[Senate Hearing 110-962]
[From the U.S. Government Publishing Office]
S. Hrg. 110-962
CONFRONTING CHILDHOOD OBESITY: CREATING A ROADMAP TO HEALTHIER FUTURES
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FIELD 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 HOW TO CREATE A ROADMAP TO
HEALTHIER FUTURES FOR YOUNG PEOPLE GROWING UP IN AMERICA
__________
DECEMBER 3, 2008 (Santa Fe, NM)
__________
Printed for the use of the Committee on Health, Education, Labor, and
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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 and Chief Counsel
______
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)
David P. Cleary, Minority Staff Director
(ii)
C O N T E N T S
__________
STATEMENTS
WEDNESDAY, DECEMBER 3, 2008
Page
Bingaman, Hon. Jeff, a U.S. Senator from the State of New Mexico,
opening statement.............................................. 1
Udall, Hon. Tom, a U.S. Representative from the State of New
Mexico, opening statement...................................... 2
Sanchez, Eduardo, M.D., FACP, Vice President and Chief Medical
Officer, Blue Cross and Blue Shield of Texas, Richardson, TX... 4
Prepared statement........................................... 7
Thompson, Joseph, M.D., M.P.H., Associate Professor, the
Colleges of Medicine and Public Health at the University of
Arkansas for Medical Sciences, Chief Medical Officer for the
State of Arkansas, Little Rock, AR............................. 12
Prepared statement........................................... 16
Morris, Patricia McGrath, Ph.D., Director, New Mexico Interagency
for the Prevention of Obesity with the New Mexico Department of
Health, Santa Fe, NM........................................... 26
Prepared statement........................................... 31
Walters, Lynn, Executive Director, Cooking With Kids, Santa Fe,
NM............................................................. 37
Prepared statement........................................... 40
(iii)
CONFRONTING CHILDHOOD OBESITY:
CREATING A ROADMAP TO HEALTHIER
FUTURES
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WEDNESDAY, DECEMBER 3, 2008
U.S. Senate,
Subcommittee on Children and Families, Committee on Health,
Education, Labor, and Pensions,
Santa Fe, NM.
The committee met, pursuant to notice, at 10:00 a.m. in
Room 321, New Mexico State Capitol Building, 490 Old Santa Fe
Trail, Santa Fe, New Mexico, Hon. Jeff Bingaman, presiding.
Present: Senator Bingaman.
Opening Statement of Senator Bingaman
Senator Bingaman. Soon-to-be Senator Udall and I are glad
to be here and to welcome everybody.
This is a hearing of the Subcommittee on Children and
Families of the U.S. Senate Health, Education, Labor, and
Pensions Committee. It is focused on a very important issue, in
my view, that is childhood obesity and how we can create a
roadmap to healthier futures for young people growing up in
this country.
We ought to thank whoever arranged to let us use this
wonderful hearing room here in the Capitol. They have much
nicer hearing rooms here than we do in Washington.
[Laughter.]
Also much nicer art on the walls, I would point out.
Now we have four great panelists here, and I will introduce
them in just a minute, who are going to give us their views on
this important issue. The idea here is to bring together
national and State leaders in combating childhood obesity to
talk about what are the most effective strategies available to
our State and to other States and also to communities, and to
the country as a whole.
I think we are all aware of the problem. Over the past two
decades, the prevalence of childhood obesity has grown to
staggering proportions in this country. Almost 32 percent of
American children and adolescents--that is 23 million in
total--are considered overweight or obese.
The problem is even worse among certain minority groups.
Hispanic and Native American communities are disproportionately
affected by this epidemic.
Obviously, it is a costly problem for us in New Mexico. It
is a costly problem for our healthcare system, healthcare
delivery system generally.
According to the Centers for Disease Control, the rate of
new diabetes cases nearly doubled in the United States in the
last 10 years. About 80 percent of the cases are type 2
diabetes, the form that is linked to obesity.
The findings echo geographic trends seen with obesity and
physical inactivity, which are also tied to heart disease. In
total, more than 23 million Americans have diabetes today.
It is not just type 2 diabetes that is the problem. Also,
the incidence of high blood pressure and progressive liver
disease, these are ailments that used to be only associated
with adults. Their incidence is rising among overweight
children.
We need to have policies to address this. To this end, I
introduced a bill in the Senate this year called the Obesity
Prevention, Treatment, and Research Act of 2008. The
legislation would develop a national strategy to organize our
efforts to combat childhood and adult obesity.
Let me just acknowledge Frederick Isasi and Dan Derksen.
Dan was working as a fellow in our office, helping with the
preparation of this. Frederick does all of our healthcare
issues and worked on this as well.
This legislation would help develop a national strategy. It
would result in increased collaborations and collective actions
across agencies, among private entities, individuals, and
communities. We have also tried to champion efforts to improve
access for beneficiaries in Medicare and Medicaid and other
Federal programs to nutrition counseling, as well as improved
training and access to prevention services and physical
education programs.
One other related effort we have made in the Congress is to
increase funding for the Fresh Fruits and Vegetables Program in
New Mexico schools. This year, that program will receive
$700,000 in Federal funding. It is scheduled to increase under
the Farm bill that we passed, up to $2 million by 2012 to
provide healthy foods to children in more of our schools.
We have a great group of panelists, as I indicated. Before
I introduce our panelists, let me call on Congressman Udall,
soon-to-be Senator Udall for his comments.
This is a group of issues that he has been vitally
interested in during his entire time in the Congress, and I
look forward to working with him on these when he gets sworn in
to the Senate on the 6th of January.
So go right ahead.
Statement of Hon. Tom Udall, U.S. Representative
from the State of New Mexico
Mr. Udall. Thank you very much, Senator Bingaman. It is a
pleasure to be here with you today, and it is a real honor for
you to have invited me.
Distinguished members in the panel and guests, it is also
an honor to be here with you, especially to discuss an issue
that I think is of such great importance to both New Mexico and
the Nation.
In Senator Bingaman's opening comments and the written
testimony of our witnesses, the challenges we face are outlined
starkly and clearly. For most of us here today, this crisis is
not news. For years, we have seen the headlines--``Healthcare
Crisis Looms,'' ``Diabetes Epidemic,'' ``Increase in Childhood
Obesity.''
Everyone seems to have a solution, but the one that could
make a real difference--prevention--is only paid lip service.
We say an ounce of prevention is worth a pound of cure, but
then we fail to re-invent our healthcare policy to make
prevention a cornerstone.
That is why it is so refreshing to read your testimony
today. All of the work you are doing is very important and is
greatly needed by our Nation. I think what you are trying to do
is get our healthcare system on the right track.
I have heard some people say that we don't have a
healthcare system, we have a sick care system and that we
should really orient ourselves toward prevention. I notice, Dr.
Sanchez, you say in your testimony, your written testimony,
``Shifting the healthcare paradigm away from treating diseases
after they occur and toward preventing them from ever
occurring.'' That statement, I think, is particularly poignant.
Senator Bingaman and I have been saying this for years, and
today, we spend 95 percent of our healthcare dollars on
treating chronic and acute illnesses, many of which could be
prevented in the first place. In other cases, we could at least
delay the onset of disease for a number of years and provide a
higher quality of life.
The dollars we spend on prevention are miniscule, and we do
not track the outcomes in a meaningful way. This Nation needs a
new approach to healthcare, which puts prevention front and
center. The key to prevention is personal responsibility and
personal action. If people are given the facts and
alternatives, they can take charge of their health.
Senator Bingaman, like you, I am very eager to hear the
witnesses and appreciate, once again, being here with you
today.
Senator Bingaman. Great. Thank you very much.
Why don't we do this? Let me introduce and call up two of
our witnesses, and we will hear from them and ask them
questions. Then we will call forward the other two witnesses
and do the same thing with them.
First, let me call Eduardo Sanchez up and let me say a
little bit about his background. He is currently the vice
president and chief medical officer at Blue Cross Blue Shield
of Texas. He serves on the Institute of Medicine on the
National Academy's Committee on Progress in Preventing
Childhood Obesity. He is chairman of the IOM's Childhood
Obesity Prevention: Actions for Local Government Project.
So he has spent a lot of time on this issue. If you would
just take a seat up there, that would be great.
Our other witness on this first panel will be Joseph
Thompson, who is a physician, also the surgeon general of the
State of Arkansas, the director of Arkansas Center for Health
Improvement. He is board certified in both pediatrics and
preventive medicine, serves on the faculty of the University of
Arkansas for Medical Sciences.
He has been instrumental in the very aggressive effort that
the State of Arkansas has made to try to deal with this
problem. I had the good fortune to hear his testimony on this
subject when he testified to our full Health and Education
Committee in the Senate earlier this year.
Thank you both for being here. I guess, Eduardo, why don't
you go ahead and start, and give us your thoughts as to--I
guess there are microphones that are picking this up? OK.
Terrific.
Well, please, go right ahead.
STATEMENT OF EDUARDO SANCHEZ, M.D., FACP, VICE PRESIDENT AND
CHIEF MEDICAL OFFICER, BLUE CROSS AND BLUE SHIELD OF TEXAS,
RICHARDSON, TX
Dr. Sanchez. Good morning, Mr. Chairman and Senator-elect
Udall. Congratulations to you, sir.
Mr. Udall. Thank you.
Dr. Sanchez. My name, as stated, is Eduardo Sanchez. I am
vice president and chief medical officer of Blue Cross Blue
Shield of Texas, a division of Health Care Service Corporation,
a non-investor-owned health plan.
I previously served as the Texas commissioner of health
from 2001 to 2006, leading the Texas Department of Health and
then the Texas Department of State Health Services as the State
health officer.
I am here today, however, as a member of the Institute of
Medicine's Standing Committee on Childhood Obesity Prevention.
I am grateful for the opportunity to appear before you today
and thank you, Senator Bingaman, for your leadership.
This morning, I want to focus my comments on solutions to
prevent, to reverse childhood obesity in the United States. In
order to succeed and to offer parents some assurance that our
children will outlive us, we need to concentrate on four key
areas--leadership and commitment at the highest levels,
monitoring the problem, identification and funding of best
practices, and evaluation of our efforts.
Please allow me to set the stage. Health experts have
warned that for the first time, children today are in danger of
having a shorter lifespan than their parents.
More children are obese now than at any other time in
history and are experiencing unprecedented levels of type 2
diabetes, something that was called ``adult onset'' diabetes
when Dr. Thompson and I were going to medical school, and early
risk factors for cardiovascular disease. A recent study found
that the arteries of obese 10-year-olds resemble those of 45-
year-olds.
Obesity is more prevalent among poor and nonwhite children.
That is important because the demographic shift in our Nation,
particularly the race/ethnicity shift, is one that will shift
the burden of obesity fairly significantly in some States more
than others. As Senator-elect Udall said already, prevention is
the key to reversing childhood obesity trends.
According to the Department of Health and Human Services,
obesity and overweight in U.S. adults cost from $69 billion to
$117 billion annually. The State of Texas decided to look at
Texas cost of obesity and estimated that the cost will increase
from around $10.5 billion today to $39 billion by the year 2040
if current trends continue. That is a doubling in the cost
because the population will have quadrupled.
Obesity cost Texas business an estimated $3.3 billion in
2005 and could cost employers $15.8 billion by the year 2025 if
trends continue. These are very conservative figures.
Point being, obesity is a health issue and an economic
issue. It is time for a national strategy to reverse childhood
obesity in the United States. Your bill addresses that national
strategy.
I want to suggest that we could use the Federal pandemic
influenza efforts that started in 2005 as a model. The United
States should develop a comprehensive, coordinated plan led by
the U.S. Departments of Health and Human Services, Agriculture,
and Education, and that involve every department and agency of
the Federal Government, including the legislative branch; State
and local governments, including health departments;
businesses, foundations, communities, schools, families, and
individuals.
The plan must outline clear roles, responsibilities, and
objectives. In Texas, a State strategic plan is driving efforts
in the State. The Texas Department of State Health Services, as
part of that, developed what is called a Texas Obesity Policy
Portfolio to help decisionmakers decide what makes sense, what
doesn't make sense.
Much like the challenge of preparing for a flu pandemic,
our leaders should challenge the entire Nation to share in the
responsibility to reverse childhood obesity and do their part
to improve our Nation's health. We must make the healthy choice
the easy choice by giving our communities, our schools,
businesses, and the people of this country the tools they need
to make it easier to follow the dietary and physical activity
guidelines for Americans.
Effectively addressing childhood obesity requires adequate
monitoring of national, regional, State, and local obesity
prevalence rates and its related risk factors. Doing so will
make the case for what works and what does not work.
The evidence gathering must extend beyond the public health
and healthcare systems, however, to include food systems,
education systems, and transportation systems. We need evidence
of the effectiveness of prevention interventions, of clinical
treatment interventions, of system-level interventions, and of
all of those interventions in the context of diverse
communities and stage of child development.
The CDC National Center for Health Statistics and some
individual States have developed a monitoring system for some,
but not all of those data needs. Data and information systems
are the backbone for informed policymaking. Yet they are under-
resourced and sometimes under-utilized. They track critical
health risk behaviors and health problems, and they are used to
plan and evaluate responses and to target populations with the
greatest needs.
Texas has funded the School Physical Activity and
Nutrition, SPAN, Survey Project, a statewide childhood obesity
surveillance system, using Federal funds. Preliminary data show
that the prevalence of obesity in Texas among 4th, 8th, and
11th grade students is higher than the national average. The
trend among fourth graders appears to be leveling off and
possibly decreasing in some parts of Texas, namely El Paso,
where implementation and funding of coordinated school health
and community-wide nutrition and physical activity programming
has made a difference.
Texas is also now requiring fitness assessments among
children in grades 3 through 12. FITNESSGRAM assesses aerobic
capacity, strength, and flexibility. Last year, two thirds of
3.4 million students were tested. Less than one third of 3rd
grade students are fit, and by 12th grade, less than 10 percent
of students met the health standards in all six tests. We are
going backwards as our children go through the school system.
We can ill-afford to treat the ever-increasing numbers of
medical conditions associated with increasing childhood
obesity. In Texas, type 2 diabetes as a pediatric condition is
no longer an uncommon finding. Fifty percent of the new
pediatric diabetes in some parts of our State are type 2
diabetes, again, a condition that was not seen in children when
Dr. Thompson and I were going to medical school.
Prevention of childhood obesity is the key to a healthier
future for the United States. We have enough evidence about
what works to act now, but we need the political leadership,
more political leadership like yours, Senator Bingaman, to
adequately fund programs that have proven effectiveness.
In Texas, we have seen results with CATCH, the Coordinated
Approach to Child Health, the coordinated school health program
for elementary schools. In 1997, based on the results of a
clinical trial and subsequent 3-year follow-up study, the board
of the Paso del Norte Health Foundation approved the first of
two grants for CATCH in El Paso.
CATCH focuses on balanced nutrition, physical activity,
health education, and tobacco avoidance and proved successful
through
its coordinated, multi-platform approach--classroom
instruction, healthy cafeteria lunches, activity-based physical
education classes, at-home parent involvement, and after-school
community-based programs.
CATCH does make a difference. The Texas SPAN survey of
fourth grade students in El Paso County suggests that CATCH was
a contributing factor to a 7-point drop in student obesity
rates measured from 2000 at 25 percent to 2005 at 18 percent.
Paso del Norte Health Foundation funded CATCH at $4.2 million
over a 7-year period and estimated the cost of implementation
at $10 per student per year.
Not every community has a benefactor like Paso del Norte
Health Foundation. Nevertheless, over 2,100 Texas elementary
schools and nearly 10,000 schools nationwide have been trained
in the use of CATCH.
Here, in New Mexico, the New Mexico Plan to Promote
Healthier Weight calls for increasing the number of schools
offering CATCH. New Mexico health, education, and cooperative
extension agencies are working together to implement CATCH in
grades K through 5. Funded largely with tobacco settlement
funds, each CATCH school is encouraged to include all
components of the intervention.
In 2008, a total of 45 elementary schools and after school
programs were funded to provide the CATCH program. Not only
does CATCH improve diet, physical activity, and obesity, but
Texas researchers have documented significant improvements on
Stanford achievement test scores.
Among the group for predominantly poor Latino elementary
school students, the CATCH classroom physical activity
intervention produced significant increases in achievement in
math problem solving. Among children identified as not adapting
well to school, CATCH produces significant improvements in
Stanford math and reading scores.
If we want our children to lead healthy, productive lives,
we need a national strategy to address childhood obesity. The
challenge to our Nation's future, health, and economic
prosperity warrants Federal leadership to bring together all
levels of Government, private and nonprofit sectors, as well as
parents and teachers, to emphasize wellness and enhance
nutrition and physical activity.
Fully funding and implementing coordinated school health
programs like CATCH and others--and there are others--with a
proven track record is low-hanging fruit that can assure our
communities and our Nation a large cohort of healthier children
and a much brighter future.
A national response to the obesity epidemic should be
commensurate with the scope of the problem. The obesity
epidemic should be met with a fire hose instead of a garden
hose, with boots on the ground to mobilize communities and to
assure sustained application of the evidence. Anything less
threatens our economic welfare and the very future of our
children.
Thank you again for the opportunity to testify.
[The prepared statement of Dr. Sanchez follows:]
Prepared Statement of Eduardo J. Sanchez, M.D., FACP
Good morning, Mr. Chairman and Members of the Senate HELP
Committee. My name is Eduardo Sanchez, Vice President & Chief Medical
Officer of Blue Cross Blue Shield of Texas, a division of Health Care
Service Corporation, and former Texas Commissioner of Health. I am here
today, however, as a member of the Institute of Medicine Standing
Committee on Childhood Obesity. I am grateful for this opportunity to
appear before you today on behalf of the children of Texas, my home
State, and the children of the United States.
I would first like to thank the Chairman and members of the
subcommittee for your past support of programs and initiatives that
invest in our Nation's young people and for the opportunity to testify
today on a very serious issue--the declining health of America's
children, which is closely linked to our Nation's obesity epidemic.
Recent natural disasters such as the fires in California and
Hurricane Ike in Texas shine a spotlight on the critical role that
public health plays in preparing our communities and in the relief
efforts that followed. In these events, storms or fires swelled out of
control with little or no warning, and with little time to respond.
Inadequate preparation and inadequate heed to warnings of some people
in communities contributes to the protracted recovery from these
disasters.
In the case of obesity, Mr. Chairman, we see the forecast, and
``perfect storm'' conditions are brewing. The effects of this storm
will be more devastating than the wind and waves in Louisiana,
Mississippi, and Texas. Its damage will impact generations to come.
What will be lost is more precious than buildings, houses, and
infrastructure: it is human life. Unlike our natural disasters, the
good news is we can control this storm.
Today, I am here to discuss the extent of childhood obesity and
diabetes in America, their associated health and economic impact, and
my thoughts on coordinating the strategic national response necessary
to confront this growing health problem. In order to succeed and to
offer American families assurance that our children will outlive us, we
need to concentrate on four key areas: leadership and commitment at the
highest levels, monitoring of the problem, identification and funding
of best practices, and evaluation of the effects of our strategic
response.
SCOPE OF THE PROBLEM
Recognizing that health behaviors acquired during youth follow into
adulthood, the current health status of youth is alarming. Health
experts have warned that, for the first time, children today are in
danger of having a shorter lifespan than their parents.\1\ More
children are obese now than at any other time in history and are
experiencing unprecedented levels of type 2 diabetes and early risk
factors for cardiovascular disease.
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\1\ Olshansky, S Jay; Passaro, Douglas J.; Hershow, Ronald C.;
Layden, Jennifer; Carnes, Bruce A.; Brody, Jacob; Hayflick, Leonard;
Butler, Robert N.; Allison, David B.; Ludwig, David S. A Potential
Decline in Life Expectancy in the United States in the 21st Century.
Obstetrical & Gynecological Survey. 60(7):450-452, July 2005.
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Overall, approximately 23 million children in the United States are
obese or overweight, and rates of obesity have nearly tripled since
1980, from 6.5 percent to 16.3 percent.\2\ Eight of the ten States with
the highest rates of obese children are in the South.\3\ Obesity is
striking poor and non-White children at much higher rates compared to
whites and wealthier populations. In Texas, the School Physical
Activity and Nutrition surveillance study in 2000-2001 found that 35
percent of Hispanic 4th grade boys, 20 percent of African-American, and
only 14 percent of white were obese.\4\ We should set as a a national
goal childhood obesity rates of 5 percent, the level prior to the start
of this epidemic.
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\2\ Ogden, C.L., M.D. Carroll, and K.M. Flegal. ``High Body Mass
Index for Age Among U.S. Children and Adolescents, 2003-2006.'' Journal
of the American Medical Association 299, no. 20 (2008): 2401-2405.
\3\ U.S. Department of Health and Human Services, Health Resources
and Services Administration, Maternal and Child Health Bureau. National
Survey of Children's Health 2003. Rockville, MD: U.S. Department of
Health and Human Services, 2005, http://www.mchb.hrsa.gov/overweight/
techapp.htm (accessed Nov 20, 2008)
\4\ Hoelscher DM, et al., 2004. Measuring the prevalence of
overweight in Texas school children. American Journal of Public Health;
94(6): 1002-1008.
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As a result of increasingly overweight Americans, the United States
is also experiencing an epidemic of diabetes. Type 2 diabetes is on the
rise among children and accounts for almost half of new cases in
teenagers in some areas of the country. CDC projects that one in three
children born in the United States is expected to develop diabetes in
their lifetimes. However, the projection for Hispanic/Latino
populations is even more alarming: one in every two. This is a
statistic we take very seriously in the State of Texas, where it is
projected that by 2025, the non-White population will exceed the White
population (as is already the case in California, Hawaii, New Mexico,
and the District of Columbia). These four States and the District of
Columbia represent one quarter of the total U.S. population, and we
know that unhealthy eating and physical inactivity are risk conditions
that are disproportionately represented among some of our States'
racial and ethnic groups.\5\
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\5\ U.S. Department of Health and Human Services (USDHHS). The
Surgeon General's Call to Action to Prevent and Decrease Overweight and
Obesity. Washington, DC: USDHHS, 2001.
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A recent study shows that among children as young as 10 years old,
increased body fat is related to arterial stiffness in otherwise
healthy children, independent of blood pressure and heart rate.\6\ The
study shows that obese 10-year-olds have the arterial thickness of many
45-year-olds. Dr. Henry McGill, the noted pathologist from San Antonio,
reports that 77 percent of young men killed in the Korean war had
advanced atherosclerosis; 18 years later, Vietnam casualties had a
similar prevalence of atherosclerosis. Dr. McGill's research shows that
a substantial proportion of today's young people have coronary artery
lesions with the potential to develop premature coronary heart
disease.\7\ The recent recommendation by the American Academy of
Pediatrics for cholesterol screening of kids--with the possibility of
prescribing cholesterol lowering drugs for young children--is just
another tragic example of how much obesity has negatively affected the
health of our children.
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\6\ Sakuragi, S, et al. 2008. Influence of Adiposity on Arterial
Stiffness in Healthy Children. Circulation 118: S_1115-a.
\7\ McGill Jr H, et al., 2008. Preventing Heart Disease in the 21st
Century. Implications of the Pathobiological Determinants of
Atherosclerosis in Youth (PDAY) Study. Circulation, 2008;117:1216-1227.
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ECONOMIC IMPACT
These health impacts come at a great cost to our Nation. According
to the Department of Health and Human Services, obese and overweight
adults cost the United States anywhere from $69 billion to $117 billion
per year.\8\ One study found that obese Medicare patients' annual
expenditures were 15 percent higher than those of normal or overweight
patients. The cost of childhood obesity is also growing. Between 1979
and 1999, obesity associated hospital costs for children (ages 6 to 17
years) more than tripled, from $35 million to $127 million. In a report
published by the Texas Department of Health, the estimated costs of
health care, lost work days, and premature death related to overweight
and obesity in Texas adults may increase from $10.5 billion in 2001 to
$39 billion by 2040 if the obesity epidemic continues.\9\ This is a
call to action for all States.
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\8\ U.S. Centers for Disease Control and Prevention. ``Preventing
Obesity and Chronic Diseases Through Good Nutrition and Physical
Activity.'' U.S. Department of Health and Human Services, http://
www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm.
(accessed Nov 20, 2008).
\9\ The Burden of Overweight and Obesity in Texas, 2000-2040, 2003.
Texas Department of State Health Services. 2005.
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The poor health of Americans of all ages is putting the Nation's
economic security in jeopardy. More than a quarter of U.S. health care
costs are related to physical inactivity, overweight and obesity.
Health care costs of obese workers are up to 21 percent higher than
non-obese workers. Obese and physically inactive workers also suffer
from lower worker productivity, increased absenteeism, and higher
workers' compensation claims. Obesity cost Texas businesses an
estimated $3.3 billion in 2005 and could cost employers $15.8 billion
annually by 2025 if the trend continues unchecked.\10\ To maintain our
economic competitiveness and our general health and well-being, we must
improve the health of America's next generation. To do that, we must
improve diet and increase physical activity levels.
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\10\ Susan Combs, Texas Comptroller's Office, Counting Costs and
Calories Measuring the Cost of Obesity to Texas Employers March 2007
http://www.window.state.tx.us/specialrpt/obesitycost/ (accessed Nov 20,
2008).
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LEADERSHIP
Clearly, it has taken decades for the child obesity epidemic to
develop, and it will take a coordinated effort to begin to mitigate it.
Today, in the United States, we have no national, coordinated effort to
combat obesity. As a country, we are falling behind even as nations
adopt solutions, such as the Foresight \11\ project, which is centrally
funded to produce a sustainable response to obesity in the U.K. over
the next 40 years. The United States needs a comprehensive, realistic
plan (akin to the Nation's avian influenza pandemic planning efforts)
that involves every department and agency of the Federal Government,
State and local governments, businesses, communities, schools,
families, and individuals. It must outline clear roles and
responsibilities.
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\11\ Foresight. Tackling Obesities: Future choices http://
www.foresight.gov.uk/OurWork/ActiveProjects/Obesity/KeyInfo/Index.asp
(accessed Nov 20, 2008).
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The U.S. economic situation, while dire, provides a window of
opportunity to act boldly, implement new programs and policies, and
achieve health-related goals. Now, more than ever, when critical
economic and social decisions are being made, the positive and negative
impact on the health of Americans must be considered. Our leaders
should challenge the entire Nation to share in the responsibility and
do their part to help improve our Nation's health. All levels of
government should develop and implement policies to make the healthy
choice the easy choice--by giving our communities, our schools,
American businesses, and the American people the tools they need to
make it easier to follow the Dietary \12\ and Physical Activity \13\
Guidelines for Americans. Our leaders must take up the challenge of
making safe, affordable, healthy food choices and recreational places
available for all Americans.
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\12\ USDA, Dietary Guidelines for Americans, http://www.health.gov/
DietaryGuidelines/ (accessed Nov 20, 2008).
\13\ CDC, Physical Activity Guidelines for Americans http://
www.health.gov/PAGuidelines/ (accessed Nov 20, 2008).
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The trend, over the past 5 years, has been to decrease our Federal
investments in child health.\14\ Real discretionary spending on
children has declined by more than 6 percent since 2004, while at the
same time all other non-defense discretionary spending has increased by
more than 8 percent. Only one penny of every new, real non-defense
dollar spent by the Federal Government has gone to children and
children's programs. Our children are our future and they deserve
better.
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\14\ First Focus. Childrens Budget 2008. http://www.firstfocus.net/
pages/3391/ (accessed Nov 20, 2008).
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MONITORING
Effectively addressing childhood obesity will require continued
investments in the development of evidence, measures, and longitudinal
data. The evidence needed spans all levels of the public health and
health care systems: we need annual national, regional, and State-level
monitoring of child obesity and its related risk factors, we need
evidence of the effectiveness of prevention interventions, evidence of
the effectiveness of clinical treatment interventions, evidence of the
effectiveness of system level interventions, and evidence of the
effectiveness of these interventions in the context of diverse
communities and stage of child development.
The CDC National Center for Health Statistics and some individual
States have developed information systems for some, but not all, of
these pressing data requirements. These systems are the backbone for
informed policymaking. They track critical health risk behaviors,
providing timely data for State and metro areas, which are used to
identify health problems, plan and evaluate responses, and target
populations with the greatest needs. These measures need to be
coordinated and consistent throughout the States, so that data can be
used for comparisons by State and across the Nation.
In Texas, over the past few years, the Department of State Health
Services has been able to fund the development and implementation of a
statewide childhood obesity surveillance system called the School
Physical Activity and Nutrition (SPAN) survey project using Preventive
Health and Health Services Block Grant funds. Thus far, two surveys
have been funded by the block grant in 2000-2002 and 2004-2005, at a
total cost of about $1.5 million. Using these data, Texas has been able
to establish a baseline prevalence rate for childhood obesity and
observe trends over time. Preliminary data show that although the
prevalence of obesity in Texas among 4th, 8th, and 11th grade students
is higher than the national average, the trend among 4th graders
appears to be leveling off and possibly decreasing, especially in
certain regions of the State. This trend is reflected in El Paso, TX
where extensive implementation and funding of coordinated school health
and community-wide nutrition and physical activity programming have
occurred for at least 5 years.
In 2007, Texas added to it's monitoring system by requiring fitness
assessments among children in grades 3-12. FitnessGram is composed of
six measures: aerobic capacity; body composition; abdominal strength
and endurance; trunk strength and flexibility; upper body strength and
endurance; and flexibility. During the program's first year, 2.6 of the
almost 3.4 million students were tested. Preliminary results show that
only 32 percent of third-grade girls and 28 percent of third-grade boys
reached the ``Healthy Fitness Zone.'' By 12th grade, just 8 percent of
the girls and about 9 percent of the boys met the health standards in
all six tests. Clearly our children need some help.
TREATMENT
Reimbursement for medical services related to childhood obesity is
emerging as a major issue surrounding childhood obesity management
throughout the country.\15\ The bad news is the likelihood of extremely
obese children (or adults) ever returning to normal weight is small
because treatment strategies, in the long term, remain largely
ineffective.\16\ This includes the use of radical, expensive, and
invasive interventions such as gastric bypass and stomach lap-banding
surgeries. Treatment, while necessary for many, cannot be expected to
solve the child obesity epidemic.
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\15\ National Initiative for Children's Health Care Quality.
Childhood Obesity: The Role of Health Policy, http://www.nichq.org/
NICHQ/Programs/ConferencesAndTraining/Childhood
ObesityActionNetwork.htm (accessed Nov 20, 2008).
\16\ Summerbell CD, et al., 2003. Interventions for treating
obesity in children. Cochrane Database Syst Rev;(3):CD001872.
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PREVENTION
The time is right to look at innovative ways to reduce and prevent
child obesity and the staggering long-term health and productivity
costs. We need a paradigm shift away from treating diseases after they
occur and towards preventing them from ever occurring. By definition,
prevention of chronic diseases means focusing on the generation growing
up, the children that are overweight at age 2 or 3 and living with type
2 diabetes and high blood pressure by the time they are 8 years old. We
cannot afford to wait. We need to place prevention at the center of our
health priorities.
We cannot afford to wait for our healthy children to become obese
and seek medical treatment for diabetes, cardiovascular disease, sleep
apnea, gall bladder disease, and orthopedic problems. In 2004, we spent
$117 billion on conditions related to obesity and $132 billion on type
2 diabetes. What if we invested that kind of money to make healthy
choices the easy choices? To fully fund school-and-community based
health programs? To build parks, playgrounds, and community-supported
agriculture and local farmers markets? We might begin to reverse the
alarming health trends we are seeing in our children. What if we could
put that money into preventive medicine, after school programs, senior
recreation centers, and workplace wellness? If we want to see a bright
and healthy future, we must change the way we think about health
priorities and focus on prevention.
We do not need more data to act now--just the political will to
adequately fund programs that work. In Texas, we've seen prevention in
action with an elementary school program called the Coordinated
Approach To Child Health (CATCH). Based on the solid results of a
clinical trial \17\ and the subsequent 3-year follow-up study,\18\ in
1997 the Board of the Paso del Norte Health Foundation approved the
first two grants for the CATCH Program in El Paso, TX. CATCH quickly
gained momentum and support because of its focus on balanced nutrition,
physical activity, health education, and tobacco avoidance. CATCH
proved successful through its coordinated, multi-platform approach--
classroom instruction, healthy cafeteria lunches, activity-based
physical education classes, at-home parent involvement, and after-
school community-based programs. CATCH does make a difference. The
Texas SPAN survey of 4th grade students in El Paso County suggested
that CATCH was a contributing factor to a 7-point drop in student
obesity rates measured from the year 2000 (25 percent) to the year 2005
(18 percent). PdNHF funded CATCH at $4.2M over a 7-year period and
estimated the costs of implementation at $10 per student per year. Our
children deserve programs like CATCH.
---------------------------------------------------------------------------
\17\ Luepker RV, et al. Outcomes of a field trial to improve
children's dietary patterns and physical activity: The Child and
Adolescent Trial for Cardiovascular Health (CATCH). J Am Med Assoc
1996; 275: 768-776.
\18\ Nader P, et al. Three-Year Maintenance of Improved Diet and
Physical Activity: the CATCH Cohort. Arch Pediatr Adolesc Med. 1999;
153(7): 695-704.
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Since then, over 2,100 Texas elementary schools and nearly 10,000
schools nationwide have been trained in the use of CATCH. As
Commissioner, I estimated that if CATCH could avert diabetes in only 1
or 2 obese children per school, it will have more than paid for itself.
Here in New Mexico, CATCH is a popular prevention program. The NM
State Plan calls for increasing the number of schools offering the
CATCH program (Activity 2.2.A-2).\19\ A collaboration between New
Mexico Health, Education and Cooperative Extension agencies is
implementing CATCH in grades K through 5. Funded largely by tobacco
settlement funds, each CATCH school is encouraged to include all
components of the intervention. In 2008, a total of 45 elementary
schools and after-school programs were funded to provide the CATCH
program.
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\19\ The New Mexico Plan to Promote Healthier Weight A
Comprehensive Plan to Reduce Obesity, Overweight, and Related Chronic
Diseases 2006-2015.
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Not only does CATCH improve diet, physical activity and obesity,
but Texas researchers have documented significant improvements on
Stanford Achievement test scores.\20\ Among a group of predominantly
Hispanic, economically disadvantaged elementary school students, the
CATCH classroom physical activity intervention produced significant
increases in achievement in math problem-solving. Among children who
were not adapting well to school, CATCH produces significant
improvements in Stanford Math and Reading scores.
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\20\ Personal communication, Dr. Nancy Murray, University of Texas,
School of Public Health.
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I know I have given a gloomy forecast, Mr. Chairman. We have a long
way to go before we will make a significant impact on this enormous
problem we are trying to tackle. However, there is hope of sunnier days
ahead. We know that nutrition and physical activity are cross-cutting
risk factors and that effective prevention of obesity also prevents
diabetes, cardiovascular disease, and some cancers. Fully funding and
implementing coordinated school health programs like CATCH and others
with a proven track record can assure our communities and our Nation of
healthier children and a much brighter future.
CONCLUSION
Our country needs to focus on developing policies and making
funding decisions that help Americans make healthier choices about
nutrition and physical activity. We know that even small changes can
make a big difference in people's health--and that individuals don't
make decisions in a vacuum. If we want our children to lead healthy,
productive lives, we need a strong partnership from the government,
private and nonprofit sectors, as well as parents and teachers, to
emphasize wellness and enhance nutrition and physical activity. The
challenge is a big one, but we can make a difference together. Thank
you again for the opportunity to testify.
Senator Bingaman. Well, thank you very much for your
excellent testimony.
Dr. Thompson, why don't you go right ahead?
STATEMENT OF JOSEPH THOMPSON, M.D., M.P.H., ASSOCIATE
PROFESSOR, THE COLLEGES OF MEDICINE AND PUBLIC HEALTH AT THE
UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES, CHIEF MEDICAL
OFFICER FOR THE STATE OF ARKANSAS, LITTLE ROCK, AR
Dr. Thompson. Sure, sure. Thank you, Senator Bingaman and
Senator-elect Udall. I appreciate being here. Dr. Sanchez and I
will, I think, make a good team here in front of you.
I am a father of two, a pediatrician. I am the director of
the Center for Health Improvement, which is the policy
development center for our State. I am now serving my second
governor as the cabinet-level advisor on health as the State
surgeon general.
I know that you are faced with fiscal crises that are acute
and impending and immediate, but I think we are here today
talking about a health crisis that may dwarf the current fiscal
crisis in the future if we don't take action soon.
I am going to submit my written record in full and also re-
submit a letter to the committee that I sent after our last
discussion with the fiscal issue, so that there is a written
record of the fiscal comments and touch on some of those.
This economic crisis--if I could--in our State, we have
actually documented. We know that in our Medicaid program,
about 35 percent of our kids are either overweight or obese and
that they are costing our Medicaid program 9 percent more. That
the children who are obese cost 9 percent more than the
children who are normal weight.
We know that when we get into the teenage years that the
difference is 29 percent more, and we have tracked that through
the adult State employee population, the largest insured group
of employees in our State. I would be willing to suggest across
all States, except maybe Rhode Island.
In that State employee population, 26 percent of their
healthcare costs are associated with either obesity, physical
inactivity, or tobacco use. As they age, our obese State
employees, full-time workers, cost 100 percent more than our
normal weight full-time workers. One hundred percent more, and
we put them on the doorstep of Medicare.
We cannot find that Medicare has in their future of
Medicare actuarial projections a factor that takes into account
the obesity risk burden that is in the growing population that
is coming to the doorstep of Medicare for healthcare services
in the future.
This starts in childhood. We pay for it through our
employed populations as they are working adults, and the
Federal Government has a huge fiscal liability for the future
if we do not turn this spigot off and address with the
treatment, the prevention, and the research issues that you
called for in your act of 2008. We cannot afford not to act.
Let me spend a few minutes on focusing on our actions in
Arkansas. We are now in our sixth year of actions that we took
in 2003 under our legislative proposal, where we tried to
tackle childhood obesity after it was announced by the Centers
for Disease Control and others that we were in a nationwide
epidemic.
They had said approximately 30 percent of children were
either obese or overweight in 2003. Our legislature initiated
and our then-Governor Huckabee supported major changes in our
schools and our environments. We changed the education that
cafeteria workers had. We changed what was in the vending
machines, restricting sugared soft drinks in vending machines.
We restricted vending machines to only be available after
lunch so that kids didn't get breakfast and lunch from a
vending machine. They got it from the cafeteria. They used
vending machines for snack products after lunch and after
school.
We established physical activity requirements in every
grade, K through 12. I will need to come back to that when we
look at where we are currently. Now we created, in advance of
the Federal requirements, local parental advisory committees to
try to get engagement of parents to change the school system
and the environment.
We required publicly disclosing so-called ``pouring
contracts,'' basically advertising privileges that companies
have inside of the school setting to advertise their products.
Historically, not something that we thought was harmful, but
that we now know may be influencing children's consumptions of
soft drinks or foods of minimal nutritional value.
Somewhat controversially in 2003, we started and followed
the Academy of Pediatrics national physician organization's
recommendations, as well as the Institute of Medicine's
recommendations, to make sure that every parent knew their
child's body mass index so that parents have warning, because
we have slowly become heavier and heavier.
If you look at a kindergarten class from 1970, it is a
bunch of thin kids. If you look at a kindergarten class from
2007, it is hard to find the thin child. We have gradually
turned the thermostat up of what we accept. The BMI is a way to
quantify that and make sure people know where their risk is.
We started in 2003 reporting every child's body mass index
across 380 school districts, 1,300 schools, almost half a
million children each year in our relatively poor and
southerly, sisterly State with you.
Our BMI information pushed things forward. It provided an
annual report. It provided parent information. It provided
legislative stamina to stay the course. I am proud to say now
that we are in our sixth year, that over the last 3 years, we
have been able to claim with hard data that we have halted the
progression of the childhood obesity epidemic.
We cannot say for sure that we have reversed it, although
what we will be coming out with later this year are communities
within which we have reversed that epidemic and some other
communities that we might need to make additional investments
in.
As I think you are well aware, those other communities
frequently are poor communities, more isolated communities,
minority communities, disenfranchised communities. So those
communities that need more help, we need to provide more help
to.
Our BMI assessments from an external evaluation by our
College of Public Health have been found to be helpful by
parents. Sixty-one percent of school districts now have
policies prohibiting vending machines from selling junk foods,
up from just eighteen percent in 2004.
Twenty-six percent of vending items in schools are healthy,
up from eighteen percent. That is if they are allowed vending
items, a fifty percent increase in the healthy category.
Parents are changing their home environment, what they
purchase for their children. They are reducing the television
and video-game screen time because they have been made aware of
the obesity risk as an issue.
In 2007, 72 percent of students reported that they
increased their physical activity, up 10 percent from just a
year before. Some of these changes have raised awareness,
changed the environment within which kids go to school every
day, and wrapped support around parents to make those changes
that they need to.
We have another evaluation coming out this January that I
look forward to providing you. I will also say that in our last
legislative session, we repealed the physical activity
requirement in every grade K through 12 because of the academic
performance needs necessary to reach the No Child Left Behind
standards.
While we had achieved 30 minutes of physical activity
requirements in every grade K through 12 across 4 or 5 years,
not intentionally, but the pressure for academic performance
over here in an isolated silo eroded our ability to support
physical activity across all grades, K through 12.
Now we are back to where we have it in kindergarten through
fifth grade, half a semester in middle school, half a semester
in high school. That is all the physical education requirements
that we have across our 1,300 schools in the State.
There is a role for everyone to play, and I think this is a
call for all of us--families, communities, churches, schools,
States, and our Federal leaders--to play.
The Robert Wood Johnson Foundation, the Nation's largest
healthcare foundation, has made a commitment to invest half a
billion dollars--a dollar amount that has never been previously
invested from a private corporation--to change something for
which they don't make any money on, and many of the programs
that they put in place are important.
In schools, the Alliance for a Healthier Generation with
the Clinton Foundation and the American Heart Association, a
joint initiative, has put efforts in schools in all 50 States,
almost 1,900 schools. You have 18 schools here in New Mexico
that are signed up and trying to change the cafeteria
environment, the physical education environment, the parental
engagement along similar lines to those we took in Arkansas.
We have State evaluation projects in States that have taken
efforts. That report that I mentioned from Arkansas, and also
Delaware, Mississippi, New York, Texas, West Virginia--are
coming forth with new and innovative strategies that we look
forward to sharing and incorporating in our State, as I am sure
Texas will and others.
The National Governors Association Healthy Kids, Healthy
America Project has funded governors' offices in 15 States,
including here in New Mexico, where you now have within the
Office of the Health Secretary a coalition composed of more
than 40 State agencies across 8 departments with 60 private
organizations and public organizations working together to
break down these silos, to wrap support around parents, and to
make this be a real change.
Safe Routes to School program, Food Trust, community-based
programs. Yesterday, Healthy Kids, Healthy Communities
announced funding opportunities for 60 new communities to get
funding from the foundation to make changes. Half of those are
targeted for the Southern States, where the risk burden is the
greatest. From Georgia on the east coast all the way across to
Arizona and California on the west coast, draw a line below
that line, these Southern States need to come together to take
advantage of this.
We need coordination, and we need a national plan. I think
your proposed prevention, treatment, and research is an
important and critically needed first step, but there are other
challenges. You are going to be faced with major pieces of
legislation in an acute, compressed timeframe where action
needs to be taken. There can be small steps that make a
difference--your reauthorization of the State Children's Health
Insurance Program, the K through 12 education program, the
Child Nutrition and WIC program, the transportation
reauthorization. You will have the opportunity on each of those
to make a major change that wraps support around States,
communities, and families.
For example, you could include explicitly obesity as a
treatable condition in the State Children's Health Insurance
Program. You could provide funding to implement in force the
federally required school wellness policies, which are required
of schools now, but that don't have adequate funding flowing
through.
We could require nutrition standards for competitive foods
offered within the school system. Right now, those are outside
of the Department of Agriculture requirements.
We could align the reimbursable school meal programs with
the recently released dietary guidelines for Americans to make
two different agencies in the Federal Government work together
to be telling schools the same thing. We are telling them
different things right now.
The intensity and duration of quality physical activity in
schools--just a performance indicator to say how physically fit
kids are when they graduate would actually change the balance
to not just look at academic performance, but also look at
physical fitness as a component of a healthy lifelong
educational strategy.
The physical fitness index, ``Complete Streets,'' and
through the transportation bill to make sure that new roads
that we are going to build for part of the stimulus package and
over the next 5 years due to transportation advancements also
incorporate safe and convenient mechanisms for people to use
pedestrian or cycles or nonpetroleum fuel-generated forms of
transportation.
Then, finally, you have existing programs within your
agencies--the Centers for Disease Control, many of the outreach
programs across Education, Agriculture--that if there was a
requirement within their authorization bill to at least pay
attention to the needs of childhood obesity, that is going to
re-inforce the cross-agency collaboration that you have called
for in your 2008 bill.
Finally, in conclusion, let me just say we need the Federal
Government and State governments to join together to support
communities and families. I have never yet met a mom, as a
pediatrician or as a father, who wanted a healthy, uneducated
child or an educated, unhealthy child. They want both, and we
need to make our programs work together to give that.
I will tell you that I think the most serious threat to the
future of our children and also I think to the future of our
Nation is this obesity epidemic that is, quite candidly, very
similar, from my perspective, to the financial crisis we are
in.
Let me just draw the parallel. Ten years ago, nobody really
thought about the number of credit card free applications you
were getting in the mail, but today, people are thinking about
it differently. Today, people are not thinking about as much as
we need them to not getting the super-sized fries or not
selling the school environment out to advertisement or not
having physical activity in the 8 hours of school that the kids
are sitting down all day.
We need to change that. We need to have it be just like we
are focused on the fiscal crisis today to focus on this health
crisis before it becomes the fiscal crisis of tomorrow.
Thank you very much for being here.
[The prepared statement of Dr. Thompson follows:]
Prepared Statement of Joseph W. Thompson, M.D., M.P.H.
Senator Bingaman, 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. During this time of true economic crisis that is affecting
families all across the United States, it is more important than ever
that we get on track to reversing this epidemic. As people resort to
cheaper, less nutritious foods because of the rising cost of fresh
produce, some researchers already are predicting higher obesity rates
within 3 years.
Obesity-related expenses already cost State Medicaid budgets $21
billion annually. If we think the cost of obesity is high now, just
wait until our current generation of obese and overweight youth reaches
adulthood and begins to experience the ill health and disability of
chronic disease--not in their 50s and 60s but in their 30s and 40s.
Let me state emphatically: ``We cannot divert our attention. We
must reverse this epidemic of obesity or it threatens to undermine
America's future far more than the current economic crisis.''
Through a series of hearings held in this subcommittee over the
summer, you examined the environmental factors that have led us to
where we are today: supermarket flight, food and recreation deserts,
urban sprawl, unsafe places to play, squeezed physical education time,
vending machines in schools and increased time in front of a screen--
television, video game or cell phone, just to name a few.
We did not intentionally allow our families to be negatively
affected by our decisions, but we must intentionally reverse these
effects. We need your leadership now.
This epidemic cuts across all categories of race, ethnicity, family
income and geography, 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 among those
affected more than their peers.
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.
Unlike other southern States, we 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 during the 2003-2004 school
year, a little less than 34 percent of children ages 2 to 19 nationally
were either overweight or obese. 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.
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.
The most recent evaluation from the Fay W. Boozman College of
Public Health at the University of Arkansas for Medical Sciences shows
that Arkansas's law is working to create a healthier environment in
schools across the State--and that some families are starting to make
healthy changes at home. Some of the key findings of the report include
the following:
The BMI assessments have been accepted and found helpful
by parents--and recognition of specific health problems associated with
obesity, such as diabetes, high blood pressure, asthma and high
cholesterol, has increased over the first 3 years. Student teasing
about weight has not increased since BMI screenings started in public
schools--a finding that counters initial concerns proposed by opponents
of the act who feared that the BMI mandate would lead to more children
being the target of jokes about body fat.
Sixty-one percent of school districts in Arkansas have
policies prohibiting vending machines from selling junk foods, up from
just 18 percent in 2004.
Twenty-six percent of vending items at schools are in a
healthy category, up from 18 percent 4 years ago.
Parents are making efforts to create healthier
environments at home by limiting junk foods--and limiting the time
their children spend in front of a television or video game screen and
by encouraging more physical activity.
In 2007, 72 percent of students increased their physical
activity overall, up 10 percent from the 2006 study. There is still
work to be done, especially in schools. Only 41 percent of students
reported participating in daily PE in 2007--a drop from 71 percent in
2004.
Every year since implementation we are learning more about how this
law is working and we look forward to the next evaluation report from
the College of Public Health which will be issued this January.
Beyond the statistics, the positive impact that our policy changes
are having on individual kids like ``Samantha'' has been the one of
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 everyone to play in reversing this epidemic.
That is why the Robert Wood Johnson Foundation has committed $500
million over 5 years to reverse childhood obesity rates by 2015. For
millions of young people, the Foundation wants to avert, the life-
limiting consequences increasingly associated with obesity--type 2
diabetes, heart disease, stroke, asthma, certain kinds of cancer and
many other debilitating diseases. We are investing in three
interlocking areas--research, action and advocacy--with a specific
focus on children at greatest risk for obesity.
In order to coordinate and maximize our efforts, next month we will
launch the new Robert Wood Johnson Foundation Center to Prevent
Childhood Obesity. The Center will be the only national institution
focused solely on reversing the epidemic that threatens our country's
children and adolescents.
We will provide expertise and support to organizations,
policymakers and communities. The Center will help shape and coordinate
these groups' efforts and build a nationwide movement to solve this
critical health issue. The major programs funded by RWJF on the ground
and in communities across the Nation will form the core of this
movement.
I want to share some of these programs with you--and how in
addition to what we are doing in Arkansas--we are starting to craft
creative solutions that will help fight this epidemic.
As you will see, we are concentrating our efforts broadly--in
schools, at the State level and within vulnerable communities--by
investing in systemic and lasting changes that will improve healthy
eating and active living. Our goal isn't to drop in, spend some money
and then leave. We want to create systems so the change carries on.
The Alliance for a Healthier Generation's Healthy Schools Program
is our biggest investment in school-based solutions to the epidemic.
The Alliance is a joint initiative of the Clinton Foundation and the
American Heart Association. The Healthy Schools Program works with
schools nationwide to develop and implement policies and practices that
promote healthy eating and increased physical activity for students and
staff. The program places special emphasis on reaching schools that
serve students at highest risk for obesity.
After 2 years of operation, the Healthy Schools Program now
provides on-site support to more than 1,900 schools and online
assistance to more than 1,900 schools in all 50 States, including 18
schools in New Mexico. The online assistance includes a Web site
providing tools to help schools create a healthier environment and
evaluate the nutritional value of foods and beverages. To date, the
program has reached more than 1.66 million students, held three annual
forums and recognized nearly 70 schools for creating healthier
environments. We expect the program to expand to more than 8,000
schools by 2010.
We are also investing in statewide change through State evaluation
projects and funding the National Governors Association's Healthy Kids
Healthy America Project. RWJF funds evaluations of State-wide policies
designed to prevent childhood obesity in six States: Arkansas,
Delaware, Mississippi, New York, Texas and West Virginia. Some States
have changed policies to provide healthier foods at schools, improve
physical education and assess the body mass index of school children,
while others are addressing the foods and services offered through
their Women, Infants, and Children (WIC) programs.
The evaluations examine whether or not the policies are being
implemented as they should be, if they are effective in addressing
childhood obesity, and what residents think of them. Each of these
evaluations will have valuable lessons to share once their evaluations
are completed.
The Healthy Kids, Healthy America initiative, which encourages
governors and State leaders across the country to support increased
physical activity and healthy eating among children, is funding
projects in 15 States. Such projects include: integrating healthy
messages into the classroom through hands-on activities; increasing
physical activity levels in daycare settings; developing school and
community action plans; creating model voluntary guidelines for
nutrition, physical activity and screen time for after-school
providers; tracking students' physical fitness; and providing
comprehensive wellness screenings for children in school.
New Mexico is a Healthy Kids Healthy America State. Building off
momentum already present in the State, Gov. Bill Richardson (D) has
improved alignment and collaboration among the State's obesity
prevention efforts by creating a senior-level, childhood obesity
advisory position in the Office of the Health Secretary. A coalition--
composed of more than 40 State agencies in 8 departments and more than
60 private and public organizations--agreed to deliver consistent youth
obesity prevention messages across all their programs. The importance
of this cross-cutting coordination cannot be stressed enough and needs
to be a model for what we are doing at the Federal level as well.
Other programs we fund reflect the importance of increasing
opportunities for active living and healthy eating, as well as
complement State government-led efforts that are already under way. Our
work with the Safe Routes to School National Partnership and The Food
Trust demonstrates this approach. Safe Routes to School is a national
and federally funded program to create safe, convenient and fun
opportunities for children to bicycle and walk to and from school. The
national partnership supports organizations, government agencies and
professional groups in their efforts to develop coalitions and action
plans to make this happen. The partnership focuses on nine key States
and the District of Columbia, chosen because they have large
populations at a greater risk for childhood obesity.
The Food Trust helps to expand the supply of food resources
available to low-income communities by advocating policies that increase the
availability of fresh food in communities, creating model programs,
undertaking research studies on food disparities and disseminating
findings to government officials and policymakers. Collectively, these
efforts are addressing the systemic issues that prevent our food and
farming system from adequately serving hundreds of thousands of
individuals throughout the region every year.
The Food Trust was a partner in creating the Pennsylvania Fresh
Food Financing Initiative, the Nation's first statewide program to
address the lack of access to healthy food in low-income neighborhoods.
With RWJF funding, The Food Trust is working with partners in Illinois,
Louisiana and New Jersey to explore State-level solutions to the
problem of poor food access in these States.
We are also right in the middle of launching three new community-
based programs, the largest of which is our Healthy Kids, Healthy
Communities Program. Healthy Kids, Healthy Communities is a $44 million
initiative that is the Foundation's largest investment to date in
community-based solutions to childhood obesity. Just yesterday we
announced nine leading sites that will receive grants of up to $400,000
over 4 years to help make policy and environmental changes to increase
opportunities for physical activity and healthy eating among children
and their families
The leading sites are urban and rural, large and small. They
include: Chicago; Columbia, MO; Louisville, KY.; Seattle; Somerville,
MA; Washington; and Baldwin Park, Central Valley and Oakland in
California. Through impressive partnerships of neighborhood
associations and public agencies, all are pursuing an array of
strategies to reshape their communities and promote active living and
healthy eating--through farmers markets in public schools and community
gardens, new bicycle lanes and wider sidewalks, even a pedestrian-only
boulevard on weekends.
The program will grow to approximately 70 communities when another
round of funding is awarded late next year. The leading sites will then
act as mentors for these additional cities and counties. Yesterday,
RWJF released a call for proposals for the second round of Healthy
Kids, Healthy Communities funding. Preference will be given to
applicants from communities in 15 States where rates of childhood
obesity are particularly high--Alabama, Arizona, Arkansas, Florida,
Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina,
Oklahoma, South Carolina, Tennessee, Texas and West Virginia. About
five dozen grants of up to $360,000 will be awarded to qualified
community partnerships. I ask that all of you present today share this
news with your community organizations here in New Mexico, since you
are one of the target States.
In addition to the Healthy Kids, Healthy Communities program, we
are going to be launching another national program called Communities
Creating Healthy Environments that aims to prevent childhood obesity by
increasing access to healthy foods and safe places to play in
communities of color. Grants totaling $2.5 million will be awarded to
20 diverse, community-based organizations and federally chartered
tribal nations to develop and implement effective, culturally competent
policy initiatives to address childhood obesity at the local level.
The Foundation soon will be funding 22 faith-based coalitions
across the country--many of them centered in Latino communities--to
push forward policy and environmental changes that can make the biggest
difference such as: building community gardens; increasing access to
healthy and affordable foods and safe places to play in low-income
communities and communities of color; and fostering urban agriculture
and youth engagement.
We are enthusiastic about all the programs under way, but we
understand that we can't solve this crisis alone.
We know it is crucial to work with Federal, State and local
leaders--those from public health and public schools, industry and
business executives, and physicians, hospitals and nonprofit
organizations in the community.
In August, the Foundation was pleased to partner with Trust for
America's Health in releasing the 2008 F as in Fat Report. The report
issued a clarion call for a National strategy to fight obesity.
``This needs to be a comprehensive, realistic plan,'' according to
the report. One that ``involves every agency of the Federal Government,
State and local governments, businesses, communities, schools,
families, and individuals.''
And, the report continued, the strategy ``must outline clear roles
and responsibilities and demand accountability. Our leaders should
challenge the entire Nation to take responsibility and do their part to
help improve our Nation's health.''
I am pleased to endorse, your plan, Senator Bingaman, to create an
interagency coordinating task force or council, across all agencies
within the Federal Government to create strategies and synergies to
prevent childhood obesity. With a new Administration and a new Congress
and a renewed focus on prevention, I am hopeful we will be able to
really take a wholesale look at how the Federal Government is organized
and identify opportunities to push a comprehensive active living and
healthy eating agenda.
Additionally, as Congress is faced with major pieces of legislation
to reauthorize SCHIP, No Child Left Behind, Child Nutrition and WIC and
SAFETEA-LU, I would be remiss not to make recommendations. At a
minimum, I urge Congress to:
Include obesity as a treatable condition in the State
Children's Health Insurance Program;
Provide funding to implement and enforce federally
required school wellness policies;
Require nutrition standards for competitive foods;
Align the federally reimbursable school meal programs with
the Dietary Guidelines for Americans;
Increase the intensity, duration and quality of physical
activity in schools;
Incorporate a physical fitness index or physical education
quality score in school performance ratings;
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;
Support Safe Routes to School; and,
Adequately fund Centers for Disease Control and obesity
prevention grants to States.
As I said at the beginning, we must intentionally reverse this
epidemic. All of us have a role to play. I believe the reforms we have
put in place in Arkansas are working and are replicable. I believe that
the programs funded by the Robert Wood Johnson Foundation will help the
Nation chip away at this problem. None of this is enough. We need the
Federal Government and State governments to lead by promoting and
incentivizing model policies--some of which I touched on today.
As research points us to new and innovative solutions, we must
remain flexible to fund and implement them as well. We must change the
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 you face the acute crises facing the Nation today, please do not
fail to look for strategies to support the long-term changes needed to
reverse this epidemic. As you reauthorize important programs in the
coming year, on behalf of the Nation's families, please incorporate
steps to intentionally align Federal incentives with supportive
environments.
We did not develop this problem overnight. We must act now to start
the process in reversing the epidemic of obesity that threatens to rob
our children, our families, and our Nation of its future.
We simply cannot fail to take action.
Senator Bingaman. Thank you very much for your excellent
testimony.
Let me start with a few questions, and then Congressman
Udall will have some, I am sure.
Let me ask, this whole issue of measuring body mass or
physical fitness, doing a physical fitness index, I guess
Arkansas has done more than any other State to sort of make
that universal? At least that is my impression.
Has there been a lot of pushback? Have you had a lot of
folks come back and say this is none of the State's business,
none of the school's business? You shouldn't be getting into
this? What has been the favorable response and the unfavorable
balk?
Dr. Thompson. Sure. Let me just start. We have had a lot of
news stories, I can promise you that. We have had a lot of
press coverage, and let me get below the press coverage to give
you a kind of boots-on-the ground report.
We are now in our sixth year, and when we started this, we
really didn't mean to step out as far in advance probably as we
did. We were just following what the Academy of Pediatricians
and the Institute of Medicine said, that every parent should
know their child's BMI.
When we turned to parents to say do you know theirs, almost
none did. Just like hearing screening or vision screening or
developmental screening that the schools did, we thought how do
we get to all kids quickly, and we put it into the process of
the school assessment program.
We did take cautions to make sure that kids were measured
in a high-quality way. They were measured in a confidential
way. The child did not know their weight or their height and
that the report that we generated was sent home confidentially
to the parents with things that explained what the BMI was,
what they could do about it if it indicated a potential
problem, where they could turn to for help.
Then I think, over time, we really, through the external
evaluation, have dramatically increased the awareness of
parents who have obese children--that their child may have a
health risk--from less than a third to more than two thirds now
of parents of obese children are taking steps and think that
their child has a health risk that they need to address.
Having said that, the first year, we sent that health
report home to 90,000 parents who had an obese or an overweight
child. My name and phone number was at the bottom of it. So, I
think I can fairly confidently tell you what the pushback was.
We got 300 phone calls. Half of those were parents who
wanted more information, and half of those were parents who
felt like we had infringed upon their rights as parents or
penetrated the safe zone of their child in school. They did not
appreciate--some very vociferously--being told that their child
had a weight problem.
Out of 90,000 that we sent, I have got 150 that felt
strongly enough to just pick up the phone and call or to send
in a letter. I think any business would take that as a
complaint rate over time, particularly given the risk that we
were addressing.
Over time, we have now moved to where we have a written
method that if a parent wants to say, ``I will take
responsibility for my child's health,'' they can opt out of the
school-based screening. We want the parents to take
responsibility for that screening process and that health risk.
We don't want to go blind just because there is some tacit
resistance to the issue of: Is obesity a problem we should be
worried about?
We are now in our sixth year. Now we measure every other
year. Kindergarten, 2nd, 4th, 6th, 8th, 10th grades. So a
parent gets a health report every 2 years.
We coordinate that with their vision screening and their
hearing screening so that they get all of that as a health
report from the school. That enables the school nurse personnel
and others to focus more on the kids that need help in the off-
years when we are not doing that annual assessment.
Senator Bingaman. Your conclusion is that this is an
essential part of dealing with the problem, as I gather?
Dr. Thompson. It hits multiple leverage points in a way
that nothing else does. It gives the parents a number that they
can track. It gives the school personnel a profile of the
school that they both have internal mechanisms to understand
what their risk is, but they have some external accountability
for what they are doing about it.
It gives our legislative bodies--we publish by legislative
district what the obesity rates are. That lets local
constituents engage their legislators more substantively and
actually holds the legislature accountable for the educational
and health goals.
At our State level, just like at the Federal level, we are
running the Medicaid program over here, and we are running the
education program over here. How do we get those two programs
to link together? This data has been one source that has been
critical in helping us link those two programs together.
Senator Bingaman. Dr. Sanchez, let me ask you a question
and then defer to Congressman Udall here.
This CATCH program that you talked about is privately
funded, as I understand it, through this foundation?
Dr. Sanchez. The CATCH program is funded in different ways
in different parts of Texas. While the State of Texas has
passed legislation that has requirements for physical activity,
has passed rules about nutrition policy, has passed legislation
about a requirement for coordinated school health programs,
like sometimes happens in our poorer States, it was done in a
way that didn't have the funding attached to that policy
change.
Communities have been finding different ways. When there
are benefactor foundations--El Paso, as I mentioned, Paso del
Norte Health Foundation helped fund. In Austin, TX, Travis
County, the Michael and Susan Dell Foundation have helped fund
CATCH implementation in Travis County. In Harris County, which
includes Houston, the Houston Endowment has been a large
funder.
Other communities have used other sources of funds, but
there was no--it has been privately funded perhaps to a greater
degree than one would like.
Senator Bingaman. What percent of the elementary schools in
Texas are currently involved with this CATCH program?
Dr. Sanchez. It is 2,100 schools out of about 4,000, so
about 50 percent. The degree to which they have incorporated
CATCH is variable, though. Because that funding of $10 per
student per year sometimes is not consistent and schools
sometimes do parts of, not all of the CATCH program.
Senator Bingaman. You referred to the fact that in New
Mexico, we are also using this CATCH program to some extent. Is
that right?
Dr. Sanchez. Correct. The State health plan, called the New
Mexico Plan To Promote Healthier Weight, calls for increasing
the number of schools, and there are now about 45 schools.
There are other programs that have actually been incorporated
in New Mexico. One is called OrganWise, and one is called
Healthier Opportunities--Healthier Options for Public School
Children.
Those are programs that have some evidence base, not nearly
as robust as the evidence base for CATCH. There are a handful
of schools in New Mexico that are using that coordinated school
health program.
Senator Bingaman. Tom, you go ahead.
Mr. Udall. Thank you, Senator Bingaman.
Dr. Sanchez, first of all, do you have any comment on this
idea that Dr. Thompson has put on the table about the BMI and
how that would relate in terms of the things that you have
discussed and the parental involvement that he is talking about
that seems so important to this?
Dr. Sanchez. Sure, absolutely. Parental involvement, very,
very important. CATCH includes a parental involvement
component.
Dr. Thompson knows that when the State of Texas first
looked at the notion of doing BMI, I was a bit reluctant. I was
worried about how we would address what we were going to learn.
I have changed my mind on that. I absolutely believe that
the only way for us to, in an informed way, make policy
decisions at a policy level or make personal decisions or
family decisions at that level is to have information.
A BMI, particularly as it has been constructed now in
Arkansas, FITNESSGRAM, which actually includes BMI within it--
that is what we are doing in Texas--is a way to provide
information.
I think the other thing, though, that I know Dr. Thompson
was alluding to and has addressed is that we can measure
progress by doing these kinds of annual assessments. Whether it
is at the family level, your child has gone from here to here.
Whether it is at the school district level, the school
population has gone from here to here. Or at the State level,
then one can determine whether those particular interventions
that might have been different in different school districts
worked or didn't work.
Then inform the next set of decisions about what programs
should we be promoting and what programs should we put on the
shelf. Monitoring BMI is one element that is very, very
important, I believe, or some surrogate of BMI.
And then evaluating programs so that we have a sense of
progress. We have the sense of what worked, and then we can
continue building the evidence base and making sense about what
we are doing.
Mr. Udall. Thank you.
Now, Dr. Thompson, the things that you have recommended
were part of this Act 1220, and what I am wondering is you have
mentioned some very laudable successes there. Is there anything
you might structure differently in the act? Is there anything
that was particularly important that was included?
Then in pulling the coalitions together to pass this piece
of legislation, is there anything that you can share with us in
terms of encouraging us to maybe do differently or to do in
terms of moving forward with comprehensive legislation in this
area?
Dr. Thompson. Sure. Let me offer, and I think there are two
or three things if we can unbundle them. The Act 1220 really
did target the school environment and the place, the food, the
activity levels where kids spent most of their day each day. We
were in parallel doing everything we could with the adult
environment, too, with the State employees plan. I mentioned
the assessments that we have done.
We actually added obesity treatment preventions to their
health benefit plan, and we tiered their health insurance
premiums. So that if people smoked or were physically inactive
or were overweight, they ended up paying slightly more in their
health insurance premiums.
Remember, all of our schoolteachers were in that same plan.
It really was--we did everything we could think of to make
these changes during the last 5 years.
With respect to Act 1220 and the school-based initiative, I
do want to caution, I think there is a right way and a wrong
way to do the BMI assessment.
The BMI assessment needs to be done in a confidential,
protected way, and that information treated just like you would
grades or anything else provided to the parents as a reflection
of the health risk, just like we provide to parents their
educational grades that reflect their academic risk or
performance.
I have been on several news shows where it has been the way
we did it versus the way somebody else did it, where they just
weigh the kids and they give the kids the BMI. I mean keep it
confidential. Do it right. Have it be a high-quality
assessment, and I think it can be safely done.
In fact, we have actually not seen any of the adverse risks
that people had concerns about, myself included--eating
disorders and other things. We have not seen any of those
because we followed a safe path.
With respect to passing the act itself, and I think today
would be different than it would have been 5 years ago or in
2003, 2002. We passed it then, it was a 4-page act, double-
spaced with no funding. It didn't get a whole lot of attention.
It kind of went through, and then we had it and we made
something out of it.
I think today that awareness of the obesity risks, the
willingness, candidly, of communities, of governors, of our
elected leaders, industry to come to the table is much greater.
I think what I would encourage is really to think about how do
you get the different programs, the different agencies to work
together?
Have something with teeth in every agency's budget that
forces them to work together on childhood obesity as opposed to
staying isolated. Because that is how you are actually going to
get the most work done.
I think in this obesity act that we did, we have seen--we
have seen our health department led by Dr. Halverson, our
education department by Commissioner James, our human services
department, they are starting to work together more effectively
and efficiently.
We now have coordinated school health programs that are
trying to reach the community resources that Dr. Sanchez has
reflected are present in Texas with our Medicaid resources,
with our school resources. If we can align the incentives,
there are some very powerful local leaders that will take
advantage of that.
If we set the programs up to not have those incentives, the
local leaders get frustrated and can't make things happen. It
is our kids who end up suffering.
Mr. Udall. Thank you. Thank you both very much for your
excellent testimony.
Senator Bingaman. Yes, I appreciate it as well. We could go
on with questions here for quite a while, but I think your
written testimony and what you have also testified to today
gives us a lot of good suggestions for things we could be doing
in Washington.
I hope we can take those suggestions and make some progress
here in the new Congress. Thank you all very much.
Dr. Thompson. I appreciate the opportunity to be here, and
I know Dr. Sanchez and I would be glad to help any way we can
because this is a major issue facing our Nation.
Dr. Sanchez. I also thank you. I think that childhood
obesity is--creates the issue around which we can think about
health system reform in a different way than we have. If all we
do is focus on the medical care side of things, we are going to
lose the opportunity, as Dr. Thompson talked about, to try to
slow the spigot down.
If we don't slow the spigot down, all of the medical care
system reform in the world is not going to be enough to address
what is coming our way.
Senator Bingaman. You commented that you didn't think
Medicare in their current projections has taken into account
the bow wave of problems that they are going to be faced with
when folks get to the age for Medicare and find that a lot of
them are overweight.
You have looked into that, and you don't think it is part
of their projections. Is that right?
Dr. Thompson. We cannot find either the data source they
would use or the calculations that they have employed to
consider that--I mean, in my State employee population, 8
percent of my State employees of all 110,000 State employees
have type 2 diabetes.
Thirty percent are obese. We have 300 who have a BMI, if
the level for obesity is 30, I have got 300 State employees
that have a BMI of 50. Those we will deposit on Medicare's
doorstep pretty soon.
I think this is an issue, critical issue, particularly on
the House side on the pay-go rules and on the financing side,
to get the mechanism for assessing future cost to consider what
the current risk burden is so that it provides some flexibility
to make an investment upstream, not just an investment, as Dr.
Sanchez says, on how we are going to treat the diabetic who
needs renal dialysis or heart surgery or foot amputation.
Those are coming. We have got to figure out how we justify
the investment upstream and what that investment is to keep
those from overwhelming us in the future.
Dr. Sanchez. We are both willing to help. I would like to
provide both of your staffs--send additional documents from
Texas--the strategic plan that I alluded to, the Texas Obesity
Policy Portfolio (go to http://www.sph.uth.tmc.edu/
uploadedFiles/Centers/Dell/obesityportfolio.pdf), and some
information about CATCH (go to www.sph.uth.tmc.edu/catch), the
Healthier Options for Children, and OrganWise. I will get those
to your respective staffs, if that is OK?
Senator Bingaman. That would be great. We would appreciate
it.
Thank you very much.
We have got two other witnesses here, and we would welcome
them, invite them to come to the table.
Patricia Morris is a Ph.D. She is a senior advisor with the
Office of the Secretary in the Department of Health here in New
Mexico. She serves as the director for New Mexico's Interagency
for the Prevention of Obesity. She is the coordinator for more
than 40 programs in New Mexico's public obesity prevention
efforts.
And Lynn Walters has initiated a program here in Santa Fe
called Cooking With Kids. She initiated this in 1995, serves
over 4,000 kindergarten through sixth grade students in the
Santa Fe area. The program was awarded by the Department of
Health and Human Services, with a 2007 National Innovation in
Prevention Award.
Thank you both for being here very much.
Dr. Morris, why don't you go right ahead?
STATEMENT OF PATRICIA MCGRATH MORRIS, PH.D., DIRECTOR, NEW
MEXICO INTERAGENCY FOR THE PREVENTION OF OBESITY WITH THE NEW
MEXICO DEPARTMENT OF HEALTH, SANTA FE, NM
Ms. Morris. Thank you very much, Senator Bingaman. I
appreciate the opportunity.
It is nice to see you, Senator-elect Udall.
I think it is particularly appropriate that the hearing is
here in New Mexico. The State has recognized the growing
incidence of childhood obesity epidemic, and we have initiated
what we think are some very promising practices that might not
only be models for the State of New Mexico, but for other
States as well.
My written testimony discusses in detail the growing health
epidemic of childhood obesity in New Mexico. In the interest of
time, and given that both Dr. Sanchez and Dr. Thompson really
talked about this, let me pass and talk specifically about what
the State of New Mexico is doing.
I would, however, like to just make sure that we note in
New Mexico, Native Americans and Hispanics are at tremendous
risk for obesity and childhood obesity. I am not sure I heard
that statistic in some of the discussion. I just want to make
sure.
The other one that I think is always very interesting is
those who are food insecure. We somehow can't quite wrap our
minds around, ``If I am hungry, how I can also be obese?'' I
think because of the economic disadvantages of people who are
food insecure, they are often having to purchase the high-
calorie, sort of low-dense foods. The cheap foods tend to be
the unhealthier foods.
With that, let me just tell you a little bit about what the
State of New Mexico is doing. Recognizing the growing childhood
epidemic, Governor Richardson charged the Health and Human
Services cabinet secretaries to establish the New Mexico
Interagency Council for the Prevention of Obesity.
It was started in 2006. Under the leadership of the
Department of Health, it was charged to develop consistent and
collaborative efforts and messages across more than 40 State
programs in 9 different departments. It also was charged to
increase public/private partnerships, to build community-wide
obesity prevention programs, and develop policies for obesity
prevention.
Currently, we have 9 State departments, and as I said, they
represent over 40 public programs. They include Aging and Long-
Term Services; Children, Youth, and Families; the Department of
Agriculture; Health; Transportation; Human Services Department;
Public Education Department; Energy and Natural Resources; and,
most recently, the Indian Affairs Department.
We also have nonvoting affiliates. These organizations play
very important roles in the development and the implementation
of programs and policies. They include the American Heart
Association, Envision New Mexico, the New Mexico Food and
Agriculture Policy, the New Mexico Healthier Weight Council,
and the New Mexico State Cooperative Extension Services.
When I look back over the last year and I say, ``Well, what
have we accomplished? '' I think that there are several sort of
key pieces that we have accomplished.
One is we have begun to build some of those consistent
messages across programs around obesity prevention, such as
healthy eating, increased physical activities. We are also
beginning the process of really identifying the State and
Federal regulatory and administrative barriers.
For example, in the State of New Mexico, the U.S.
Department of Agriculture has over 12 different food assistance
and nutrition programs. They are administered in five different
departments here. As you can imagine, it creates a lot of
administrative barriers, and it is easy for people to go into
their silos, as we speak.
In addition, we try to fill gaps where we see that maybe
there are issues or problems or programs that are needed in the
States. One good example of where the interagency really worked
in close corroboration with a specific department was in the
efforts to develop a Team Nutrition Grant that was awarded to
the public education department to really create healthier
meals in schools.
The Team Nutrition Grant I think also really is a good sort
of representation or a good example of how interagency members
can really share resources and reduce on duplication. Public
education leads the Team Nutrition effort. However, there was a
piece in that proposal which asked for the creation of a
child's healthy eating Web page. The Department of Health had
already begun to develop one.
It became really clear that we didn't need two different
Web pages in two different departments doing basically the same
thing. And so, the Department of Health was given that
leadership role to develop that.
Another major accomplishment is really our community-wide
program that we have started, called Healthy Kids Las Cruces.
We received last fall, just a year ago, $100,000 from the
National Governors Association as sort of start-up money to
create a community-wide experimental pilot program.
We used the New Mexico Plan to Promote Healthier Weight to
develop, sort of, what did we want to do in the community? What
were the target groups that we wanted to look at? What we did
was we brought together stakeholders in Las Cruces as well as
the State to develop a plan.
The plan aims to really create and sustain community
efforts that motivate children, youth, and families to eat
healthier, to increase physical activity, and to achieve
healthier weight. It is a strong collaboration with the city of
Las Cruces, the Las Cruces public schools, Dona Ana County
Cooperative Extension, interagency members, and nearly 50 local
leaders.
It focuses on really creating healthy environments in the
community, and we focused on five different settings based,
again, on this New Mexico Plan to Promote Healthier Weight. The
five settings are schools; the food system, which includes
restaurants; food retailers; the healthcare system; the built
environment; and then community and families.
I detail in my written testimony the sort of specific
accomplishments that have really happened over the last year in
each of those settings. Let me just highlight a few of them
that I think represent what the Healthy Children--Healthy Kids
Las Cruces is all about.
Healthy Kids Las Cruces has partnered with the city of Las
Cruces and the mayor's office to develop and promote the
mayor's Fitness and Nutrition 5-2-1-0 Challenge. This challenge
was just released within the last month.
Basically, the mayor's office is using his office as a
bully pulpit in many ways to challenge elementary school-age
kids to eat at least five fruits and vegetables a day, to watch
no more than 2 hours of TV or other screen time, to increase
physical activity to at least 1 hour a day, and no sodas.
Now many times, you can see it to cut back on your sodas,
but the mayor felt it was really important because we are
beginning to see cirrhosis of the liver in very young people. A
lot of people say it is due to the consumption of highly
sweetened sodas. It is the 5-2-1-0 challenge.
We have increased the number of schools in Las Cruces that
are implementing the Safe Routes to School. Three of the
seventeen elementary schools in Las Cruces receive State
Department of Transportation funds.
Again, this was really a function of the interagency.
Because we brought the interagency State members with the local
members together to develop the plan, the State understood that
Safe Routes to School was important, and so they made sure that
Las Cruces knew about the Safe Routes to School grants so that
people could prepare in advance and really write for those
applications.
We have also developed more than a dozen walking and
bicycling paths. We have increased the number of schools
holding fresh fruit and vegetable tastings, providing PE to
students for 30 minutes 3 times a week, and having recess
before lunch.
Recess before lunch is a no-cost and very simple idea, and
what we have found when we have done plate waste studies on it
is kids who actually go and have their recess before lunch,
they come back. They will drink more of the milk, and they will
throw away less of the food because they are hungry. They will
sit down and settle in.
We also have established a flagship school at Conlee
Elementary. What we wanted to do is make sure that we were
putting as many of our resources as we could into one school.
We consider Conlee Elementary really a microcosm of the larger
Las Cruces community, and so we have got more than a dozen
programs going into the Conlee school, both during school as
well as out of time.
We also have tried to include the neighborhood in that, and
we are trying to deal with the local grocers. We are trying to
deal with disclosure in chain restaurants in those
neighborhoods to see if we can create a whole sort of
neighborhood community intervention project.
One of the important parts of it, I think, is really
bringing together multiple community organizations all around
healthy eating and active lifestyles. Just last month, Healthy
Kids Las Cruces held a Fall Fitness and Fun Family Fiesta at
Conlee. It was an extraordinary event, where the city of Las
Cruces really led in the leadership of organizing that.
The Las Cruces mayor, Ken Miyagishima, opened the event,
announcing his Fitness and Nutrition 5-2-1-0 Award. More than
425 children and their family participated in the different
events on this Saturday afternoon, which is quite an
extraordinary number of people.
We had over two dozen community organizations participating
and sort of leading different physical activity and healthy
eating events. For example, the Las Cruces Police Department
and the Las Cruces Fire Department provided activities, which
included a bike rodeo, a canine demonstration, and they also
did blood pressure checks.
We had more than 200 people receive flu immunizations. The
new edible school garden was dedicated. Two Conlee
schoolchildren won free bikes.
Our funding is over. We have no money left in Las Cruces,
but we have built sustainability. We have got the commitment
from the Department of Health, from the Interagency Council,
from the city of Las Cruces, the public health, and the 50
local stakeholders that we are going to continue this.
We came together in October, and we developed our second-
year action plan. I think it says a lot about what communities
can do in terms of sharing resources and building that synergy
that I think is so important.
What are our next steps in terms of the interagency? I
think we would really like to replicate our Healthy Kids Las
Cruces in other communities. It is not that we are trying to
replicate a blueprint or the exact programming, but rather the
process and a framework.
The New Mexico Healthier Weight Council in many ways gives
us a framework and a direction for where we want communities to
be. We have a good process that we think brings together the
necessary sort of leadership at the State and the local level
to develop the local plan. Ultimately, the plan has to be
locally determined.
It is the local communities who know where their strengths
are. They know where their gaps are. It is for the State to
sort of come in and say, ``How can we help build what you are
doing, support what you are doing,'' as well as bringing in
innovative ideas.
In many ways, we will continue to coordinate and strengthen
our collaborative State and local efforts, and I really do
think it is very important that we build some kind of a State
obesity prevention monitoring system. Whether it is the use of
the FITNESSGRAM, the BMI, it is really necessary. In New
Mexico, we have no way to measure or track how kids are doing
in elementary school.
How can we create programs, how can we identify where the
needs are if we don't know what the status is? I think it is
really critical that we do it. I do agree with Dr. Thompson
that it needs to be done in a way where we have privacy and
confidentiality.
With Government and the interagency and what we are doing
in the State, we are really only part of the solution. It is
great for us to build consistent messages, to build
collaboration across State partners, and build private
partners. We still have to counter, and this certainly isn't
enough, to counter the more than $20 billion spent annually by
industry in food marketing to kids and billions more to the
adults.
Sharing resources and eliminating duplication, they are
important. Again, it is not the time to reduce or eliminate
spending on obesity prevention as we all face very tight
budgets. I think Dr. Thompson made very compelling arguments
for why we shouldn't.
A roadmap to healthier futures remains, I believe, largely
unchartered. We know the problem, but I think we still lack a
clear, comprehensive solution. Part of the solution may lie in
taking what I call a more social entrepreneurial approach.
Governments tend to look at problems programmatically. Even
when we build collaborative efforts, we tend to frame solutions
from traditional nutrition and health perspectives. But,
obesity is only one part of a quality of life issue in a modern
industrial society. If we step back and look at the larger
picture, we may find ways to connect fighting the rising tide
of obesity with other efforts aimed at improving the quality of
life.
For instance, the new Federal Government's efforts to
increase the number of bicycle paths and pedestrian walkways.
Well, a social entrepreneur might further suggest adopting the
model of some European systems, which are providing free use of
bicycles.
Combining these two ideas would be good for the
environment, and if more people have easy access to bicycle to
work or to school, they may become fitter--or they will become
fitter and reduce the healthcare costs.
I think it is an untapped resource that we are only
beginning to think about. One of the things that I keep
thinking about is how do we convert all of the mechanical
energy that we use in our workout gyms and convert that so it
becomes electrical energy to actually provide energy for
buildings.
In conclusion, let me say that the road to reversing
childhood obesity trends is long. We shouldn't expect changes
overnight. It took decades to reach this obesity epidemic. This
insidious problem grows slowly, just like our personal weight
gain, and it will take years to change the culture of our
communities.
I think it is incredibly important that we all work toward
building that as a social norm, a norm in which our children
have an equal chance of making healthy choices as making
unhealthy choices.
Thank you very much.
[The prepared statement of Ms. Morris follows:]
Prepared Statement of Patricia McGrath Morris, Ph.D.
Thank you Senator Bingaman for the opportunity to testify at this
hearing ``Confronting Childhood Obesity: Creating a Roadmap to
Healthier Futures.''
It is particularly appropriate that this hearing is taking place
here in Santa Fe, New Mexico. The State has recognized the growing
incidence of childhood obesity among its citizens and has initiated
some exciting and promising measures to stem the increase. The
innovative approach the State is using may not only help New Mexico's
children but may well be a model for others to follow.
As you and the committee well know, childhood and youth obesity is
a growing public health epidemic in our Nation and in New Mexico.
Nearly one-quarter of New Mexico's high school students (24.4 percent)
and its 2-5-year-olds (26.3 percent) who participate in the WIC program
are overweight or obese.\1\ Far more American Indian and Hispanic high
school students are overweight or obese compared to White non-Hispanic
students. In 2007, 32.4 percent of American Indians and 26.0 percent of
Hispanic high school students were overweight or obese compared to 18.6
percent of White non-Hispanic students.\2\
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\1\ Currently there is no statewide system in place in New Mexico
to collect weight-related data on children from Kindergarten through
eighth grade.
\2\ New Mexico Department of Health and New Mexico Public Education
Department (2007). New Mexico Youth Risk and Resiliency Survey, Santa
Fe, NM.
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Childhood obesity rates continue to grow and occur at younger ages.
Obesity rates for New Mexico's children ages 2-5 years participating in
the WIC program increased by nearly 30 percent in just 7 years going
from 9.0 percent in 2000 to 12.7 percent in 2007 (WIC data).\3\
Further, New Mexico's youth fare worse than youth in other States. New
Mexico ranks 10th highest in youth obesity rates compared to other
States (Trust for America's Health, 2008).\4\
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\3\ New Mexico Women, Infants, and Children Nutrition Program
provided the statistics.
\4\ Trust for America's Health (2008). F as in Fat: How Obesity
Policies are Failing in America. Washington, DC.
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Increases in childhood obesity have resulted in dramatic increases
in youth-onset diabetes. No longer do we call type 2 diabetes adult-
onset because of its alarming rates in our youth--a phenomenon that
rarely existed a generation ago. Overweight and obese children are more
likely to be overweight adults and suffer from chronic diseases, such
as heart disease, certain cancers and diabetes (Dietz, 1998).\5\ Some
health experts have predicted that this generation of children will be
the first in our Nation's history destined to have a shorter life than
its predecessor.
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\5\ Dietz, W. (1998). Health Consequences of Obesity in Youth.
Pediatrics, 101(3) Suppl:518-525.
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Paradoxically, food insecurity and obesity go hand in hand. A major
factor in this seemingly contradictory connection is that families
experiencing food insecurity have limited incomes and are thus likely
to purchase cheaper, higher fat or calorie-dense foods to satiate
appetite and stretch food dollars. Such nutritious foods as fresh fruit
and vegetables are often beyond their financial means to purchase. Low-
income families often have limited access to affordable and quality
retail food stores. Some who experience food insecurity may also store
fat more efficiently than others in order to conserve energy for times
of food deprivation. Other New Mexico groups identified as being at
greatest risk for obesity are Hispanic and Native Americans, those
living on annual incomes of $10,000 or less, non-college graduates,
people with disabilities, and those living in the Northwest and
Southeast quadrants of the State (NMDOH, 2006).\6\
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\6\ New Mexico Department of Health. (2006). The New Mexico Plan to
Promote Healthier Weight: A Comprehensive Plan to Reduce Obesity,
Overweight, and Related Chronic Diseases.
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Research consistently shows that healthy eating behaviors and
regular physical activity decrease the risk for childhood obesity,
youth-onset diabetes, increased risk for chronic diseases and a lower
quality of life. Unfortunately, New Mexico's youth fare poorly in terms
of eating healthfully and being physically active. According to the
State's 2007 Youth Risk and Resiliency Survey \7\ only 17.9 percent of
students eat five or more daily servings of fruits or vegetables. Only
28.0 percent of New Mexico high school students drink three or more
glasses of milk a day. In terms of physical activity more than one-half
(56.4 percent) of students do not meet recommended levels of either
moderate or vigorous physical activity.
---------------------------------------------------------------------------
\7\ New Mexico Department of Health and New Mexico Public Education
Department (2007). New Mexico Youth Risk and Resiliency Survey, Santa
Fe, New Mexico.
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BUILDING A FIT FUTURE
Recognizing the growing obesity epidemic among children and youth,
Governor Bill Richardson charged the State's Health and Human Services
(HHS) Cabinet Secretaries to establish the New Mexico Interagency
Council for the Prevention of Obesity. Created in the fall of 2006, the
DOH-led Interagency Council is charged to: (1) build greater alignment
across State programs to create sustainable, consistent, and
collaborative efforts and messages that increase physical activity,
improve nutritional well-being, and prevent obesity; (2) partner with
the private sector to strengthen and support obesity prevention
efforts; (3) build community-wide obesity prevention programs; and (4)
develop policies for obesity prevention. Currently, Interagency Council
voting members represent more than 40 State programs (see Appendix A
for complete listing) across the following eight State departments:
Aging and Long Term Services Department; Children, Youth and Families;
Department of Agriculture; Department of Health; Department of
Transportation; Energy and Natural Resources, Division of State Parks;
Human Services Department; and the Public Education Department.
The Indian Affairs Department recently agreed to become a member.
In addition, the Interagency Council has five affiliate (non-voting)
member organizations: the New Mexico Healthier Weight Council, NMSU
Cooperative Extension Services, NM Food and Agriculture Policy,
Envision, and American Heart Association.
INTERAGENCY COUNCIL'S KEY ACCOMPLISHMENTS IN 2008
Building Consistent and Collaborative Messages and Programs
Interagency Council members agreed to focus their nutrition and
physical activity messages and programming on the behavior changes
recommended by the Expert Committee on the Assessment, Prevention and
Treatment of Child and Adolescent Overweight and Obesity (January 25,
2007). The recommendations focus on the following 9 behaviors:
Increase physical activity to 1 hour a day;
Limit TV and other screen time to 2 hours a day;
Eat 5 or more fruits and vegetables a day;
Drink fewer sweetened beverages;
Eat breakfast daily;
Limit eating out at restaurants, especially fast food
restaurants;
Encourage family meals;
Limit portion size; and
Promote infant breastfeeding.
The State Nutrition Action Program (SNAP), which represents public
and private State and local agencies involved in food security issues,
joined the Interagency Council's effort by agreeing to focus its
messages and programming on the above nine behavior outcomes. One of
the results was that the NM Human Services Department established these
behavior outcomes as the State's focus for its 2009 Food Stamp
Nutrition Education program.
Building consistent messages and programming across public efforts
is important. This alone is not enough to counter the more than $12
billion spent annually by industry in marketing directed to kids and
billions more directed to adults.
The Interagency Council is also working to identify State and
Federal regulatory and administrative barriers to building
collaborative efforts among publicly-funded programs. USDA alone has
more than a dozen nutrition and food assistance programs which are
administered in at least five different New Mexico Departments. This
administrative fragmentation, compounded by regulatory restrictions,
has the unintended negative consequence of making it harder to
effectively build obesity prevention collaborative efforts. For
example, the Food Stamp Nutrition Education program supports nutrition
education programs for low-income families focusing on the U.S. dietary
guidelines. While its goals are laudable, the regulations make it near
to impossible to tap this stream of revenue to address the specific
issue of obesity. This is but one of many possible examples for which
the Interagency Council is well-suited to address.
Addressing Gaps in the Continuum of Nutrition and Physical Activity
Efforts
Recognizing the need to improve school lunches, the Interagency
Council worked closely with the New Mexico Public Education Department
to develop and apply for a 2-year $200,000 USDA Team Nutrition grant.
PED was awarded the grant in September 2008. The grant provides for the
development of kid-friendly healthy school meals' recipes, technical
assistance to school cafeteria staff to learn how to purchase and
prepare healthier school meals, educational and promotional materials
to motivate students to make healthier school meal options, and provide
materials to parents and classroom teachers to support students efforts
in making healthier choices in and outside of school.
The Team Nutrition grant is also a good example of how Interagency
Council members can share resources to strengthen programs and reduce
duplication. While PED leads the Team Nutrition effort, DOH was asked
to take the lead in the development of a Web page. DOH was in the
process of developing a Healthy Kids New Mexico Web page and many of
the elements proposed in the Team Nutrition grant were already part of
the DOH design. It was quickly decided that it made no sense to develop
two similar Web sites, one at DOH and one at PED.
Sharing resources across programs and eliminating duplication are
extremely important, especially now as Federal, State and local
governments face huge budgetary shortfalls. However, this is not the
time to reduce or eliminate spending on effective obesity prevention
programs. The long run health costs to cope with a nation of obese
children growing up into obese adults will far exceed funds spent now
in prevention. Beyond the financial cost, there is an enormous human
cost. These children face a dim future of premature death, physical
ailments, and a lower quality of life. Cutting funds now would be truly
a case of being penny wise and pound foolish.
Building Community-wide Obesity Prevention Initiatives
Under the leadership of DOH, the Interagency Council is piloting a
community-wide childhood and youth obesity prevention initiative in Las
Cruces. The Interagency Council was awarded a $100,000 1-year grant
from the National Governors Association for start-up funding. The focus
of the initiative is best captured in a Las Cruces Sun-News editorial
(April 29, 2008): ``If we want to be a healthy Las Cruces, it starts
with healthy kids; and if we want healthy kids, it starts with a
healthy Las Cruces.''
Healthy Kids--Las Cruces: Building a Fit Future One Community at a Time
Healthy Kids--Las Cruces aims to create and sustain public and
private efforts to build healthy environments that motivate children,
youth and families to eat healthier, be more physically active, and
achieve healthy weights. It is a local and State collaborative effort
of nearly 50 local leaders representing government, education,
healthcare, human and social services, agriculture, non-profit and
faith-based organizations, academia, foundations and businesses and
State leaders representing the Interagency Council.
Healthy Kids--Las Cruces focuses on building healthy environments
in five community settings reaching children and youth where they are:
in schools, restaurants (the food system), the healthcare system; the
built environment; and families and community. Below is a brief
description of the overall aim and key first year accomplishments in
each setting.
Schools: The aim is to motivate Las Cruces students to make healthy
food choices and increase physical activity in the classroom, cafeteria
and school at-large. Key accomplishments include: (1) increasing the
number of Las Cruces (LC) elementary schools participating in monthly
fresh fruit, vegetable and grain tastings; (2) increasing the number of
LC elementary schools using the Cooking with Kids curriculum during
school and in after-school programs; (3) the creation of edible school
gardens in two LC elementary schools; (4) the promotion of healthy
snacks and non-food rewards in schools; (5) increasing the number of LC
elementary schools holding recess before lunch; (6) increasing the
number of LC elementary schools requiring Physical Education for 30
minutes, three times a week; and (7) piloting a half credit health
class in one LC high school.
Food System: The aim is to increase access to a nutritious,
affordable and seasonal food supply and to provide point of purchase
nutritional information on foods offered in schools and chain
restaurants. Key accomplishments include: (1) holding weekly cooking
demonstrations in the Income Support Division's waiting room; (2)
exploring the availability and cost of a healthy food market basket in
low-income neighborhoods; (3) working with the LC Farmers' Market
Coordinator to encourage local producers to sell their produce at local
farmers' markets; (4) creating a community garden in the Mesquite
Historic District; and (5) exploring ways to assist consumers make
informed food choices at chain restaurants.
Healthcare System: The aim is to increase obesity prevention and
treatment healthcare services. Key accomplishments include: (1)
providing a half day best practices obesity prevention training session
to more than 70 pediatricians, nurses, school-based health center staff
and other health care personnel; (2) developing walking paths on
hospital and medical facility properties; and (3) conducting the
Healthy Eating Active Lifestyle (HEAL) program by the LC public health
regional office to empower at-risk or obese children and youth to make
healthier choices.
Built-Environment: The aim is to improve ``walkability'' in Las
Cruces. Key accomplishments include: (1) developing more than a dozen
new walking trails for the LC community; (2) receiving State funding
for a Safe Routes to School program (SRTS) in three schools; (3)
conducting a LCPS district-wide parent survey to determine concerns and
needs for the establishment of a SRTS program in their child's school;
(4) conducting an inventory of bike racks at schools; and (5)
testifying before the LC City Council on creating a built environment
that promotes healthy lifestyles.
Families and Community: The aim is to increase opportunities and
support for community activities that motivate children, youth and
families to be more physically active and make healthy food choices.
Key accomplishments include: (1) The LC Mayor's Fitness and Nutrition
5-2-1-0 Challenge. It challenges elementary students to eat 5 or more
fruits and vegetables a day, watch 2 hours or less of TV and other
screen time, get 1 hour or more of physical activity a day, and drink
zero sodas and other sweetened beverages; and (2) the creation of a
Healthy Kids New Mexico Web page designed to provide parents, teachers
and community organizations with fun-filled activities, lesson plans,
recipes and useful tips to assist elementary-age children in making
healthy food choices and increase physical activity. The Web site
address is: healthykidsnm.org.
Conlee Elementary School: Conlee Elementary is the initiative's
flagship school for SY 2008-2009. Nearly a dozen new programs are being
implemented this school year (See Appendix B for a complete listing of
programs). Not only is the initiative adding new programs during the
school day but also outside of school. A key to its success is bringing
in multiple community organizations to promote and support healthy
eating and active lifestyle behaviors.
A good example of this is the Conlee Elementary Fall Family Fiesta
that was held last month. Sponsored by Healthy Kids--Las Cruces roughly
425 people participated. Las Cruces Mayor Ken Miyagishima opened the
event announcing his Fitness and Nutrition 5-2-1-0 Challenge. The Mayor
is calling on elementary students to eat at least five servings of
fruit and vegetables a day, spend no more than 2 hours a day watching
TV or playing videos, get at least 1 hour of exercise a day, and
eliminate soda from their diet--for 3 straight weeks. Throughout the
day there were numerous physical activities, food and nutrition events
sponsored by more than 2 dozen community organizations. The Las Cruces
Police Department and Las Cruces Fire Department provided activities
that included a bike rodeo, K-9 demonstration, Identi-child, and blood
pressure checks. 203 flu immunizations were provided to both children
and adults. The school garden was dedicated with past, present and
future students planting flowers in the garden along with encouragement
to parents and community members to assist with the garden throughout
the year. Two Conlee Elementary students won new bikes provided by the
city of Las Cruces Public Service Department and another student won a
year-long free admission pass to the New Mexico State Parks.
Despite NGA funding ending last month, DOH, the city of Las Cruces,
the Las Cruces Public School District, community leaders and the
Interagency Council have agreed to continue and expand Healthy Kids--
Las Cruces. Local and State leaders met on October 22, 2008 and
developed the second-year action plan. Building sustainability was
certainly a goal of the initiative and in thinking about what made
sustainability a reality there are at least three key structural
elements:
High-level State Leadership: The Interagency Council
reports to the Health and Human Services Cabinet Secretaries and the
Director of the Interagency Council resides in the Office of the
Secretary, DOH. This gives the director authority to move across
divisions and bureaus in DOH and across different Health and Human
Services Departments. The result is a unified vision for Healthy Kids
New Mexico and an increased number of collaborative efforts and sharing
of resources across public programs to motivate children and youth to
make healthy food choices, increase physical activity and achieve
healthy weights.
A Strong Local and State Collaborative: While the
Interagency Council established a framework and process for Las Cruces
leaders to develop Healthy Kids--Las Cruces, the actual implementation
plan was and continues to be locally driven. In December 2007, DOH
convened a 2-day meeting with a diverse group of nearly 50 local and
State leaders to develop an obesity prevention 5-year vision, goals,
and action plan. On the first day local leaders developed a draft of a
Healthy Kids implementation plan and on the second day presented the
plan to State leaders. Together State and local leaders set priorities
for the first year and committed their agencies or groups to work on
specific parts of the action plan. As a result of the strong State-
local collaborative, DOH Secretary Alfredo Vigil along with three other
NM Cabinet Secretaries were joined by the Las Cruces Mayor Ken
Miyagishima, the Las Cruces Public Schools Superintendent Stan Rounds,
State legislators and numerous community leaders to launch the Healthy
Kid--Las Cruces initiative in April, 2008.
A Coordinating Mechanism: The success of implementation is
in many ways due to the work of DOH's public health regional office in
Las Cruces. Ray Stewart, the Las Cruces public health regional director
dedicated resources and staff time to build, support and coordinate the
community-led activities identified in the first-year action plan. The
Health Promotion Team in the regional office has become the nerve
center tracking the progress of activities, keeping groups on task,
building cooperation and synergy across groups, and at times providing
staff or resources to activities requiring additional support.
CONCLUSION
A roadmap to healthier futures remains largely uncharted and we in
government may be missing a vital piece of the puzzle. We know the
problem, we lack a clear solution. Part of the solution may lie in
taking a social entrepreneurial approach. Governments tend to look at
problems programmatically. Thus we tend to tackle obesity through
agencies such as USDA and CDC. Even when we build collaborative
efforts, we tend to frame solutions from traditional nutrition and
health perspectives. But, obesity is only one part of a quality of life
issue in a modern industrial society. If we step back and look at the
larger picture we may find ways to connect fighting the rising tide of
obesity with other efforts aimed at improving life. Take, for instance,
the new Federal Government's efforts to increase the number of bicycle
paths and pedestrian walkways. This has been viewed as a means of
bettering the environment by reducing our carbon footprint. A social
entrepreneur might further suggest adopting the model of some European
cities which are providing free use of bicycles. These two ideas would
not only be good for the environment but if more people have easy
access to bicycling to work or school, they will become fitter and
reduce our health care costs.
The road to reversing childhood obesity trends is long. We
shouldn't expect changes over night. It took decades to reach this
obesity epidemic. This insidious problem grows slowly, just like our
personal weight gain, and it will take years to change the culture of
our communities and our Nation so that physical activity and healthy
eating is a social norm. A norm in which our children have an equal
chance of making healthy choices as unhealthy choices.
Thank you.
______
Appendix A: The New Mexico Interagency for the Prevention of Obesity
As part of Governor Richardson's priority to reverse the increasing
rates of obesity in New Mexico, the State's Health and Human Services
(HHS) Cabinet Secretaries established the New Mexico Interagency for
the Prevention of Obesity. Created in the fall of 2006, the DOH-led
Interagency is charged to (1) build greater alignment across State
programs to create sustainable, consistent, and collaborative efforts
and messages that increase physical activity, improve nutritional well-
being, and treat and prevent obesity; (2) partner with the private
sector to strengthen and support the Governor's obesity prevention
priority; and (3) develop policies for obesity treatment and
prevention.
Currently, Interagency voting members represent more than 40 State
programs across 8 State departments. Members include:
DOH: Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC), WIC Fit Families, Get Healthy Together,
WIC Fit Kids = Happy Kids, WIC Farmers' Market Program, Commodity
Supplemental Food Program, Coordinated Approach to Child Health
(CATCH), Kitchen Creations, National Dance Institute--``Hip to be
Fit,'' Fruits & Veggies: More Matters, Children's Medical Services,
Public Health Clinics, School-based Health Centers, Community Health
Councils, LEND, and Senior's Local Motion;
PED: National School Lunch, National School Breakfast,
Special Milk, Summer Seamless School Feeding, Fresh Fruit & Vegetable
Program, Healthier U.S. Schools, Physical Education, before & after
school physical and nutrition programs, School Districts Wellness
Policy, Nutrition Competitive Foods Rule, and Health Education and
Physical Activity Standards;
HSD: Food Stamp Program, Food Stamp Nutrition Education
Programs (ICAN, Kids Cook, and Cooking with Kids), Food Distribution
Program, Food Banks, Medicaid, and NM Hunger Task Force;
CYF: Child and Adult Care Food Program & Summer Service
Food Program;
ALT: Nutrition Services Incentive Program (NSIP), Senior
Olympics and Farmers' Market Pilot;
DA: Farmers' Markets, Farms to School Program, and Taste
the Tradition Program;
DOT: Safe Routes to School; and
SP: New Mexico State Parks.
In recent months, the Interagency added five affiliate (non-voting)
organizations: the New Mexico Healthier Weight Council, NMSU
Cooperative Extension Services, NM Food and Agriculture Policy,
Envision, and American Heart Association.
Healthy Kids, Las Cruces--Conlee Elementary Nutrition & Fitness Programs
[SY 2008-2009]
----------------------------------------------------------------------------------------------------------------
Nutrition and Fitness Programs Pre-K K 1st 2nd 3rd 4th 5th Lead Agency
----------------------------------------------------------------------------------------------------------------
During School:
* SAJAI Fitness Program............ X X X X X X Conlee PE teachers
* PE 3 times/week.................. Conlee PE teachers
* Recess before lunch.............. Conlee teachers
* Color Me Healthy................. X CYFD train P-K teachers
* Cooking With Kids................ X X Dona Ana Coop. Extension
* Eat Smart, Play Hard............. X Dona Ana Coop. Extension
* Organ Wise Guys.................. X X X X Extension train Conlee
teachers
Fruit, Vegetable & Grains Tastings. X X X X X X LCPS Student Nutrition
Services
Breakfast in the Classroom......... X X X X X X LCPS Student Nutrition
Services
Out of School Time:
* Safe Routes to School............ X X X X X X DOH & Metropolitan
Planning Org.
* School Edible Garden............. X X X X X X Master Gardeners &
School Council
* 4-H Activities................... X X X X X X Dona Ana Coop. Extension
* Family Cooking & Fitness Program. X X X X X X X DOH & Dona Ana Coop.
Extension
* Family Fitness & Fun Fiestas (2). X X X X X X X LC Rec. Dept. & DOH
* HEAL Program..................... X X X X X X DOH
Before & After School Program...... X X X X X X LC Recreation Dept.
* Conlee Staff wellness program.... DOH
* Mayor's 5-2-1-0 Challenge........ X X X X X X X LC Mayor
* HealthyKidsNM Web Page........... X X X X X X DOH
* Social Marketing Efforts......... X X X X X X X DOH & Interagency
Members
* Program Evaluation:
* Students' Eating & Fitness DOH
Behaviors.
* Students' BMI & Fitness Measures. DOH
Conlee Neighborhood:
* Nutrition Disclosure on Menus and
menu boards in chain restaurants
(pending).
----------------------------------------------------------------------------------------------------------------
New programs established by Healthy Kids, Las Cruces initiative.
Senator Bingaman. Thank you very much.
Ms. Walters, why don't you go ahead and tell us about
Cooking With Kids and similar programs and what they contribute
to solving this problem?
STATEMENT OF LYNN WALTERS, EXECUTIVE DIRECTOR, COOKING WITH
KIDS, SANTA FE, NM
Ms. Walters. Thank you, Senator Bingaman and Senator-elect
Udall. Thank you for this opportunity. I appreciated seeing you
both in our schools and for all your efforts on behalf of
children over the years.
As you well know and has been really well said here,
childhood obesity and nutritional deficiency is a serious
public health issue. Last year in Santa Fe, actually due to the
efforts of the Salazar Partnership for Healthy Schools, two
schools did measure BMIs.
Actually, they have done it for 2 years now with private
funding and found that of the 904 students attending Salazar
and Agua Fria elementary schools, 28 percent were obese--not
overweight or obese, but obese. That is rather startling. One
of the schools actually was 34 percent.
I feel like it is my role here to really talk to you about
one solution or one piece that can be the solution. Today, many
children are no longer learning from their parents or
grandparents how to cook or where food comes from, how to grow
it. We have forgotten, in large part, the pleasure of preparing
and eating healthy foods, the connection among families and
community that comes from such pleasure.
We have observed today that children know that they are
supposed to eat vegetables rather than candy. Almost every
child knows that, right? Preferences and availability drive
most of our food choices. Developing healthy preferences and
cooking skills through direct experience with food is an
important component of changing the culture of obesity.
As you mentioned, Cooking With Kids was initiated in 1995
as a volunteer program in two schools in Santa Fe with the
intent to improve children's nutrition through hands-on food
and nutrition education and to positively impact school meals.
Cooking With Kids' purpose is to motivate and empower
children to make healthy choices by supporting their innate
curiosity and enthusiasm for food. They learn directly about
healthy eating through hands-on activities with fresh,
affordable foods from many different cultures.
We currently work with over 4,400 children, prekindergarten
now, some, through 6th grade in 12 low-income Santa Fe public
schools. Last year, over 1,200 parents and grandparents
volunteered during school day cooking classes, and we found
that many parents who might be intimidated by coming to school
when they were not successful in school are comfortable in
participating in cooking classes.
The objectives of this program and other programs that work
with hands-on food experience are for children to learn to
accept a wide variety of healthy foods, that they will acquire
practical food preparation skills, and to learn about people of
other cultures while working cooperatively.
We have developed a bilingual interdisciplinary curriculum
that meets many New Mexico public education standards in math,
language, art, science, and social studies, which supports core
curriculum. The heart of our program is the hands-on
experience--touching, smelling, preparing, cooking, and
tasting.
The classroom component consists of cooking classes taught
by our staff, who partner with classroom teachers and parent
volunteers, and fruit and vegetable tastings, to helping
classroom teachers with materials and food provided by Cooking
With Kids.
Patty Morris alluded to, in Las Cruces, actually those
fruit and vegetable tasting classes are being implemented as
well.
Some of the foods that children cook we might not think of
as child foods. They are not macaroni and cheese that we have
made children friendly. Children cook vegetable paella with
green salad, minestrone soup with breadsticks, East Indian
lentils with carrot rice pilaf, and vegetable tamales with red
chili. Senator Bingaman years ago saw students preparing fresh
green and white fettuccine with tomato basil sauce.
As the students prepare, share, and enjoy the fresh healthy
foods together, they have multiple opportunities to learn, to
exercise choice, and to enjoy eating together. In an effort
also to link classroom learning with school meals, we continue
to work with Santa Fe public schools to improve the appeal and
quality of school lunches that children will eat.
We provide hands-on training for cafeteria managers using
real food, although only once a year. Cooking With Kids-
inspired school lunches are served about twice a month in all
21 Santa Fe public schools' elementary school cafeterias, and
now in some of the middle and high schools.
The challenges really are our current eating and lifestyle
patterns, which are a reflection of our societal values. As a
result, cheap processed foods, conflicting messages, a dearth
of cooking skills, lack of availability of affordable healthful
foods in many areas are some of the barriers that we face.
In the realm of school meals, the status afforded to the
women, mostly women, who cook for our children is very low,
with accompanying low wages. Were we to give school food
service workers the status and wages of high-powered chefs,
were we to respect them and care that they are feeding our
children, we would be making a meaningful statement about our
priorities.
Lack of time for helping on this programming also is a
growing challenge as the demands of No Child Left Behind are
increasing. Cooking With Kids was initiated before No Child
Left Behind, which I think has afforded it an advantage in the
Santa Fe public schools.
However, were such a program to become an integral part of
a school district rather than being implemented by a community
partner, as we are, it could be swept away in a moment by any
number of pressures that are facing schools, financial or
academic.
Sustainability for social programs, as you know, is a
continuing challenge. Funding, staffing, and community support
must be ongoing. Facilities in schools also pose challenges,
especially, for such a program as ours, the availability of
dedicated classroom with adequate utilities. As computers are
taking more energy in schools, we have even found that circuits
are not adequate for even electric appliances.
In addition, in Santa Fe, more schools would like to have
Cooking With Kids than we are able to serve.
As I have said, the experience of cooking together is at
the heart of what we do. It is a success when a child fishes
around in his minestrone soup that he just helped make, pulls
out a piece of kale, and says, ``I like this.'' And that has
happened.
A second grade student reported, ``You know these recipes
you give us? My grandma cooks all of them for dinner.'' A
teacher commented, ``We all benefit as a society when kids have
skills, confidence, and a broader appreciation of many
cultures.''
We are currently fortunate to be involved in a research
project that was funded by USDA/CSREES/NRI that is being
directed by Colorado State University. It is entitled,
``Cooking With Kids: Integrating Classroom, Cafeteria, and
Family Experiences to Increase Fruit and Vegetable Preference
and Intake.''
The project is investigating the following--do the
experiences provided by Cooking With Kids contribute to more
healthful food choices and thus reduce children's risk for
developing obesity and chronic disease?
We just have some preliminary results from the initial data
collected last year from 700 fourth grade students in 11 Santa
Fe public schools. These are preliminary. We will have full
results next year.
We have found that in comparison with children that are not
participating in Cooking With Kids, cooking and tasting
classes, children enjoy cooking, whether it is in the classroom
or at home. That might seem small, but perhaps it is a missing
piece.
Confidence in cooking abilities, their self-efficacy
increased significantly in children participating in Cooking
With Kids compared with children from nontreatment schools.
Preferences for fruits and vegetables were greater in children
from Cooking With Kids schools than in children from
nontreatment schools.
In conclusion, I appreciate your concern for the health of
our children and applaud your efforts to make the world a
better place. You can help by supporting sustained funding for
nutrition education programming and, in addition to the SNAP ed
or formerly Food Stamp Nutrition Education funding, which
rightly serves children from low-income families, I believe
that Government commitment to all children is needed.
This means support for children to have hands-on experience
with healthy real foods as an integral part of their education.
In addition, there is need to support new funding for school
meals, which I know is a pipe dream at the moment. Also,
though, continuing to support farm-to-school and local
agricultural initiatives, which are really burgeoning across
the country.
Convenience and indifference have brought us to this
moment. Diligence, attention, and the commitment to work
together is needed to make a positive difference in our
communities.
Teaching nutrition using real food is not fast, cheap, or
easy. There is value and satisfaction in self-reliance, and all
children deserve to eat healthful, delicious foods and have the
skills to take care of themselves. They are proud of these
schools.
We must remember the child who remarked after eating
delicious Greek food that they had just prepared, ``There is
joy in my mouth now.''
Thank you.
[The prepared statement of Ms. Walters follows:]
Prepared Statement of Lynn Walters
Senator Bingaman, guests, and distinguished leaders. Thank you for
your work on the pressing issues of our time and for the opportunity to
testify before you today. As a parent and as Founder and Executive
Director of a small non-profit organization, I am deeply concerned with
the health and well-being of children. We hope that the efforts of
Cooking with Kids will not only benefit the children with whom we work,
but will inspire others in their efforts to support a healthy future
for all children. I appreciate your invitation to discuss Cooking with
Kids purpose, challenges, and successes with this committee.
OBESITY IN NEW MEXICO CHILDREN
According to a recent study of New Mexico children 2-5 years old
participating in Federal nutrition programs, 24 percent were considered
overweight or obese. In a 2005 New Mexico survey of high school
students, 26 percent were overweight or obese. As you are aware, the
health risks of obesity are significant, including increased risk for
the development of diabetes, hypertension, cardiovascular disease, and
psychosocial problems. In Santa Fe, an evaluation summary of the
Salazar Partnership Health Promotion Project reported in 2008 that 28
percent of the 904 students attending Salazar and Agua Fria Elementary
Schools were considered obese. These two public schools have an average
of 80 percent of students who qualify for free or reduced-price school
meals.
cooking with kids gets children excited about eating healthy foods!
Cooking with Kids was initiated in 1995 as a volunteer program in
two schools with the intent to improve children's nutrition through
hands-on food and nutrition education and to positively impact school
meals. Through Cooking with Kids' activities, elementary school
students learn directly about healthy eating through hands-on
activities with fresh, affordable foods from diverse cultures.
The objectives of Cooking with Kids are that children will:
(1) Learn to accept a wide variety of healthy foods;
(2) Acquire practical food preparation skills; and
(3) Learn about people of different cultures, while working
together cooperatively.
Cooking with Kids serves 4,400 low-income children in 12 Santa Fe,
NM schools; an average of 77 percent qualify for free or reduced-price
school meals. During 2007-2008, the organization provided 2,043 hands-
on food and nutrition education classes, including 868 fruit and
vegetable tasting lessons taught by classroom teachers. Cooking with
Kids delivers trained food educators, bilingual Spanish/English
curriculum materials for teachers and students, equipment, food and
supplies schoolwide.
The bilingual curriculum is a unique, interdisciplinary model of
classroom food and nutrition education aligned with New Mexico Public
Education Standards and Benchmarks in the areas of math, language arts,
science, social studies, wellness, and art that is linked with school
meals. Cooking with Kids develops and provides curriculum materials for
teachers and students, with student materials and home recipes for
families in Spanish and English. Activities are designed to correspond
to developmental needs of the children, with student materials tailored
for grades K-1, 2-3, and 4-6. Guided lessons with fresh healthy foods
provide a quality experience that is not otherwise available to
students, particularly students from low-
income families. As students prepare, share, and enjoy fresh affordable
foods from diverse cultures they have multiple opportunities to learn
food preparation skills, to exercise choice (children are never forced
to eat), and to enjoy healthy foods. Families are invited to
participate as volunteers and family cooking classes in the evening
offer unique opportunities for families to learn together.
Many families who might otherwise feel excluded and intimidated by
the school environment feel welcome and valued in cooking classes.
During the 2007-2008 school year, 1,200 parents and grandparents
volunteered in cooking classes during the school day.
Cooking with Kids school lunches are served several times a month,
connecting classroom learning to cafeteria meals. Examples of foods
that students prepare in cooking classes and are subsequently prepared
by school food service to be served as school lunches are Llapingachos
(Ecuadorian potato dish), Chinese-American Fried Rice, Vegetable Paella
with Green Salad, East Indian Lentils with Carrot Rice Pilaf, Vegetable
Tamales with Red Chile, and Minestrone with Bread sticks. Cooking with
Kids provides hands-on training for the foodservice workers who prepare
school meals, and collaborates with the Student Nutrition staff to
serve Cooking with Kids school lunches. In collaboration with the New
Mexico Department of Agriculture and Santa Fe Public Schools, we
encourage and facilitate the use of New Mexico-grown produce in school
meals as part of a Farm to School Program. Cooking with Kids produced
large-scale posters that depict New Mexico farmers which are displayed
in cafeteria dining rooms.
AWARDS
2005: Cooking with Kids received a national award
recognizing Leadership, Innovation, and Nutrition Collaboration from
USDA Food and Nutrition Services in the category of Partnerships and
Collaborations. The award recognizes projects that use collaborative
methods and integrated approaches in planning, developing, and
delivering nutrition education involving multiple Food and Nutrition
Services programs, which include Food Stamp and Child Nutrition
programs.
2007: Cooking with Kids, Inc. was chosen as the non-profit
to receive a national Innovation in Prevention Award by the U.S.
Department of Health and Human Services for its efforts in promoting
healthy lifestyles in communities.
Children's voices:
I love Cooking with Kids! I can make things I didn't think
I'd like, but I do!
CWK helps us to learn to eat more healthy foods and less junk
food.
Lentils have iron--that makes you strong.
We learned what India eats.
We learned how to cook and clean up after ourselves.
I learned to do the rice with my mom.
We know where the food is from.
We learned how to hold the knives.
We cleaned our hands and everything else.
Cooking with Kids makes us feel healthy and not tired.
Chinese Fried Rice has lots of vegetables.
I think we learned how to work better together.
Try new things because maybe you will like them.
The fruit salad is healthy because it has vitamins and
minerals.
You have to be patient.
When you cook it's good and you're doing something for
yourself.
There is joy in my mouth now!
CHALLENGES
Our current eating and lifestyle patterns are a reflection of
societal values. As a result, the challenges are many, including cheap
processed foods, conflicting messages, a dearth of cooking skills, and
lack of availability of affordable, healthful foods in many areas. In
the realm of school meals, status afforded to women who cook for our
children is very low, with accompanying low salaries. Were we to give
school foodservice workers the status and remuneration of high-powered
chefs, we would be making a meaningful statement about our priorities.
Lack of time for health and wellness programming is a growing
challenge, as the demands of No Child Left Behind (NCLB) are
increasing. Cooking with Kids was initiated before NCLB, which has
afforded it an advantage in Santa Fe Public Schools. However, were such
a program to become an integral part of a school district, rather than
being implemented by a community partner such as Cooking with Kids, it
could be swept away in a moment by any number of the myriad pressures
facing schools: financial or academic.
Sustainability for social programs is a continual challenge.
Funding, staffing, and community support efforts must be ongoing.
Teaching nutrition using real food is not fast, cheap, or easy!
SUCCESSES
The experience of cooking together is the heart of what we do. In
this process, we observe that all of the children are enthusiastic
participants and almost all children are excited to eat the foods that
they have prepared.
A FEW STORIES
I consider it a success when a child fishes around in his
Minestrone soup that he just helped make, pulls out a piece of kale and
says, ``I like this.''
A second grade student reported, ``You know those recipes you give
us? My grandma cooks all of them for dinner.''
A teacher noted that she was happy to have a (CWK) teacher that
speaks Spanish because now the Spanish speaking moms who don't feel
comfortable coming to other activities come to Cooking with Kids
cooking classes.
Two classroom teachers noted that the autistic special needs boys
in their classes were able to stay with the cooking activity for the
entire 2 hours without disruption. The boys learned to enjoy the food
preparation, enjoy social interaction, and especially enjoyed washing
dishes. They were proud contributors to the class.
Two fifth grade classes had ``salad parties'' and brought in extra
ingredients to make big salads to share.
As one teacher commented, ``We all benefit as a society when kids
have skills, confidence, and a broader appreciation for other
cultures.''
Cooking with Kids' innovative model of interdisciplinary education
for Kindergarten through sixth grade students has inspired programs in
several New Mexico communities. Las Cruces Public Schools now offers
Cooking with Kids fruit and vegetable tasting classes in 14 schools and
is currently piloting cooking classes in several schools. Inspired by
the Cooking with Kids founders and curriculum, Albuquerque Public
Schools has adapted the program and materials to meet the unique needs
of a large urban school district. In an effort to offer the curriculum
more widely, with support from the Robert Wood Johnson Foundation,
Cooking with Kids developed a Web site that provides free access to
fruit and vegetable tasting lessons for grades K-1, 2-3, and 4-6:
www.cookingwithkids.net. Cooking curriculum, a program DVD, and Cooking
with Kids school lunch recipes for institutional use are available for
sale via the Web site. Over 1,500 individuals have downloaded free
fruit and vegetable tasting lessons and individuals and institutions
from over 20 States have purchased curriculum. Several colleges of Home
Economics and Extension have procured curriculum for use through County
Extension programs.
RESEARCH
Funded by USDA CSREES National Research Initiative, a 4-year
research project is being conducted by Colorado State University.
Entitled: Cooking With Kids: Integrating Classroom, Cafeteria and
Family Experiences to Increase Fruit and Vegetable Preference and
Intake, this project is under USDA Agreement No.: 2006-55215-18718;
Proposal No.: 2007-05062. The Principal Investigator is Leslie
Cunningham-Sabo, Ph.D., RD, Colorado State University; Co-PI Lynn
Walters, Cooking with Kids, Inc.
This project is investigating the following questions: Does direct
experience with fresh, affordable foods from diverse cultures,
including cooking and tasting fruits and vegetables, increase
children's preferences for and consumption of these foods? Will
positive experiences with fruits and vegetables in the classroom plus
cafeteria promotion improve students' acceptance of fruits and
vegetables? Can family food preparation and eating practices be
modified to support more healthful dietary patterns? Do these
experiences contribute to more healthful food choices, and thus reduce
children's risk for developing obesity and chronic diseases?
Results are promising from initial data collected from 700 4th
grade students in 11 Santa Fe Public Schools. The preliminary results
below are from the first year of a 2-year data collection in this
evaluation of the Cooking with Kids program:
1. Children enjoy cooking, whether it is in the classroom or at
home;
2. Confidence in cooking abilities (self-efficacy) increased
significantly in children participating in Cooking with Kids compared
with children from non-treatment schools;
3. Preferences toward fruits and vegetables were greater in
children from Cooking with Kids schools than in children from non-
treatment schools.
CONCLUSION
I appreciate your concern for the health of our children and
applaud your efforts to make the world a better place. Congress can
support increased and sustained funding for nutrition education
programming and for fresh and healthy school meals. Convenience and
indifference has brought us to this moment. Diligence, attention, and
the commitment to work together is now needed to make a positive
difference in our communities.
There is value and satisfaction in self-reliance. We must remember
the child who remarked, after preparing and eating Greek Pastitsio,
``There is joy in my mouth now.''
Thank you for providing this opportunity to participate in the
democratic process by testifying before this committee.
Senator Bingaman. Thank you very much.
Let me ask, do you have any more information on this, you
say that two of the schools are Acequia Madre and Salazar?
Ms. Walters. No, it was Agua Fria and Salazar.
Senator Bingaman. Agua Fria. There was for a 2-year period,
where they did measure body mass?
Ms. Walters. Yes.
Senator Bingaman. How was that done? Was that funded?
Ms. Walters. Well, it was funded primarily by a private
foundation that is actually in New York State who has a
connection to community members here. It is really a project
that was started by several people who started a reading
program at Salazar, and then it expanded to Agua Fria. Now it
is really a small consortium of people working on how to look
at the health of the students in these schools.
There is more information that I can certainly send you,
but the funding for--and there has been a lot of discussion,
too, about the measuring of BMI or not. The school nurses in
Santa Fe are part-time. Usually a school has a nurse 2 or 3
days a week. This funding, in addition to other things, has
paid for the nurses at these two schools to be full time. They
have had time to do the BMI measurements.
Senator Bingaman. Dr. Morris, what is your reaction to the
thought that maybe we should just follow Arkansas's lead and go
ahead and do this measurement of body mass throughout our
elementary schools?
Ms. Morris. I think it is an excellent idea. If I could
just add one barrier that I don't think I heard discussed
around the BMI, which I have heard from a lot of nurses, school
nurses in the State of New Mexico that they have difficulty--
they don't want to measure kids.
The reason they don't is so many of their kids are
uninsured. If they measure the child and if they determine the
child is obese, what do they tell their parents if the children
are uninsured? So that there is a link at least in the State of
New Mexico that there is a concern around, where do I send
them?
Now in our Healthy Kids Las Cruces, what we are trying to
do is to initiate a BMI in at least our Conlee Elementary, if
not in the entire Las Cruces public school district, where the
Department of Health will take on the burden and hopefully work
with some of the pediatricians, even if you are uninsured. If
you come up with a BMI level that puts you at obese, that you
will have the medical attention that you need.
That is one difficulty that we have, at least here in New
Mexico. I think we absolutely have to measure BMI in order to
get a handle on where the problem is, the extent of the
problem, and whether or not we are making any progress. I think
it is an excellent idea.
Senator Bingaman. Let me just ask for my own information
here, Dr. Thompson, the actual measurement, collection, and all
of this information on BMI was done through the Department of
Education in Arkansas. Is that right?
Dr. Thompson. It is actually the responsibility of the
local school districts and local schools. We had the same sets
of issues with limited nursing personnel. We found an enormous
wealth of interest.
Actually, we found in a few of our elementary schools, PE
teachers who were already trying to do it with a hand
calculator. The PE teachers in elementary schools were probably
the strongest advocates because they took it as a professional
affront that they were losing on the obesity side. We really
brought in not just the school nurse personnel, but the
physical education teachers.
We also found that many of our nurse training programs--the
LPN schools, the others that were across the State--highly
value the chance to get their students just hands-on contact on
doing basic assessments. We got a lot of free labor, if you
will, by connecting schools that needed help with nurse
training programs at the LPN or at the bachelor-level training
programs.
I might comment about that letter, if I could?
Senator Bingaman. Please.
Dr. Thompson. Our letter home to parents, we struggled with
the same issue on the uninsured piece. I think there is a
critical decision and a potential trap if we think that this
obesity epidemic is a medical issue. It is a social issue.
What we did was give parents four things that had evidence
bases underneath that they could do, that they could reduce the
soft drinks, as your 5-2-1-0.
Ms. Morris. No, we are not----
Dr. Thompson. You are at zero. Eliminating sugared soft
drinks, going to no-fat milk, 2 hours of screen time a day, and
for the whole family to have a physical activity pattern where
they were trying to do something because it is not going to
work to tell the kid to go out if the dad is sitting on the
couch. It is as big a problem as ever.
This we did take--we said it is a social issue, and then we
worked with our healthcare system to be able to wrap around
that. We didn't primarily say to parents of overweight
children, you need to go see your doctor. I mean, that was not
the approach that we took.
Dr. Sanchez. Can I jump in and say that is the right
approach. However, one of the things that Dr. Thompson did
mention is that some change in how we go about using Medicaid
and SCHIP would allow for some of the concern about where one
goes to be addressed.
I agree wholeheartedly that if we make this a medical
issue, then what we start doing is sticking needles in
children's arms and testing them for a whole host of things for
which just the testing is going to cost more money than having
a rational approach to a population-based social and population
health issue.
I wholeheartedly agree with the issue of the uninsured,
remember, I said I was initially opposed? That was why. The
State of Texas has the dubious distinction of having the
highest uninsurance rate not only for everyone, not only for
adults, but also for children.
My concern was that the system might not be able to
accommodate what we found and that parents would find
themselves in a situation where they didn't know what to do. I
think this approach of giving folks some solutions is an
excellent approach that again says the solution lies within
you, and the medical care system is there if you need it for
other things. At the end of the day, the solution lies within
your home and within your community.
Senator Bingaman. Well, the changes in Medicare and SCHIP
that you are talking about are, I think Dr. Thompson referred
to it, we should change the definition of what is covered to
include obesity. Is that the main change?
Dr. Sanchez. Not only diagnosis change, but what
constitutes--I would add what constitutes a reimbursable
intervention.
So that we have communities where if you see a nutritionist
dietician, you may end up having to go to an endocrinologist's
office, where there are equally qualified folks in communities,
sometimes within school districts, who could provide the same
service in a community setting as opposed to a medical care
setting, and our reimbursement mechanisms aren't as friendly to
that community-based setting or school-based setting as they
might be.
If you have a school-based clinic, that is one thing. If
you don't have a school-based clinic, and in Texas, there are
many communities that don't, you still might be able to avail
yourself of the services of a nutritionist, of a behavioralist,
somebody to meet with the family and help begin thinking about
change.
The one other thing about the behavioralist is sometimes
the reimbursement is around the service provided to the child.
We need to think about how we might have services that are
provided to the family because it is a family change that has
to take place ultimately.
What happens in the school provides the hub, but all the
other places where a child lives his life is--it is all
complementary and synergistic.
Dr. Thompson. If I could add something? In the SCHIP
legislation explicitly, just including obesity as a
reimbursable condition is a specific change that would be very
beneficial for guidance to State programs.
Now I think the other issue, which we get into and I think
State programs will have to work with the Center for Medicaid
and Medicare Services, is our healthcare programs are pretty
good at paying the doctor for doing something. The doctor is
probably, as we learned with tobacco cessation, not the person
you want teaching the parent or the family how to do better
nutrition.
We want a nutritionist who is educated on how to engage
families and support those changes. Right now, many of our
Medicaid and SCHIP programs don't extend the reimbursement to
that nonphysician support, which frequently can be done in a
group setting very efficiently and maybe more economically. I
would be willing to bet much more successfully than having the
physician do it, even though we will pay the physician to do
it.
This is one of those places we can make the system better,
make it more effective, and probably not cost that much.
Senator Bingaman. Dr. Morris, did you have a comment you
wanted to make?
Ms. Morris. I did. I have two comments. One was back to the
BMI. One of the things that we are struggling with to overcome
this barrier around how do we actually measure it is actually
use it as an empowerment tool or an education tool.
Why is it that we can't in our physical education classes
have kids learn how to take their--some very simple fitness
measures and then set goals for themselves, and then a month
later, ``I am going to get my resting heart rate down,'' or ``I
am going to know what my weight is and my height.'' So that
they begin to take more ownership of it. You can collect the
data as a monitoring piece, but it also can be used as an
educative piece.
Now we have to sort of keep them separate at a State level
in terms of monitoring, but one of the things we are hoping to
do in the Conlee Elementary School is to really test that, and
I think we are going to use the FITNESSGRAM that Dr. Cooper
from Texas has really set up, which is five or six very simple
measures around fitness and have the kids use those and measure
themselves during their classes so that we can do that.
I think that is one way of sort of dealing with greater
integration. The other piece is it is really important for the
Federal Government to open up some of the--in the Medicaid
issue. Also, at the State level, we have to get our State
legislators to agree to open up those pieces as well.
We absolutely need it at the Federal level, first and
foremost. Then, again, it comes up to how much is the State
willing to pay to whether or not they are going to open it up.
Senator Bingaman. Congressman Udall, go ahead.
Mr. Udall. Thank you, Senator Bingaman.
Just building on what all of you just exchanged back and
forth there, which I think was a very, very good exchange in
terms of saying that this, if you identify the problem, is a
social problem rather than immediately turning it into a
medical problem, when we were discussing the BMI, and having
that kind of approach.
Now Dr. Morris mentioned in her testimony, and we know that
this is true, these disproportionate rates of obesity and
diabetes among minorities. In New Mexico, I believe you put in
32.4 percent of American Indians, 26 percent of Hispanic high
school students--this is in 2007--were overweight or obese
compared to 18.6 percent of white, non-Hispanic students.
My question for all of you is what are the particular
challenges in reaching minority populations on these issues,
and what particular approaches should we keep in mind as we
attempt to craft legislation at the Federal level?
Ms. Morris. We struggle with this, and I think what I--sort
of based on my experiences, I think we are balancing best
practices versus innovation, experimentation, local
determination of the kinds of programs we want.
One of the reasons we picked Las Cruces was because more
than half of its student population is Hispanic. In order for
us to reach hard-to-reach groups, it has to be done more from
the local community and the local ethnic group taking charge in
responsibility and leadership.
I see my role at the interagency of providing resources,
providing advice, guidance, helping set frameworks. Ultimately,
it has to be the Hispanics in Las Cruces saying these are the
barriers I face. These problems are real to me today, and this
is how I want to make those changes. Then it is for us to work
together to set them up. It is very difficult.
Dr. Sanchez. I would say, to add on to that, we talked
about cultural sensitivity and cultural competence, very
important. At the end of the day, what we ought to be measuring
is cultural effectiveness.
I would say to you the interesting thing about the CATCH
program is that it was tested in what is a demographically very
diverse population in El Paso, TX, and it had the desired
effect.
While we need to be sensitive to cultural sensitivity and
cultural competence, we ought to be measuring whether things
are effective or not and how much they might be applicable in
different subpopulations. Outreach is very, very important.
There are some subpopulations where our standard approaches
to school-based activities or even community-based activities
are not going to work the same way that they might in another
subpopulation. We need to understand how we might do outreach
differently.
I am somebody who believes very, very strongly in the
community lay health worker model, the Promotores model. It is
not only effective in Latino populations, the Southern States
has been using those community lay health worker models to go
out and engage at the home level and at the community level,
rather than having the thought that you initiate gatherings at
the school or some other independent setting.
I think also just the issue of poverty is one. If we think
about the fact that one of the challenges that we have in our
Nation is that when we look at graduation rates of our
subpopulations, Latinos, African-Americans, and American
Indians are not as high as they ought to be.
If we could think about approaches that, particularly in
the school setting, was about not leaving any child behind even
while we address this issue of childhood obesity, we could
begin to convince ourselves that fit kids are smart kids, smart
kids are fit kids. They go together. It is not one or the
other.
As it relates to the nonwhite subpopulations, it might make
sense to do these three things--cultural sensitivity, outreach
in a different way, and then assuring that in the school
setting, we are not only doing the right nutrition things and
physical activity things, but actually thinking about and
demonstrating what works in terms of graduating our young kids
out of school.
Because at the end of the day, as we think about this and
we look at the statistics--Dr. Thompson, I think everyone here
would agree with me--is that if we could achieve graduation
rates among Latinos and African-Americans that we have among
whites and some of the subpopulations among Asians, some of
what we are talking about begins to go away because it tracks
with poverty and educational attainment as much as it tracks
with race/ethnicity.
Dr. Thompson. I think the one thing, and I completely agree
with the cultural issues. I would not want, because you are
going to have actionable opportunities in the short run, to
highlight the interrelationship to poverty. I have poor white
communities. I just have more poor minority communities
concentrated in our State.
On your economic stimulus package or on the decisions on
reauthorization, to the extent that you can assure or ensure or
require or incentivize or heighten awareness of the need for
those investments to not just be sprinkled geographically
evenly across the States that are going to receive that
funding, but to be targeted to communities that have been
economically disenfranchised. Because those are the communities
that have the least capacity to use the information from a BMI
report or from a local leader who wants to make something
happen or from a change in the cultural perspective.
Those are the communities that need the most support. So
that when the new road gets built, it actually doesn't divide
where the kids live from where the school is. Because when the
road gets built, it won't be decided by that local community.
Just incorporate some of those poverty-related issues into
the thoughts on your economic stimulus package and targeting
not just to States, because your States and your communities
that are more affluent are going to get through this. The
communities that are least affluent and least empowered are
going to be set back farther and have more risk for their
children on this issue.
Ms. Morris. If I could just add one other point? I think we
have forgotten a very important group, which are our students.
We are working right now, the interagency, with the Santa Fe
Indian School. We are helping in their culinary arts program,
teaching students basically how to prepare healthy traditional
American Indian foods.
They are learning how to do nutritional analysis and
reformulating. What they are going to do is go back, because
the Santa Fe Indian School is owned by and run by the 19
pueblos in New Mexico, and so the students, part of their
responsibility is then to go back and to teach the elders in
their community and go to the senior centers in their community
and teach them the healthy alternatives to traditional
indigenous foods.
As part of that cultural sensitivity and cultural
effectiveness and bridging the community and the schools and
the students, students I think can play a very important role
when they go back to their culture, especially in communities
where culture, community, and families are still important,
which tends to be in Native American and Hispanic cultures,
more so I think than Anglo.
Dr. Sanchez. Can I add because we talked about food, it is
I think important for us to have a sense of what the
relationship between obesity and access to food is.
Food insecurity was mentioned, and one other area that has
to do with USDA that is worth looking at is, how we think
differently about what kinds of foods we subsidize production
of so that we can make the availability and access to the
healthy foods that we are talking about actually affordable to
those folks who live in communities where they may not even
have access to a supermarket where those kinds of foods are
available.
Then, when they show up, and they look at the list of
things that we have advised that they ought to be eating, they
say, ``You know what, we can't afford this. We need to buy the
beans, and we need to buy what is in the can and pretty
cheap.''
We need to figure out how we make the healthy choices the
easy choices, and I am not sure that we talked so much about
that. Access to affordable healthy foods in communities that
might otherwise not have access is something that I think is
really important to consider.
Mr. Udall. Let me just thank you, all of you, again and say
to Senator Bingaman that I have watched over the years in my
work in the House how he has worked on healthy kids and moving
New Mexico forward. I really look forward to joining him in the
Senate and working with him on this issue in just a very short
period of days.
Thank you, Senator Bingaman, for your invitation today.
Senator Bingaman. No, thank you very much for
participating, and I know you are strongly committed to making
progress on this. I am, too.
Thank all of you for coming, particularly our witnesses
from out of State, and those of you from New Mexico as well. I
thank you, all of you who attended. I think this was a useful
hearing. We have got some good suggestions for actions we need
to take in the next Congress, and we will try to do that.
That will conclude our hearing. Thank you very much.
[Whereupon, at 11:43 a.m., the hearing was adjourned.]