and the public school system we are insuring
fruit is available every Friday. Our goal is to provide an environment
that encourages healthy eating.
Walking School Bus: In partnership with the Milford Board
of Health and local elementary schools we have created one Walking
School Bus system and are working on a second, in which parent
volunteers ``pick up'' children along a route and provide a safe and
secure pathway to school--while encouraging increased physical activity
for children.
Second is to Persuade: Healthier Lifestyles is in Their Best Interest
and Compatible With Their Values
Parks & Recreation--CAS, YMCA alliance: The Connecticut
State Alliance of YMCAs gathered the leadership of the Parks and
Recreation Associations and the Connecticut Alliance of Schools to
discuss how they can work together. One innovative idea being discussed
is to allow youth to get school credit for participating in physical
education activities in community agency-based settings. The school day
has focused on academic-only classes to improve test scores--forcing
physical education and arts out of the curriculum in many schools. That
trend will continue and so schools should be given incentives to meet
national standards of physical education and should be encouraged to
allow those standards to be met through community-based settings like
the YMCA and local parks.
Healthy Family Home Starter Kits will be distributed in
the 2008-2009 school year to middle schools in Bridgeport among 6th
graders to help families support their child's need for increased
activity and improved nutrition. The YMCA's Healthy Family Home is a
new program developed from a partnership between YMCA of the USA and
Eli Lilly and Company, to leverage two of the most powerful forces in
health today--the family home and the proven impact of small, sustained
changes. The starter kit provides families with guidelines and
suggested activities in the following areas, known to reduce the onset
of chronic diseases in later years:
How to insure moderate, fun activity at least a total of
60 minutes a day.
How to engage in vigorous, fun physical activity 3 days a
week with a goal of 20 minutes each day.
Coaching families to serve fruits and vegetables at every
snack and meal.
Coaching families to sit down as a family for 1 meal a
day.
How to involve youth in snack and meal preparation and
clean up every day.
Making water the primary drink option.
How to include a whole grain or protein option with every
snack.
Provide healthy ``unsaturated'' fat foods at meals and
snacks.
Emphasis on moderation, balance and variety in meal
choices.
Third is to Decide: Help Individuals and Families Adopt a Healthier
Lifestyle
Teen Projects, New Haven: Forty agencies in New Haven have
formed a Youth Collaborative to coordinate programs and share
resources. The YMCA is part of this group's leadership so we asked a
group of youth from these agencies to prepare application packages,
invite youth from the 40 agency collaborative to apply for a mini-
grant, evaluate the submitted proposals and choose four activities
presented by the:
Family Learning Center will operate a Healthy Hearts
Club that will engage youth ages 5-14 in physical activities
such as dance, yoga and Tae Kwon Do. Youth will be encouraged
to exercise more every week, create healthy recipes and invent
group games that can be taught to other kids on how to stay and
play healthy all the time.
Casa Latina, Youth as Leaders Program will initiate
an activity this fall called Mission Nutrition. A youth cooking
club will teach children how to prepare and cook easy, healthy
meals for both themselves and their families that are low cost,
nutritious and tasty. A cookbook of healthy meals will be
distributed to families engaged in the program and to other
youth agencies in New Haven.
The Consultation Center will engage 30 youth from the
Hill neighborhood to inspire them to be healthier by engaging
in physical activities and advising them on healthy snacks.
Solar Youth, Inc. have engaged 10 youth from the
Westville Public Housing project to introduce them to health
issues through a community service learning model program that
discusses health topics such as exercise, nutrition, hunger and
mental health.
Each of these mini-grants have been designed to help youth groups
address the issues of increasing physical activity and improving
nutrition among teens in New Haven. Youth create the project, they
apply to a youth-led foundation board who award the mini-grants and
then the youth implement the program. We believe that peer to peer
teaching will be more persuasive and lead to a longer term commitment
to healthy lifestyle changes.
Teen Projects, Bridgeport: We implemented a similar
program in Bridgeport. Working with our partner, Work and Learn, a not-
for-profit associated with the local Council of Churches, we recruited
a group of 25 middle school-aged youth, considered at risk and living
in the east side and east end of Bridgeport, to prepare application
packages, invite 11 elementary schools serving their neighborhoods to
apply for a mini-grant and evaluate the proposals. They chose the
programs presented by Beardsley and Barnum schools. Barnum School youth
will create a community garden and will combine this activity with
classroom education about the value of nutritional fruits and
vegetables that can be grown in their garden. The Beardsley School
fifth grade class will engage in an assessment process, calculating
their BMI and nutritional habits as well as evaluating their fitness
level. This information will be used to create a personal intervention
program that will include bi-monthly visits from a personal trainer and
monthly classroom visits by a nutritionist. Students will keep journals
recording physical activity and eating habits throughout the school
year. A year-end celebration, organized by youth engaged in the Work
and Learn program will take place during a ``mini Olympics'' program
featuring physical activity, healthy foods and awards to all students.
The goal is to foster a life-long commitment to a healthy lifestyle
that students will then share with their families and their east end
community.
Fourth is to Help Youth and Families Implement a Change of Lifestyle
Through Incentives
No Child Left Inside: More than any other generation,
today's kids spend a great deal of time indoors. The No Child Left
Inside initiative sponsored by Gov. M. Jodi Rell's office is a promise
and a pledge to help Connecticut's children live active, healthier
lives. This special outreach and education awareness campaign was
created to encourage families to enjoy all the recreational resources
and outdoor activities offered by Connecticut's State parks, forests
and waterways. The State has provided transportation, funded by a
corporate grant insuring inner city families could participate. The
Fairfield and Bridgeport YMCAs have participated in NCLI events by
organizing urban families to take advantage of this initiative.
Urban Fishing Program: The Fairfield and Bridgeport YMCAs
are collaborating with the CT Department of Environmental Protection by
teaching the Connecticut Aquatic Resource Education (``CARE'') program.
We are in our second year. This summer, 60 campers and 25 youth from
Work and Learn will be taught about their coastal environment. Everyone
gets outside, exercises and enjoys our natural resources while learning
the technical aspects of fishing and also learning to respect the
environment.
Too often physical activity is focused on sports activities,
leaving out many youth who need to develop habits of physical activity
that can last a lifetime, such as fishing.
Free Swim Lessons at State Parks: Over 700 families are
participating in this program which is operated by CT YMCAs as part of
Governor M. Jodi Rell No Child Left Inside initiative. Families receive
a free pass to a State park and are encouraged to use it for the day to
explore the trails and natural resources of the park. YMCAs provide
free swim lessons, funded from a grant by CT DEP, so that enjoyment of
the aquatic resources can be done safely while everyone gets exercise.
Milford Walking Trails: Milford had already identified
their 12 ``best'' walking trails. Through the leadership of the Milford
PHC effort, and inviting leaders of that effort to the PHC team
meetings; this project is being given more attention.
Fairfield Walking Trails: In partnership with the
Fairfield Board of Health and the local conservation commission that
has purchased and managed open space, we are going to improve the trail
system within town-owned land to create an environment that encourages
physical activity. The simple process of creating better signage,
better publicity and creating a point system where children, and their
families earn points every time they spend a weekend on a walking
trail, encourages better use of this available resource. The first, of
what is hoped will be 15 walking trails have been identified and a
brochure describing how to access the trail was produced.
Fifth is to Promote Consistent Action so Youth and Families Can Confirm
Benefits of the Changed Behavior
HEALTHY KIDS DAY: About 1,000 youth participated from the
CCC PHC service area with the theme of ``Passport to Fitness.'' Each
participant at all YMCA's received a passport which incorporated
stations around the Y that engaged youth adults and families in
physical tasks as well as answering queries focusing on health and
fitness. The stations were manned by YMCA staff and an assortment of
community wellness volunteers; dentists, doctors nurses, nutritionist,
massage therapist; all joined the YMCA in teaching participants how
they could achieve an active healthy lifestyle in their community with
support from the YMCA and community health and wellness professionals.
America On the Move Week (``AOM''): Eleven branches of the
CCC YMCA participated in AOM week with millions of steps taken towards
more active and healthy lives. Mayors and Selectmen started the week
with community walks and a healthy luncheon. The Bridgeport YMCA hosted
a Salsa Smart Spot Dance party at Seaside Park. YMCA's Implemented a
holistic approach focusing on educating the community about healthy
eating and increasing activity, local doctors, wellness centers,
clinics and naturopathic doctors participated; AOM week launched a year
long program of continuous workshops and free screenings given by YMCA
staff and health care professionals addressing disease prevention such
as diabetes, high blood pressure, cancer, heart disease, weight
management and smoking cessation.
Remove soda machines and serve healthy snacks at meetings:
Something as simple as removing soda and unhealthy snacks from vending
machines can make a difference. You will hear that ``we can't lose the
money'' from these sales. In fact our commissions from vending machines
has remained the same, and in some cases grown, after a period of time
when youth adjusted to the new products and found them just as good.
The Central Connecticut Coast PHC team realizes this process needs
to be sustainable, and we are committed for the long haul.
iv. examples of ymca academic and community work around the country
Harvard Research to Help Guide YMCA Child Care and 2009 USDA Childhood
Nutrition Reauthorization
From an academic standpoint, through our partnership with Harvard
University School of Public Health, YMCAs participated in an
organizational change intervention study to achieve new environmental
standards. We evaluated interventions in our afterschool child care
settings at pilot YMCAs. Through this study, we not only established
``Environmental Standards for Healthy Eating guidelines'' to share with
YMCAs nationwide, but we also have now submitted recommendations for
the 2009 Reauthorization of USDA Child Nutrition Programs based upon
this research. We look forward to working with members of this
committee and others to ensure that this research can be utilized when
Congress addresses this issue next year.
Community-Based Models Nationwide
Communities participating in Pioneering Healthier Communities
across the Nation have had success in a number of areas including:
influencing community walkability and pedestrian safety, access to
fresh fruits and vegetables, and physical education requirements in
schools. Specific examples include:
Nutrition
A program at five Pittsburgh-area YMCAs makes high-quality
fresh fruits and vegetables available to community members to purchase
at lower-than-market prices. This is in an urban area with limited
access to healthy foods. Response to this program has been
overwhelming.
In the Quad Cities--an area that overlaps between Illinois
and Iowa--the community team was able to influence a grocery store
chain to remodel the floor plans of their new stores to include
teaching kitchens to help residents learn how to make healthy meals.
Built Environment
In Attleboro, MA they were able to get the right partners
to the table to collaborate on the creation of an extensive city-wide
trail system that would also connect to adjacent communities allowing
commuters an opportunity to engage in physical activity and families an
area for activity.
The team in Rapid City, SD was able to influence local
leaders to require that new developments being built have sidewalks.
They were also able to get ``count-down'' walking signals installed at
crosswalks.
Where we Live, Work, Learn and Play
The Pittsburgh team worked with a large medical center to
change organizational policies to provide more time for staff to engage
in physical activity and for meetings to include healthy foods.
Clearwater, FL was able to restore physical education in
schools and require licensed child care sites to require 30 minutes of
daily physical activity by working with policymakers.
In Pittsburgh, the Afterschool with Activate Pittsburgh
Program--or ASAP--serves about 6,500 low-income kids. As a result of
the program: 76 percent increased muscular strength, 56 increased
muscular endurance, and 69 percent increased their flexibility.
The Healthy U Program in Grand Rapids, MI serves about
3,400 low-
income kids, which has resulted in a dramatic decrease in blood
pressure and an increase in strength and flexibility. More than 90
percent of the participating kids improved school attendance, completed
homework and chose not to smoke, drink or use drugs.
As you can see there are a good mix of programs, policies and
environmental changes represented here. All of these things need to
work together in a community. We know that the programs can change
behavior, but you need the policies and environmental changes to make
those behaviors stick.
iv. summary and call to action
An Ounce of Prevention is Worth a Pound of Cure
Our grandmothers and mothers are correct; an ounce of prevention is
worth a pound of cure. Unfortunately our spending priorities in this
country don't match up to this fact. For every $1.00 spent on curing a
problem, only a nickel is spent on prevention. Further we now know,
thanks to the Trust for America's Health's recent study, there is a
proven Return on Investment (ROI) for every dollar spent on prevention
due to a savings in medical costs. Youth obesity caused by inactivity
and poor nutrition is a very preventable condition. Prevention-based
solutions have a slow rate of adoption because individuals have
difficulty in perceiving their relative advantage. But we can increase
the rate of adoption with the correct incentives and the support of
healthy relationships. With that support, people will make everyday
healthy choices that are compatible with their existing values and we
can increase the rate of adoption.
What Should You Do, Where is the Priority? It Begins With Funding
We support $30 million for the Community Health/Steps
program at the CDC, including $5 million for the Pioneering Healthier
Communities initiative which will help community-based organizations
like the YMCA in their efforts to address this crisis.
We support expanded eligibility and funding for Federal
nutrition programs, and look forward to working with Senator Harkin
when the 2009 USDA Reauthorization of Child Nutrition legislation comes
up next Congress.
We support protecting the $1.1 billion in funding for the
21st Century Community Learning Centers in the U.S. Department of
Education Budget; and thank Senator Dodd for his incredible leadership
in this regard. Nationwide, more than 200 YMCAs receive the U.S.
Department of Education's 21st. C.C.L.C. funding. As the largest source
of afterschool funding in the Federal Government, this represents a key
area in which this committee and others can bring to bear proven
solutions in addressing childhood obesity. Our YMCA in Connecticut
operates programs in elementary schools and two local high schools
through this funding stream. We support the 21st Century Community
Learning Centers Act of 2007, sponsored by Senator Dodd, which would
include the provision of physical fitness and wellness programs as
allowable activities under 21st C.C.L.C.
We support a minimum of $75 million in funding for the
Carol White Physical Education for Progress (PEP) Grants administered
by the U.S. Department of Education. PEP grants are the only Federal
funding for physical education in schools.
As for legislation, we support the following proposals
introduced by Senator Harkin: (1) The Play Every Day Act (S. 651)--to
ensure that children and youth achieve the national recommendation of
60 minutes of physical activity every day; (2) The ``Fit Kids Act'' (S.
2173)--to expand physical education and physical activity for all
public school children through grade 12 before, during and after
school.
Two Legislative Ideas Worth Exploring (Connecticut Local Concepts)
Tax Credits for Urban Environments: Low-income housing tax
credits have proven effective in encouraging private investment in
solving the country's housing crisis. Why not create a tax credit to
encourage investment and development in urban environments to insure
youth and families have access to safe places and programs aimed at
increasing physical activity, improving nutrition and creating the type
of relationships needed among families to change lifestyle behavior and
sustain that changed behavior over time.
School Credit for Physical Education in non-school hours:
Another innovative idea we are working on is to allow youth to get
school credit for participating in physical education activities in
community agency-based settings during non-school hours. We know that a
small percentage of schools provide daily physical education or its
equivalent. This decline of physical activity programs has many causes,
including parents and school boards desire to increase the academic
requirements to improve standardized test scores. We should acknowledge
that the desire to focus on academics will continue and the hours
available to teachers to accomplish those goals will not change. Thus,
why not give schools incentives to meet national standards of physical
education, but allow those standards to be met through participating in
physical activity and nutrition programs in community-based settings
like the YMCA.
v. conclusion: the ymca and america
I don't believe that the YMCA can single handedly improve health in
America--we need governmental, foundation and private support--but I
don't think health in America can be improved without the YMCA. Our
charitable mission calls us to support the healthy development of
children and youth and to help find ways to combat the lifestyle health
crisis that our children face. We have a history of working through
partnerships that allow us to bring our collective resources to bear on
major social issues. After all, don't forget innovation is in our DNA,
over our 160 years, at the YMCA, we invented basketball, racquetball,
indoor swimming lessons, we were among the first to serve soldiers on
the battlefield and introduced youth outreach workers in the 1960's and
countless other solutions to community need. We hope to match this
innovation with our passion and reach to address the current crisis in
childhood obesity. Across the Nation in YMCAs, neighborhoods, schools,
in small towns and big cities, and in the halls of State and Federal
Government we are actively engaged and commit to continue to be part of
the solution to the childhood obesity crisis.
Thank you to Senator Dodd, Senator Alexander, and the other members
of the committee for inviting me to this hearing and allowing me to
share my thoughts on this important issue.
Addendum I
Hon. Tom Harkin, Chairman,
Subcommittee on Labor, HHS, and Education, Committee on Appropriations,
731 Hart Senate Office Building,
Washington, DC 20510.
Hon. Arlen Specter, Ranking Member,
Subcommittee on Labor, HHS, and Education,
Committee on Appropriations,
711 Hart Senate Office Building,
Washington, DC 20510.
Dear Chairman Harkin and Ranking Member Specter: We are writing to
urge the highest level of funding possible in the 2009 Labor, HHS
Appropriations bill for the Centers for Disease Control and Prevention
(CDC) Community Health/Steps Program. In fiscal year 2007 Steps funding
was $43 million and fell to $25 million in fiscal year 2008. With the
crisis of chronic disease and obesity in this country, it is essential
that CDC has a healthy communities' budget that reflects the severity
of this burden. So many of the decisions that will turn the tide on
obesity and chronic disease are in the hands of local decisionmakers
and we need to provide them with the tools and resources to support
healthy environments where we live, work, learn and play.
We need your help to ensure this generation of American children
outlive their parents and do not suffer from the human and economic
costs of chronic disease. Years of research and funding have amassed a
wealth of knowledge and proven strategies to increase physical activity
and advance healthy eating, but to date that knowledge has not yet
reached our communities. CDC has convened State and local health
departments, national organizations with extensive community reach and
a wide range of local leaders and groups and has a powerful vision of
how to support the spread of this knowledge and change across the
Nation.
Over the last 5 years CDC has made deep inroads into innovative
strategies to prevent and control chronic disease and risk factors at
the community level, through the Steps to a Healthier U.S. program and
the Pioneering Healthier Communities program. CDC has recently launched
an initiative called ACHIEVE that builds on the work and lessons of
these and other premiere healthy communities programs. In total, CDC
has funded 114 initiatives to advance policy and environmental change
strategies in hundreds of communities to support of healthy eating,
active living and chronic disease prevention.
CDC has a comprehensive vision of how to spread community-based
initiatives that promote policy and environmental change that helps
people make the healthy choice where they live, work, learn and play.
Included in this vision is:
A network of mentoring sites that can help spread the
learning and strategies to additional communities;
Funding of hundreds of new healthy community sites through
State and local health departments and community-based organizations;
and
Funding lead national partners with footprints in
thousands of American communities to continue to explore innovative
approaches to this community change work.
Community level interventions show some of the most promising
approaches to attacking this national crisis of obesity and chronic
disease. Communities have shown success by:
Restoring physical education (PE) to the school day and
require 30 minutes of physical activity and healthy snacks in child
care sites;
Starting or enhancing farmers markets and community
gardens in areas lacking grocery stores or with limited access to fresh
fruits and vegetables;
Changing zoning requirements to ensure developments
include sidewalks;
Building new trails and bike paths; and
Implementing safe routes to school strategies.
National partnerships have helped CDC work on the ground in
communities and gain a deeper understanding of how to advance best
practices and policies at the local level.
During these difficult budget times, there is no greater challenge
to the Nation's economy than the cost of treating chronic disease and
obesity--most of which are preventable. This healthy communities work
not only recognizes the urgency to focus our communities on preventing
these diseases and associated conditions but brings together such a
diverse sector of leaders making the ``real change'' possible.
Thank you in advance for your consideration of this request that
will help stem the tide of obesity and chronic disease in this country.
Sincerely,
National Orgs:
American Association for Health Education; American College Health
Association; American College of Preventive Medicine; American
Hospital Association; American Public Health Association;
Association of State & Territorial Health Officials; Campaign for
Public Health; National Association of City & County Health
Officials; National Association for Chronic Disease Director;
National Recreation and Park Association; Research to Prevention;
Society for Public Health Education; Trust for America's Health;
and YMCA of the USA.
State and Local Organizations:
Activate Elgin, Elgin, IL; Adair County Family YMCA, Kirksville,
MO; Alliance of Texas YMCAs; America on the Move in Ft. Wayne, IN
American Heart/American Stroke Association, Framingham, MA;
American Lung Association of PA; Ann Arbor YMCA, MI; Ashland YMCA;
Attleboro Area Chamber of Commerce, MA; Attleboro Public Schools,
MA; The Battle Creek Family YMCA, MI; Beaumont Metropolitan YMCA,
TX; Bikur Cholim-Partners in Health of Monsey, NY; Binghamton
Metropolitan Transportation System, NY; Binghamton University
Decker School of Nursing, NY; Binghamton University Department of
Health and Physical Education, NY; Black Hills Workshop, Rapid
City, SD; Black Knight Security, NY; Boston Collaborative for Food
and Fitness, Boston, MA; Boston Medical Center, Department of
Pediatrics, Boston, MA; Boston Public Health Commission, Boston,
MA; Boston Public Schools, Boston, MA; Broome County Clerk of the
Legislature, NY; Broome County Economic Development Group, NY;
Broome County Executive, NY; Broome County Health Department, NY;
Broome Tioga BOCES Communications, NY; Broome Tioga BOCES Food
Service, NY; Broome Tioga BOCES Professional Development, NY,
Broome County YMCA, NY; C. Scott Vanderhoef, County Executive,
Rockland County, NY; California State Alliance of YMCAs, CA; Casper
Wyoming Family YMCA, WY; Center for Community Health and
Evaluation, Seattle, WA; Center for MultiCultural Health, Seattle
WA; Central Connecticut Coast YMCA, CT;Chelsea Community Hospital,
Chelsea, MI; Chenango Forks School District, NY; Chenango Valley
School District, NY; Chesterfield Family YMCA, SC; Chiku Awali
African Dance Company of Rockland, Inc., NY; Child Care Resources
of Rockland, Inc., NY;
Clallam County YMCA, Inc., WA;Clark County Family YMCA, WA; Clear
Channels Radio, NY;Central New York Kidney Foundation, NY; The City
of Pueblo, CO; City of St. Louis Department of Health, MO; Colorado
State Alliance of YMCAs, CO; Community Choices, Clark County, WA;
Community Mediation Institute, Wilkes-Barre, PA; Connellsville Area
School District, PA; Corner Health Center, Ypsilanti, MI; Crowder
College, MO; Crusader Clinic, Rockford, IL; Cumberland Cape
Atlantic YMCA, NJ; Custer YMCA, SD; Department of Public Health,
Cleveland, OH; Diabetes Management and Nutrition Center Wyoming
Valley Health Care System, Kingston, PA; Dryades YMCA, New Orleans,
LA; Edgemont YMCA, SD; Eugene YMCA, OR; Family Resource Network of
the Panhandle, Inc., Martinsville, WV; Family YMCA of Black Hawk
County, Waterloo, IA; Fargo-Moorhead Family YMCA, ND and MN;
Fayette County Community Health Improvement Partnership, PA; Feet
First, Seattle, WA; Fort Worth Public Health Department, IN;
Freeman Health System, Neosho, MO; Freeman Neosho Hospital, Inc.,
MO; Freeman Southwest Family YMCA, Neosho, MO; Gamma Theta Omega,
Inc., Tampa, FL; Get A Move On, Dallas, TX; Grants Pass YMCA, OR;
Greater Binghamton Chamber, NY; Greater Elgin Area YMCA, IL;
Greater Pittston YMCA, PA; Greater Wilkes-Barre Chamber of Business
& Industry (HR Committee), Wilkes-Barre, PA; Harvard Prevention
Research Center on Nutrition and Physical Activity, Boston, MA;
Hazleton YMCA & YWCA, PA; Healthier Berkeley County, WV; Healthier
Jefferson County, WV; Hockomock Area YMCA, MA; Hopewell Valley
YMCA, NJ; Hot Springs YMCA, AR; Idaho Falls Family YMCA; Interfaith
Resource Center for Peace and Justice, Wilkes-Barre, PA; Itasca
Community College, Grand Rapids, MN; Itasca County Family YMCA, MN;
Janet Weis Children's Hospital, Danville PA; Jawonio Inc., NY
Jewish Family Service, Wilkes-Barre, PA; Johnson and Associates,
Albuquerque, NM; Johnson City School District, NY; Joint Urban
Studies Center, PA; Jonesboro YMCA, AR; Justice Resource Institute,
Boston, MA; Keep Rockland Beautiful, Inc., NY; Ken Baxter Senior
Community Center, Marysville, WA; Kit Clark Senior Services, Inc.,
Boston, MA; Kitsap Family YMCA, WA; La Crosse Area Family YMCA, La
Crosse, WI; La Voz Latina, Rockford, IL; Lake-Lehman School
District, PA; Little Rock YMCA, AR; Local and National List for
Hudson Health Plan and Case Management Society of America, NY;
Luzerne County Breastfeeding Coalition, PA; Maternal and Family
Health Services, Inc., Wilkes-Barre, PA; Marion-Polk County YMCA,
OR; Marshalltown Medical & Surgical Center, WV; Marysville Parks
and Recreation, WA; Mayor Dennis L. Kendall, City of Marysville,
WA; Mayor Kevin J. Dumas, Attleboro, MA; Mayor Larry Morrissey,
Rockford, IL; Mayor Matthew T. Ryan, Binghamton, NY; Mental Health
America of Pueblo, CO; Mexico Area Family YMCA, Mexico, MO;
Michigan Inter-Tribal Council, MI; Mid-Delmarva Family YMCA, MD;
Mid-Willamette Family YMCA, OR; Neponset Health Center, Boston, MA;
Newport County YMCA, RI; Nyack Teacher Center, NY; Oneonta Family
YMCA, NY; Oregon State Alliance, OR; Orville YMCA, OH; Ozarks
Regional YMCA, MO; Palestine YMCA, TX; Palmer College of
Chiropractic, IA; Parkview Medical Center, Pueblo, CO; Partners in
Community Care, NY; Pennsylvania Department of Health, Diabetes
Prevention Program, PA; Pioneering a Healthier Marshall, Marshall,
MN; Plainview YMCA, TX; Public Health--Seattle & King County, WA;
Pueblo City--County Health Department, in Pueblo, CO; Pueblo Step
Up, CO; Quad City Health Initiative, IA and IL; Rockford Health
Council, Rockford, IL; Rockland County Department of Health, NY;
Rockland County YMCA, NY; Rogue Valley YMCA, OR; Roxbury
Comprehensive Community Health Center, Inc., Boston, MA; Rural
Health Network, NY; Sarah Walker, MA, University of Binghamton, NY;
Scene International, NY; Scott County Family YMCA, IA; Seabrook
YMCA, AR; Shasta Family YMCA, CA; Sidney Borum Jr. Health Center,
Boston, MA; Smithfield YMCA, RI; South End Community Health Center,
Boston, MA; South Sound YMCA, WA; Southern Jamaica Plain Health
Center, Boston, MA; St. James Middle School, NY; Sturdy Memorial
Hospital, MA; Superintendent Pia Durkin, Ph.D., Attleboro Public
Schools, MA; Tacoma-Pierce County Health Department, WA; Tecumseh
YMCA, OH; Tillamook County Family YMCA, OR; Town of Orangetown, NY
Parks and Recreation, NY; Trane Manufacturing, Pueblo CO; Treasure
Valley YMCA, Boise, ID; Two Rivers YMCA, IL; Union Endicott School
District, NY; Uniontown Area YMCA, PA; Unitarian Universalist
Congregation of the Wyoming Valley, Kingston, PA; United Health
Services, NY; United Medical Associates, NY; UW Health Pediatric
Fitness Initiative; Warren YMCA, AR; Washtenaw County Public
Health, MI; Wayne County YMCA, PA; WBNG TV, NY; Wilkes-Barre Family
YMCA, PA; Wilkes-Barre City Health Department, PA; Wyoming Valley
Wellness Trails Partnership, Wilkes-Barre, PA; WV Kids in Action,
WV; YMCA at Washington State University, WA;
YMCA of Abilene, TX; YMCA of Attleboro, MA; YMCA of Austin, TX;
YMCA of the Brandywine Valley, PA; YMCA of the Capital Area, LA;
YMCA of Central New Mexico, NM; YMCA of the Coastal Bend, TX; YMCA
of Columbia-Willamette, OR; YMCA of Corsicana, TX; YMCA of Dane
County, WI; YMCA of Delaware, DE; YMCA of Eastern Union County, NJ;
YMCA of El Paso, TX; YMCA of the Fox Cities, WI; YMCA of Gray's
Harbor, WA; YMCA of the Golden Crescent, TX; YMCA of Greater
Cleveland, OH; YMCA of Greater Dallas, TX; YMCA of Greater Fort
Wayne, IN; YMCA of Greater Grand Rapids, MI; YMCA of Greater
Houston, TX; YMCA of Greater Kansas City; YMCA of Greater
Louisville, KY; YMCA of Greater New Orleans, LA; YMCA of Greater
Omaha, NE; YMCA of Greater Pittsburgh, PA; YMCA of Greater
Providence, RI; YMCA of Greater Rochester, NY; YMCA of Greater San
Antonio, TX; YMCA of Greater Seattle, WA; YMCA of Greater St.
Louis, MO; YMCA of Greater St. Petersburg, FL; YMCA of Greater
Tampa, FL; YMCA of the Greater Tri-Cities, WA; YMCA of the Inland
Northwest, Spokane, WA; YMCA of Kanawha Valley, WV; YMCA of
Lincoln, NE; YMCA of Marshalltown, IA; YMCA of Memphis & the Mid-
South, TN; YMCA of Metropolitan Denver, CO; YMCA of Metropolitan
Ft. Worth, TX; YMCA of Metropolitan Milwaukee, WI; YMCA of
Metropolitan Tucson, AR; YMCA of Moore County, TX; YMCAs of New
York State, NY, YMCA of Orange County, CA; YMCA of the Pikes Peak
Region, CO; YMCA of Pueblo, CO; YMCA of Rapid City, SD; YMCA of
Rock River Valley, IL; YMCA of Rye, NY; YMCA of San Francisco, CA;
YMCA of Snohomish County, WA; YMCA of Southern Nevada, NV; YMCA of
the Suncoast, FL; YMCA of Tacoma-Pierce County, WA; YMCA of Walla
Walla, WA; YMCA of Western North Carolina, Asheville, NC; Yuma
Family YMCA, AZ.
Addendum II
Community Healthy Living Index
Activate America Community Healthy Living Index: Tools To Change
Your Environment
The Community Healthy Living Index (CHLI) is a compilation of
community assessment tools that measure opportunities for physical
activity and healthy eating in areas that impact an individual's daily
life. These tools also facilitate discussion to determine actions for
improvement in the community environment to increase opportunities for
healthy living.
A host of local experts, including representatives from
governmental agencies, non-for-profits, and academic institutions have
collaborated to create these tools. YMCA of the USA, Stanford
University, Harvard University, and St. Louis University have co-led
the effort with funding from the Centers for Disease Control and
Prevention (CDC).
The specific areas that the community assessment tools focus on
are: (1) schools, (2) afterschool child care sites, (3) work sites, (4)
neighborhoods, and (5) the community at large. Team members who
participate in this process will be able to plan for policy and
environmental change strategies, identify and remove barriers, and
expand opportunities for healthy living in communities where
individuals of all ages live, work, learn, and play. The ultimate aim
of this work is not to assess where these sites are today, but to set a
course for where they can go tomorrow and how they will build
environments that support healthy living.
CHLI has been developed from the YMCA perspective because YMCAs
serve a vital role as trusted conveners and action-oriented
organizations in nearly 10,000 communities across the Nation.
The CHLI assessment and improvement plan process needs to take
place with the engagement of a broad set of community stakeholders. It
is currently undergoing pilot testing in eight communities around the
United States. Once the tools are finalized and approved for broader
distribution, YMCAs will take the lead in their communities to convene
stakeholders and facilitate the assessment and improvement planning
process. YMCAs cannot do this work alone; it will be incumbent on local
and community leaders to assess, discuss, design, and implement
improvement plans.
Addendum III
Statement of the YMCA--Activate America
pioneering healthier communities
1. 2004: Santa Clara & South San Mateo Counties, CA; Boulder, CO;
State of Delaware; Des Moines, IA; Boise, ID; Tampa, FL; St. Louis, MO;
Rochester, NY; Pittsburgh, PA; Dallas, TX; Seattle, WA; State of West
Virginia; Milwaukee, WI.
2. 2005: State of Arkansas; Tucson, AZ; Orange County, CA;
Clearwater, FL; Marshalltown, IA; Lexington, KY; Shreveport, LA;
Attleboro, MA; West Michigan (Grand Rapids); Marshall, MN; Springfield/
Greene County, MO; Charlotte, NC; Lincoln, NE; Rye, NY; Tulsa, OK;
Chester County (Brandywine Valley), PA; Greater Greenville, SC; Rapid
City, SD; Tarrant County (Fort Worth), TX; Dane County (Madison), WI.
3. 2006: Shasta County, CA; Central Connecticut Coast; Elgin, IL;
Quad Cities, IL and IA; Fort Wayne, IN; Greater Louisville, KY; Mid
Coast Maine; Mid-Delmarva, MD; Rahway, NJ; Champaign County, OH;
Cleveland, OH; Memphis, TN; Fox Cities, WI.
4. 2007: San Francisco, CA; Colorado Springs, CO; Longmont, CO;
Rockford, IL; Hockomock Region, MA; Ann Arbor, MI; Battle Creek, MI;
Itasca County, MN; Asheville Area, NC; Fargo, ND; and Moorhead, MN;
Omaha, NE; Woodbridge, NJ; New York, NY; Providence, RI; Chesterfield/
Darlington/Hartsville, SC; La Crosse, WI; Marysville, WA; Spokane, WA.
Addendum IV
National Survey: Majority of U.S. Parents Don't Enforce Good Health
Habits in Their Household--Most Parents are Unaware That Their
Children's Generation May Have Shorter Lifespan Than Their Own
ymca of the usa, eli lilly and company create healthy family home
program to fight childhood obesity
New York (March 11, 2008).--Nearly half of parents \1\ admit their
family is not eating a balanced diet, and more than three in four
concede that some family members do not practice good health habits,
according to a new national survey released today by YMCA of the USA
and Eli Lilly and Company.
---------------------------------------------------------------------------
\1\ For the purposes of this survey, ``parents'' were defined as
U.S. adults ages 18+ who are the parent or legal guardian of a child
under the age of 18 living in their household (n = 461).
---------------------------------------------------------------------------
Nevertheless, most American parents expect their children's
generation to have a longer lifespan than their own, or to live just as
long, the survey showed. Such optimism has been rejected by research
that has concluded that the current generation under the age of 18 may
be the first in 200 years to have a shorter lifespan than their
parents. The main culprit is obesity, caused by lack of physical
activity and poor nutrition.
If not slowed or reversed, the rapid rise in childhood obesity
could shorten lifespans by as much as 5 years, according to researchers
who say the problem has grown worse in the 3 years since their study
was published in the New England Journal of Medicine in March 2005.
Responding to this crisis, YMCA of the USA and Lilly are partnering
to create a program called Healthy Family Home
(www.HealthyFamilyHome.org) to help the entire family work together at
home to make healthier choices and live healthier lives. Successful
pilot programs have been completed at five YMCAs, and the program
launches nationwide during YMCA Healthy Kids' Day at more than 1,700
YMCAs next month.
``The family home is the place that defines, creates and predicts a
family's lifelong health and well-being,'' said Lynne Vaughan, Chief
Innovation Officer for YMCA of the USA. ``Healthy Family Home empowers
families to create a home environment that supports healthy living.
It's a program that can work for any kind of family in any kind of
home, regardless of whether the family lives near a YMCA.''
Healthy Family Home provides families with practical, flexible
tools and support for making lasting changes for a healthier, happier
life. Actions aimed at the whole family that lead to small, sustained
changes--like eating better, getting exercise and connecting as a
family--are proven to have a long-term impact.
``We are a nation struggling with obesity and other chronic
diseases that are lifestyle-related and often preventable,'' said
Kristine Courtney, M.D., an internist and Director of Corporate Health
Services at Lilly. ``Lilly is proud to support the Healthy Family Home
program, which jumpstarts and supports a family's efforts to be healthy
in practical ways.''
healthy family home starter kit offer tips, ideas free on web site
In April, the ``Healthy Family Home Starter Kit,'' a free guide
with tips for healthy living, will be available at local YMCA Healthy
Kids Day events and on www.HealthyFamilyHome.org. The Healthy Family
Home program is designed to work in any home and in any community, and
lets families pick the actions and health goals that make the most
sense for them. A sample from the Healthy Family Home Starter Kit:
1. Make family time. Sit down as a family for one meal a day.
Research has shown that family meals are more nutritious than ``solo''
meals and kids who eat with their family end up making healthier snack
choices.
2. Sneak in more physical activity. Plan a weekly family breakfast
where you are the transportation. Skip the car, bus or train and ride
bikes, walk or jog/run.
3. Get more fruits and vegetables in your diet. Have all family
members identify their favorite fruit and write each one down on a
list. Then fill a family fruit bowl with those fruits and keep it on
the counter. This way everyone in the family will have easy access to
their favorite fruit when they're looking for a snack.
4. Make getting exercise fun. Turn up the music and do chores
together (clean the house, wash windows, do laundry, etc.).
national survey: parents unaware of toll of obesity on children's
lifespan
According to an online survey conducted by Harris Interactive on
behalf of YMCA of the USA and Lilly, parents spend more time worrying
more about their children's health than their own (48 percent versus 33
percent), yet most believe their children's generation will live longer
than their own (57 percent said longer; 32 percent said about the same;
11 percent said shorter).
The survey also showed that most parents know what behaviors are
elements of a healthier lifestyle, yet many just cannot seem to put
that knowledge into practice. For example, 91 percent of parents know
their family should eat a balanced diet, yet only 56 percent say their
household does, and 93 percent know their family should exercise
regularly, yet only 45 percent say their household does. While 59
percent of parents say that everyone in the family knows what they
should be doing to lead a healthy lifestyle, only 23 percent say
everyone in the family practices good health habits.
The top five barriers to putting what is preached into practice are
lack of time (48 percent), lack of motivation (46 percent), lack of
willpower (45 percent), lack of money (36 percent) and lack of
participation from some members of the family (29 percent).
experts: reverse obesity trend with bite-sized changes in american home
life
Experts in public health say that while genetics may play a role in
obesity, the gene pool has not changed enough over recent decades to
explain the dramatic rise in obesity. Rather, it's the Nation's gradual
move, ``quarter step by quarter step,'' toward less physical activity
and more food that is processed or high in saturated fat that has
pushed up obesity rates, says Wesley Alles, Ph.D., Director of the
Health Improvement Program at Stanford University and an adviser to
Activate America, the YMCA's response to our Nation's growing health
crisis.
That trend can be reversed, quarter step by quarter step, through
programs like the YMCA-Lilly Healthy Family Home. Seemingly small but
extremely manageable changes like adding a fruit or vegetable to every
meal or getting the entire family together for a 20-minute walk around
the block three times a week add up and make a difference, experts say.
``For all the interventions at school and elsewhere, kids do most
of their eating and physical activity at home,'' says Jean Wiecha,
Ph.D., Senior Research Scientist at Harvard School of Public Health and
an adviser to Activate America. ``Kids are always observing their
parents and their siblings and this is how they get an idea of what
behavior is considered normal. The reverse is also true: children can
affect grown-ups' behavior and health by influencing what foods the
family eats and what activities they engage in. The home has a circular
dynamic that is very different from what takes place in other settings
like school or in the doctor's office.''
success at pilots in san diego, nyc, indianapolis, chicago,
marshalltown, ia
Five pilot programs at YMCAs across the country have already
sparked small but meaningful changes in families. In New York City, the
Carles family is now walking to the deli rather than driving. In San
Diego, the Alcala family now stocks the pantry with brown rice rather
than white rice and buys cereal only if it has a minimum of 3 grams of
fiber. In Indianapolis, the Rowland's family's snack cabinet has been
stripped of trans fats and located to the bottom of the refrigerator:
the fruit drawer, filled with intriguing new choices including mangos
and Ugly Fruit.
``What I got out of this program was more participation from my
husband and kids as a family trying to be healthy. It's hard to be the
only one. It doesn't work out,'' said Jennifer Alcala, a client
services worker, who lives with her husband, a mechanic, three sons and
a nephew; the oldest of the kids is 14.
``Now I have a starting point so I can say `Remember what we did at
the Y? Let's eat fruit instead of something sugary. Let's walk around
the block. Let's get back on track.' It's not just Mom saying this on
her own. Sometimes you need a third parent and that's what the Y is,''
said Bridget Carles, an after-school teacher who lives with her
husband, a city government contract specialist, and their three
teenagers.
survey details
The Family Health Issues survey was conducted online within the
United States by Harris Interactive on behalf of YMCA of the USA and
Lilly between February 6 and February 8, 2008, among 2,015 U.S. adults
ages 18+, of whom 461 are parents or legal guardians of children under
18 who are living in their household. This online survey is not based
on a probability sample and therefore no estimates of theoretical
sampling error can be calculated. Complete methodology is available
upon request.
ymca of the usa
YMCA of the USA is the national resource office for the Nation's
2,663 YMCAs, which serve nearly 20.2 million people each year,
including 9.4 million children under the age of 18. Through a variety
of programs and services focused on the holistic development of
children and youth, health and well-being for all and family
strengthening, YMCAs unite men, women and children of all ages, faiths,
backgrounds, abilities and income levels. From urban areas to small
towns, YMCAs have proudly served America's communities for nearly 160
years by building healthy spirit, mind and body for all.
Activate America is the YMCA's response to our Nation's growing
health crisis. YMCAs are redefining themselves and engaging communities
across the country to better support Americans of all ages who are
struggling to achieve and maintain well-being of spirit, mind and body.
Visit www.ymca.net to find your local YMCA.
eli lilly and company
Lilly, a leading innovation-driven corporation, is developing a
growing portfolio of first-in-class and best-in-class pharmaceutical
products by applying the latest research from its own worldwide
laboratories and from collaborations with eminent scientific
organizations. Headquartered in Indianapolis, Ind., Lilly provides
answers--through medicines and information--for some of the world's
most urgent medical needs. Additional information about Lilly is
available at www.lilly.com.
about harris interactive
Harris Interactive is one of the largest and fastest-growing market
research firms in the world. The company provides innovative research,
insights and strategic advice to help its clients make more confident
decisions which lead to measurable and enduring improvements in
performance. Harris Interactive is widely known for The Harris Poll,
one of the longest running, independent opinion polls, and for
pioneering online market research methods. The company has built what
it believes to be the world's largest panel of survey respondents, the
Harris Poll Online. Harris Interactive serves clients worldwide through
its North American, European and Asian offices, and through a global
network of independent market research firms. More information about
Harris Interactive may be obtained at www.harrisinteractive.com.
Addendum V
Partnership to Fight Chronic Disease Launches National Almanac
The PFCD offers a united voice that injects common-sense, patient-
focused policies and practices into the local and national dialogue on
important health care issues and works to:
Increase access to high-quality health care, including
preventive care;
Promote health and wellness;
Help reduce health disparities;
Eliminate bureaucracy in the health system; and
Enhance health information.
Help us make a difference: attend local and national events, work
to improve your health and the health of others, explore model programs
that make a difference, and arm yourself with the knowledge to
instigate change.
The 2008 ``Almanac of Chronic Disease'' presents comprehensive
facts that characterize the crisis of chronic disease and how it is
contributing to problems with access, affordability and quality of
care. In five chapters, we provide information and commentary by health
care experts and advisory board members from the Partnership to Fight
Chronic Disease, on:
The human cost of chronic disease;
The economics of chronic disease;
The costs of chronic disease tomorrow;
Opportunities for improvement; and
Public understanding of the problem.
It is our hope that this Almanac will serve as a key reference
point for where our Nation can focus its attention with respect to
reforming our health care system.
For additional information, please go to: http://
ww.fightchronicdisease.org/re-
sources/documents/PFCD_FINAL_PRINT.pdf.
Senator Dodd. Thank you very much, Mr. Dwyer. We appreciate
it very much.
Ms. Neely, thank you for being with us.
STATEMENT OF SUSAN K. NEELY, PRESIDENT AND CEO, AMERICAN
BEVERAGE ASSOCIATION, WASHINGTON, DC
Ms. Neely. Well, thank you, sir.
I am Susan Neely, president and CEO of the American
Beverage Association, representing the manufacturers and
distributors of nonalcoholic beverages in this country.
Of all the things you shared from my biography, you left
out the most important part: that I am the mother of two
elementary school-age children. So it is a privilege to be here
to talk about real solutions to this national epidemic that we
face, both on behalf of the great industry I represent, and as
the mother who has a large stake in the outcomes of these
deliberations.
To do my best to hold up my end of this distinguished panel
and talk about some concrete solutions that this industry has
been part of, I want to tell you about a couple of things. One
is the agreement that we reached with the Clinton Foundation,
the American Heart Association that had formed a partnership
called the Alliance for a Healthier Generation. Governor
Huckabee was co-chair of that effort at the time that we formed
this agreement.
As part of their initiative to promote healthy behaviors
through physical activity and good nutrition in schools, we
agreed to implement a school beverage standard in all the
schools across this country. The school beverage standard or
guidelines are based on input from parents and educators that
said younger children should have more limited choices, and so
our policy reflects that.
For elementary and middle schools, it is milk, juice, and
water only. Based on the same input that said high school
students should have more choice, the policy offers more choice
of beverages, but only in the no-, low-calorie options or in--
for the nutritious beverages, such as 100 percent juice, in
smaller portion sizes.
We are implementing this policy, this low-calorie, good
nutrition policy in schools across the country. We have been at
it for 2 years. Our Memorandum of Understanding (MOU) promised
that we would have this completely implemented across the
country in 3 years. At the end of the first year, which was
last year, 2007, we had hit all of the markers in the MOU, and
I am proud to say that 41 percent fewer calories were being
shipped in beverages to schools.
We have just closed this year at the end of June. It is
based on the school year. Dr. Robert Westcott, who was an
economist in the Clinton administration, is compiling the data.
The early returns look very promising. The marker that we
intend to meet on the second year is that 75 percent of schools
under contract in this country will be in compliance with our
policy, and I look forward to sending you a good report that we
have met that marker as well.
So, again, we have 1 year left on our MOU, and it is a
concrete program that is being implemented across the country.
Second, we have gone the next step in terms of our
marketing programs to children and through the International
Coalition of Beverages Associations have agreed to marketing to
children guidelines that are very comprehensive. They are
global and very significant.
Similar to the philosophy or the approach on our school
beverage guidelines that are really intended to reinforce the
role of parents and other adults as gatekeepers of information
for young children, these marketing to children guidelines seek
to do that and are another responsible step forward and another
responsible commitment on the part of our industry.
In conclusion, I would just again reiterate that we are
committed to being part of the solution to fight childhood
obesity. We are providing the impetus for change in our
communities, and we will continue to look for ways to be a
leader on this issue. To that end, I will tell you that we
believe in our school beverage standard so strongly that we
have called for legislation to establish a national beverage
standard.
We are proud to support Senator Harkin and Murkowski's
amendment to the Farm bill last year that would, in fact,
establish such a standard. It was backed by a very strong
coalition that represented the public health community as well
as the food and beverage industry. We would hope that those
Senators and others will support such a standard again, and if
they do, we are ready to support them and that initiative.
Again, thank you very much for the opportunity to be here.
[The prepared statement of Ms. Neely follows:]
Prepared Statement of Susan K. Neely
introduction
Good morning, Mr. Chairman and members of the committee. Thank you
very much for the invitation to appear before the committee to discuss
current efforts to explore meaningful solutions to the Nation's
childhood obesity problem.
I am Susan K. Neely, President and CEO of the American Beverage
Association (ABA). As a representative of the Nation's beverage
industry and the mother of two elementary school children, I applaud
the committee for holding a hearing on an issue that is critical to the
health of our children. I also want to thank the Chairman and Ranking
Member for your continued leadership on this issue over the years.
The American Beverage Association has been the trade association
for America's non-alcoholic refreshment beverage industry for more than
85 years. Founded in 1919 as the American Bottlers of Carbonated
Beverages and renamed the National Soft Drink Association in 1966, ABA
today represents hundreds of beverage producers, distributors,
franchise companies and support industries. ABA's members employ more
than 211,000 people who produce U.S. sales in excess of $88 billion per
year.
According to John Dunham and Associates, Inc., direct, indirect and
induced employment in the beverage industry means 2.9 million jobs that
create $448 billion in economic activity. At the State and Federal
level, beverage industry firms pay more than $27 billion in Federal
taxes and more than $21 billion in taxes paid to State governments. The
beverage industry and its employees are active members of their
communities throughout America who have generously contributed at least
$1.4 billion to charities across the country. In fact, we are leading
the way when it comes to doing ones part to help children achieve a
balanced lifestyle.
ABA members market hundreds of brands, flavors and packages,
including diet and full calorie carbonated soft drinks, ready-to-drink
teas and coffees, bottled waters, fruit juices, fruit drinks, dairy-
based beverages, and sports drinks.
adoption of school beverage guidelines
The American Beverage Association agrees that the obesity crisis is
a complex, national challenge that requires us to re-examine old
practices and find new solutions. All of us--policymakers, parents,
educators, industry and community leaders--have a responsibility to do
our part to help teach our children how to have a healthy life style. I
am proud to report that the American beverage industry is doing just
that.
In May 2006, the American Beverage Association, Cadbury Schweppes
Americas Beverages, The Coca-Cola Company and PepsiCo teamed up with
the Alliance for a Healthier Generation (a joint initiative of the
William J. Clinton Foundation and the American Heart Association) to
develop new School Beverage Guidelines that limit calories and increase
nutritious beverages in schools.
We agree with parents and educators that schools are special places
and play a unique role in shaping our children's health. The guidelines
provide students with a broad array of lower- and no-calorie options
along with nutritious and smaller-portioned beverages to help kids
build healthy habits as they learn to balance the calories they consume
with the calories they burn. The guidelines are designed to balance
children's nutritional and hydration needs with appropriate caloric
consumption for their age.
the guidelines
Elementary School
Bottled water.
Up to 8 ounce servings of milk and 100 percent juice.
Low fat and non-fat regular and flavored milk and
nutritionally equivalent (per USDA) milk alternatives with up
to 150 calories/8 ounces.
100 percent juice with no added sweeteners, up to 120
calories/8 ounces, and with at least 10 percent daily value of
three or more vitamins and minerals.
Middle School
Same as elementary school except juice and milk can be
sold in 10 ounce servings.
As a practical matter, if middle school and high school
students have shared access to areas on a common campus or in common
buildings, then the school community has the option to adopt the high
school standards.
high school
Bottled water.
No or low-calorie beverages with up to 10 calories/8
ounces (e.g., diet soft drinks, diet and unsweetened teas, fitness
waters, low-calorie sports drinks, flavored waters, seltzers).
Up to 12 ounce servings of milk, light juice, 100 percent
juice and certain other drinks.
Low fat and no-fat regular and flavored milk and
nutritionally equivalent (per USDA) milk alternatives with up
to 150 calories/8 ounces.
100 percent juice with no added sweeteners, up to 120
calories/8 ounces, and at least 10 percent daily value of three
or more vitamins and minerals.
Other drinks with no more than 66 calories/8 ounces
(e.g., light juices and sports drinks).
At least 50 percent of non-milk beverages must be water
and no or low-calorie options.
For elementary and middle schools, we limit the beverage offerings
to water, milk and juice because parents believe, and we agree, that
younger children need more guidance to choose foods and beverages
appropriate for their nutrition and caloric needs.
By the time students reach high school, parents believe children
should have more freedom to choose their food and beverages during the
school day. These guidelines provide more options for older children,
while still capping calories and portion-sizes.
No full calorie soft drink products will be offered in any grade.
We hope the committee appreciates the extraordinary steps our
companies are taking with these guidelines. Our companies are removing
full-calorie soft drinks from elementary, middle and high schools
throughout America--an unprecedented move by a member of the broader
food and beverage industry. They're also reducing the portion sizes of
many beverages and capping the calories of products offered in schools.
This is all happening right now in schools across America. And this
change does not come without real cost and risk to the industry.
guidelines developed using nutrition science
The American Heart Association wielded great influence in the
development of the School Beverage Guidelines along with the Clinton
Foundation and the beverage industry.
The guidelines were designed using nutrition science, including the
Dietary Guidelines for Americans, 2005 as well as the American Heart
Association's Dietary Guidelines for Healthy Children and 2006 Diet and
Lifestyle Recommendations in order to balance children's nutritional
needs with the requirement to manage caloric consumption. The
guidelines are also developmentally appropriate, taking the age of the
student into great account. They balance children's nutritional and
hydration needs with appropriate caloric consumption.
By using nutrition science, along with parental concerns, we were
able to develop guidelines that are responsive to concerns about school
wellness and that will make a meaningful impact on our children.
parents support this commonsense approach
We are very proud of these guidelines and are happy to report that
parents think we've struck the right balance by limiting calories and
increasing nutritious offerings in schools. A nationwide survey showed
that 82 percent of parents surveyed support our school beverage
guidelines. In fact, they clearly support our school beverage
guidelines over more restrictive alternatives.
When asked to choose between the School Beverage Guidelines and a
policy that provided bottled water, 100 percent juice, and low fat milk
for K-12, parents supported our guidelines by a margin of 56 percent to
42 percent. And when asked if they preferred our guidelines or a
complete vending ban in schools, they chose the guidelines by a margin
of 82 percent to 14 percent.
Some of the reasons parents gave for supporting the guidelines:
They appreciate the age-appropriateness of the policy.
They like that it limits choices for younger students.
Most feel that high school students are old enough to make
choices.
Additionally, 88 percent of health professionals surveyed,
including pediatricians, family physicians, dieticians, and
nutritionists, support the School Beverage Guidelines.
This poll was conducted of 700 parents (59 percent female/42
percent male) by the highly respected Public Opinion Strategies firm,
which is the research firm for the NBC News/Wall Street Journal poll.
The parents responding to the survey reaffirm that our policy makes
good sense. It is based on sound nutrition and reflects the reality of
how most of us live. Like grown-ups, kids want to drink both nutritious
and enjoyable beverages. As a result of these guidelines, schools can
help our children learn to choose beverages that are lower in calories
and/or high in nutrition.
committed to implementation
The beverage industry is working hard to implement these
guidelines. Since we signed the Memorandum of Understanding (MOU) with
the Alliance for a Healthier Generation, our companies have spent
hundreds of hours training their marketing and sales teams about the
guidelines. These teams have reached out to school contract partners to
educate them. Our companies have reformulated products. They have
created new package sizes to meet the smaller portion sizes required in
the guidelines. And, they are retrofitting vending machines to
accommodate the changes in package sizes.
In addition, both the Alliance for a Healthier Generation and the
industry are continuing our outreach efforts with schools and national
education groups to garner their support to implement the guidelines.
The Alliance offers a web-based educational tool kit and product
catalog so that schools can more clearly understand what beverages fit
the guidelines when they enter into or amend contracts.
The School Beverage Guidelines MOU requires full implementation of
the guidelines by August 2009. Dr. Robert Wescott, an independent
economist and member of the Clinton administration, is overseeing the
process to gather and evaluate both sales volume and contract data from
thousands of bottlers and schools across the country. This is not a
simple process, but the work is well underway.
Our first year report showed a 41 percent decline in beverage
calories shipped to schools. We believe this was a tremendous step
forward.
The goal for our second year of implementation is to have 75
percent of school contracts in compliance--nationwide. As we speak, Dr.
Wescott is analyzing the data for his next report which is due out in
September. I am optimistic that we will meet that goal and be well on
our way to full implementation next year.
In fact, our commitment to implementation was clearly demonstrated
last year when we worked with Senate Agriculture Committee Chairman Tom
Harkin during Farm bill reauthorization to forge agreement on an
amendment establishing nutrition standards for foods and beverages sold
in schools outside of the reimbursable meal program.
In addition, we were strong supporters of the Harkin-Murkowski
School Nutrition Amendment. That amendment included beverage standards
that closely mirrored the Guidelines, however Senate procedures
precluded the amendment's consideration. As that committee considers
reauthorization of the Child Nutrition Act next year, we will continue
to work with Senator Harkin and Chairman George Miller in the House to
demonstrate our commitment to this commonsense approach that balances
good nutrition with the practical needs of schools.
In fact, the ABA and our member companies would propose and support
codification of our School Beverage Guidelines. Whether that is done in
the Child Nutrition Act--or in another form--we believe, and many
parents agree, that the School Beverage Guidelines should be the law of
the land.
This would help our member companies, school administrators and
parents move forward knowing what the Federal Government expects--in a
way that is based in sound science and appropriate public policy.
bold steps on marketing to children
Another example of our commitment to healthy children is
demonstrated by the recent adoption of a new policy on marketing to
children.
Earlier this year the International Council of Beverages
Associations (ICBA), the worldwide trade association representing the
non-alcoholic beverage industry, adopted a global policy to not market
many of their products to young children.
Under the Global Policy on Marketing to Children, ICBA members will
not market carbonated soft drinks, ready-to-drink teas and coffees,
sports drinks and energy drinks to any audience comprised 50 percent or
more of children under the age of 12. The comprehensive policy will
cover broadcast television and radio, print, digital media such as
Internet and phone messaging, and cinema, including product placement.
Our companies are also beginning a comprehensive review of other forms
of marketing practices, including the use of licensed characters,
sponsorships and other forms of marketing communications on channels
which are predominantly viewed by children.
Our largest global beverage companies have agreed to fully
implement this policy by the end of 2008. Additionally, the ICBA
intends to issue its first report on the global advertising commitment
by the end of 2009.
This global policy was developed within the framework of a wider
food and drinks industry commitment to collaborate with the World
Health Organization (WHO) and other stakeholders to help implement the
2004 WHO Global Strategy on Diet, Physical Activity and Health. This
agreement is the first, sector-specific step in a broader movement that
will include a variety of initiatives and a large number of food and
beverage partners.
physical activity
And no discussion of child health would be complete without talking
about the need for physical activity. Reports are that children are
spending upwards of 6 hours a day in front of a screen. Whether it's a
television, computer, or the latest video game entertaining
distractions have taken the place of sports, exercise, and physical
play.
Weight gain, is at its root, an excess of calories consumed over
calories burned. And without the necessary physical activity, we will
continue to see overweight children. We must not allow the calories
burned portion of this equation to be lost. It is equally as important
as calories consumed and deserves equal attention from lawmakers,
parents, schools, communities and industry.
I appreciate and thank the representative from the YMCA for being
here. It is organizations like theirs that can make safe places for
children to be more physically active. As an industry, we also support
more physical education in schools and more opportunities for physical
activity like recess.
The beverage industry supports Senator Harkin's FIT Kids Act, which
would integrate physical education into the regular school curriculum
through the No Child Left Behind Act.
conclusion
The American Beverage Association welcomes the opportunity to work
with the Alliance for a Healthier Generation and with Congress to
provide guidelines for schools that offer more lower-calorie and
nutritious beverages. While we applaud this committee's efforts to find
new ways to address childhood obesity, we hope that it will recognize
and support the significant effort by this industry to change the
beverage offerings in schools that is already well underway. Mr.
Chairman, our industry is providing the impetus for change in our
communities and we will continue to seek to lead on this issue.
Limiting calories in schools is a sensible approach that acknowledges
our industry's long-standing belief that school wellness efforts must
focus on teaching kids to consume a balanced diet and get plenty of
exercise. Our industry will continue to do its part to help our kids
learn how to lead a healthy life.
Senator Dodd. Well, thank you very much as well. Thank all
of you here for your comments.
I will keep an eye on the clock here as well so we don't
overrun here. With just the two of us here, we don't have to
run the risk of doing that.
Ms. Neely, let me start with you because I--and Mr. Dwyer
is here from Connecticut as well. In Connecticut, parents and
health advocates in my State worked very hard to get sodas out
of schools. Unfortunately, the American Beverage Association
fought against this important effort and nearly succeeded in
derailing it in Connecticut.
My understanding is that member companies have done this in
other places as well. How do those actions match up with your
statements here this afternoon?
Ms. Neely. Well, again, we have committed as an industry
nationwide to implement this policy, and the policy does
involve taking full-calorie soft drinks out of the Nation's
schools. What the policy allows or permits is low-calorie
beverages or higher calorie beverages like juice in capped
portion sizes.
So, for high schools, the diet soft drinks, sports drinks
in 12-ounce sizes, again juices and teas in 12-ounce sizes are
permitted in, and that is the policy we are implementing across
the country.
Senator Dodd. Well, Dr. Thompson, what is your reaction to
this?
Dr. Thompson. The beverage association should be commended
for the first steps that they have taken. It is an important
step to recognize the caloric load that is being placed upon
our students' energy balance through the school-vended
products, and the beverage industry has taken an important
first step.
The beverage industry is actually a more consolidated
industry than the snack food industry, and it goes down from
there to a certain extent. The expectation of a voluntary
solution here nationwide needs to be vested in assessment
across the board.
This is not, though, about pointing fingers at the beverage
industry. I mean, our school system chose over the last two or
three decades to turn to vended products as a way to serve
lunch as opposed to make capital investments in the cafeterias
to have refrigerators to offer fruits and vegetables, and it
was not intentional. That is what I am trying--it made sense.
It didn't require a cafeteria worker to offer a vended product.
But now we are 30 years later, and we recognize that those
vended products have minimal to no nutritional value and a high
caloric load, and you have to ask the question, ``Why are they
in our school environments?'' They are there. The schools are
somewhat dependent upon them for revenue. They use that revenue
for scholastic and nonscholastic activities.
The practice--which is not the beverage industry
association, is not in the industry agreement--are the pouring
contracts. These are usually private contracts between soft
drink companies for advertising space in the school
environment. If you look at a football scoreboard, it is
usually sponsored by one or another soft drink industry
proponent.
We have sold the advertising space inside of our schools.
We must intentionally work to reclaim that advertising space
and to lower the caloric load that advertising space
represents. The beverage industry represents an important, and
it should be commended, first step. But we have got to look at
other ways that we can reduce the caloric load on our students
during the school day.
Senator Dodd. In Connecticut, we had the experience of
parents really wanting to do something, and obviously, they
faced opposition in that regard. But your point being that the
schools themselves and the local communities really have the
final say in all of this. It is really up to them to decide
whether or not they want to proceed.
It would seem to me that educators of all people would be
on the front line of all of this. I mean, they can't claim
ignorance. They see it every day. They are watching the
children for whom they are sort of in loco parentis going
through all of this. Why aren't we doing a better job and why
isn't that working better?
Dr. Thompson. We are waking up. I mean this is a slow
epidemic. It is not like SARS or something that is going to
happen overnight. It has happened over the last 30 years. If
you look at kindergarten class pictures from 30 years ago and
today, it is dramatically different. But if you look at last
year's and this year's, it is not that different.
It has been a slow recognition. The changes are
increasingly clear about this energy balance between the
calories you take in, the calories you have to burn off, or you
are going to gain weight every day. Some of the research
supported by the Robert Wood Johnson Foundation says that the
entire epidemic could be caused by as little as 100 calories a
day over the course of a lifetime of a child being out of
balance.
Senator Dodd. Yes. You don't need to lose 137 pounds?
Dr. Thompson. Don't need to lose 137 pounds, and we have
individual champions that should be commended, as well as the
beverage industry, for taking that personal risk. But it is a
system change. This is not about an individual's choice.
This is about the environment that they grew up in that we
support, whether it is implicitly or explicitly through the
rules, the regulations, the decisions we independently make
about what our school environment is going to look like, what
is going to be available to our students within that, what the
communities look like, whether they have sidewalks or not,
whether we have safe routes to school or not, whether we have
parks and other places that are safe or not, those are
intentional investments we have to make.
Senator Dodd. The learning capacity and ability? I mean,
there is no longer any doubt that a child that is more obese is
probably going to have a greater problem learning.
Dr. Thompson. We know that the children who are more obese
in our State have more health problems and, therefore, are much
more likely to miss school. The evidence for the tie between
educational attainment and obesity is not as strong, but it is
a rational one.
The most important thing, and if I could appeal to Senator
Bingaman and yourself and your colleagues, as a pediatrician, I
have never met a mother who wanted a healthy uneducated child
or an educated unhealthy child. Yet we have, at the Federal
level all the way down, set our programs up to only focus on
one or the other of those issues.
Parents want healthy and educated children out of the
pipeline. We ought to make sure every program we are putting
money into is coordinated, and it is an investment. I really
commend your task force because at the Federal level that is
where that must start.
Senator Dodd. And my last question for you. I don't think I
made this clear last week. But, some people think the
antithesis of obesity is being thin. The antithesis of obesity
is being healthy, correct?
Dr. Thompson. Correct.
Senator Dodd. Too often we are leaving that impression, and
the whole problem with the advertising, the marketing, and the
branding is that we associate health with almost anorexic sort
of weight loss, which is dangerous. We talk about obesity on
one side, but eating disorders are a different issue. Maybe you
want to just take a minute and distinguish between obesity and
an eating disorder.
Dr. Thompson. Right. On the range of a spectrum, we have
some children that clearly have an eating disorder that are
underweight with anorexia or other specific psychological
conditions that cause them to have an inappropriate assessment
of what their weight should be.
We have a middle range, which is really where we want
people to be. It is not just a healthy weight, but it is a
healthy set of activities on a weekly pattern so that it is
this balance that we have talked about.
Then we have, unfortunately, gone from where only 5 percent
of our kids were in this at risk or obese group to now 30
percent of our children. Really, we have lost healthy weight
kids to the obese and at-risk group. When we look at what their
diseases are, those are the kids that are having the chronic
diseases start in the teenage years and that we are actually
having to pay for in their 20s and 30s.
We have looked at our State employees--just for the record.
We have looked at our State employee population, and an obese
State employee who is 64 costs twice as much, $9,000 a year, as
one who is at a healthy weight. We deliver those to your
Medicare doorstep at age 65.
Senator Dodd. What does that cost again?
Dr. Thompson. Nine thousand dollars compared to four
thousand and five-hundred dollars.
Senator Dodd. Per year?
Dr. Thompson. Per person per year.
Senator Dodd. Per year?
Dr. Thompson. Per year. We deliver those to your Medicare
financial doorstep at age 65.
Senator Dodd. Jeff.
Senator Bingaman. Thank you all very much for your
testimony.
Let me ask you, Jonathan, about this nutrition and physical
activity group that you said was really key to getting you on
track to begin losing weight, as I understood what you said.
Mr. Miller. Yes.
Senator Bingaman. How long had this been in existence in
your high school, as you understand it? Is this something that
is common, or do you know?
Mr. Miller. It is actually not common for me. It was brand
new when I signed up for it 2 years ago as a senior in high
school. It is very uncommon for me. Middle school, never heard
about it.
Actually, I remember missing recess in middle school
because all of a sudden after elementary school, recess
stopped. Recess wasn't important. You didn't have to take gym.
Honestly, if people didn't want to do basketball or soccer,
then they would just not take gym. I sadly happened to be part
of that percentage of people who decided I am not going to take
gym anymore.
So this physical activity and nutrition group, very
uncommon. But it was a miracle that I found it.
Senator Bingaman. OK, Dr. Thompson, let me ask you, is this
a common thing in high schools? I mean, when I was in high
school back in the Middle Ages, we didn't have such a group.
But it sounds as though we should have today in every high
school and in every middle school.
Dr. Thompson. I would commend the program that has been
described. It is uncommon. It usually takes a local champion to
organize resources and to put it together. It is not at all a
broad-based set of activities. The Y and other community
organizations are trying to do similar-type activities after
school.
But we don't have a coordinated strategy to make sure that
every student finds the way that they are most comfortable
being physically active and healthy every day. In the lack of
that, in an environment that is ``obesigenic,'' some people
say, we end up with what we unintentionally end up with. We
have to intentionally change it.
Senator Bingaman. From your testimony, Jonathan, it sounds
like you really needed this nutrition and physical activity
group in school, but you also needed access to the Y to be
physically active. The fact that they connected you with the Y
and said here is a scholarship and why don't you go over to the
Y and get some exercise?
Mr. Miller. Yes, it was definitely 50/50. Having it in
school was a great thing, but also having something to rely on
outside of school was another great thing because there are
weekends. There are days off school. There is the summer. So
having another place that I could go to where I knew I could
exercise was a great thing for me.
I believe it is not just one thing or the other, there has
got to be a balance because, great things happen when things
are in balance, compared to just going from one side to the
other.
Senator Bingaman. Well, it does seem, Mr. Chairman, that
one simple thing that doesn't require and wouldn't require a
lot of money, I don't believe, would be to encourage every high
school and every middle school in the country to establish a
group like this that people could join up so that they could
begin to help people the way Jonathan was helped. That sounds
like a very positive thing to me.
Let me also ask Dr. Thompson to elaborate a little more on
his testimony. You said something earlier that caught my
attention. You said that, ``In Arkansas, we have halted the
epidemic of obesity.'' I believe you said that in reference to
childhood obesity. What do you mean when you say you have
halted the epidemic?
Dr. Thompson. Sure. When you look at the Centers for
Disease Control's national numbers over the last three decades,
you see this dramatically increasing rate where we have gone
from 5 percent to 10 percent to 15 percent up to 30 percent
cumulatively of children in the United States that are either
obese or overweight.
The first year we measured it, we were at 38 percent. We
expected in years two and three to see our line going up, just
like the national numbers were going up by report. What we can
now say is we have flattened that line. We have halted the
progression. We don't have more children becoming obese.
We haven't reversed it. We haven't turned the aircraft
carrier around yet. Candidly, I am not sure we can, without
continued and more support from the local community level and
from the Federal Government's level. But we have halted it.
If I might add, Jonathan represents an incredibly powerful
individual inside of a community school program that was
incredibly supportive. I don't know what age, Jonathan, you
were when you started into that, but we have got young families
whose parents are equally mobilized, just to share a couple of
stories.
We had a third grader. When we sent the first confidential
health report home, mom had been worried about it. She had been
going to birthday parties that were dress-up parties, and her
third grader had to not participate in the dress-up party
because she was too big to fit in the clothes. So she ended up
being ostracized from the birthday party because she was too
big and it didn't work.
Well, she got the health report, and in that report, we
recommend that families change from sugared soft drinks to non-
sugared soft drinks, go to low-fat milk or no-fat milk, have a
family activity period, and to limit screen time to 2 hours a
day. The family did that. Didn't see a doctor. Didn't have any
clinical support.
She went from morbidly obese to now she is right smack dab
in the middle of the healthy range on her BMI, and she is the
starlet, if you will, in the seventh grade, where she was the
ostracized kid in the third grade. She changed her course, her
whole lifetime course she changed.
Equally important, we had a family we sent it home to--on
this health activity for family--saying go out and do
something. I had a mom with three teenage boys, and after about
the third day that I saw them coming by--I live on a hill. When
they were going uphill on a forced march, I said, ``OK,
something is wrong here.''
So I went out and I interrupted mom, and I said, ``Why are
you out with your kids walking?'' She goes, ``Well, my mom died
last year at age 50 of diabetes, and I was told last year that
I have diabetes. Jonathan here, my oldest, is overweight. I
don't want him to get diabetes. And the youngest child, Fred,
he got a bad report last year, and we are not going to have
this happen to the rest of my family.''
So there are parents, there are families, there are whole
community organizations ready to move. They need support, and
they need help. That is what you have represented before you,
both industry, community, State, and individual organizations
that are here and recognize the issue and look forward to
working with you.
Senator Bingaman. Thanks a lot, Mr. Chairman.
Senator Dodd. Thank you.
We have been joined by Senator Murkowski from Alaska, who
was with us throughout the entire hearing last week and has a
real interest in the subject matter. We thank you for joining
us. I don't want to ask if you want to jump right in, or do you
want to just take a minute to do what you would like to do?
Have you got any opening comments or questions for our panel?
STATEMENT OF SENATOR MURKOWSKI
Senator Murkowski. Well, I don't really have any opening
comments that I would like to add at this point in time other
than to let you know, Mr. Chairman, that the meeting that we
had last week was, I felt, very helpful and very beneficial.
I don't know whether you are planning on calling on anyone
from the audience again, but I thought it was great. It added a
real personal component to an issue, that sometimes gets you
bogged down in the statistics and theory. When you ask for
input from young people that are living with obesity, you get
some pretty good ideas. I felt that opening up the ``Question
and Answer'' session to the audience was very, very helpful.
I want to welcome all of you. I apologize for my tardy
arrival, and for I not being able to listen to your opening
statements. But I do have a keen interest in how we tackle
obesity; a very difficult issue, and tackle it not only from
the family perspective, but also the community perspective and
how we can at the Federal end provide for policies that make
sense, that are supportive rather than counterproductive to
what we are trying to achieve.
From my perspective, it has been great to work with Senator
Harkin on some of the nutritional aspects and the legislation
that we have tried to advance will make sure that the foods in
our schools are healthy and are good. We are making great
headway in terms of the awareness by young people when it comes
to what they should be eating.
Partly it is the changes that we are seeing within the
schools. When we take some of the bad foods out of the vending
machines in schools, that sends a strong signal to the kids.
I do have a confession to make. I had Fruit Loops for
breakfast this morning, and I was starved by about 10 o'clock.
We laugh about it but, I have teenage boys, and I admit that,
as a mom, sometimes I give them what they like rather than what
I would like them to have. I will tell you that we do make sure
that it is more than just Fruit Loops for breakfast.
But we have a responsibility as parents, as community
leaders, and as policymakers to help young people make the
right choices so that they don't live with the consequences of
obesity, that results in health consequences they live with for
their lives.
So, again, I want to thank you.
Mr. Chairman, are we at the Q and A point?
Senator Dodd. We are. We have been having a good
conversation already.
Senator Murkowski. OK.
Senator Dodd. In fact, we have terrific witnesses. Dr.
Thompson is the surgeon general for the State of Arkansas and
has done a remarkable job in the State of Arkansas on the
ideas.
Jonathan has lost 137 pounds in 2 years.
Senator Murkowski. Amazing.
Senator Dodd. He attributes it to the fact, we were just
talking about this with Senator Bingaman, with this school-
based initiative that really made a difference. I wrote down
the word ``support.'' I underlined it and put exclamation
points next to it because without support this is awfully
difficult to do.
Phil Dwyer is from my home State of Connecticut and has
been with the YMCA for 39 years, and they are doing a terrific
job on a community-based level. This is where Jonathan talked
about not only in school, but then going to his YMCA to be able
to continue his efforts in developing a healthier lifestyle
that would produce the results you are looking at here today.
And Susan Neely is with the licensed beverage association,
and they have been setting some standards for beverages being
sold in schools. Dr. Thompson was very complimentary of what
the association is doing. I was a little less than
complimentary about what the association is doing, but we are
getting there. I am learning, as we are talking here, what has
to be done.
Senator Murkowski. We are making some headway.
Senator Dodd. So that will sort of give you a flavor, and
we are just sort of in the middle of it. So you are welcome to
join us.
Senator Murkowski. Well, if I can ask a question of
Jonathan and I applaud you for your personal efforts to make a
difference with your life and your health.
One of the observations that was made last week was that
oftentimes you can be in an environment, whether its your
family or just the area that you live, where your weight is not
an issue because everybody else, the same size, believes its
OK. And the kind of acceptance, if you will, that there isn't
an issue of health that I need to deal with because we all look
the same.
How big of a factor is that? We recognize particularly with
young people, that they are very susceptible to wearing what
everybody else is wearing. There is a desire to fit in. Well,
if the fitting in is at a larger size than what is healthy for
you, how do you deal with that? And was that something that you
faced?
Mr. Miller. It was something I did have to deal with. I
don't know the exact perfect way to deal with it, but one way
that worked for me was just deciding that it didn't have to
deal with looks. It had to deal with how I felt.
That was basically the way that really worked for me
because it is true, a lot of my peers, there is this thing
where it is like, ``You look too skinny. You need to eat a
burger.'' Things of that nature.
So I am trying--I don't know. There is like--because there
is so much on the opposite side, where there are people who are
accepting it. There are size-acceptance groups. I was a part of
that team. I used to say things like, ``I am not fat. I am big
boned.'' It turned out I am not big boned, just fat. So----
[Laughter.]
Mr. Miller. So, for me, I guess I basically just had to
kind of ignore it and just not let it faze me. But that is on
the personal level. There is that problem with fitting in, and
it is the challenge mainly for the person themselves, the
individual. Because like I said earlier, there is the balancing
act because it is not just one thing or the other. There are
like so many things that have to come together in a way for it
to work in a correct way or work in the best way for the person
or the challenge.
I happened to be one of the lucky few where it just sorted
itself together to work for me in order to lose weight and get
healthy. So----
Senator Murkowski. That speaks very much to you and the
type of person that you are--a strong individual, who has made
a commitment to yourself. But you also speak about the support.
I would throw this out, Dr. Thompson, Mr. Dwyer; in so many
parts of the country, we don't have programs that we need. You
mentioned support. You can have different levels of support or
you can have opportunities for young people to spend time
outside, engaged in physical activity, whether it is increased
activity, physical activity in the schools or simply where we
are providing for alternatives for our kids other than staying
inside, watching TV, and playing video games.
In Alaska, we have a lot of villages where there isn't a
lot to offer in terms of programs. For example, we don't have a
Boys and Girls Club. We don't have a YMCA. The one thing that
we do have is the school gym. But during the summertime, when
the schools are closed, so are the gyms.
After hours, the school is completely closed because the
property is unmanned, which could bring about liability issues.
And so, the one main indoor activity, basketball, is shut down.
Do you have any suggestions as to how else we can provide
for the level of support for the kids? Not only when it comes
to their diet, but also when it comes to the level of physical
activity that they need on a daily basis?
Dr. Thompson. Let me offer briefly, and I am sure that Mr.
Dwyer or Ms. Neely have some other suggestions, but the way to
potentially approach this is the energy balance equation.
Instead of looking for a single thing, think about what can we
do through the wealth of programs that you support to improve
the calories or increase the physical activity? A few
suggestions.
You mentioned the capital investment present in our schools
that get locked up at the end of the school day. That has
already been an investment that was made. It would not cost
much to open that up, and I bet you, you would have community
leaders that found ways to support adult oversight on those
sites if we had that opportunity.
Just a few off the top suggestions. We found that it was
the support in the community and support of families that made
such a difference. Of overweight teenagers in our schools, we
found that weight-based teasing dropped by 50 percent. We
looked. We were worried it was going to go up when we focused
on obesity.
What we did is when we made it be a community-wide issue,
it stopped being an individual problem. It became a group
problem. The group synergy started looking for solutions that
made a much larger reinforcing, positive impact, and that is
the program that Jonathan describes. There was a reinforcing
positive there with other folks going through similar
challenges. That is what was very positive in your story to me.
We have got some outside of the box--Mr. Dwyer said it is
not rocket science. City police departments across the Nation
are telling their officers to stop their car a quarter of every
hour. It matters whether that car is stopped in front of the
donut shop or the city park. If you stop it at the city park,
suddenly people think that the park is a safer place. It
probably is a little safer place to actually go and recreate.
So some of these things don't cost anything, Senator Dodd,
as you alluded to earlier. They are just common sense. But
somebody has to think about them, and somebody has to make the
connections, and somebody has to be charged with the
reinforcement.
Somebody has to be charged with wrapping support around
individuals like Jonathan and the many, many others that are
out there that want to make change happen, to give them a group
dynamic where it is safe to make those changes happen and they
get positively reinforced and then you are on the path. That is
what the Y and other programs across the Nation offer.
Senator Dodd. Lisa, before you came in, that is what we
were talking about. This is something Senator Harkin and
Bingaman and I would love to have you take a look at. This
Federal interagency task force, to do exactly what Dr. Thompson
is talking about. So you get people talking to each other and
about how this works.
Because normally the nutrition people will look at
nutrition. And you will get those who are involved in
recreation or infrastructure issues to look at some of these
things. But to the extent there is at least some forum for
people talking to each other about all of this, you have a far
greater likelihood you are going to see some things happen.
Which brings me to you, Mr. Dwyer, because you are the
community-based witness we have here. We have got, obviously, a
physician that cares about this, an individual that cares about
it, a company that is involved in this and has to be involved.
Tell me now, what sort of obstacles you have run into in
getting the kind of community response we're all looking for.
Pete Domenici, Senator Domenici, and I started a program
years ago called Character Counts. It made me think of it when
Senator Bingaman brought up, what could we do? People derided
it initially. But it provides very small grants, maybe $5,000 a
piece, that went to communities to take five or six pillars of
good citizenship, and promote at the elementary school level
things like honesty, integrity, and simple concepts like those.
And promote them not on a one-time basis, but for a whole month
the school would work on one concept.
But these small grants really caught on, and they developed
the program nationwide on Character Counts, and I thought maybe
some small little grants to schools to help start some of these
ideas, that might be a way of looking at it.
Mr. Dwyer. Let me comment, although I--at the risk of
disagreeing with my home State Senator, the word
``obstacles''----
Senator Dodd. You shouldn't feel shy about it. A lot of
people do.
[Laughter.]
Mr. Dwyer. The word ``obstacles'' is not part of our
vocabulary. It is amazing, with our effort as a pioneering
healthier community YMCA and our effort to convene people from
our community who care about this issue, they are starved for
the support. Jonathan probably had support from individuals who
helped him achieve his goals.
Communities need support as well, just with the simple task
of convening the mayors and the superintendents who are
always--their days are jam-packed, and just asking them to come
to the table to talk about this issue and say how can we work
together, share resources, to make a difference in our
community?
We have not found, I will say, obstacles because our local
community-based agencies, whether they are State--and our work
with the No Child Left Inside initiative of our State
governor--or through local school districts, working with our
beverage suppliers to find a correct mix of products that
children will still like and want. There are a host of people
that are ready, willing, and able to work on this issue,
implement small win decisions.
We have been working with teens to offer mini grants so
that youth groups will study this issue and implement programs
that will teach other teens the value of increased activity and
better nutrition.
So it doesn't take a lot of money. Collectively, across the
country, it may. But it doesn't take a lot of money to cause
people, to teach them, to persuade them, to help them decide
that they want to change their life.
At the end of the day, it is an individual decision, and
you need to provide the support to people. Jonathan made his
individual decision. We need programs that help communities and
individuals make their own individual decisions.
Senator Dodd. Well, what would you suggest we do? How do we
help in that regard?
Mr. Dwyer. I am not sure that we have reached the tipping
point yet. But take the simple issue of vending machines. So
every Y used to have vending machines, and every Y did not pay
attention to what was in those vending machines. And so, there
was an educational process.
YMCAs are like herding cats, where each one is individually
owned and operated and serves its local community. But there
became a tipping point because people like yourself and Senator
Harkin and others around the country have kept raising this
issue and teaching and educating. There became a tipping point
to where virtually all of our vending machines now are trying
to look carefully at the mix of products we put in there.
And so, on providing support to local communities through
the grants that you have provided so that people pay attention
to this issue, I would say stay the course. Don't let this be
an issue that is talked about for the last 12 or 15 months and
then some other issue pushes it off the agenda.
Keep talking about it. Keep funding activities that will
keep this in front, and at some point there will be a tipping
point in each State. Arkansas perhaps has hit it. But, I think
there will be a tipping point in each State where parent groups
will just force their institutions to address this issue.
It will become a voluntary event because you have set
standards and said to schools, ``Look, you need to have X
number of hours of physical education. You decide how to
accomplish that, but you have to have it for graduation.'' If
you set the standards, this country is ready to adopt a healthy
lifestyle.
Senator Murkowski. Let me ask you, if I may, Mr. Dwyer,
because I used that terminology last week. I said, in the
energy debate, when gas has hit about four bucks at the pump,
that was the tipping point, and the American consumer is
demanding action. They are demanding action from Federal
lawmakers saying, ``Congress, what are you going to do about
it?''
My comment at last week's hearing was, are we at that
tipping point, as a nation, when it comes to what I believe is
a childhood obesity crisis, and what are we going to do about
it?
It seems that there is most certainly a growing awareness,
but I am not seeing--and maybe something in Arkansas was
different that allowed you to galvanize on this issue more
readily than others. In the city where my family lives,
Anchorage, they are readily acknowledging that obesity is a
problem. But we are just not coalescing around this issue yet.
How do we do it? I don't want to see more hugely negative
statistics about the complications as they relate to growing
rates of diabetes. Oftentimes, that is what pushes communities
and States to action. How can we make sure that others
appreciate where we are so that you have that momentum for the
communities to organize?
Mr. Dwyer. It is one of the words that was used earlier, a
``common'' strategy, and I would add another adjective to that,
a ``consistent'' strategy. We send mixed messages to our young
people as to the importance of health and the importance of
good eating and enough physical activity.
We have to work on the policies that say it is important to
walk, but we won't put sidewalks in so you can do that. It is
important to have physical education, but we don't allow for
enough time or requirements in the school day or to graduate.
It is the consistency of the message. It is the common
strategy, not a single strategy. Every human being is
different, and the kind of program that attracts Jonathan is
not the kind of program that attracts somebody else. We run a
program under the No Child Left Inside about fishing. It is not
about teaching children to fish. It is teaching them that there
is another form of activity beyond sports.
We can't think of physical activity as only sports because
somewhere around eighth, ninth grade, it becomes competitive
sports, and kids, if they don't make the team, stop
participating. We have to fund a variety of activities using a
variety of agencies and State governments and governmental
programs. But, we all have to get together and provide a
consistent message and a common strategy.
Senator Dodd. How many States have a surgeon general?
Dr. Thompson. There are three States that have a surgeon
general.
Senator Dodd. That is a pretty good idea from Arkansas. We
don't have a surgeon general in Connecticut, do we?
Senator Murkowski. No.
Senator Dodd. Not only do you get one person, but you also
get an office that can focus a lot of attention on these
things.
Dr. Thompson. My job exclusively--I have no programmatic
management. My job, on behalf of the governor of the State of
Arkansas, is to look at the horizon, and that is what I commend
the hearing today.
Senator Murkowski, something I shared earlier and I want to
just touch on, there are multiple levels of government here
where there are vested controls. I mean, Congress isn't going
to necessarily tell local communities that they have to put
sidewalks in. That is going to have to be a local community
decision. States have certain responsibilities.
But the leadership of the Congress really is demonstrated
and expressed in three ways--through how you put limited
resources into play, what you set as standards across the
various programs, and what you put in place as incentives. I
would really commend the task force or any other mechanism that
you can look across the different funded programs that you have
for what are the standards and the incentives to work together
to reinforce local community early adopters.
Mr. Dwyer is more optimistic. I don't think we are nearing
the tipping point. We have some early successes. But there are
not enough of those, and we are not at a point where the scales
are about to tip because we have enough successes.
If we are not careful, we will fool ourselves into thinking
that we are at that tipping point, and we will stop short of
making the systematic changes at every level that we need to to
ensure long-term reversal of this epidemic and to avoid,
candidly, the future economic impact that we can't even fathom
right now on worker productivity, on healthcare cost and
conditions, on the economic profile of our health and
healthcare system.
Senator Dodd. Lisa, were you here when Dr. Thompson told us
a startling statistic. I made you repeat it twice. For that
person 64 years of age in Arkansas, that is obese, it costs the
State $9,000 more every year.
Dr. Thompson. Well, it is twice as much. Essentially, we
looked at our State employees population. Most States, the
State employees health insurance plan is the largest State-
based employer. So we looked at the health risks in our
insurance plan, and we looked at their claims cost. If you were
obese, physically inactive, or smoked cigarettes, you cost
twice as much as the counterparts that didn't have those three
risk factors.
So what we did as a State--and again, this is not rocket
science--it is an incentive. Our State employees now can earn
extra vacation days if they eliminate those risk factors. So we
are putting----
Senator Murkowski. All three of them?
Senator Dodd. What, do you start first and then take them
off slowly?
Dr. Thompson. Well, if they have one of these risk factors
and they go into an incentive plan, like Jonathan represented,
you know, his individual plan, we give our employees sick days.
We turned around and said can't we give them wellness days for
actually becoming healthier, more productive workers?
Senator Dodd. Good idea.
Dr. Thompson. So you have a Federal employee health
benefits plan that probably is the largest health insurance
plan in the United States.
Senator Dodd. Believe me, it is. Yes.
Dr. Thompson. It is probably not costing you less this year
than it did last year. Just a guess, I mean.
Senator Dodd. That is a pretty good guess.
Mr. Dwyer. But decisions that you make filter down. In this
country, we often work with what we call ``best practices,''
and you say here is what you should do. If you hold those best
practices up, I think people will strive to accomplish them.
I take no offense that the surgeon general accused me of
being an optimist. After all, I am a YMCA director, and that is
part of my job.
[Laughter.]
Senator Dodd. Absolutely.
Dr. Thompson. No mal-intent was meant.
Senator Dodd. Senator Murkowski and I will associate with
your sense of optimism. We sit on this side of the dais. We
have to be optimistic.
Senator Murkowski. That is right.
Senator Dodd. Let me ask you, if I can, Susan, about these
guidelines. You highlight the school beverage guidelines that
the industry has adopted. As I understand it, these are
voluntary guidelines. Is that true?
Are there any incentives for your members to comply? Are
there any consequences for continuing to sell products that
don't comply with your guidelines? In 2007, the Institute of
Medicine recommended stricter guidelines, and I wonder why your
guidelines don't meet The IOM's standards for the health of our
children?
Ms. Neely. Well, I would take the second question first.
Our guidelines were actually developed in conjunction with
nutrition scientists at the American Heart Association and then
again those participating in the Alliance for a Healthier
Generation that are part of the Clinton Foundation, along with
Governor Huckabee and his team. They reflect the perspective
that, again, consistent with IOM, for younger children--middle
school, elementary school--it is milk, juice, and water only.
They should have very limited choices, and that is what parents
tell us they want.
For high school students, a range of choices is actually
useful and productive because they are young adults, and they
should be able to make choices. But the choices that are
allowed are the lower calorie, zero calorie, smaller-portion
size options. So it is no full-calorie soft drinks.
So our standards were developed in conjunction with the
Heart Association and those participating in the Alliance for a
Healthier Generation, and it is a low-calorie, high-nutrition
policy.
In terms of implementation, my response in terms of what
the consequences are is that when three major world-class
trademarks put their name on a public document--Coca-Cola,
Pepsi-Cola, and Cadbury Schweppes, now Dr. Pepper Snapple--and
say they are going to do something, they are very determined to
do it. As part of the agreement, we signed a memorandum of
understanding. It is a 3-year implementation schedule, and we
have just completed the second year.
In addition to our very public commitment that we will meet
the markers in the agreement, I can tell you in 2 years we are
meeting those markers. First year, we met all of the markers
that had been laid out for us. Forty-one percent fewer calories
in beverages are being shipped to schools.
The second year, which is just ended now--the year follows
the school year--we are still compiling the data from the year,
and it will be another few weeks before we have the final
report. But the marker was to have 75 percent of all the
schools under contract in this country in compliance. The
initial look is that we will meet that marker.
Senator Dodd. I have got a couple of questions for you on
this. Why shouldn't we make it mandatory, your guidelines? This
is yours. Why shouldn't we just insist that that be the
standards?
Ms. Neely. We agree with that, actually.
Senator Dodd. You would make it mandatory?
Ms. Neely. Yes. We are honoring our commitment. We are
implementing the guidelines. The third year will be achieved
next year, and at that point, the guidelines are to be
implemented across the country. I am optimistic and confident
we will reach that.
But there is no question that it would propel it further
faster if it was mandatory, and that is why last year we were
such strong supporters of Senator Murkowski and Senator
Harkin's legislation that was an amendment to the Farm bill
that would have created a national food and beverage standard.
Before you got here, Senator, I said if you are ready to go
again, we are.
Senator Murkowski. Good.
Ms. Neely. And stand ready to support that because we think
it is a sensible standard and, again, just makes it that much
easier to effect the kind of change we are talking about.
Senator Dodd. Explain this 41 percent. Was it a 41 percent
decline in beverage calorie shipped to schools? Can you break
that down? Is it a large percentage of schools ordering fewer
beverage calories, or is it a smaller percentage of schools
that have dramatically decreased their orders?
Ms. Neely. Well, it is a combination. If you are taking
full-
calorie soft drinks out, you are taking--as we are in the
process of implementing the agreement, you are obviously
reducing calories because what is left in the school are the
diet soft drinks, which are zero calorie, or other beverages
that are now in smaller portion sizes. So even if you are
getting 100 percent juice--
Senator Dodd. So it is not a large number of schools,
necessarily?
Ms. Neely. Well, we are looking at all the schools in the
country. At that point in time, which was 1 year into the 3-
year implementation schedule, that was the progress we could
report. I don't know where we will be from a calorie standpoint
when we completely implement the agreement.
Senator Dodd. Or how many, what percentage of schools,
public schools that have actually participated in this? Do you
know?
Ms. Neely. Well, I don't have the number of schools. But I
can tell you the markers relate to all schools under contract,
and this applies to all schools where our members do business.
We don't have 100 percent of the business in the country, but
we have certainly a large percent.
Senator Dodd. How much does it earn the school to put a
soft drink advertisement up on the school football scoreboard?
What does that earn on average a school? What do they get?
Ms. Neely. Well, there are thousands of contracts in the
country, so I couldn't answer how that shakes out. You are
speaking, though, to marketing practices, which you alluded to
earlier, as did Dr. Thompson. That was the other part of my
report. That we have as an industry, not just in this country,
but globally, said we will look at our marketing to children
policies commensurate with the IOM report that looked at
policies and had specific recommendations for advertising for
children under 12.
We have committed that in--and this is broader than
schools--digital media, broadcast, print, product placement
media, we will not be marketing our products to children under
12 in those media, and we have committed to look at our
practices in schools as it relates to that. So that is another,
sort of, forward-leaning commitment this industry has made.
I can tell you, just practically, the policy I hear from
our distributors is that they are not advertising products that
are not allowed in the mix in the schools. So if you have a
machine with bottled water and sports drinks, that is what is
featured on the front of the machine, either that or generic
vending fronts that feature kids working out and that sort of
thing. So we are in the process of changing.
Senator Dodd. OK. Very good.
Senator Murkowski. Mr. Chairman, may I ask a question about
that?
Senator Dodd. Yes, please, go right ahead. Yes.
Senator Murkowski. It has been interesting to watch how
attitudes have changed, and how whole communities have changed
about the products that are available in school vending
machines. When we first started this, the hue and the cry was
you can't possibly take the soda out because it will cut into
revenues that the schools need for the football team, pep club,
chess club or what have you.
But the changes were put in place nonetheless. And believe
me, I heard from my share of parents who were saying you guys
better be prepared to give money to the teams because these
revenues are going to be cut back dramatically. I didn't think
that was going to be the case.
I figured a kid who had a dollar and wanted something to
drink would still put that dollar into the machine, and if they
didn't get a Coca-Cola, but got a Diet Coke or water instead,
at least were able to get something to drink.
At least, as those districts in my statement have made
these changes, we are initially seeing a drop-off in revenue.
But then, as they have been in the schools for even just less
than a year, we are seeing that the revenues are coming back
up. Is that what you are hearing from your folks that, in fact,
the revenues to the schools are not declining?
Ms. Neely. Well, we are not tracking revenues. We are
tracking people complying with the policy. So I can't give you
kind of a macro answer to that. I mean, kids are still--the
beverage mix is changing. Kids are still buying beverages in
schools, and the contracts are getting amended in a way that is
fair to the schools and fair to the----
Senator Murkowski. But somehow or another, Pepsi and
Cadbury and the others are still making money there. They are
still interested in having contracts with the school. They have
endorsed our bill and have been working with us, which I
appreciate, on these guidelines. It would seem to me that
everybody is doing OK, that the sky didn't fall, as some had
predicted that it might, when we took the full-calorie content
sodas out of the school.
Ms. Neely. There are still members of my industry doing
business with the schools and are happy to do so. That is
correct.
Mr. Dwyer. Senator, this is a micro answer, not a macro
answer. We serve 25 communities. We had vending machines in
various program sites and YMCA branches. We took all soda out
of the machines. We didn't even leave diet soda there. After
about 90 days, the commissions returned back to normal.
There was some concern by my local branch executives that I
am going to lose the money from those commissions. But it took
about 90 days for the kids to adapt, put their dollar in the
machine, and try a different product, and they kept buying it.
I think that is a false issue, personally.
Dr. Thompson. If I could just add, we have probably taken
this on the chin, and Ms. Neely may have more information on
this. The beverage industries themselves don't control 100
percent of the school products in the school.
In fact, in our region, we have much more control by the
local vending companies than we do the major soft drink
suppliers. So it is not a one-size-fits-all across the Nation,
and we actually have had much more resistance from our
suppliers than are represented in the beverage industry
guidelines.
Having said that, however, the--it is about what your goal
is. If your goal is to raise money off kids to support schools,
let us figure out how we want to do that and optimize it. If
your goal is to have healthy kids come out at the end of the
pipeline, let us figure out how to do that and optimize it.
It is what your goals are. Figure out what the goals are
and align the programs to do it and hold harmless as many
people as you can----
Senator Dodd. Well-educated, healthy kids.
Dr. Thompson. That is what every mom I have talked to
always wants. I have never found any mom that says I want one
or the other.
Senator Murkowski. What about the concern that I have
heard, that we are doing a much better job in the schools. We
have got cooperation on the vending machine issue. We are doing
a much better job with just the food service in the schools,
healthier meals for the kids. But then you hear that, the kids
are still getting their soda pop.
They are going down to the corner store, and they are
buying it there. Or that you have some enterprising young
students that are making a little bit of money on the side by
selling it themselves. How big of an issue is this? I mean,
kids are kids, and it is probably all those that are eating
Fruit Loops in the morning instead of good oatmeal. But is it
this big of a problem, and what are you seeing?
Mr. Dwyer, you mentioned that at the Y, you took the soda
out. Do the kids just go to the neighboring stores? What do
they do?
Dr. Thompson. Well, kids represent the innovative future of
America. So I don't think we want to quelch that. When we
measured BMIs and they were--just as an example, we had one set
of high school students who just decided they would have a
little fun with the system. So they all wore leg weights in
when they had their weight assessed, and they really skewed
things up. Everybody said, ``Wait a minute. What is going on in
this community?''
[Laughter.]
Dr. Thompson. But having said that, some students will test
whatever boundary or whatever goal or whatever program you want
to put in place. What we have to do is capture that energy,
have a good time with it, and make it fun to pursue that
healthy goal.
One of the things I have wanted to do and we haven't is
could we capture the skits about all of our obesity efforts
across schools in the State of Arkansas and have a competition?
Because there is some pretty good comedy going on on what we
have tried to do. Releasing the vending machines from prison
was one that I was aware of. Having the obesity police come
into the school, which was not quite so positive.
But I mean, all of these things are positive and how we
actually capture that energy--the direct answer to your
question, we have had pockets of resistance. But, the
recognition of this as a major threat both communally for
everyone and for 30 percent of our kids, which means 30 percent
of our parents, they will mobilize and they will overcome those
threats. They actually come together and make it be a group
dynamic that is pretty hard to resist.
Senator Dodd. You haven't made this point today, but Lisa
and I heard this last week. And it is that for children with
obese parents, the likelihood that the children are going to be
obese as well is fairly high. You haven't talked about that
today, but is that your conclusion as well?
Dr. Thompson. That is our finding, and that is why we have
focused on childhood obesity for two reasons. One is, it is
where we probably have the easiest changes to make, and we can
have the biggest long-term lifelong impact.
But that is why we have also focused on our State
employees. By doing a health risk appraisal, by modifying their
vacation days, we have actually tiered their health insurance
premiums in a minimal way so that if they have these health
risks, they pay more than if they have eliminated these health
risks.
So we have actually, as I said, done everything we can
think of at the State level to try to impact this. We do need
help from Congress, and we need more mobilized local community
efforts like Mr. Dwyer represents.
Senator Dodd. I would like you to send us that information
on the wellness days, and how you do that. We would be very
interested in that.
Dr. Thompson. OK, I would be glad to.
Senator Dodd. Let me ask you a couple of just quick
questions. The BMI, the body mass index, for those who are not
familiar with the terminology, reporting requirement in your
State, as of last summer, only 12 States have undertaken
initiatives for schools to screen BMI or other obesity-related
measures.
I wonder, Doctor, if you could tell us about the challenges
surrounding the BMI.
Dr. Thompson. The weights were--that was a pleasant
challenge. We have had some other challenges along--we just
completed our fifth year of assessment. The first 4 years, we
measured every child in kindergarten through 12th grade. Last
year, we measured every child in even years. So, from now on,
we will do even years.
We have measured children in a confidential way. The child
did not know what their weight was, didn't know what their
height was, didn't know where they were in the BMI calculation
because we want it to be a parental support tool. We sent home
a confidential health report to parents saying your child was
weighed on this day. It puts him in this risk category. This is
what we are worried about. These are things your family can do.
If you need more help, turn to your primary care provider.
Meanwhile, over here, we are changing our Medicare and
SCHIP programs so that primary care providers are reimbursed
for actually providing that support. The primary reason why we
did the BMI is because both the Institute of Medicine and the
American Academy of Pediatrics, since about 2002, have said
every parent ought to know their child's BMI percentile every
year to make sure that they are managing this risk.
When we talked to parents, almost no parents had been given
their child's BMI percentile through the regular clinical
process. So we did, just like we do for hearing screening or
vision screening or scoliosis screening, we did a simple
addition to the screening process that was in place within
schools.
Senator Dodd. Reaction of parents?
Dr. Thompson. Reactions of parents. I personally sent
90,000 letters the first year to parents whose children were
either obese or overweight with my signature, my phone number,
and my address at the bottom of that letter. We got 300 phone
calls. Three hundred out of ninety thousand.
One hundred fifty of those were pretty irate. What right is
it of mine to intervene in the school and tell the parent that
their child had a weight problem. Half of them, another 150
wanted more information.
Any business that deals with 90,000 consumers would take a
150 complaint rate pretty easily. Over time we have lowered
that complaint rate as we have gotten everybody kind of
mobilized in recognizing what the problem is. But it is not
without risk. But if done right, it can be done safely.
Senator Dodd. Any follow-up to find out how parents are
responding to this?
Dr. Thompson. We have done, our College of Public Health,
independent of our implementation--so we had an independent
evaluation. They just reported their fourth year findings. We
have had a doubling of parents of overweight children who
recognized that their child has a weight problem.
We have had an increase by 10 percent of students that are
physically more active than they were 2 years ago. We have
documented changes in the purchasing patterns, not necessarily
the purchasing volume, through vended products of overweight
students.
We are starting to see some of those changes that Mr. Dwyer
alluded to at a tipping point. If we don't continue to pour
more effort and energy into it, we could lose that too easily,
and I want it to be lasting, not just a one-time finding.
Senator Dodd. That is a great effort to make. Let me ask
you one other question, again going back to the vending machine
issue. Your testimony said that 61 percent of Arkansas schools
now have policies requiring healthy foods to be available in
the vending machines.
Dr. Thompson. Correct.
Senator Dodd. But then you also state that only 26 percent
of the vending machines in schools are in a healthy category.
Dr. Thompson. Right. Our policies in the State, there are
two issues that move there. The State rules and regulations
supersede a school-based contract only when the contract
changes. So I alluded earlier to the vending companies, which
have more control than the beverage associations in our
contracts.
When these rules and regulations were going into effect,
many of them went out and put in 10-year contracts. So our
rules and regs only go into effect after those contracts expire
or are modified. When you get down to where the rubber meets
the road, it can get pretty interesting, and that is the reason
for those differentials.
Senator Dodd. Talk to me about corn syrup.
Dr. Thompson. Corn syrup, again, there are many that focus
on the Federal subsidies to agriculture. My State and my
Senators in our State are very supportive of the agricultural
subsidy programs. However, we must think intentionally about
what we are doing there.
We have lowered the cost of corn syrup as a commodity and
as a food source, and we have seen a response by the food
industry to be able to offer lower cost foods, particularly to
lower income and minority communities, and we have seen an
uptake of those food products, which are not necessarily as
healthy as they had previously been using.
That is why you see, as Mr. Dwyer alluded to, a lot of
farm-to-family programs now, trying to get healthier nutritions
back into the food supply chain. We need to intentionally think
about how we want both our subsidy programs and our school and
community support programs, through the WIC program or through
school lunch programs, to actually use the power of the
congressional leadership to lead us in the right direction.
Senator Dodd. You point out the economic benefits. But you
are suggesting as well that the move to corn syrup, while there
may be some economic advantages, there is a direct correlation
between that and the growing problem of obesity.
Dr. Thompson. There is a direct correlation and
association. The causation--we don't have a group of people who
have not been exposed to the corn syrup subsidy. So the
researchers in the room would have less comfort with me drawing
the conclusion.
If you look at what has changed between 1970 and 2008,
which is when this epidemic blossomed, and we look at what has
changed in our food supply and we look at what has changed in
our subsidy programs and we look at what has changed in the
experience of our families and their children, that is a major
component.
Senator Dodd. Just lastly, on economics, we are looking
today, obviously--and Senator Murkowski mentioned--at the
rising cost of fuel and other items. What correlation do you
see on this economic issue, and what is going on with obesity?
Dr. Thompson. Without question, lower income families have
to stretch their dollar farther. Their ability to afford
healthier foods is in direct causation more limited.
One of the challenges we have is how we can affordably
change our food distribution system and, as Jonathan mentioned,
make available safe physical activity places that people can
affect that energy balance so that the calories people take in
equal every day the calories they burn off, or we are going to
gain weight.
The only way to lose weight is to have the calories you
take in be less than the calories you burn off. That is the
only way to lose weight. One of the challenges, and just to
raise your awareness, when the Congressional Budget Office
scores a program, they only look at the next 10 years' return
on that investment. It may be that we need to take a different
view on obesity prevention programs because it may be a
generation where we have to look at what the cost impact is,
not just the next 10 years.
We did not get here overnight. We did not get here
intentionally. We are going to have to take many years, if not
decades, to get to a different place, and it is going to have
to be very intentional.
Senator Dodd. Thank you. That is great.
Senator Murkowski. Mr. Chairman, may I ask a question on
this because this is something like we've seen with energy
price increases, and we are seeing our prices in Alaska go
through the roof. It is not necessarily because of what we are
paying at the pump. It is the fact that all of our goods and
services get to the State by barge or by airplane. We don't
have the roads to put them on a road system.
The goods that we get, the food products that we get are
immediately going to be that much more expensive than anywhere
in the Lower 48. So in many of the outlying areas of the State,
the school districts are faced with their budget and that they
know they need to work within ones budget. Their fuel costs
have gone up to keep the school warm. They can't control that.
They have got to get that money from somewhere.
They are probably going to get it from the school lunch
budget, which means that they are going to have to figure out
ways to cut the corners. I have already been talking to some of
my school nutrition program folks, who are saying, we basically
will have to do more with less. This means that instead of the
fresh fruits and vegetables, which are difficult to get in the
first place, they are going to be going back to the canned
peaches and the products that we can get.
But in terms of being able to say that this is a healthy
lunch to feed these kids, I am quite concerned that we are not
going to see that help. I applaud Senator Harkin's effort to
get fresh fruits and vegetables into the schools, but I
recognize that in Alaska, we are probably not going to see that
at all.
I will give you one example about soda in rural Alaska and
why I get a little bit animated about it. Up in the rural parts
of the State where you don't have local delivery on a daily
basis, we simply don't have milk in the stores. My sons and I
went on a 5-day river trip out on the Kuskoquim River. I have
teenage boys that drink a lot of milk. For 5 days, they
couldn't find milk. There was no milk for breakfast.
You can buy the powdered milk, but you have water systems
that, quite honestly, the people do not drink water because the
water is not pure, clean water. So they don't have the water
and they don't have milk. But what they do have for liquids is
soda pop.
So, the soda pop comes into the school, and that is what
everybody drinks. Everyone drinks pop. What we see then are
increasing levels of diabetes. We see increasing levels of
tooth decay to an enormous extent. We can't get milk out there.
Buying bottled water in the villages is more expensive than the
soda pop.
We have got to be able to provide for the healthy options
because when you are thirsty in many of the villages that I
represent, there is really nothing healthy to drink. What I
would like to do is work with the industry to encourage them to
bring more of the water and healthy drinks in, as opposed to
the soda pop.
We actually have a ``Stop the Pop'' campaign at the
legislative level because we see, and it is not to pick on soda
pop necessarily, but when it is your source of liquids, that is
a real problem for us.
Dr. Thompson. You have got a finger on the pulse of the
issue, and it is being made worse by some of the economic
conditions and the fuel prices that are around. We have areas
where it is 20 or 30 miles to get a piece of fresh fruit--not a
whole State away, and I don't mean to minimize the Alaskan size
and breadth. But this is an issue that we can work with, and
that is why I commended the beverage industry's first step
earlier, but also challenge, incent, reward.
I mean, our industry needs to step forward and help us
solve this problem, and we have some leaders that are willing
to do that. They are not necessarily always rewarded for having
done so. We need to make sure that they actually feel momentum
coming into their priority list, too. We have got to come
together. Again, the cross-fertilization across different
programs, recognizing some of these issues, being aware is the
first step, and I commend the opportunity here to share with
you.
Senator Dodd. I also should tell you that Senator Kennedy
and Senator Mikulski are co-sponsors of this proposal, and we
would love to have you look at this, Lisa, as well as the
interagency task force.
Senator Murkowski. I will take a look.
Senator Dodd. It would be helpful.
Senator Murkowski. I think Susan wanted to make a comment.
Ms. Neely. I was just going to say, we certainly believe
soft drinks have their place as part of an overall healthy
lifestyle. So maybe the focus, rather than Stop the Pop, should
be on bringing in more choices and more options, and we would
be happy to work with you and address that.
Senator Dodd. I am shocked. I am shocked to hear you say
Stop the Pop is a bad idea.
[Laughter.]
Ms. Neely. Soft drinks are part of a healthy, balanced
life.
Senator Dodd. Let me just ask our panelists if they could
stay around for a few extra minutes. Last time, we had a
wonderful audience of younger people, and I see a lot of
younger people here today as well. Any of you have any comments
or questions at all that you would like to raise? We did this
the last time.
Yes, back over here? We are going to get you a microphone
so that we can hear you this time, too. We don't do this
normally, but I am just so impressed with the turnout. I was so
interested that so many people wanted to come and hear. As
Senator Murkowski said, we get some great ideas that come from
the audience as well.
Yes. Tell us who you are.
Ms. Worsham. I am Jenna Worsham. I am an undergraduate at
Washington and Lee University, a summer intern. I actually just
had a question for Dr. Thompson.
In your initial statement, you mentioned the reforms needed
with the WIC nutritional programs, and I was wondering if you
could maybe elaborate on that? I know there are some issues
right now, specifically like the infant formulas and the
nutrient levels they are in. If you are talking about really
getting to the root of this problem, that would be it. So I was
wondering if you had any comments?
Dr. Thompson. Very briefly, and I appreciate the question.
The programs that we put in place, which were to optimize
nutrition for women, infants, and children, have been surpassed
by our knowledge--or our knowledge has surpassed their
standards. And so, ways to tie, as you mentioned this earlier,
Senator Dodd, what we know from the science, the IOM
recommendations and others, to almost automatically come into
the WIC guidelines as opposed to wait until a reauthorization
or a reestablishment.
I mean, if there was a way we could figure out how to let
science directly inform a program that, candidly, I don't know
that Congress wants to get into the details of the science on
what the WIC formula of consistency is supposed to be----
Senator Dodd. You don't want a 51-49 vote here.
Dr. Thompson. But there are ways that we could actually
streamline our knowledge of science into the WIC formula and
into the WIC program so that there actually is a more real-time
update as we learn more.
Senator Dodd. Yes, that is a great suggestion.
Yes, ma'am? Back here. It doesn't have to be questions
either, if you have any observations you want to make.
Ms. Cantor. I have a suggestion. My name is Rebecca Cantor.
I am a doctoral student at the Johns Hopkins School of Public
Health in international health and human nutrition, but I am
also an intern here at the National Family Farm Coalition.
My first suggestion is something that Mr. Dwyer brought up,
and it is talking about the CDC Steps Program. This is a
program by the CDC that encourages public and private
partnerships to be made at the community level.
Senator Dodd. This is the Centers for Disease Control?
Ms. Cantor. Yes. But the appropriations for this particular
Steps Program have been cut every year by millions of dollars
since the Steps Program started. I would encourage you all at a
Federal level to promote at least restoring the budget to the
CDC Steps Program so that more CDC Steps communities may evolve
over the course of time and encourage public and private
partnership because that is the direction we really need to go
here.
My second comment is we are talking a lot about physical
activity and beverages, but we need to think about our food
system here and around the world. I would caution just
decreasing corn subsidies because subsidies are actually what
keeps the family farmer in business. But the problem is that
the main foods that are subsidized are corn and soy. But these
are the same foods in which our food system and what is made
most affordable and popular in the United States are the most
caloric and they taste good.
But we need to think about how we can subsidize fruits and
vegetables and incentives to corporations to make foods that
are healthier the most affordable, but not the most caloric.
Senator Dodd. Very good. Good suggestions.
Yes? Back here.
Ms. Brosnihan. Hi. Claire Brosnihan from the Girl Scouts of
the USA. First of all, I want to thank the subcommittee for
addressing this really important issue. While you are
addressing it, we just strongly recommend that while we focus
on the physical, we also should take a holistic view of health,
meaning that we also address the emotional, the social health
of our children.
From our research, ``The New Normal? What Girls Say About
Healthy Living,'' we are finding--the girls are telling us that
we care about our physical health, but we also equally care
about our emotional and our social well-being, our self-esteem,
how we fit in the classroom. So when we are figuring out our
policy solutions, we definitely need to take into consideration
an all-encompassing viewpoint of health.
Thank you.
Senator Dodd. Very good. Good thoughts.
Yes, right over here?
Ms. Keyes. Hello, my name is Mia Keyes. And sir, Dr.
Thompson, my question is for you today.
Senator Dodd. Where are you from, Mia?
Ms. Keyes. I am from Philadelphia, PA, originally.
Senator Dodd. Are you in school, an intern here?
Ms. Keyes. I have recently--I am an intern here, and I have
recently graduated from Cheyney University of Pennsylvania.
Senator Dodd. Very good. Welcome.
Ms. Keyes. Thank you.
Dr. Thompson, you mentioned, as the surgeon general of
Arkansas, you are in a southern State, and obesity runs
rampant, especially in southern States. And Arkansas, as a
southern State, has a high population of minority citizens.
While obesity is certainly an epidemic that affects and
touches all, blacks, Latinos, and Asians are disproportionately
affected by the obesity epidemic. As the surgeon general or
just as a citizen of Arkansas, are you familiar with any
initiatives that culturally intervene with families in order to
just decrease their effects of obesity?
Dr. Thompson. Excellent question and a point that, for the
committee, I want to make sure that we highlight and
accentuate. When we measured the BMIs in all of our school
students, the African-American school students had a heavier
risk profile than the Caucasian. The Hispanic, particularly
Hispanic boys, one out of every two Hispanic boys in our school
system were in one of the two heaviest weight categories of the
Centers for Disease Control.
It clearly differentially affects a risk exposure by
minority status. It also is a differential risk exposure by
economic, as we talked earlier about what families can afford
to purchase or participate in.
We have tried to address some of those by making sure that
all of our information is in whatever--either Spanish language,
if a family is a primarily Spanish-speaking household, and is
culturally appropriate for some of our others. We have to do
better, particularly if we are addressing the multiple
generational characteristics. That is across all races, but
disproportionately the minority races, where a lot of times it
is, ``That is the way my mom was. That is the way my grandmom
was. That is the way I am. Of course, that is the way that my
daughter is going to be.''
So trying to get people to realize it doesn't have to be
that way and to go, as Jonathan was talking about earlier,
upstream a little bit against some of the social norms that may
reinforce the wrong direction.
How do we find programs that work? How do we frequently
find leaders from those communities to actually be able to
deliver the message that, candidly, I, as the surgeon general
from the center part of Arkansas, am not going to be able to
deliver? Those are the people that we have to lift up and
support and find as new ways to be able to wrap information,
programmatic support, resources around to reach those target
populations that have been disproportionately affected.
Senator Dodd. Jonathan, did you have people in your family
that were obese? Parents or grandparents?
Mr. Miller. Yes. Yes, I do. My mother, my grandfather, and
my grandmother. My grandmother also has type 2 diabetes, and my
grandfather has hypertension. So, yes.
Senator Dodd. So, a family history?
Mr. Miller. Yes.
Senator Dodd. Back here. I will go back and forth. Go
ahead.
Audience Member. Hi. I am Anne. I am from Iowa originally,
and now I am in school at Harvard, and I work with youth in the
Boston area. I am leading wellness promotion programs with
others, where we focus not just on nutrition and physical
fitness, but on mental health, as well, as was mentioned.
But one of the difficulties we face is that while children
are extremely enthusiastic about learning about healthy
lifestyles, often there is a disconnect between the parents and
the children. Sometimes the programs are even seen as an
affront to their lifestyle or their culture.
You mentioned wonderful things that you are doing in
Arkansas and with the YMCA programs to educate families, and I
was wondering if you had any ideas or suggestions that could be
done at a Federal level to help end this disconnect and create
the cultural shift you are talking about?
Senator Dodd. Great questions.
Dr. Thompson. These are excellent questions.
Senator Dodd. I know. We sort of shut up up here and just
let them go.
Dr. Thompson. Yes, a lot of the culture and the family
issues are local. A lot of the leadership we have to have is
local. Some of the things that we have had are churches or
local parent-teacher associations that look for ways to, in a
safe way, teach new food preparation techniques or to change
essentially what has been a long-standing habit of food
preparation or lack of physical activity or both that lead to
this imbalance.
At the Federal level, it is going to take some support to
make sure that the message is culturally appropriate and not
accusatory.
Senator Dodd. Yes.
Dr. Thompson. There is a piece of individual responsibility
here, but nobody wishes to be in this situation. It is an
environmental risk that too many people are succumbing to. If
we change the environmental risk, it makes it easier for
individuals, families, and groups to look at a new cultural
norm or a new cultural outcome and move toward that.
Senator Dodd. I started to raise this earlier, because
people say, ``If I am obese, to get healthy, I just can't go
through--I can't do what Jonathan did. I just can't do it.''
But, that is an exaggeration.
As I recall, on average, a loss of 6, 8 or 10 pounds can
move someone from that set--correct me if I am wrong. Am I
overstating the case or simplifying it too much?
Dr. Thompson. You are not overstating. If I could peel it a
little bit?
Senator Dodd. Yes.
Dr. Thompson. Your future health is about both what your
weight status is and what your physical activity level is,
because both convey and confer health benefits. A relatively
small weight loss tied to daily physical activity can
immeasurably improve your health.
So, those two things. Again, it is align your incentives,
and you will get your outcome.
Senator Dodd. It is not that hard to achieve, you are
saying, on average.
Dr. Thompson. I don't want to minimize the effect, or the
burden. It is not hard to achieve a health benefit. You have to
start. You may not have 100-plus weight loss, as our co-witness
here has. That is a great achievement. But people shouldn't
take a 10-pound weight loss as a failure.
Senator Dodd. Yes.
Mr. Dwyer. Senator, you are on the right track. It does not
take a lot of change to have a positive impact. You may not get
to everything that you want, but a little bit of extra
activity, a little less food does, over time, have a big
impact.
Senator Dodd. People now are stating, for instance, that
even 15 minutes--it used to be we wanted a full half hour or an
hour. But I have listened to nutritionists say even if you only
get 15 minutes of exercise, better the 15 minutes than nothing.
So----
Dr. Thompson. There is a health benefit to that.
Senator Dodd [continuing]. People say, ``Oh, I can't afford
an hour. I can't get that. I guess I won't do anything.'' But
if you can do a little bit, it can make a difference.
Back here. Yes, ma'am?
Senator Murkowski. Before we go to that question, I want to
go back to the young woman's question, which was very
articulate, because sitting here thinking we are the Federal
Government basically telling you that you are a bad parent
because your child's BMI is too high. This is--to find that
balance that you keep talking about, culturally appropriate
without being the government nanny telling you what it is that
you can eat and drink and that essentially you are a bad parent
because your child doesn't fit the norm.
Dr. Thompson. I want to emphasize your point. We have
actually declined to support other communities and other States
in measuring their BMIs because they weren't doing the whole
package. We threw 26 different things at this in our
initiative, and BMI was only one.
So it is wrapping all the support around parents and then
providing them information. It is not pointing an accusatory
finger and saying you failed as a parent.
Senator Murkowski. That makes all the difference.
Mr. Dwyer. Senator, if I could add, the YMCA has worked
with the Eli Lilly company and has launched a Healthy Family
Home Starter Kit as a way of positively working with parents
and helping educate them on little things that they can do that
would support their own child's goals toward a healthy
lifestyle. You can approach parents from an educational point
of view with tool kits that will be useful to them.
Senator Dodd. Yes, this woman here had a question.
Ms. Van Helden. Hi, my name is Bethany van Helden, and I
appreciate the chance to speak from the audience. I am the
dietician that facilitates the program that Jonathan Miller was
in in his school-based health center.
What has been raised seems like a lot of questions, and I
feel as though school-based health centers really offer a lot
of those answers. Not only do we provide that safe place where
the students are, we are their place to go to during the school
day. But we have mental health services. We have clinical
services, preventive services where the student can go to have
that all-around care.
When we are talking about questions on what can be done,
the people that are in school-based health centers are those
champions. So they are already there. But, of course, more
funding for those school-based health centers is something that
you can do as far as legislatively.
Senator Dodd. I appreciate that.
Ms. Van Helden. That is as far as sitting here and
listening to the questions and the answers, that is a big one
that I want to make sure is--
Senator Dodd. No, it is a good point. I meant to raise
that, the idea that it was a school-based clinic where Jonathan
could go. In the absence of that, I suspect, this might have
been a short journey.
Ms. Van Helden. Right. Which is full of champions.
Senator Dodd. That is great. Good point.
In fact, Senator Smith and I have introduced S. 600 to fund
school-based health clinics. Gordon Smith of Oregon as well.
Thank you very much. Now let me take one more. I will take
one or two more. Are there any more? Over here, let me see,
just students. Are you a student as well?
Ms. Quinn. Yes.
Senator Dodd. Yes?
Ms. Quinn. I am Abigail Quinn. I was here last week.
Senator Dodd. Wait until we get you a microphone here. Are
you a repeat? You came here last week as well?
Ms. Quinn. Yes. Yes, I am a repeat. Couldn't get enough.
Back for more.
I am in the education program at the University of
Virginia. It is a master's program. We have talked a lot about
schools today. Schools have a big role to play in this
discussion. But the other thing that I have to say is I feel
like it is more than that, though.
I feel like substituting in the schools, having a mom who
works in the schools, with all of the stuff with No Child Left
Behind, schools are strained to try and implement all of that.
While the graduation standards would be great, if it is just
about the schools, there is going to be tremendous resentment.
Senator Dodd. No, no.
Ms. Quinn. It needs to be that and these other community
programs, too.
Senator Dodd. I agree with that totally. I have a sister
who just retired from teaching, and she would give you chapter
and verse on how her job changed over 40 years from when she
started out to what it looked like at the end, where she was
doing far more than she ever anticipated she would ever do as a
teacher.
Ms. Quinn. Yes, so I think that the schools need to be a
part of it, but it has to be well-rounded.
Senator Dodd. Take one more. Yes, sir? Back here.
Mr. Young. Hi. My name is Nick Young. I am from Indiana
University. I just had a quick comment about the body mass
index. I have always kind of looked at it as not the--I have
always been kind of off the charts, and I weigh 281 pounds. But
I am also an athlete, so I consider myself in relatively good
shape.
Would it be possible to measure more in like a body fat,
using different calipers or whatever? Would that be almost more
accurate?
Dr. Thompson. The comments and the visual here is clear,
with no condescension intended. BMI is a screening tool. It is
just like when you get your cholesterol screened at the mall.
If it is abnormal, then you need to check and to say does it
make sense that it is abnormal? Or is this just an outside
variable?
People that are extremely muscular--Governor Schwar-
zenegger has a BMI which is in the unhealthy range also. That
is not because he has excessive body fat. It is a screening
tool. Measurement of body fat through other mechanisms is more
accurate, but also more difficult and more costly and more time
consuming.
The things that we do here as we screen is to make sure
that--particularly for individuals that may fall outside the
normal distribution on either height or weight--that we have a
follow-up mechanism to make sure that it is an accurate
assessment. We have tried to take some of those into account,
but your point is well made. BMI by itself doesn't make the
diagnosis.
Senator Dodd. Well, listen, these are great questions. We
could spend all afternoon. I can't begin to thank our
witnesses.
Susan, we thank you very, very much.
Mr. Dwyer, thank you for coming down from Connecticut, very
proud of you and what you are doing in Connecticut. So I thank
you. At 39 years of service, that is a great, great
accomplishment. There have got to be a lot of kids in
Connecticut who are doing better today because you have been
involved.
Mr. Dwyer. Well, thank you.
Senator Dodd. So we thank you for that.
Jonathan, you are a star, I will tell you. You have been a
great witness. You are extremely articulate, and your story is
a compelling one, and I am sure it is going to be a source of
some encouragement to someone out there who may be
participating or watching this a little bit and decide they are
going to follow the example of Jonathan Miller, and that will
make a difference.
We thank you. If you make a difference even in one person's
life, that is not a bad accomplishment. Thank you for being
here.
Dr. Thompson, you have been terrific. You've been
wonderful. Arkansas is very lucky to have you doing what you
are doing. You are making a difference, and congratulations to
you.
We will have some more questions maybe. I am going to leave
the record open for a few days if other members want to raise
some issues that I haven't raised here for you to comment on.
Then we are going to try and move forward. I don't know how
much we are going to get done with only a few legislative days
left in this session of Congress, but we are setting the table
in a sense.
If not in the next few weeks, then certainly come January,
there will be a new day. We will have a new administration and
new people coming into town. We will try to urge them, whether
it is a McCain administration or Obama administration, to talk
about how we can get moving on this issue, provide good support
at the national level for what is happening at the local and
State level as well.
I thank everyone. The committee will stand adjourned.
[Additional material follows.]
ADDITIONAL MATERIAL
Prepared Statement of Senator Mikulski
Mr. Chairman, I have been a longtime supporter of
prevention and nutrition programs and firmly believe we must
look out for the day-to-day needs of our Nation's children.
Today's children are over-fed and under-nourished. Only 2
percent of American children eat a healthy diet and 1 in 4
Americans eat fast food every day. In my own State of Maryland,
13 percent of young children aged 2-5 years old are considered
overweight and only about half of all children get some
physical activity 3 days a week.
Let me share with you the story of my constituent, Zachary
Aaronson. Zachary weighed 306 pounds when he was 17 years old.
After attending a special school in California for obese
children, he now weighs 179 pounds 1 year later. However, this
weight loss did not come cheaply for Zachary and his family--it
cost them $6,000 a month. Not every child can be sent to such a
costly school.
How can we solve this epidemic? As a social worker, I know
we need to meet the basic needs of our children. They need
healthy food and safe spaces to play. Teenagers should not need
heart bypass surgery or Lipitor to lower their high cholesterol
levels. I am a long-time supporter of programs such as Head
Start, and the School Lunch Program, that provide nutritious
meals and fresh fruits and vegetable to children. We also need
to promote physical activity inside and outside of schools and
design communities where people want to be outside and active.
This is how we save lives and communities.
I am proud of Maryland and some of their creative
initiatives. The Johns Hopkins University has a project to get
healthy foods into stores in Baltimore and then works with
these stores to promote the marketing of healthy foods.
Especially in today's economy, people forego healthy, more
expensive foods, for cheaper, fattening foods. We need to
encourage people to eat an apple-a-day to replace the Big Mac
every day!
As the committee moves forward to tackle this crisis, I
will continue to work with my bipartisan colleagues to ensure
that we are a fit Nation and not a fat Nation. Improving
nutrition and increasing physical activity will ultimately
reduce health care costs while improving our Nation's health.
We must make sure that our Nation, and especially our children,
are not over-fed yet undernourished. I thank Chairman Dodd for
his leadership on this issue.
Prepared Statement of Senator Alexander
We are at a time in our history where reports by
distinguished journals of medicine such as the New England
Journal of Medicine, the Institute of Medicine's ``Preventing
Childhood Obesity: Health in the Balance,'' and health experts
such as the Trust for America's Health say today's children are
likely to be the first generation to live shorter, less healthy
lives than their parents. This is a health care crisis. One of
the biggest reasons for this is the growing childhood obesity
problem, and the increasing rates of diseases normally
associated with adults such as type 2 diabetes, heart disease,
and other chronic illnesses.
Just last week, The Tennessean reported that the Centers
for Disease Control and Prevention (CDC) ranked Tennessee the
third most obese State in 2007. Thirty percent of Tennesseans
are obese. Even more sadly, Tennessee has the fourth most
overweight children according to the Trust for America's
Health. Twenty percent of Tennessee's children are overweight--
that's one of every five kids.
This isn't just a problem for Tennessee alone--this is a
national epidemic. Over the last 40 years, obesity rates
quadrupled for children ages 6-11 years, and tripled for
adolescents ages 12-19 years. While obesity is an increasing
problem among children and youth across the country, Hispanic,
African-American, and Native-American children and adolescents
are disproportionately affected when compared to the general
population.
Another health problem resulting almost solely from the
childhood obesity epidemic is that the incidence of type 2
diabetes in childhood in the United States has increased over
the past 20 years. This is a disturbing statistic, especially
since diabetes is preventable and controllable through diet and
exercise. Diabetes can cause heart disease, stroke, blindness,
kidney failure, pregnancy complications, lower-extremity
amputations, and deaths related to flu and pneumonia.
In addition to the numerous adverse health effects
associated with childhood obesity, some reports indicate that
childhood obesity costs an estimated $14 billion annually in
direct health expenses.
Our response to preventing or addressing this childhood
obesity epidemic as a country has been woefully inadequate.
I am looking forward to exploring with my colleagues what
role the Federal Government can play in reversing this
epidemic, as well as learning about some of the innovative
approaches that are being taken across the country by State and
local governments, public-private partnerships, and industry.
Any efforts to reverse this problem will require efforts across
society, including all levels of government, public-private
partnerships, all sectors of the economy, and by individuals
and their families as well.
Prepared Statement of Bethany van Helden, MS, RD, University of
Michigan, Regional Alliance for Healthy Schools (RAHS)
Childhood obesity is the No. 1 health concern for kids in 2008
according to a report released this July by the University of Michigan
C.S. Mott Children's Hospital National Poll on Children's Health,
topping smoking and drug abuse. Childhood obesity was ranked third in
2007.
School-based health centers are uniquely positioned to provide
direct physical, mental and preventive health care where students spend
most hours of the day.
University of Michigan has 3 school-based health centers in Ann
Arbor and Ypsilanti. These sites serve student populations composed
predominantly of low-income families. A chart review in 2005 showed
that about 35 percent of all our students were overweight and about 20
percent were obese.
The Nutrition and Physical Activity Program was developed in 2006
for our school-based health centers and a Registered Dietitian was
hired to facilitate individual counseling, walking clubs and fitness
classes.
The Nutrition and Physical Activity Program follows guidelines
developed by the AMA, CDC and HRSA. It is a replicable model program to
address child obesity.
Weight loss is not a performance target for the program, behavior
modification and lifestyle change is the goal of the program. Research-
based goals include: eat 5 servings of fruits/vegetables a day, drink
no more than 1 sugary drink a day, exercise at least 60 minutes a day,
and no more than 2 hours of ``screen time'' a day.
During the 2007-2008 school year, 90 students participated in
individual counseling with the dietitian, out of those students 50
decreased their Body Mass Index (BMI) and 21 maintained their BMI,
meaning a total of 78 percent of participants stopped gaining weight
with intervention.
During the 2007-2008 school year, 133 middle and high school
students participated in a weekly walking club, an easily implemented
program increasing access to physical activity.
Also, during the 2007-2008 school year, the Nutrition and Physical
Activity Program was recognized for innovative practice by the National
Kidney Foundation of Michigan and the Michigan Association of Health
Plans.
Prepared Statement of the American Psychological Association (APA)
On behalf of the 148,000 members and affiliates of the American
Psychological Association (APA), we thank you for holding this
important series of hearings to discuss childhood obesity.
APA is the largest scientific and professional organization
representing psychology in the United States and is the world's largest
association of psychologists. Comprised of researchers, educators,
clinicians, consultants, and graduate students, APA works to advance
psychology as a science, a profession, and a means of promoting health,
education and human welfare.
In the last quarter century, the prevalence of obesity in children
and adolescents has increased more than threefold (Ogden et al., 2006).
Recent evidence suggests that prevalence rates remain high, affecting
between 11 percent and 27 percent of children and adolescents depending
on age and ethnicity (Ogden, Carroll, & Flegal, 2008). In addition, it
is currently estimated that 30 percent of girls and 16 percent of boys
in U.S. high schools suffer from disordered eating (Austin, Ziyadeh,
Leliher, Zachary, & Forman, 2001). Obesity and disordered eating and
their associated morbidities often co-occur over time and share both
risk and protective factors. Therefore, APA supports joint prevention
efforts to address the physical and mental health complications
associated with these problems (Neumark-Sztainer et al., 2006; Neumark-
Sztainer, Wall, Haines, Story, & Eisenberg, 2007).
It is of paramount importance to promote healthy lifestyle changes
without inadvertently perpetuating weight stigmatization or promoting
disordered eating. Therefore, APA recommends that emphasis be placed on
behavior and health outcomes for children and families across the
weight spectrum. Specifically, we support legislative initiatives aimed
at improving nutrition and physical activity; increasing body
satisfaction; decreasing weight stigmatization and weight-related
teasing; promoting responsible marketing to children; and supporting
healthy home environments.
We strongly support efforts to educate families on the importance
of family meals at home and support innovative initiatives to help
families across all socioeconomic levels successfully implement family
mealtimes. In addition, APA encourages efforts to increase the
availability of healthy food options, including fresh fruits and
vegetables and sources of calcium, in daycare settings, preschools and
schools. Furthermore, we support initiatives that enable increased
opportunities for physical activity through ensuring that schools offer
the recommended daily levels of physical activity to students.
In addition, we acknowledge that to promote active family
lifestyles, all family members need access to opportunities to be
physically active, to live in communities that provide safe spaces for
physical activities, and to have access to a variety of affordable
healthy foods (Sallis & Glanz, 2006). We believe that the consideration
of issues related to socioeconomic status and culture is critical to
the development of policies and initiatives addressing weight-related
concerns. As prevention efforts will have the greatest impact in
reducing the individual and societal consequences of childhood obesity,
more research is also needed to develop and implement appropriate
interventions to promote the adoption of healthy eating and activity
early in childhood.
In closing, the American Psychological Association would like to
thank you for the opportunity to share our comments related to
childhood obesity. We appreciate the subcommittee's ongoing commitment
to children's health and look forward to serving as a resource and
partner as you work on this and other important issues affecting
children and their families.
References
Austin, B., Ziyadeh, N., Leliher, A., Zachary, A., & Forman, S. (2001).
Screening high school students for eating disorders: Reports of a
national initiative. Journal of Adolescent Health, 28(2), 96.
Neumark-Sztainer, D., Wall, M., Guo, J., Story, M., Haines, J., &
Eisenberg, M. (2006). Obesity, disordered eating, and eating
disorders in a longitudinal study of adolescents: How do dieters
fare 5 years later? Journal of the American Dietetic Association,
106(4), 559-568.
Neumark-Sztainer, D., Wall, M., Haines, J., Story, M., & Eisenberg, M.
(2007). Why does dieting predict weight gain in adolescence?
Findings from Project EAT II: A 5-year longitudinal study. Journal
of the American Dietetic Association, 107(3), 448-455.
Ogden, C.L., Carroll, M.D., Curtin, L.R., McDowell, M.A., Tabak, C.J.,
& Flegal, K.M. (2006). Prevalence of overweight and obesity in the
United States, 1999-2004. Journal of the American Medical
Association, 295, 1549-1555.
Ogden, C.L., Carroll, M.D., & Flegal, K.M. (2008). High body mass index
for age among U.S. children and adolescents, 2003-2006. Journal of
the American Medical Association, 299(20), 2401-2405.
Sallis, J.F., & Glanz, K. (2006). The role of built environments in
physical activity, eating, and obesity in childhood. The Future of
Children: Childhood Obesity, 16, 89-108.
Prepared Statement of The National Assembly on School-Based
Health Care (NASBHC)
school-based health centers and childhood obesity: an ideal location
to address a complex issue
One of today's most pressing public health problems is the rise in
childhood overweight and obesity. School-based health centers (SBHCs)--
the convergence of public health, primary care, and mental health in
schools--represent an important element in our public health arsenal
for combating this challenging epidemic. When working side-by-side in a
school setting, medical and mental health professionals have a unique
window into the lives of their patients and unparallel opportunities
for addressing obesity problems from a distinctly population-based
approach.
Childhood obesity is a public health epidemic and requires
collaborations with all sectors of the community to make a difference
in the lives of these youth. SBHCs work with the school and community
to foster collaborative models for preventing obesity and encouraging
healthy lifestyles, whether incorporating a nutrition education program
into the school's curricula, promoting healthy food choices and
exercise, developing partnerships with local fitness centers, or
providing daily encouragement to the school community to eat healthy
and stay fit.
Schools are one of the most natural social settings for a child-
focused healthy intervention. By locating health services directly in a
school, health visits become a normal part of school life, especially
for students who feel stigmatized by their weight. Located in areas
where families have limited income and health care access, SBHCs are
uniquely positioned to care for many of the Nation's youth who are most
at risk for obesity and its secondary effects.
Medical management is a critical contribution of SBHCs: medical
providers can screen and evaluate problems with proper laboratory
testing and referrals to specialists when required. For students with
medical complications related to obesity such as type 2 diabetes, SBHCs
can work collaboratively with specialists and primary care providers to
teach the student about self care and monitor the student's condition.
The interdisciplinary SBHC team also ensures that the emotional risk
factors for obesity and overweight--depression, stress, and low self-
esteem--are not overlooked. The team also works to change behavior
through nutrition education, counseling, and encouragement of physical
activity.
SBHCs can organize groups of high-risk kids to help foster cohesion
and peer and family support toward healthy lifestyle goals. Many SBHCs
creatively integrate their services into after-school physical activity
promotion programs that kids like, are fun, and have built-in
incentives. By offering families support, encouragement, and materials,
SBHCs enhance the efforts of the children to live healthy lifestyles,
while involving parents and encouraging them to do the same.
You have heard from Jonathan Miller, a former student at Stone High
School, in Ann Arbor, MI. With the help of the Nutrition and Physical
Activity Program offered at his SBHC, he was able to lose almost 140
pounds. At Lincoln High, in Denver, CO, the SBHC providers launched an
obesity management program that caused a paradigm shift in the lives of
their student participants. Through the power of peer support, and with
the expertise of a nutritionist, the students, who weighed an average
of 300 pounds, started to think differently about the food they ate and
began to enjoy the group exercise classes offered through the SBHC. And
as mentioned previously, a prevention strategy is perhaps the most
crucial component of shifting and abandoning preconceived negative
attitudes about nutrition and exercise. The Montefiore Medical Center's
School Health Program (MSHP), which operates SBHCs in Bronx, NY, has
organized committees to review, develop, and promote changes in food
policy in several Bronx elementary schools. One committee's successful
campaign spread citywide as advocates worked to increase opportunities
for safe exercise and nutritious foods in the communities around the
SBHC.
There is no specific Federal funding for SBHCs and it becomes
increasingly difficult for SBHCs to sustain their comprehensive scope
of services. Regardless of their perfect position to address childhood
obesity from both a prevention and treatment perspective, SBHCs are
only able to provide services for which they have the appropriate
financial resources.
More students can experience the same success--emotionally and
physically, as Jonathan if they have the same access to a SBHC. If
there is a SBHC in every school that wanted one, these kinds of
prevention and treatment programs would become the norm and students
would have a viable and accessible solution to their weight problems
where they spend the majority of their time. Or better yet, students
would understand the importance of healthy eating and exercise before
they develop health problems. SBHCs allow their patients the
opportunity to grow up healthy, strong, and achieving their educational
potential and at present, they belong to too few of our Nation's youth.
Obesity can be treated and prevented and SBHCs are an excellent
approach to reaching our Nation's youth in a safe and accessible
environment.
______
Surgeon General,
State of Arkansas,
July 26, 2008.
Hon. Christopher J. Dodd,
U.S. Senate,
404B Hart Senate Office Building,
Washington, DC.
Senator Dodd: Thank you for the opportunity to testify before the
HELP Subcommittee on Children and Families on July 23, 2008 for the
hearing ``Childhood Obesity: The Declining Health of America's Next
Generation--Part II.'' I applaud your leadership in raising awareness
of this critical threat to the health of our Nation's children.
As we discussed during the hearing, obesity has a tremendous
negative impact both on the health of children and adults as well as
the cost of delivering health care. The following data are provided in
response to your request for more information regarding the fiscal
burden obesity imposes on the health care system.
The results of analyses conducted at the Arkansas Center for Health
Improvement (ACHI) are troubling. In a study of Arkansas Medicaid, our
team determined that children who were classified as overweight (the
highest CDC-defined weight category) utilized program services at a 3
percent higher rate and were 9 percent more costly to the program when
compared with children who were classified as having a normal weight
(Graphic 1).
In our study, the differences in cost of care between those
enrollees classified as normal weight and overweight become more
pronounced as children get older. As shown in Graphic 2, those
enrollees aged 15-19 years who were also classified as overweight cost
Medicaid 29 percent more than enrollees of the same age group who were
classified as normal weight.
The difference between cost of care for normal weight and
overweight adults is also striking. Analyses conducted by ACHI staff
showed that obese adults aged 65 to 74 years had average annual costs
104 percent greater than normal weight adults in the same age group.
This represented an average annual difference in cost of $4,522 more
per person among those who were obese in 2005 (Graphic 3).
The physical and fiscal negative impact of obesity on the present
and future health and well-being of our Nation's people and health care
system is staggering. Inaction cannot be an option.
I look forward to working with you and your colleagues in creating
a healthier America. Thank you.
Sincerely,
Joseph W. Thompson, M.D., MPH,
Arkansas Surgeon General;
Director, Arkansas Center for Health Improvement;
Director, Robert Wood Johnson Foundation Center to Prevent
Childhood Obesity.
[Whereupon, at 4:39 p.m., the hearing was adjourned.]