[Senate Hearing 111-1130]
[From the U.S. Government Publishing Office]
S. Hrg. 111-1130
CHILDHOOD OBESITY: BEGINNING THE DIALOGUE ON REVERSING THE EPIDEMIC
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HEARING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
ON
EXAMINING CHILDHOOD OBESITY, FOCUSING ON REVERSING
THE EPIDEMIC
__________
MARCH 4, 2010
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
TOM HARKIN, Iowa, Chairman
CHRISTOPHER J. DODD, Connecticut MICHAEL B. ENZI, Wyoming
BARBARA A. MIKULSKI, Maryland JUDD GREGG, New Hampshire
JEFF BINGAMAN, New Mexico LAMAR ALEXANDER, Tennessee
PATTY MURRAY, Washington RICHARD BURR, North Carolina
JACK REED, Rhode Island JOHNNY ISAKSON, Georgia
BERNARD SANDERS (I), Vermont JOHN McCAIN, Arizona
SHERROD BROWN, Ohio ORRIN G. HATCH, Utah
ROBERT P. CASEY, JR., Pennsylvania LISA MURKOWSKI, Alaska
KAY R. HAGAN, North Carolina TOM COBURN, M.D., Oklahoma
JEFF MERKLEY, Oregon PAT ROBERTS, Kansas
AL FRANKEN, Minnesota
MICHAEL F. BENNET, Colorado
Daniel Smith, Staff Director
Pamela Smith, Deputy Staff Director
Frank Macchiarola, Republican Staff Director and Chief Counsel
(ii)
C O N T E N T S
__________
STATEMENTS
THURSDAY, MARCH 4, 2010
Page
Harkin, Hon. Tom, Chairman, Committee on Health, Education,
Labor, and Pensions, opening statement......................... 1
Enzi, Hon. Michael B., a U.S. Senator from the State of Wyoming,
opening statement.............................................. 3
Benjamin, Regina M., M.D., MBA, Surgeon General, U.S. Department
of Health and Human Services, Washington, DC................... 4
Prepared statement........................................... 7
Dodd, Hon. Christopher J., a U.S. Senator from the State of
Connecticut, statement......................................... 16
Hassink, Sandra, M.D., Chair, American Academy of Pediatrics
Obesity Leadership Workgroup, Wilmington, DE................... 25
Prepared statement........................................... 27
Thompson, Joe, M.D., MPH, Director, Robert Wood Johnson
Foundation Center to Prevent Childhood Obesity, Little Rock,
Arkansas....................................................... 32
Prepared statement........................................... 34
Mendenhall, Rashard, Pittsburgh Steelers Running Back, National
Football League, Pittsburgh, PA................................ 39
Prepared statement........................................... 41
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
Senator Murray............................................... 50
Senator Casey................................................ 51
Senator Hagan................................................ 52
Senator Franken.............................................. 53
The Surgeon General's Vision for a Healthy and Fit Nation.... 54
(iii)
CHILDHOOD OBESITY: BEGINNING THE DIALOGUE ON REVERSING THE EPIDEMIC
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THURSDAY, MARCH 4, 2010
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The committee met, pursuant to notice, at 10:04 a.m. in
room SD-430, Dirksen Senate Office Building, Hon. Tom Harkin,
chairman of the committee, presiding.
Present: Senators Harkin, Dodd, Casey, Merkley, Enzi, and
Burr.
Opening Statement of Senator Harkin
The Chairman. The Senate Committee on Health, Education,
Labor, and Pensions will come to order.
Our hearing this morning is going to be the first in a
series dealing with childhood obesity and how we can reverse
it.
The harsh and sad reality is that, for the first time in
our Nation's history, we're in danger of raising a generation
of children who will live sicker and die younger than the
generation before them. Today, all the gains that we've made in
life expectancy, thanks to public health and wellness programs,
are at risk. And one of the main reasons is the seemingly
inexorable rise in childhood obesity.
Currently, more than a third of our children are overweight
or obese, and half of these kids are clinically obese. More
than one out of six kids in America is obese, and that's more
than twice the rate of just 30 years ago. As we all know,
children who are overweight and obese are at greater risk for a
whole range of serious health problems, both during childhood
and later on in adulthood. Children who are obese are at risk
for cardiovascular problems, such as high cholesterol, high
blood pressure, type 2 diabetes. And children and adolescents
who are obese are likely to remain so as adults.
One in three children born today runs the risk of
developing type 2 diabetes. Unless we reverse this disturbing
trend, countless children's lives will be cut short because of
a preventable condition.
Obesity's toll on children is especially disturbing. On the
macro level, childhood obesity is a national public-health
crisis. But, on the individual level, for each child affected
with this condition, it's something else; it is a true tragedy.
A Yale University study concluded that children who are
overweight are stigmatized by their peers as early as age 3.
They're subject to teasing, rejection, bullying, and are two to
three times more likely to report suicidal thoughts, as well as
to suffer from high blood pressure and/or diabetes. The author
of the study concluded, ``The quality of life for kids who are
obese is comparable to the quality of life of kids who have
cancer.''
So, if we're going to transform our Nation into a true
wellness society, we need to begin with our kids. Childhood
obesity is more than a threat to public health, it's a threat
to public and private budgets. By increasing the risk for
chronic diseases, obesity drives up the costs of healthcare.
The cost for treating a child who is obese is approximately
three times higher than the cost for treating an average-weight
child. This adds up to $14 billion annually in direct health
expenses, $3 billion of which is covered--children who are
covered by Medicaid. So, we can see the impact it has on
budgets.
As we will hear today, the childhood obesity epidemic has
many causes, and everyone has a part to play if we hope to
reverse this epidemic.
I applaud First Lady Michelle Obama for recognizing the
urgency of this crisis and for personally mobilizing a new
national effort to combat it. As she so eloquently put it, ``We
need commonsense solutions that empower families and
communities to make healthy decisions for their kids.''
I also applaud our Surgeon General, Dr. Regina Benjamin,
for giving priority to the obesity epidemic in her vision for a
healthy and fit Nation. As our Nation's top doctor, her
recommendations highlight the importance of addressing this
problem, not only from a clinical perspective, but also in our
homes, childcare settings, schools, and neighborhoods. It is
just invaluable for our country to have both the First Lady and
the Surgeon General teamed up to take on this challenge.
There are other reasons for optimism. Two days ago, at a
Health Affairs briefing on childhood obesity, researchers
reported on multiple initiatives to address the factors driving
childhood obesity. Examples include improving primary care
doctors' roles in preventing children from becoming obese,
promoting healthy behaviors to employer-based programs for
parents, so that parents know what to do, and both community-
based efforts and public/private partnerships that facilitate
healthy choices by increasing access to healthy foods and
physical activity.
Today we're beginning the dialogue, here in this committee,
about how we can confront the crisis of childhood obesity. To
help us better understand the issue, we'll be hearing from four
distinguished witnesses that will talk about how this epidemic
has unfolded and why. They'll talk about smart, effective
solutions that are emerging in our doctors' offices, in our
communities, and through public/private partnerships.
I thank all the witnesses for coming here today. I'll have
more to say about each of them shortly, when I introduce them.
Now I'll turn to someone else who has a great interest and
has been very good on this issue, in promoting childhood
awareness of this, and family awareness of the obesity problem,
my Ranking Member, Senator Mike Enzi from Wyoming.
Opening Statement of Senator Enzi
Senator Enzi. Thank you, Mr. Chairman. I appreciate your
punctuality. I could have been here just a little earlier, but
I decided, if we were talking about obesity, I ought to use the
stairs.
[Laughter.]
Takes a little longer.
The Chairman. Very smart.
[Laughter.]
Senator Enzi. But, I do thank you for convening the hearing
today on this very important issue, childhood obesity.
Our Nation faces an epidemic of childhood obesity. As a
result of this epidemic, millions of children are going to
develop heart disease, diabetes, and a host of other serious
medical conditions. Costs for programs, like Medicare and
Medicaid, will further increase beyond their already
unsustainable levels. Today, we'll discuss the First Lady's
initiative to stop childhood obesity through a public campaign
focused on nutrition, physical activity, healthy options in
school, and helping families to make good lifestyle choices. I
applaud the First Lady's efforts to raise obesity awareness,
encourage children to adopt healthier behaviors, and provide
families with the tools they need to make better choices.
According to the Centers for Disease Control and
Prevention, in the past 30 years the prevalence of childhood
obesity in children between the ages of 2 and 5 has increased
from 5 percent to 12.4 percent. And the rate of childhood
obesity doubled from 1,980 to 2,000.
Today, 30 States have obesity rates of 30 percent or more,
and one in five children struggle with obesity. According to
the Centers for Disease Control and Prevention, 80 percent of
children who were overweight in their teenage years were also
obese adults in their late 20s.
This obesity epidemic has a direct and immediate impact on
national healthcare spending. According to a recent article in
Health Affairs, the medical bills of an obese individual are 42
percent more than someone who is not obese. A 2004 study cited
by the Centers for Disease Control and Prevention shows that
Americans spent 9.1 percent of total U.S. medical expenditures
on obesity-related care, or a total of $78.5 billion.
While the financial impacts of obesity epidemic are
daunting, the human cost is even greater. People who are obese
face a much higher risk of developing conditions like heart
disease, cancer, type 2 diabetes, hypertension, and stroke.
Studies show that obesity in children only leads to greater
health, social, and economic problems in the future. We have to
stop obesity in our children to slow the epidemic for future
generations.
In Wyoming, we have the Commit to Your Health Campaign
which hosts walks in the communities with third-graders to
bring attention to childhood obesity. They also conduct media
campaigns that focus on physical fitness, healthy lifestyles,
and sound nutritional practice. It's important to work with the
children in our communities to educate them about the
importance of being physically active and aware of their food
choices. Unfortunately, the Federal Government does not have a
great track record in implementing programs that actually
modify people's behaviors. I hope we can learn from a variety
of sources, including employers, educators, and community
leaders, about how to encourage incentive-based solutions that
will promote greater personal responsibility and result in
healthier lifestyles for American families.
I'd also like to thank all the witnesses for their
dedication to combating the serious problem that faces
America's children. I'm looking forward to all of their
testimony. I noted that Dr. Benjamin listed the increase in
technology as one of the problems. I just saw some kids playing
video games. They didn't get much exercise with it. Maybe the
new Wii will help with that.
The Chairman. Right.
Senator Enzi. Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Enzi.
Our lead-off witness today, Dr. Regina Benjamin, the 18th
Surgeon General of the U.S. Public Health Service. As America's
doctor, she provides the public with the best scientific
information available on how to improve their health and health
of the Nation. Dr. Benjamin oversees the operational command of
6,500 uniformed health officers who serve to promote, protect,
and advance the health of the American people. Dr. Benjamin is
founder and former CEO of the--this is where I'm going to have
trouble--Bayou La Batre? Is that close? Oh, thank you.
[Laughter.]
The Chairman [continuing]. My French, anyway--Rural Health
Clinic in Alabama. She's a former associate dean for rural
health at the University of South Alabama College of Medicine
in Mobile. In 1995, she was the first physician under the age
of 40, and the first African-American woman to be elected to
the American Medical Association board of trustees. In 2002,
she became president of the Medical Association, State of
Alabama, making her the first African-American female president
of a State medical society in the entire United States.
Dr. Benjamin has her B.S. in chemistry from Xavier
University in New Orleans, her M.D. from University of Alabama,
and an MBA from Tulane University, and five honorary
doctorates, a member of the National Academy of Science's
Institute of Medicine and a fellow of the American Academy of
Family Physicians. She was also a Kellogg National fellow and a
Rockefeller Next-Generation Leader.
Dr. Benjamin, welcome back to the committee. And I am
honored to have you here. We are all honored to have you here.
I understand this is your first time to testify before a
congressional committee. Let me assure you, we are honored to
have you here, and I thank you, personally, for your great
leadership on so many issues, but especially on this issue of
childhood obesity.
Your statement will be made a part of the record in its
entirety, please proceed as you so desire.
STATEMENT OF REGINA M. BENJAMIN, M.D., MBA, SURGEON GENERAL,
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, WASHINGTON, DC
Dr. Benjamin. Thank you, Chairman Harkin, Ranking Member
Enzi, and members of the committee. I want to thank you for
holding a hearing on this important issue, and for giving me
the opportunity to testify today.
Mr. Chairman, thank you and the other members of your
committee, for being such enthusiastic advocates of wellness
and prevention, because, as I mentioned when I met with many of
you, wellness and prevention is my priority as Surgeon General.
I look forward to working with you, as well as with partners in
government, in the nonprofit world, in the private sector, to
confront serious problems that challenge the health of our
Nation. And perhaps the most serious challenge to the Nation's
health and well-being is childhood obesity.
Since 1980, obesity rates have doubled in adults and
tripled in children. The problem is even worse among black,
Hispanic, and Native American children.
Needless to say, we've been working on this issue for some
time. In fact, in 2001 former Surgeon General David Satcher
released his Call to Action to prevent and decrease overweight
and obesity. In it he warned us about the negative effects that
weight gain and unhealthy lifestyles were having on Americans'
health and well-being. And now I've followed up on his report
with my first paper, ``The Surgeon General's Vision For A
Healthy and Fit Nation.''\1\ In my paper I lay out ways in
which to respond to the public health issues that was raised 9
years ago.
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\1\ This publication may be found at: www.surgeongeneral.gov.
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Although we've made some strides since 2001, the number of
Americans who are struggling with their weight and health
conditions related to their weight remains much too high. Most
of you know, as has been repeatedly stated, the statistic that
today in America more than two-thirds of adults and one in
three children are overweight or obese. We see the sobering
impact of these numbers in the high rates of chronic diseases,
such as diabetes, heart disease, and other chronic illnesses,
that is starting to affect our children more and more. Just
this week, a study from the University of North Carolina School
of Medicine reported that obese children as young as 3 years of
age show signs of an inflammatory response that has been linked
to heart disease in later life.
So, I was pleased to join the First Lady for the launch of
her Let's Move! initiative to solve the problem of childhood
obesity within a generation. Both my vision for a healthy and
fit Nation and the First Lady's Let's Move! campaign take a
comprehensive approach that engages families and communities as
well as the public and the private sector.
For years we've encouraged Americans to eat more
nutritiously, exercise regularly, and maintain healthier
lifestyles. But, for these things to happen, Americans need to
live and to work in environments that support their efforts.
There's a growing consensus that we, as a Nation, need to
recreate our communities and our environments where the healthy
choices are the easy choices and the affordable choices.
My vision for a healthy and fit Nation is an attempt to
change that national conversation from a negative one about
obesity and illness to a positive conversation about being fit
and being healthy.
We need to stop bombarding Americans with what they can't
have, what they can't eat, what bad things will happen to them
10 years from now. We need to begin to talk about what they can
do to become healthy and fit. We need to make exercise
activities fun, something people enjoy, something they really
want to be doing, such as playing sports, swimming, or just
going dancing because they enjoy it, or simply taking a walk.
To do this, we need to reach out to parents and teachers,
as well as mobilize action across the Federal Government, in
partnership with Governors and mayors, medical community,
leading foundations, and the sports and business communities.
We need everyone's help to support commonsense innovative tools
and solutions.
For example, healthy foods should be affordable and
accessible to all Americans in our diverse communities.
Children should spend less time in front of the TV. Research
shows that--the correlation between time watching TV and weight
gain. Children should be having fun and playing in safe
neighborhoods that provide parks, recreational facilities,
community centers, and walking and bike paths. Schools need to
serve healthy food and set higher nutrition standards. Schools
should also require daily physical education classes, as well
as recess. Hospitals and work sites, as well as communities,
should make it easy for mothers to initiate and to sustain
breast feeding. Employers should implement wellness programs
that promote healthy eating in cafeterias, encourage physical
activity through group classes, and create incentives for
employees to participate.
My hope is that the communities across the country will use
my vision for a healthy and fit Nation as a blueprint for
action, a blueprint to share resources, to develop
partnerships, and to use innovative solutions for change. As
Surgeon General, I want America to become a healthy and fit
Nation. To do this, we must remember that Americans are more
likely to change their behavior if there is a meaningful
reward, something more than just reaching a certain weight, a
certain dress size. The real reward has to be something that
people can feel, something they enjoy, something they can
celebrate. That reward is an invigorating, energizing, and
joyous health. That is a level of health that allows people to
embrace each day and live their lives to the fullest, without
disease, without disability, and without the loss of
productivity.
Finally, today we stand at a crossroads. The old normal was
to stress the importance of attaining recommended numbers for
weight and BMI. Although these numbers are important measures
of disease and disability, the total picture is so much bigger.
It involves the creation of a new normal, with emphasis on
achieving an optimal level of health and well-being. People
want to live long and to live well, and they're making their
voices heard across this Nation.
Today's obesity epidemic calls for committed, compassionate
citizens to mobilize and to demand the health and well-being
that they so richly deserve. I've heard their call, we've all
heard their call, and with your help, I'm honored to do
everything in my power to help Americans to live long and live
well and to be a healthy and fit Nation.
Thank you, Mr. Chairman, and I would like to entertain any
questions.
[The prepared statement of Dr. Benjamin follows:]
Prepared Statement of Regina M. Benjamin, M.D., MBA
introduction
Mr. Chairman and members of the committee, I want to thank you for
holding a hearing on this important issue and for giving me the
opportunity to testify today. I am Vice Admiral Regina M. Benjamin,
Surgeon General of the United States, U.S. Department of Health and
Human Services (HHS). My statement provides you with an overview of the
obesity epidemic, examples of individual and community interventions to
reverse trends, and recent Federal actions initiated to help Americans
achieve optimal health.
Mr. Chairman, I know you have been a tireless advocate for wellness
and prevention, as have so many other members of the committee. I share
your enthusiasm, and I look forward to working with you to help both
the public and private sectors confront the serious problems that
challenge the health of our country.
background
In 2001, former Surgeon General David Satcher in his ``Call to
Action: To Prevent and Decrease Overweight and Obesity'' warned us
about the negative effects that weight gain and unhealthy lifestyles
were having on Americans' health and well-being.
To reverse these trends, he outlined a national public health
response. As Surgeon General I am advancing his initial efforts and
have recently outlined a vision for a healthy and fit Nation. This past
January, I issued my first paper to the Nation entitled, ``The Surgeon
General's Vision for a Healthy and Fit Nation.'' This document lays out
ways to concretely respond to the public health issues that were raised
9 years ago.
Although we have made some strides since 2001, the number of
Americans who are struggling with their weight and health conditions
related to their weight remains much too high.
In recent decades, the prevalence of obesity has increased
dramatically in the United States, tripling among children and doubling
among adults.\1\ \2\ \3\ \4\ Today, two-thirds of adults \5\ and nearly
one in three children are overweight or obese.\6\ \7\ The prevalence of
obesity changed relatively little during the 1960s and 1970s, but it
increased sharply over the ensuing decades--from 13.4 percent in 1980
to 34.3 percent in 2008 among adults and from 5 percent to 17 percent
among children during the same period. The prevalence of extreme
obesity also increased over the past 30 years, and approximately 6
percent of U.S. adults are now considered extremely obese.\8\ \9\ \10\
\11\
There are important age, gender, geographic, socio-economic and
racial and ethnic differences in the prevalence of adult and childhood
overweight and obesity that need to be noted to ensure community and
national efforts are tailored to be effective and responsive. Adult men
have higher rates of overweight and obesity than adult women: 72.3
percent of men and 64.1 percent of women are considered overweight or
obese.\12\ Middle age men and women 40-59 years of age and older
adults, 60 years and older, are more likely to be obese when compared
to younger adults 20-39 years of age. Adults who did not live in a
Metropolitan Statistical Area (MSA) were more likely to be obese than
adults who lived in an MSA, and obesity percentages are highest in the
Midwest and the South.\13\ Several racial and ethnic populations are
disproportionately impacted by overweight and obesity. Non-Hispanic
blacks are more likely to be obese compared to non-Hispanic whites, and
Mexican-American women are more likely to be obese compared to non-
Hispanic whites.\14\ American Indian and Alaska Natives suffer the
greatest disparity as approximately 70 percent of American Indian and
Alaska Native adults are overweight or obese.\15\ \16\ An inverse
relationship exists between education and obesity among U.S.
adults.\17\ Among some population subgroups such as white women and
Mexican American men, there is an inverse relationship between income
and obesity.\18\
The Nation's childhood overweight and obesity rates, if not
corrected, may dramatically impact the quality and longevity of life
for an entire generation of children. 31.7 percent of children 2-19
years of age are overweight or obese, and 16.9 percent of the Nation's
children 2-19 years of age are obese. Sadly, overweight and obesity are
reflected at youngest ages of children. Recent studies show that 1 in 5
children (21.2 percent) 2-5 years of age are overweight or obese and 1
in 10 children (10.4 percent) 2-5 years of age are obese.\19\ Among
children in the United States, the relationship between socio-economic
status and obesity is less consistent than among adults, and the
relationship appears to be weakening over time.\20\
The health impacts of childhood obesity can already be seen during
childhood. Just this week, a study from the University of North
Carolina School of Medicine reported that obese children as young as
age 3 show signs of an inflammatory response that has been linked to
heart disease later in life.\21\
Improper nutrition and inadequate physical activity are the
underlying factors for the Nation's overweight and obesity epidemic.
High-calorie, good-tasting, and inexpensive foods have become widely
available and are heavily advertised. Portion sizes have increased,\22\
and Americans are eating out more frequently.\23\ Twenty years ago, the
average blueberry muffin was 1.5 ounces and 210 calories. Today that
muffin is 5 ounces and over 500 calories. The average soda was 12
ounces or less and less than 150 calories. Sodas today are 20 ounces
and over 250 calories.\24\ Additionally, the most recent Youth Risk
Behavior Surveillance System found that only 21.4 percent of high
school students eat the recommended 5 or more fruits and vegetables per
day.\25\
The Physical Activity Guidelines for Americans released by HHS
recommends that adults should do at least 150 minutes of moderate-
intensity physical activity per week, and young people ages 6 to 19
should engage in 60 minutes of moderate to vigorous activity daily.\26\
Nearly one-third of adults are not getting their recommended levels of
physical activity. The most recent Youth Risk Behavior Surveillance
System found only about one-third (34.7 percent) of high school
students met recommended levels of physical activity, and only about
half (53.6 percent) had physical education classes even once a
week.\27\ Advancements in technology are also fueling a sedentary
lifestyle among youth. Youth ages 8-18 devote an average of 7 hours and
38 minutes to using entertainment media including television,
computers, video games, cell phones, and movies across a typical
day.\28\ \29\
The twin epidemics of adult and childhood overweight and obesity
are inter-connected. If one parent is obese, there is a 40 percent
chance that the children will also be obese. If both parents are obese,
the children have up to an 80 percent chance of being obese.\30\ Good
nutrition and regular physical activity are the keys to helping
Americans, especially children, live healthy, fit, and well. By
practicing these healthy lifestyle behaviors, excess weight is
prevented, weight loss is sustained, and strength and endurance are
achieved.
opportunities for prevention
To make and sustain progress in the fight against obesity, mothers,
fathers, teachers, businesses, government and community leaders all
must commit to changes to promote the health and wellness of our
families and communities.
As adults, we need to help our children get off to a good start.
The earliest risks for childhood obesity begin during pregnancy. Excess
weight gain, diabetes, and smoking during pregnancy are not just health
risks for the mother--they also put children at risk for obesity early
in life. Keeping pregnancy weight gain within recommended limits will
help prevent diabetes in the mother, and breast feeding exclusively for
the first 6 months after birth has also been shown to prevent childhood
obesity.\31\ Parents and other caregivers play a key role in making
good choices for themselves and their loved ones. Children and
teenagers look to their mothers and fathers and other caregivers to
model healthy lifestyle habits. Parents need to teach by example, and
we need to give them the proper tools to be effective.
As American families make changes for their health and wellness,
environments need to support their healthy choices. Recent studies have
shown that making changes to social and physical environments that make
the healthy choice the easy or ``default'' choice will have the
greatest impact on reducing and preventing obesity.\32\ To help our
Nation evolve toward wellness, communities should implement policies to
promote healthy eating and active living. Increasing exposure and
access to healthy affordable foods is critical to Americans meeting the
recommended U.S. Dietary Guidelines. Community coalitions should work
with local governments and supermarket chains to ensure all
neighborhoods make nutritious and affordable foods available to their
residents. Success is being seen in some, but not enough, in parts of
the Nation. For instance, Pennsylvania has implemented a Fresh Food
Financing Initiative. This public-private grant and loan partnership
has developed 74 fresh food outlets throughout the Commonwealth, giving
over 500,000 Pennsylvania residents access to nutritious foods.\33\ As
I'll describe shortly, the Obama administration is proposing to take
this initiative nationwide.
Policies can be crafted to make physical activity opportunities
more accessible, safer, and attractive. Community design that
incorporates sidewalks, bike lanes, traffic safety, improved lighting,
and pleasant landscaping will encourage more Americans to walk to work
or do daily errands by foot or bicycle. Locating schools within easy
walking distance of residential areas and ensuring safe routes will
increase the percentage of children walking to school each day. And
finally, subsidizing memberships to recreational facilities can provide
opportunities for individuals and whole families to stay active.\34\
As communities work together to improve the built environment,
child-specific community settings should make policy changes as well.
It is estimated that over 12 million children ages 0-6 years receive
some form of child care on a regular basis from someone other than
their parents.\35\ Recommended policies that can help child care
programs support healthy weight for young children include the
following: require 60 minutes of a mix of structured and unstructured
daily physical activity, establish nutrition requirements in child care
by using national recommendations such as the Dietary Guidelines for
Americans, appropriately train child care providers how to promote
physical activity and good nutrition and how to involve parents in
these activities, and provide parents materials that reinforce the
healthy practices promoted in the child care setting.
Each day, over 50 million children wake up and head off to
schoo1.\36\ The school environment plays a pivotal role in preventing
obesity among youth, as each school day provides multiple opportunities
for students to learn about health and practice healthy behaviors.
Well-designed school programs can promote physical activity and healthy
eating, reduce the rate of overweight and obesity among children and
teenagers, and improve academic achievement.\37\ \38\ Examples of
effective school wellness program components include:
A planned and sequential health education curriculum for
pre-kindergarten through grade 12;
A school and school workplace wellness policy that
includes teachers and other school employees to model healthy
behaviors;
Partnerships with parent-teacher organizations, families,
and community members to support healthy eating and physical activity
policies and programs;
Providing students appealing, healthy food options
including fresh fruits, vegetables, whole grains, and lean proteins;
Limiting high calorie snack options, including beverages
in vending machines; and
Requiring daily physical education for students in pre-
kindergarten through grade 12, allowing 150 minutes per week for
elementary schools and 225 minutes per week for secondary schools.
Doctors and other health care providers are often the most trusted
source of health information and are powerful role models for healthy
lifestyle habits. Medical care providers must make it a priority to
teach their patients about the importance of good health. When
discussing patients' Body Mass Index (BMI), providers should explain
the connection between BMI and increased risk for disease and, when
appropriate, refer patients to local resources that will help them meet
their physical, nutritional, and psychological needs. Advancing the
medical home concept to foster community and clinical partnerships will
provide families more effective comprehensive care from their health
care providers with access to additional supports to help make and
sustain healthy changes. We must also teach our health professional
students how to counsel patients on effective ways to achieve and
maintain healthy lifestyle habits so it becomes a regular and natural
part of everyday practice.
recent federal actions
The Obama administration has made a historic commitment to
prevention and wellness, creating environments that support health and
extending health care coverage for millions of kids. One of President
Obama's first acts while in office was to sign the Children's Health
Insurance Program Reauthorization Act of 2009 (CHIPRA). We are grateful
to Congress for passage of this important legislation which brings
health coverage to an additional 11 million children as well as
provides authority for a new community-based program to develop
systematic models for reducing childhood obesity.
In addition, nearly 1 year ago, the President and Congress included
an unprecedented $1 billion for prevention and wellness in the American
Recovery and Reinvestment Act. HHS has developed a new national
program, Communities Putting Prevention to Work that will focus on the
prevention of obesity and tobacco use. Communities, States, and
national organizations will work together to implement solid prevention
policies that will help residents live longer, healthier lives. Many of
the recommendations I have outlined today will be implemented across
the Nation with this landmark Recovery Act funding.
And to address the specific national epidemic of childhood obesity,
First Lady Michelle Obama recently announced the ambitious national
goal of solving the challenge of childhood obesity within a generation.
Her Let's Move! national campaign will provide schools, families
and communities simple tools to help kids be more active, eat better,
and get healthy, and empower parents with information and tools to make
healthier choices easier choices.
On February 9, President Obama issued an Executive Order
establishing the first ever Task Force on Childhood Obesity. Within 90
days, cabinet agencies across the government--from Health and Human
Services to the Departments of Education, Agriculture and Interior--
will conduct a review of every single program relating to child
nutrition and physical activity and develop a national action plan.
In addition to the national action plan, the Federal Government is
moving forward on the following actions to support the Let's Move!
campaign:
By the end of the year, HHS plans to provide guidance to
food producers on using consumer-friendly nutrition information on the
front of food packages to help 65 million parents more easily select
healthful foods for their families.
New web-based tools, such as a next generation Food
Pyramid, and USDA's Food Environment Atlas will help families make
healthier food and physical activity choices, and better understand
national and local trends on food deserts.
The Administration is supporting the reauthorization of
the Child Nutrition Programs including an additional $10 billion over
10 years to improve the quality of foods provided through the National
School Lunch and School Breakfast programs, increase the number of kids
participating, and ensure schools have the resources they need to make
program changes.
The Department of Agriculture is also moving to double the
number of schools participating in the Healthier U.S. School Challenge,
which establishes rigorous standards for schools' food quality,
participation in meal programs, physical activity, and nutrition
education--the key components that make for healthy and active kids.
To eliminate food deserts, Mrs. Obama announced a new
Healthy Food Financing Initiative, which is a joint initiative of HHS,
USDA, and the Treasury Department, to help bring grocery stores to
underserved areas. This Initiative, included in the President's Budget
for 2011, would make available more than $400 million per year in
financial and technical assistance to communities and businesses to
attract private sector capital that will more than double the total
investment. The Initiative will support projects ranging from the
construction or expansion of a grocery store to smaller-scale
interventions such as placing refrigerated units stocked with fresh
produce in convenience stores.
To help get America up and moving, HHS specifically will
expand and modernize the President's Physical Fitness Challenge, and
double the number of Presidential Active Lifestyle Awards to create
healthy habits by challenging children to commit to physical activity 5
days a week, for 6 weeks.
The Department of Housing and Urban Development has begun
its HUD Healthy Neighborhoods Program involving community health
promotion. In this pilot program, 10 public housing agencies will use
the National Institute for Health's heart health curriculum, ``With
Every Heartbeat is Life,'' to establish strategic partnerships with
community health centers and other public and private entities in order
to improve the housing agencies' low-income residents' health
conditions, including reducing obesity.
Childhood obesity is a national epidemic that will require a
national response. The Let's Move! campaign is calling on all sectors
of society, public and private, to contribute to solutions. Already, we
have seen key players answering the call. For example, pediatricians
across America are now moving to regularly monitor children's BMI and,
for the first time ever, write ``prescriptions'' for simple things
children can do to increase healthy eating and active play.
conclusion
As ``America's family doctor,'' I want to change the national
conversation from a negative one about obesity and illness to a
positive conversation about being healthy and fit. Instead of
bombarding people with lists of what not to do, we need to empower them
with what to do to promote health. Healthy eating and physical activity
should be something all Americans want to do, not something they feel
they have to do. We need to encourage people to take up activities that
they enjoy, like swimming, dancing, or biking. We need to show them how
healthy foods can be affordable, accessible and delicious.
Americans are more likely to change their behavior if they have a
meaningful reward. That reward should be something that people can
feel, that they can enjoy and that they can celebrate. The reward is a
level of health that allows people to embrace each day and live their
lives to the fullest without disease, illness, or loss of productivity.
In closing, I hope that communities across the Nation will use my
Vision for a Healthy and Fit Nation as a blueprint for action to work
more effectively, share resources, develop public and private
partnerships and use innovative solutions for change. Today's obesity
epidemic calls for committed, compassionate citizens to mobilize and
demand the health and well-being they deserve. I have heard their call,
we have all heard their call, and I am honored to do everything in my
power to help Americans live long and well; to be a healthy and fit
Nation.
Thank you for the opportunity to present information on this
important topic. I would be happy to answer your questions.
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The Chairman. Thank you very much, Dr. Benjamin, for a very
eloquent statement. You are going to be a great leader and a
great example to our country----
Dr. Benjamin. Thanks.
The Chairman [continuing]. In moving to what I've often
referred to as a wellness society.
I was just handed, this morning, a copy of a speech, a
remark I gave in the fall of 1991. I said, ``The truth is we're
spending about $700 billion a year for healthcare in America.''
Don't you wish we were still spending that?
[Laughter.]
And I said, ``We don't need to spend more money to improve
the system, we need to spend it better.'' And I said, ``We
spend more money on treating diseases, but we don't spend
enough on prevention and wellness.'' I said that in 1991. As my
mom taught me, ``An ounce in prevention is worth a pound of
cure.'' And I talked about wellness and getting us into a
wellness society.
It seems to me that's where we have to be headed. There has
to be something that people aspire to. We have to energize our
country to think about wellness. We also have to start thinking
about this way, I believe, and that is that right now in our
country it's easy to be unhealthy and hard to be healthy.
Shouldn't that be the other way around? It should be easier to
be healthy and harder to be unhealthy.
Everything is geared toward being unhealthy. Yes, we take
elevators instead of stairs, except for some of us. You know,
we drive the car a block to the store, rather than walking. We
build neighborhoods without sidewalks, so kids can't walk to
school. We have prepared foods that are high in fats and
sodium, sugars, but they're fast, they're easy. All the fast
foods, if you're in a hurry--we're always in a hurry,
everyone's in a hurry--any fast food to get us through,
basically, is not very good for you. It's easy to be unhealthy.
I have a thing; every time I'm traveling, I go through an
airport, and if I'm going through an airport around lunchtime
or something, trying to find something to eat--I mean it's hard
to find something that's healthy. You can pick anything up
that's unhealthy. So, somehow we've got to start re-engineering
things to be easier to be healthy.
One other thing--I would just ask you, a general thing--
Senator Enzi and I, and, of course, everyone here on this
committee--Senator Dodd, who chairs the Education
Subcommittee--we're now meeting with Secretary Duncan on the
reauthorization of the Elementary and Secondary Education Act,
which has been dubbed No Child Left Behind from 2002, I think
it was, or 2002, 2003--and I used to say this to Secretary
Spellings, you know, if we're not going to leave any children
behind what about their health? And so, it just occurred to
me--and we've just started our initial meetings, I haven't said
anything, brought this up--but maybe we ought to think about
pulling you in on this Elementary and Secondary Education Act
to start thinking about what needs to be done in our elementary
schools to get more health education, more exercise, things
like that for kids. So, I just sort of ask you, in an open
session here, Would you be willing to work with us and to work
with Secretary Duncan on perhaps seeing what we might do in an
education bill to promote better health for our kids in
schools?
Dr. Benjamin. I would be excited about working with you.
That's exactly what we're calling for in our paper: more
physical activity in schools. It's recommended that children
get 150 minutes of exercise a week, as elementary kids, and 225
minutes for secondary school. And yet, they're not, and many
schools aren't having as much physical education. PE is kind of
an afterthought. It used to be that health was taught in PE, it
was ``health and PE.'' And we're not getting PE, so they're not
getting health. So, it's really important that we get these
things back into the schools.
The Chairman. I saw a figure that, recently--when I was in
elementary school, we had 1 hour a day. We had 15 minutes in
the morning, half hour at lunch, 15 minutes in the afternoon,
which you had to go outside and do things. You couldn't sit
around. Saw a figure recently that said that 80 percent of the
elementary schools in America today have less than 1 hour of
physical exercise a week. A week. So, that's how far we've
gotten away from that.
One last question--my time is running out--you were a
primary care doctor before you became Surgeon General, so
you've been on the front lines of this. In your judgment, what
are the greatest obstacles to your patients in being healthy
and fit and pursuing healthy choices? What are some of the big
obstacles?
Dr. Benjamin. The biggest obstacle of the patient
population that I was seeing is the time that they had. They
didn't have enough time to do the things. Most of the patients
understand the issues, they understand that we need to become
healthier, they need to lose weight. And that's evidenced by
the amount of money spent on weight-loss products and exercise.
So, the awareness is there, it's what can they do to actually
get these things done. Most of the parents are working, or
some--many of them are working two jobs, and when they come
home between jobs they don't have the time to cook a good meal.
They grab whatever they can, the stresses in their life are
tremendous. And so, we have to find a way to make it easier for
them, in their day-to-day life, to do the things they know they
need to do and want to do. That is, make available--
particularly in fast foods and things, available choices that
are healthy choices, and affordable--because the healthier
meals are often the more expensive meals. And so, we need to
make those things available. That's one of our roles, to start
to bring these things together. Have grocery stores in the
communities where they live. They're not there. And to bring
them into those communities so they can be available for that
mom who's on her way, in between two jobs, to be able to do
those things. We need to make it easier for them.
The Chairman. Very good. Thank you very much.
Senator Enzi.
Senator Enzi. Thank you, Mr. Chairman. And I want to thank
you for the comments in your full statement.
Some of the things that I, kind of, caught in the testimony
that you just gave was to celebrate. I really don't think that
we celebrate, enough, the average child doing something
physical. I remember there used to be a program--I think it
started under President Kennedy--where you got certificates.
And it was continued later--Schwarzenegger, I think, was the--
well, now Governor--was the head of giving out some other
certificates. One of the difficulties of that certificate
program was that you had to be able to do all of the
categories. And a suggestion that I was given was that there be
a wider range of things that kids could do, and then
certificates for doing a certain number of those, so that
they're encouraged to do, not everything, but the things that
they have some capability in, hoping that they will come up
with some kind of a lifetime activity from that.
One of the difficulties I have with the PE program that I
grew up under was that I came to hate calisthenics, because
most of them I wasn't any good at----
Dr. Benjamin. Right.
Senator Enzi [continuing]. But there were several other
things, that were more sports-oriented, that I could do real
well at. But, we insisted on the calisthenics and kind of drove
kids out of the PE, which is why I think there isn't as much PE
in the schools today.
One of the things I ran across was a suggestion that there
be recess before lunch instead of after lunch, in that it would
add to the improvement in the academic performance, as well.
And I remember my daughter, who was in fourth grade, once
invited me to come to see her school lunch program. Of course,
she didn't like the school lunch program, so she brought a sack
lunch, and one for me. But I was just starting to open my sack
lunch, and she had her hand up in the air. I said, ``What's
your hand up for?'' She said, ``You have to have your hand up
to be able to go out and play.'' And that's what she really
wanted to do. Some of those free exercises on the playground.
How do you plan to work with the schools in America to design
the best policies that can lead to healthier environments for
kids, like perhaps recess before lunch?
Dr. Benjamin. Yes, recess is a great thing. Kids should
have structured play and unstructured play. We are working with
a number of partners throughout various departments--the
Education, Agriculture--to make sure that we have more
activities in the schools, that the school lunches--and the
meals that are provided in schools--are nutritious. We provide
water, and, you know, oftentimes kids will think they're
hungry, and they're really thirsty. So, to have water available
to them and the ability for them to go out and get a drink of
water often--they have to get permission for that, so encourage
that. Good, healthy things in the vending machines, when they
want to have a snack or something, that they have fruits and
vegetables--fruits and healthy things in the vending machines,
available to them. So, those are sort of the things that we
need--some of the things we need to do, particularly the
physical activity and extramural activities, even after school,
things--the playground--involve the parents, because the
parents are the first teachers. And we've seen that the more
the parents were involved and the community is involved, the
better things get to be.
Senator Enzi. Thank you. And you mentioned water, and that
brought to mind something else. Among the Native Americans in
my State, there's a high lactose intolerance. And we provide
regular milk, not Lactaid. And it's true in all sectors of the
population, but it's more prevalent there. So, there are things
that need to be done with the lunch programs and things that
can help. And what that brought to mind was that in your
statement you mentioned that there's a higher percentage of
obesity among rural than there is among urban. Can you tell me
why you think that might be? I don't disagree with it, it just
seemed to me like the kids in the rural areas would be out
doing things more than the kids in the urban area, where
everything is constrained to buildings. So, it didn't fit with
some of the other things we talked about.
Dr. Benjamin. Unfortunately, in rural areas we tend to
drive everywhere now. We don't walk, like we used to. In inner
cities, you walk from block to place, where the parking is
hard. In a rural area, parking is easy and you can--even
teenagers now get in their car and go across the street just so
they can drive. And we're not doing the things, the active
things that we used to do.
The other thing is we're not playing and doing the
activities that we tended to do, years ago. We're not seeing
that, unfortunately.
Senator Enzi. Yes, I think the computer games are cutting
into that quite a bit, too. Now, there was also mention of
building bike paths and sidewalks and that sort of thing. I
hope we can give a little bit of concentration to how we get
the rubber to meet the road, because I see a lot of those
aren't being used. And somehow we've got to get them out there.
Again, President Kennedy had a hike along the tow path here--I
think it was a 50-mile hike, and, in those days, nobody hiked,
and so there were a lot of blisters and bad shoes and that sort
of thing.
So, I look forward to working with you on this. And my time
has expired.
Thank you.
Dr. Benjamin. One of the things about the activities
outside the parks and things, and walking paths, is that
oftentimes they're not safe. And the people need to be assured
that they're safe, and that they're safe when they go out and
play, that local governments have made them safe and
comfortable for families to go out.
Senator Enzi. Thank you.
The Chairman. Thank you, Senator Enzi.
And now the person who has been our leader on children and
families for so long, and has been advocating for healthier
kids for, well, as long as I've been here anyway, and that's 30
years.
Senator Dodd.
Statement of Senator Dodd
Senator Dodd. Thank you very much, Mr. Chairman, and let me
thank you for doing this today. You pointed out, your
involvement in this issue goes back a long time. I think we all
have a renewed sense of hope that there's a possibility we're
going to start really taking some very concrete actions.
We don't have to debate the issue. A lot of times it takes
you years to convince people the merits of the issue. And then
you go to the next step: Well, then what do you do about it?
So, we're, I hope, well beyond--in a city that seems absolutely
frozen in its ability to come to at least agreement on what the
problems are sometimes. Here, that's not the issue. So, we
thank you.
Do we call you--do I call you ``Doctor'' or ``General''?
Dr. Benjamin. ``Doctor'' is good.
Senator Dodd. ``Doctor'' is fine, all right. Surgeon
General, the other----
The Chairman. Those are admiral stripes.
Senator Dodd. I know. And I know they are. That's right.
Navy----
[Laughter.]
The Chairman. I was in the Navy.
Senator Dodd. Navy, I know.
[Laughter.]
Anyway, it's good to have you with us, and thank you.
I have some opening comments that I'll just ask, Mr.
Chairman, to be made a part of the record.
Bill Frist, who was here and acted as chairman of this
committee, had a strong interest in the subject matter, a
physician. Jeff Bingaman, who's been a member of this
committee, as well, I think, in the 107th, 108th, and 109th
Congress, we had hearings and bills and so forth, all focusing
on this issue. And, as you know, we're getting into the throes
of this healthcare debate, still ongoing. This committee was
deeply involved in that issue for a good part of last year.
The numbers I was looking at that--36 percent--obese
Americans spent 36 percent more for healthcare than others, and
77 percent more on medications. The increase in the spending on
healthcare, the dollars--out of every $4 in increased
healthcare cost, one of those dollars out of four is directly
related to obesity. Again, an issue where if you're looking to
bring down costs and, this is clearly an area we can do that--
and, as you point out, so much of it begins early on. You used
to talk about a lot of these problems that were the adult onset
of diabetes and various other issues that didn't come until
adulthood, now we're looking at a staggering number of these
problems showing up very, very early in children--even in
infants.
Let me just ask you two questions, if I can. One is, what's
really needed here--and I think it's wonderful that the First
Lady is taking such a strong interest in identifying this as a
priority--it's a great issue to be involved. And that kind of
profile will help us, I think, tremendously. But, what we're
going to need, because there's so many various committees, even
up here, that can--this is the good news--that can claim
jurisdiction or a part over this thing. It involves the Finance
Committee and doing things to the tax structure, the Ag
Committee--clearly, what Tom has been on, and done such a great
job in talking about this issue--clearly, with food and
nutrition and things; obviously, this committee. You can almost
go across the board. And there's a role--sometimes it's a
problem when you get too many chefs in the process here, but
this ought to be an asset for us. What's missing is the
coordination. We sort of have these battles here over
jurisdiction. And it really does need a coordinating effort.
And I'd be interested in knowing, Doctor, whether or not this
is something--a role--if you've talked about this--how we can
coordinate this, in a way. And we all have the witnesses, and
we'll have more this morning, some wonderful people from the
American Academy of Pediatrics that I worked so closely with
over the years, and the NFL, which we're excited about having,
as well, and taking on this issue and elevating the profile of
it. But, coordinating the activities seem to be critical.
That's my first question.
And the second question--if you had to pick what time of
the day--I know the schools are an issue, and recess and so
forth, and so much of that is local and cost. I've been told,
in some cases, one of the reasons there's less recess time is
because--having the number of teachers that can actually
supervise can sometimes be a reason or problem, why you have
less recess availability. But, there's one time, I think,
during the day in which all of us can agree, given the
economics in our country, the incomes, the number of single-
parent households, is that after-school period. I mean, there's
one period where--you can argue about schools and doing things,
but once that child leaves that school and that afternoon and
that period before their parents come home or that dinner
arrives, that three or four, five--we know, for instance, it's
a dangerous time, be that either as victim or to victimize,
what can happen, in that window.
John Ensign and I have introduced some legislation again
this week on the after-school area. This is an area where I
think we can play a very critical role. We can provide
resources--we've done a lot of this already. But, I wonder if
you'd like to just comment, as a second question, about that. I
realize there's a danger in picking one time of the day we can
focus on--and I'm not excluding the others. But, this is one
area where I think you'll get universal recognition that this
is that time when unsupervised activities, such as video games,
contribute to an awful lot of the problems we see and offers, I
think, an opportunity to address a lot of what we're talking
about.
Those are two issues I have for you.
Dr. Benjamin. Well, the first question, about coordination,
the President has established a Task Force on Childhood
Obesity. And that task force is going to review each and every
government program that's related to child nutrition and
physical activity. And once they do that, they're going to come
out with a national action plan, with benchmarks that help us
reach the goal, the First Lady's goal of reversing childhood
obesity within one generation. So, that task force should be
starting to look at that.
Regarding the after-school, I think that's a tremendous
issue that you're talking about. It's really important. We
can't do it alone. Government can't do it alone. We need
partners. And that's where the parents, the community comes in,
the industry, the medical community. Starting to do things like
extramural activities after school, allowing us to use the
schools and the gyms or the walking tracks, to keep the lights
on. That takes everyone's effort, and from the entire community
at the local level, to be able to do those things. It gets the
kids moving, it gets them to learn to play with each other, the
social skills they build up. And it gets the entire community
involved. And it's tremendous, and I agree with you. I think
that's one of the things that we need to involve our partners
with.
Senator Dodd. Did you--who's on the task force again?
Dr. Benjamin. There's a number of agencies throughout
government that's on there--HHS, HUD, Education, Department of
Ag--USDA--and others. And I think they can involve anyone else
they like.
Senator Dodd. If it's not part of it, let me urge to be a
part of it--Department of Transportation----
Dr. Benjamin. OK.
Senator Dodd [continuing]. Ought to be a part of it. It may
be, and I'm not suggesting it's not, but if it's not----
Dr. Benjamin. It may be.
Senator Dodd [continuing]. You ought to insist it be a part
of it, because it's a critical--I mean, there's so many diverse
interests----
Dr. Benjamin. Right.
Senator Dodd [continuing]. Both at the executive branch as
well as the congressional level, that sometimes I think it's
the fact that--the mere existence of the diversity of it
sometimes is daunting, in terms of how you coordinate it all.
That's why I raised that issue.
I thank you very much, am excited about your stewardship.
And you've got a great leader, in Tom Harkin of this committee.
There's a long history of his involvement and his ideas and
thoughts on how we do this. And I think we all ought to get
excited. And again, if the only thing you're motivated by is
cost--we now know, without any question, categorically, that if
we don't address this issue, it is going to mount as a cost
issue, not to mention the hardship and the difficulty and the
heartache that families and individuals go through as a result
of obesity.
So, thank you.
Thanks, Mr. Chairman.
The Chairman. Thank you very much, Senator Dodd.
Another Senator who is physically fit and exercises all the
time, and a personal example of fitness, Senator Burr.
Senator Burr. Thank you, Mr. Chairman.
Dr. Benjamin, welcome. We thank you for being part of this
hearing. I thank you for highlighting a North Carolina study in
your opening statement. And let me just say, you have a lot of
fans and a lot of colleagues who think a lot of you, in North
Carolina. And I know you already know that.
This is a very difficult issue to solve. We can plan an
after-school program, but for most communities, that means that
a child is left at a program without a bus to get home. We've
got to rethink our entire education system, if in fact, we want
to integrate education and physical fitness together. Without
that we'll come up short or we will leave students behind that
don't have the transportation needs.
Let me ask you just a couple of questions. Last year, Dr.
Coburn and I introduced the Patients' Choice Act. Under our
bill, the CDC would have established a Web-based prevention
tool that would create a personalized prevention plan for
individuals. Do you think such a tool is a resource for parents
and healthcare providers that they could use to promote better
health?
Dr. Benjamin. Yes. I'm open to all innovative ideas, and
that's certainly an innovative one. And anything we can do to
help parents, help the communities, do the things they want to
do, particularly to get healthy and fit, would be good.
Senator Burr. We tend to always be focused on the
traditional things. And I think we've talked about a lot of
traditional things. Let me just cite one study, real quick.
Fifty percent of the American people receive their information
through traditional sources--newspapers, TV, radio. Fifty
percent today receive it through social networking.
Dr. Benjamin. Right.
Senator Burr. There's an incredible world of communication,
that targets exactly the folks we're after, that goes
unmentioned in a lot of the educational proposals that are out
there.
Mr. Chairman, let me highlight one thing that I'll make
available to the committee if we pursue this with further
hearings. In Kannapolis, NC, a converted textile town, is the
largest planned research park in the world for human nutrition.
It is where academia has come together with business to look
specifically at the nutrition of America. And from the research
of academia, mixed with corporations, influence, then, the
nutrition standards of the products that find their way on the
shelf. And I think that's an excellent place for us to look and
maybe get some guidance from them.
One of the areas that we do have some direct ability to
manipulate would be what the Federal Government pays for the
free and reduced school breakfast and lunch. Let me ask you
honestly, Should we set a nutritional standard that must be met
for that meal that the Federal taxpayers are providing? Should
we set the course, by example, and say to the schools, ``It's
got to meet this''?
Dr. Benjamin. You know, that's one of the things we call
for, to have higher nutritional standards in the school
lunches, school programs, and the meals that they serve in
addition to those. I tend to work the other way. I think the
parents should be demanding from us that we have higher
nutritional standards in those programs--and we should be
delivering them to them. So, the whole idea, for me, is to
say--make sure that the parents, the communities, they're the
ones asking us to deliver for them. So, the other way around.
Senator Burr. Well, as Senator Dodd mentioned, every school
system is a little bit different. We can't lay this Federal
architecture on them and say, ``You're going to do it this
way.'' But, as Senator Harkin and I have talked, we do, and
can, influence what we pay for. And my question is very simple,
Should we lead by example? Should we say, for that at-risk
population, ``We're going to set a standard, and you're going
to meet that standard.'' Hopefully, by us doing that, we
influence everything else that comes out of that cafeteria.
Because the other students look at it and see value to it, or
parents say, ``Well, you're doing it here, why don't you do it
for the general line?'' I think, in fact, it would be good
sense. If you required it for a certain portion, we would
influence, then, everything that was in that cafeteria.
Dr. Benjamin. It's hard to argue with increasing standards
and improving.
Senator Burr. Well, I thank you for that. Let me get to one
last thing before my time runs out.
I think it's extremely difficult to really penetrate this
problem, when so many Americans don't have a medical home. Now,
we have our differences as to how we get there. And Senator
Harkin and I agree totally on the need for prevention,
wellness, and chronic-disease management. We may differ on how
we get there slightly, but we know we have to get there. It's
impossible for me to believe that we can fully take advantage
of any investment in prevention, wellness, and chronic-disease
management if, in fact, the delivery point of healthcare is an
emergency room, where you see a doctor that's trained to treat
trauma, not to educate about chronic disease or about
nutrition. Now, your specialty is pediatrics?
Dr. Benjamin. Family medicine.
Senator Burr. Family medicine.
Dr. Benjamin. I'll be an honorary pediatrician.
[Laughter.]
Senator Burr. Well, I think the Chairman told me it was
pediatrics. Family medicine. But, you understand the importance
of being an integral part of the lives and the activities,
instructing, educating. It's part of your education. The
difficulty that we've got today is, the normal delivery point,
for a lot of Americans, is not the point where that specialty
was actually taught, that there's an educational component to
healthcare.
I would only say this. Were we to accomplish creating a
medical home--the best example is Medicaid; every State's got
it. To me, it's the worst delivery system in the world, because
it funnels everybody to an emergency room when they're sick.
There's no mechanism, in most States, for them to get education
on staying well. How do we change this?
Dr. Benjamin. I certainly believe the medical home is an
important concept. And I even talk about it in my paper--my
vision paper--that the role of clinicians, physicians, nurses,
and other clinicians, have a tremendous role in this obesity
epidemic. We're often the people who are well respected and who
are considered authorities, and people will listen to them. The
parents are the first teachers; and I think the doctors and the
nurses are the second. And so, we have a tremendous role. We
need to start doing a little bit more than telling patients,
``You need to lose weight.'' We do that very well. But, we need
to go a little step further and talk to them about how
important it is, and the consequences of it, and what they can
do, and be a part of the community. The doctors and the nurses
and other clinicians in the community are often leaders in
their community. And when you bring all of them together--the
school board, the chamber of commerce, business communities--
and bring everyone together in a local community, you can start
to address a problem.
This problem can't be done by one group. I think the
medical home is certainly a place that people can feel
comfortable. They'll trust their clinicians, and they can start
there. But, it's going to take a lot more, as well.
Senator Burr. The Chairman was very grateful. He came to my
office, and we sat down and talked for about 45 minutes, and
one of the subjects was obesity. And I told him about a unique
program, I hadn't seen but I'd heard about. And I promised him
I'd get him the information.
I still owe it to you.
A businessman in South Carolina that was very successful,
and--in that northwest section of South Carolina--he started a
program, in the public schools, that he funded. Wasn't State
funding, wasn't Federal funding. Every student had an ID card,
and there was a scale in every school. And, on a regular basis,
they could put their ID card in, and the scale recognized them
and it tracked their trend of weight. And when the trend line
was positive, it spit out discounts for certain things that you
could purchase or places you could eat in that town. It
rewarded those students for action that they had taken to fall
more within the norm. I share that with you, I've already
shared it with the Chairman. And it is something we'll look at.
But, just to share with everybody about how far out of the box
I think some people have gotten, this isn't about doing it a
traditional way. If we keep it limited there, we're not going
to get this done. But, I think, if we do invest by reaching out
in America and saying, ``We don't care how you do it, we just
want to get there,'' we probably won't have to drive this.
People across the country will drive it.
I thank the Chair.
Dr. Benjamin. I agree with you. I think that people are
going to rise up and do it themselves. And the more innovative
ideas are often out there in the community, in the businesses,
the people who are really the experts.
The Chairman. I thank the Senator.
I just want to say that we thought his and Senator Coburn's
idea on the CDC Web portal was so good that Senator Dodd
included it in our health reform bill.
Do we get your support?
[Laughter.]
Senator Burr. You know the difficulty is you--all three of
you have talked about your experiences in school, and I can't
think back that far.
[Laughter.]
The Chairman. Senator Merkley.
Senator Merkley. Thank you very much. My colleague from
North Carolina may be a specimen of physical fitness; me, not
so much. So, it gives me a little bit of--as I wrestle with
figuring out how to exercise and how to eat healthy--
perspective on the challenge for our children.
My wife is a nurse, and I can't tell you, during the 10
years she worked at a hospital, how often she'd come home and
just say, ``You wouldn't believe how big American children are
getting.'' And it is certainly a challenge.
In Oregon, we've done a number of things to try to take
this on. And we are now third in the Nation--I believe, behind
Utah and Minnesota--in terms of childhood obesity, on the
better end of that spectrum, if you will. So, I thought I'd
mention the nine things that Oregon has done.
First, is to adopt a bill that promotes back-to-work breast
feeding. And that bill is in the larger healthcare bill. It was
adopted unanimously by this committee. And I hope that we'll
have that, nationwide, in the future.
Second is to prohibit or limit foods of low nutritional
value in childcare centers.
Third is healthy foods for healthy students, which sets
nutrition standards and guidelines for foods and beverages;
again, trying to have the healthier food in the schools.
The fourth is a law requiring regular physical activity in
schools, with a number of minutes each week specified that
there has to be a physical activity.
Then there's a curriculum that's required for obesity
prevention, restrictions on junk-food marketing in the schools,
investment in safe hiking and pedestrian routes to try and
encourage more activity to and from school. And then, a Farms
to Schools Program to encourage better nutrition. I saw many of
these ideas in your presentation, but, I did want to ask you to
expand on the concept of ``food deserts'' and what that is and
how we tackle that.
Dr. Benjamin. Many of the communities don't have grocery
stores. They basically have convenience stores--gas stations--
and that's where they have to get their food--or get a bus or
public transportation, sometimes two buses, to go to get a
grocery store. And so, there are no opportunities for them to
have fresh fruits and vegetables and healthy foods. They're not
in their communities. And so, those ``food deserts'' exist in
urban areas and in rural areas.
And there's a number of programs that's been kind of
working on this issue. There's one in Pennsylvania that has--I
think it's called Fresh Food Financing. And this program is to
basically present capital for companies to go into these
communities, where they couldn't get financing before. And
they've shown, now, that they put a number of grocery stores in
these communities and allowed the citizens to be able to shop
where they live.
Senator Merkley. Well, that's great. I appreciate that. I
certainly saw that when I was working in the inner city. I saw
that firsthand and it may be a tough issue to get our hands
around, but identifying it and trying out some of these
approaches you're presenting are a very good idea.
When I first saw that bullet point, I thought it said to
eliminate ``food desserts.''
[Laughter.]
I thought, well--no, no. Don't go there, please. Smaller
portions, yes, absolutely. Little moments of joy in our life
that we have to hold onto.
Dr. Benjamin. Every now and then, they're good.
Senator Merkley. Yes. In moderation.
Dr. Benjamin. That's right.
Senator Merkley. In moderation.
One of the things that is apparent, as my kids go through
grade school and now through middle school, is that the
activities were all free when I was in grade school. I came
from a working-class community, but there were no fees. I think
that was generally the standard across the country--that
activities associated with school were free. We also had free
summer open gym activities and so forth. Now everything has a
fee on it. And I'm wondering if we've been able to determine
the degree to which that structure of putting fees on physical
activities--if you're going to play basketball, you're going to
pay this, you're going to pay whatever--is having a negative
impact in our efforts to take on obesity.
Dr. Benjamin. Well, certainly, logically--it sounds logical
that that would be the case. That is certainly something we
could do a little more study on, some research on. We have the
CDC and ARC and NIH that are doing studies as to finding out
why we have this obesity epidemic, and how to combat it. So,
that would be something I think we could certainly look into.
It's worthy of it.
Senator Merkley. Well, I think that'd be very interesting.
I've noticed that some activities used to be completely school
activities--say, for example, swimming--have become more club
activities. And the cost goes way, way up and, I think,
decreases access for many children. It can't help but have a
negative--but, I'm wondering how much--impact, so that would be
wonderful to study that.
Thank you very much for your presentation and your focus on
this very important issue, as you have pointed out in your
presentation, not just for our children, but then childhood
obesity becomes adult obesity, adult diabetes, etc., and a huge
healthcare issue. I think one of the things that, in the course
of this healthcare debate over the last year, is--we, too
often, have a sick-care system rather than a healthcare system.
And tackling the issues that lead to childhood obesity, it
would be part of a much stronger healthcare system.
Thank you.
Dr. Benjamin. Thank you.
The Chairman. Thank you very much, Senator Merkley.
Dr. Benjamin, again, congratulations on your assumption of
this very important job. Thank you for your leadership in this
area. We look forward to working with you to, really, seriously
address this. And, of course, the First Lady has taken a great
leadership role on this, and, as you pointed out, we're getting
all the different departments put together. I hope we have the
Department of Transportation involved, I'm not certain, but
we'll look at that and make sure that they're part of it also,
of this team effort.
Dr. Benjamin. Great. We will be going around the country,
talking about issues, and would like to invite any of you, when
I'm in your districts, to be a part of that, as well.
The Chairman. Dr. Benjamin, thank you very, very much for
your leadership. You are excused. I know you have another
appointment that you have to get to.
And we'll bring our second panel up.
Thank you very much, Dr. Benjamin.
Dr. Benjamin. Thank you.
The Chairman Now we'll call our second panel. That's Dr.
Sandra Hassink, chair of the American Academy of Pediatrics,
Obesity Leadership Workgroup. Dr. Hassink is a pediatrician and
director of the Nemours Pediatric Obesity Initiative at AI
DuPont Hospital for Children, in Wilmington, DE; also assistant
professor of pediatrics at Jefferson Medical College at Thomas
Jefferson University, in Philadelphia, PA.
Then we have Dr. Joe Thompson, director of the Robert Wood
Johnson Foundation, Center to Prevent Childhood Obesity. Dr.
Thompson is also the Arkansas surgeon general, the director of
the Arkansas Center for Health and Improvement, and associate
professor in the University of Arkansas for Medical Science's
Colleges of Medicine and Public Health. He was originally
appointed as the chief health officer for the State of Arkansas
by then-Governor Mike Huckabee in 2005, with whom I have
visited on a couple of occasions about this very issue.
And then we have, not a doctor, but Rashard Mendenhall, who
is a running back with the Pittsburgh Steelers. He grew up in
Skokie, IL, played college football at the University of
Illinois. And someone said he ran all over the University of
Iowa, but I don't know about that, now.
[Laughter.]
We won't get into that. And the Big Ten.
He was drafted by the Steelers, 23rd overall in the 2008
NFL Draft, and was part of the Pittsburgh Steelers team that
won the Super Bowl XLIII. Mr. Mendenhall has been using his
role-model status to encourage kids to be physically active by
participating in the NFL's PLAY 60 Initiative. And we'll have
more to say about that, but it's encouraging kids to be
physically active for 60 minutes every day. So, we look forward
to hearing from Mr. Mendenhall, also.
We'll start, first, with Dr. Hassink.
Again, all of your statements will be made a part of the
record in their entirety, and we ask if you could summarize in
5 or 7 minutes; we'd sure appreciate it.
STATEMENT OF SANDRA G. HASSINK, M.D., MPH, FAAP, CHAIR,
AMERICAN ACADEMY OF PEDIATRICS OBESITY LEADERSHIP WORKGROUP,
WILMINGTON, DE
Dr. Hassink. Thank you very much, and good morning. And I
thank you for the opportunity to testify before this committee
today.
As you heard, my name is Dr. Sandra Hassink, and I'm proud
to represent the American Academy of Pediatrics.
The rapid increase in the prevalence of childhood obesity
is nothing short of alarming. By 2006, 30 percent of U.S.
children were overweight and 15.5 percent were obese. During
their youth, obese children and adolescents are more likely to
have risk factors associated with cardiovascular disease, such
as high blood pressure, high cholesterol, and type 2 diabetes.
Obese children are more likely to experience acute metabolic
and orthopaedic emergencies, chronic illnesses, such as
diabetes, liver disease, and obstructive sleep apnea, as well
as increased mental health issues. Obese children also
experience decreased physical function and delayed or altered
developmental trajectories due to the physical limitations of a
significantly increased body mass. Severely obese children and
adolescents have lower health-related quality of life than
children and adolescents who have normal BMI, as well noted by
Senator Harkin.
Let me share with you a little bit of the clinicians'
perspective. In the past 3 months, patients at my clinic have
included a 2-year-old Hispanic girl, who weighed 45 pounds,
whose mother wanted someone to talk to about her child's
weight; a third-grade boy, who told me he never goes outside--
not that he doesn't play outside, he does not even go outside;
a 15-year-old girl, with suicidal thoughts, who feels she
doesn't fit in with anyone else; and a 9-year-old weighing 290
pounds with obesity-related back pain and liver disease. How do
we help these children?
First and foremost, we must recognize that there's no
single factor responsible for obesity. It is the end result of
a complex interplay of different issues. Any solution must,
therefore, be equally complex and multifaceted. But, the good
news is that we can help children with overweight and obesity,
and we're learning more every day about the most effective ways
of doing so.
In addition to those troubling cases noted above, this year
my clinic has also seen success stories, like the 3-year-old,
whose BMI went from the 95th to the 85th percentile after four
visits, and the 16-year-old boy with hypertension, who had
gained weight rapidly his entire life, but was able to lower
his BMI from 33 to 30 and begin to reduce his elevated blood
pressure.
I'd like to share with you some of the range of resources
that the Academy of Pediatrics provides to help children,
families, and parents fight childhood obesity.
AAP maintains all of its tools and resources for families,
clinicians, and policymakers at a centralized Web site--
aap.org/obesity--as well as a newly created Web site just for
parents--healthychildren.org--giving parents more access to
healthy lifestyle resources.
The AAP also publishes material for parents, including
books, brochures, and handouts that produce healthy, active
living. Here you have one called ``Food Fights,'' to help
parents of young children. ``Learn How to Manage Mealtimes,''
this is a book on a guide to childhood obesity for parents.
The AAP is a key partner with First Lady Michelle Obama in
her recently announced, Let's Move initiative. As part of this
effort, the AAP pledges to continue urging pediatricians to
calculate and plot BMI at every well-child visit. And we
provide free downloadable prescriptions for healthy, active
living, that pediatricians can give to all patients.
For pediatricians, multidisciplinary teams, and other
healthcare providers, the AAP is proud to lead the development
of Bright Futures. This is a set of comprehensive guidelines
for well-child care. And of the 10 themes in Bright Futures,
three are promoting healthy weight, promoting healthy
nutrition, and promoting physical activity.
The AAP was intimately involved in the development of the
expert committee recommendations regarding the prevention,
assessment, and treatment of child/adolescent overweight and
obesity, which provide comprehensive guidelines on the subject.
We also provide our membership and other healthcare providers
with policy statements that guide the prevention and treatment
of obesity and its co-morbidities.
We provide a wide range of clinical tools to pediatricians
and other healthcare providers, such as online BMI calculators,
parent handouts and brochures for the office, growth charts,
weight management protocols. We have created model forms to
document visits and coordinate care with other providers, and
coding resources so that pediatricians can get reimbursed
appropriately. And we have quality improvement initiatives for
practices.
We publish books and handouts for physicians on preventing
and treating obesity, and highlight obesity issues regularly in
our publications and scholarly journal pediatrics. And we have
offered continuing medical education for pediatricians and
other healthcare providers on childhood obesity through online
learning, chapter meetings and publications, national
conferences, and other venues.
We also are engaged in a whole array of partnerships to
promote various aspects of healthy active living. For example,
the AAP was a lead participant in the Alliance Healthcare
Initiative, a collaborative effort to offer comprehensive
healthcare benefits to children and families for the
prevention, assessment, and treatment of childhood obesity.
Partners included in the Alliance were Alliance for a Healthier
Generation, American Dietetic Association, AETNA, Blue-Cross/
Blue-Shield of North Carolina, Blue-Cross/Blue-Shield of
Massachusetts, WellPoint, and PepsiCo. Be Our Voice is a
partnership on community advocacy around obesity with a
national initiative for child healthcare quality, the
California Medical Association Foundation, and the Center to
Prevent Childhood Obesity, and is sponsored by the Robert Wood
Johnson Foundation.
Finally, the AAP is engaged in a multitude of efforts to
effect policy changes at the local, State, and Federal level to
help reverse the tide of childhood obesity.
In conclusion, the American Academy of Pediatrics commends
you, Mr. Chairman, for convening this hearing on the important
and timely issue of childhood obesity. I appreciate this
opportunity to testify, and I look forward to your questions.
[The prepared statement of Dr. Hassink follows:]
Prepared Statement of Sandra G. Hassink, M.D., MPH, FAAP
summary
Childhood obesity is generally recognized as one of the most
pressing pediatric medical issues of this generation. No single factor
is responsible for obesity; obesity is the end result of a complex
interplay of different issues. Experience is teaching us that obesity
is a multi-factorial problem that requires an equally sophisticated and
comprehensive solution.
Childhood obesity continues to be a leading public health concern,
as these children are more likely to be obese as adults and are
therefore at a higher risk for a range of health problems throughout
their lives. Overweight and obesity and their associated health
problems also have a significant economic impact on the U.S. health
care system. Significant disparities in childhood obesity rates exist
among races, sexes, income levels, and geographic areas.
While the challenges are significant, the good news is that we can
help children with overweight and obesity, and we are learning more
every day about the most effective ways of doing so.
The American Academy of Pediatrics (AAP) provides a range of
resources to pediatricians to help them care for their patients. These
include Web sites, comprehensive guidelines for well-child care,
clinical guidance and tools for treatment, books and publications, and
continuing medical education.
The AAP has also undertaken a range of projects to explore both
clinical and community-based models for reducing childhood obesity. The
AAP has forged partnerships with numerous organizations and both given
and received grants for innovative efforts related to childhood
obesity. Furthermore, the AAP has assisted in the development of and/or
endorsed efforts such as the First Lady's Let's Move! initiative and
the 5-2-1-0 campaign. The AAP is engaged in a multitude of efforts to
effect policy changes at the Federal, State, and local levels that will
help reverse the tide of childhood obesity.
______
Good morning. I appreciate this opportunity to testify today before
the Committee on Health, Education, Labor, and Pensions regarding
childhood obesity. My name is Sandra G. Hassink, MD, FAAP, and I am
proud to represent the American Academy of Pediatrics (AAP), a non-
profit professional organization of more than 60,000 primary care
pediatricians, pediatric medical sub-specialists, and pediatric
surgical specialists dedicated to the health, safety, and well-being of
infants, children, adolescents, and young adults. I currently chair the
AAP's Obesity Leadership Workgroup and represent the mid-Atlantic
States on the AAP's Board of Directors. I direct the Nemours Pediatric
Obesity Initiative at AI duPont Hospital for Children in Wilmington,
DE, and I have been taking care of children with overweight and obesity
since 1988. I also serve as the chair of the Hospital Ethics Committee
and am Assistant Professor of Pediatrics at Jefferson Medical College
at Thomas Jefferson University in Philadelphia, PA.
Childhood obesity is generally recognized as one of the most
pressing pediatric medical issues of this generation. Experience is
teaching us that obesity is a multi-factorial problem that requires an
equally sophisticated and comprehensive solution.
background on childhood obesity
The rapid increase in the prevalence of childhood obesity has
alarmed public health agencies, health care clinicians, health care
researchers, policymakers and the general public. In 2005-6, 30.1
percent of children were overweight (defined as at or above 85 percent
of body mass index (BMI) for age) and 15.5 percent were obese (at or
above 95 percent of BMI for age).\1\
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\1\ Ogden CL, Carroll MD, Flegal, KM. High Body Mass Index for Age
Among U.S. Children and Adolescents, 2003-6. JAMA 2008; 299(20):2401-
2405.
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Childhood obesity continues to be a leading public health concern,
as these children are more likely to be obese as adults and are
therefore at a higher risk for a range of health problems throughout
their lives. Obese adolescents have an 80 percent likelihood of
becoming obese adults.\2\ One landmark study found that 25 percent of
obese adults were overweight as children, and that if overweight begins
before 8 years of age, obesity in adulthood is likely to be more
severe.\3\
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\2\ Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH.
Predicting obesity in young adulthood from childhood and parental
obesity. N Engl J Med 1997; 37(13):869-873.
\3\ Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS.
Relationship of childhood overweight to coronary heart disease risk
factors in adulthood: The Bogalusa Heart Study. Pediatrics
2001;108:712-718.
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During their youth, obese children and adolescents are more likely
to have risk factors associated with cardiovascular disease (such as
high blood pressure, high cholesterol, and Type 2 diabetes) than are
other children and adolescents. In a population-based sample of 5- to
17-year-olds, 70 percent of obese children had at least one
cardiovascular disease risk factor, while 39 percent of obese children
had two or more cardiovascular disease risk factors.\4\ Further, obese
children are at a higher risk for a number of other short- and long-
term health outcomes. Specifically, obese children are more likely to
experience acute metabolic and orthopedic emergencies, chronic illness
such as Type 2 diabetes, liver disease, and obstructive sleep apnea as
well as increased psychosocial morbidity. Obese children also
experience decreased physical function and delayed or altered
developmental trajectory due to the physical limitations of a
significantly increased body mass. Severely obese children and
adolescents have lower health-related quality of life than children and
adolescents who have a normal BMI. In fact, severely obese children and
adolescents experience a similar quality of life as children diagnosed
with cancer.\5\
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\4\ Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH.
Cardiovascular risk factors and excess adiposity among overweight
children and adolescents: the Bogalusa Heart Study. Pediatrics, 2007
Jan;150(1):12-17.e2.
\5\ Schwimmer JB, Burwinkle TM, Varni JW. Health-Related Quality of
Life of Severely Obese Children and Adolescents. JAMA 2003; 289:1813-
1819.
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Overweight and obesity and their associated health problems also
have a significant economic impact on the U.S. health care system.
Medical costs associated with overweight and obesity may involve direct
and indirect costs. Direct medical costs may include preventive,
diagnostic, and treatment services related to obesity. Indirect costs
relate to loss of income from decreased productivity, restricted
activity, absenteeism, and income lost by premature death. According to
a 2009 study of national costs attributed to overweight and obesity,
medical expenses may have reached as high as $147 billion in 2008.\6\
Approximately half of these costs were paid by Medicaid and Medicare.
Obesity-associated annual hospital costs for children and youth more
than tripled over two decades, rising from $35 million in 1979-81 to
$127 million in 1997-99.\7\
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\6\ Finkelstein EA, Trogdon J, Cohen J, Dietz W. Annual medical
spending attributable to obesity: Payer- And Service-Specific
Estimates. Health Affairs 28, No. 5, 2009, PP. w822-831.
\7\ ``Preventing Childhood Obesity: Health in the Balance, 2005,''
Institute of Medicine.
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Although there has been an overall increase in child obesity rates
in the United States in recent years, significant disparities exist
between races, sexes and income levels. According to the Centers for
Disease Control and Prevention (CDC) National Health and Nutrition
Examination Survey (1976-80 and 2003-6), the prevalence of obesity has
significantly increased for years 2003-6 compared to the initial study
in years 1976-80. For all children aged 2 to 5 years, obesity
prevalence increased from 5 percent to 12.4 percent; for those aged 6
to 11 years, prevalence increased from 6.5 percent to 17 percent; and
for those aged 12 to 19 years, prevalence increased from 5 percent to
17.6 percent. In 2007 alone, the CDC found that 19.2 percent of boys
and 13.5 percent of girls age 10 to 17 were obese.\8\
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\8\ Child and Adolescent Health Measurement Initiative. 2007
National Survey of Children's Health, Data Resource Center for Child
and Adolescent Health Web site. Retrieved [12/10/09] from
www.nschdata.org.
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According to the CDC, obesity prevalence was highest among Mexican-
American adolescent boys at 22.1 percent and American Indian/Alaska
Native children at 21.2 percent, growing at a rate of about half a
percentage point each year from 2003 to 2008. African-American boys had
the next highest rate of obesity at 18.5 percent, followed by non-
Hispanic white boys at 17.3 percent.\9\ The most recent CDC data showed
that for girls age 12 to 19 years of age, African-American girls had
the highest prevalence of obesity at 27.7 percent, compared to that of
Mexican-American girls at 19.9 percent and non-Hispanic white girls at
14.5 percent.\10\
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\9\ Center for Disease Control and Prevention, National Health and
Nutrition Examination Survey, 2003-6.
\10\ Center for Disease Control and Prevention, National Health and
Nutrition Examination Survey, 2003-6.
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Overall, poverty has been associated with greater obesity
prevalence among adolescents; however, subgroups have differed. In one
report, for example, obesity prevalence among younger African-American
male adolescents was higher in middle- and high-income families than in
low-income families, but prevalence among older black male adolescents
was higher in low-income families.\11\ Among white teen girls, the
prevalence of overweight and obesity decreases with increasing
socioeconomic status. Among African-American teen girls, however, the
prevalence of overweight remains the same or increases with increasing
socioeconomic status.\12\ A CDC study showed that one of seven low-
income, preschool-aged children is obese, but the obesity epidemic
among this population may be stabilizing. The prevalence of obesity in
low-income 2- to 4-year-olds increased from 12.4 percent in 1998 to
14.5 percent in 2003 but rose to only 14.6 percent in 2008.\13\
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\11\ Miech RA, Kumanyika SK, Stettler N, Link BG, Phelan JC, Thang
VW. Trends in the association of poverty with overweight among U.S.
adolescents, 1971-2004. JAMA 2006;295:2385-2393.
\12\ Gordon-Larsen P. The relationship of ethnicity, socioeconomic
factors, and overweight in U.S. adolescents. Obesity Research, 2003;
11:121-129.
\13\ Obesity Prevalence Among Low-Income, Preschool-Aged Children--
United States, 1998-2008, MMWR.
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Rates of childhood overweight and obesity also vary considerably
based on geography. In 2008, statewide childhood rates of overweight
and obesity ranged from a low of 23.1 percent in Utah and Minnesota to
a high of 44.4 percent in Mississippi.\14\
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\14\ Trust for America's Health. F as in Fat 2009. July 2009.
Online at http://healthy
americans.org/reports/obesity2009/, accessed 12/11/09.
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childhood obesity: the clinician's perspective
In the past 3 months, patients at my clinic have included:
A 2-year-old Hispanic girl who weighed 45 pounds, whose
mother wanted ``someone to talk to'' about her child's weight.
A third grade boy who told me he never goes outside. Not
that he does not play outside--he does not even go outside.
A 15-year-old girl with suicidal thoughts who feels she
``doesn't fit in with anyone else.''
A 9-year-old weighing 290 pounds with obesity-related back
pain and liver disease.
How do we help these children?
First and foremost, we must recognize that there is no single
factor responsible for obesity. Obesity is the end result of a complex
interplay of different issues. Any solution must therefore be equally
complex and multi-faceted.
Davidson and Birch described the ``socio-ecologic'' model of
obesity, which illustrates the many factors that impact weight. The
concentric circles of this model show the issues related to the
individual, family, community, and larger social structure that either
promote or inhibit good nutrition, physical activity, and overall
health. Any meaningful attempt to stem the rising tide of obesity must
address many of these issues simultaneously and over a prolonged period
of time in order to produce sustainable change.
The good news is that we can help children with overweight and
obesity, and we are learning more every day about the most effective
ways of doing so. In addition to those troubling cases noted above,
this year my clinic has also seen success stories, like the 3-year-old
whose BMI went from the 95th to the 85th percentile after four visits,
and the 16-year-old boy with hypertension who had gained weight rapidly
his whole life but was able to lower his BMI from 33 to 30
Pediatricians are also working hard on obesity prevention. We are
helping families identify high-risk environments and lifestyle
behaviors before their child's BMI reaches an unhealthy level.
american academy of pediatrics initiatives and resources
The AAP provides a range of resources to pediatricians to help them
care for their patients. We have also undertaken a range of projects to
explore both clinical and community-based models for reducing childhood
obesity.
Centralized Resources. The AAP maintains all of its tools and
resources for families, clinicians and policymakers on a single Web
site, http://www.aap.org. This provides health care practitioners with
a unified, centralized source of information about childhood obesity.
The AAP recently launched a new Web site for parents,
HealthyChildren.org, which contains extensive information for families
on promoting health weight and good health (http://
www.healthychildren.org).
Anticipatory Guidance. The AAP is proud to lead the development of
Bright Futures: Guidelines for Health Supervision of Infants, Children,
and Adolescents. Bright Futures guidelines direct pediatricians and
other health care providers to discuss issues related to nutrition and
physical activity at every well-child visit from birth through
adolescence. Of the 10 key themes in Bright Futures, three are:
Promoting Healthy Weight, Promoting Healthy Nutrition, and Promoting
Physical Activity.
Clinical Guidance. The AAP was intimately involved in the
development of the Expert Committee Recommendations Regarding the
Prevention, Assessment, and Treatment of Child and Adolescent
Overweight and Obesity, which provide comprehensive guidelines on the
subject. We also provide our membership and other health care providers
with policy statements that guide the prevention and treatment of
obesity and its co-morbidities.
Clinical Tools. The AAP provides a wide range of clinical tools to
pediatricians and other health care providers, such as an online BMI
calculator, parent handouts and brochures, growth charts, weight
management protocols, model forms to document visits and coordinate
care with other providers, coding resources so pediatricians can get
reimbursed appropriately for services, quality improvement initiatives
on obesity for practices, and much more.
Books and Publications. The AAP publishes a number of books and
handbooks for both physicians on preventing and treating obesity. We
highlight obesity issues regularly in our publications, our scholarly
journal Pediatrics, and other publications. The AAP also publishes
materials for parents, including books, brochures, and handouts that
promote healthy, active living.
Continuing Medical Education. The AAP offers continuing medical
education for pediatricians and other health care providers on
childhood obesity through online learning programs like Pedialink, our
chapters meetings and publications, national conferences, and other
venues.
Partnerships and Grants. The AAP is engaged in an array of
partnerships to promote various aspects of healthy, active living. They
include:
Let's Move: The AAP was a key partner with First Lady
Michelle Obama in her recently-announced ``Let's Move!'' initiative. As
part of that effort, the AAP pledged to continue urging pediatricians
to calculate and plot BMI at every well-child visit, and we provided
free downloadable ``prescriptions'' for healthy, active living that
pediatricians can give to all patients.
Alliance Healthcare Initiative: The AAP was a lead
participant in the Alliance Healthcare Initiative, a collaborative
effort with national medical associations, leading insurers and
employers to offer comprehensive health benefits to children and
families for the prevention, assessment, and treatment of childhood
obesity. Partners include the Alliance for a Healthier Generation
(Clinton Foundation and American Heart Association), American Dietetic
Association, Aetna, BlueCross/BlueShield North Carolina, BlueCross/
BlueShield Massachusetts, Wellpoint Inc, and PepsiCo.
Healthy Active Living Grants: The MetLife Foundation
supported five chapter grants and five community pediatric training
(CPTI) residency grants for 2010. The chapter grants are focused on
improving healthy beverage consumption in the community with an
emphasis on age birth to age 5. The CPTI grants are focused on obesity
prevention in the community.
Be Our Voice: Mobilizing healthcare professionals as
community leaders in the fight against childhood obesity, also known as
the Be Our Voice Project, is a program of the National Initiative for
Children's Healthcare Quality (NICHQ), in cooperation with the AAP, the
California Medical Association Foundation and the Center to Prevent
Childhood Obesity and is sponsored through the generous funding of the
Robert Wood Johnson Foundation. This initiative aims to train
healthcare professionals to become change agents within their
communities to help reverse the trend of the childhood obesity
epidemic.
Mentorship and Technical Assistance Program (MTAP): In
2008, funding from the Robert Wood Johnson Foundation supported five
Mentorship and Technical Assistance Program (MTAP) grants focused on
obesity in underserved populations. The MTAP grants provide up to
$2,000 in funding to assist AAP Council on Community Pediatrics'
members to improve their community pediatrics skills and/or develop
innovative programs within their community.
Healthy Grandfamilies: In 2008, the Academy, in
partnership with the Strang Cancer Prevention Center and the Illinois,
Texas, and New York 3 Chapters of the AAP, conducted a program to help
teach custodial grandparents in underserved communities the importance
of healthy, active living. The program took place in Chicago, Houston,
Dallas, and Harlem. Each program consisted of six workshops facilitated
by pediatricians.
In addition, the AAP has endorsed and/or participates in a number
of national campaigns on healthy weight. They include:
Action for Healthy Kids, a national-State initiative
dedicated to improving the health and educational performance of
children through better nutrition and physical activity in schools.
CDC's VERB Campaign, which encouraged positive physical
activity among tweens, youth age 9-13.
Exercise is Medicine, a campaign led by the American
College of Sports Medicine and designed to make physical activity to be
considered by all healthcare providers a vital sign in every patient
visit.
NICHQ's Childhood Obesity Action Network, a Web-based
national network aimed at rapidly sharing knowledge, successful
practices and innovation.
President's Council on Physical Fitness and Sports
(PCPFS), which serves as a catalyst to promote, encourage, and motivate
Americans of all ages to become physically active and participate in
sports.
Shaping America's Youth, an effort to provide the latest
and most comprehensive information on programs and community efforts
across the United States directed at increasing physical activity and
improving nutrition in our Nation's youth.
We Can! Led by the National Institutes of Health, ``Ways
to Enhance Children's Activity and Nutrition'' is a national program
designed for families and communities to help children maintain a
healthy weight.
Advocacy Efforts. The AAP is engaged in a multitude of efforts to
effect policy changes at the Federal, State, and local levels that will
help reverse the tide of childhood obesity. We provide extensive
resources to our chapters about ongoing initiatives in their States
\15\ as well as training and tools for advocacy. Our Washington, DC
office is a resource for Federal policymakers on recommended changes to
policies that impact children and their health. On March 8, the AAP
roll out a major policy resource on our obesity Web site for
pediatricians seeking to advocate for policy change around childhood
obesity issues at the Federal, State, and local levels.
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\15\ For information on efforts in many States, see http://
www.aap.org/obesity/community_whatsHappening.html?technology=2.
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In conclusion, the American Academy of Pediatrics commends you, Mr.
Chairman, for convening this hearing on the important and timely issue
of childhood obesity. The Academy is grateful for the committee's
commitment to child health, and we hope you will consider us a partner
and supporter in your efforts to reduce the health and economic burdens
obesity inflicts upon our children and our Nation. I appreciate this
opportunity to testify, and I look forward to your questions.
The Chairman. Dr. Hassink, thank you very much for your
statement and for being here and for your leadership.
Now we turn to Dr. Joe Thompson.
STATEMENT OF JOE THOMPSON, M.D., MPH, DIRECTOR, ROBERT WOOD
JOHNSON FOUNDATION CENTER TO PREVENT CHILDHOOD OBESITY, LITTLE
ROCK, AR
Dr. Thompson. Thank you, Senator Harkin, Senator Enzi,
members of the committee.
With your acquiescence, I'll submit my written testimony,
but build upon the conversation and dialogue that's already
gone on this morning.
I want to commend, also, this first of what we hope are a
series of hearings, testimonies here that--because this is a
true epidemic, it is impacting the health of our children. We
will have children today diagnosed with what used to be called
adult on-set diabetes, now we've had to change the name to be
type 2 diabetes. It is affecting the military preparedness,
because we don't have recruits that are physically fit to go
into boot camp. It is costing employers, on the healthcare
side, through their health insurance costs, as we've heard
earlier today. And it really, truly threatens the productivity
and the future of our Nation if we don't address this and
reverse the epidemic of childhood obesity.
The cause is relatively simple. The solutions are going to
be multiple. But, the cause, basically, is an imbalance in the
calories that our children take in each and every day. Our
bodies are designed that we take calories in and, if we don't
burn them off, we're going to store them as weight. Over the
course of the last three decades, our children have been
exposed to an environment that causes them to be out of
balance, to take more calories in than they burn off each day.
We've discussed some today about what those causes are--the
loss of physical activity in schools; the changes in the diet
patterns; the loss of families sitting down to nutritious meals
in the evening; the pervasiveness of TV--we used to have
cartoons only on Saturday morning, now we have them on multiple
channels, 7 days a week, 24 hours a day; the preponderance of
food advertising that's on those channels 24 hours a day; the
number of televisions that our families have in their homes;
the safety of parks where kids cannot now, either because of
perception or reality, get out and play each and every day.
Each of these things has contributed to an imbalance. And the
researchers suggest it may be as little as 200 calories a day,
but it's 200 calories each and every day through a child's life
that has caused this epidemic of childhood obesity to where
now, in my State, two out of five, or 40 percent, of the
children are either obese or overweight. And in some
populations--our African-American population, our Hispanic
population, our lower income population--it's even more than
that.
So, this imbalance is real and the solutions are multiple.
I've had the opportunity, we're in our seventh year in the
State of Arkansas. I now serve as the surgeon general under
Democratic Governor Mike Beebe, and I will tell you, this is a
nonpartisan issue. It affects every family, every family is
susceptible, and it crosses all party lines, all socioeconomic
levels. We have tried to change everything we can think of in
the school, in the cafeteria, educations, taken advantage of
new programs, like the Fresh Fruit and Vegetable Snack Program,
Senator. We have tried to add physical activity back in. We
have tried to build and change the communities within which we
live. One of my local legislators said, ``Well, you know you're
making a difference when you start pouring concrete.'' We have
built the world's longest pedestrian bridge over the Arkansas
River to try to make a bike and walking trail available. And
we've measured and reported to parents, each and every year,
their child's BMI. And I'm here to confidently say we have
halted the epidemic of childhood obesity in our State. Not
reversed it, yet. We need help from the Federal Government and
more local investment to reverse it, but we've halted it.
And that's where, 4 years ago, when the Robert Wood Johnson
Foundation committed half a billion dollars to reverse the
epidemic by 2015, and 2 years ago, when they asked me to direct
the Center to Prevent Childhood Obesity, we actually have
programs across the Nation, in each and every one of your
States, making a difference, so that we're actually supporting
innovation at the local level. We've got examples, that I
submitted in the written testimony, but examples include the
Fresh Fruit Financing Initiative, that the Surgeon General
mentioned earlier, where they've reinvested to get grocery
stores back into the ``food deserts'' that Senator Merkley was
mentioning.
Making flea markets in Baldwin Park, CA, add food as a item
being sold, as a farmer's market, and then, in addition, making
electronic debit cards for Food Stamp recipients to be able to
be used, so that we actually help individuals that are on the
Supplemental Nutrition Assistance Program be able to access
fresh fruits and vegetables.
In Columbia, MO, they're looking at how they look at their
community design by using GIS mapping to say, ``Where are
people, and where are stores, and how could we get people to
the stores without having to drive?'' So they're looking at
redesign of that community.
And finally, other communities across the Nation are
actually trying to come up with innovative ways to reestablish
the calorie balance for, not only their children, but the
community at-large.
This is an important issue. It is a true epidemic. We have
to have local leaders. We have to have the school leaders. We
have to have local community leaders, State leaders,
legislative, and we're excited about the Administration's
leadership. There are true opportunities here to move forward
and to reverse this epidemic.
I might just close by saying, we didn't intentionally get
here, and nobody intentionally brought us here. This is not
something that we can say, ``Here is the entity or the
institution or the industry that caused this.'' But, we're
going to have to intentionally get ourselves out of here if
we're going to have a safe, productive, healthy future. I've
never met a parent that wanted to have a healthy, uneducated
kid or an educated, unhealthy child. They want a healthy,
educated child coming out of the pipeline, and we have to do
better to provide them that opportunity.
Thank you very much.
[The prepared statement of Dr. Thompson follows:]
Prepared Statement of Joseph W. Thompson, M.D., MPH
Childhood obesity is a true epidemic; obesity rates have soared in
the United States over the past three decades. Today more than 23
million children and teenagers are overweight or obese--nearly one in
three young people. And obesity is becoming a problem at an earlier
age, with 24.4 percent of children ages 2 to 5 already obese or
overweight.
The childhood obesity epidemic cuts across all categories of race,
ethnicity, family income and locale, but some populations are more
likely to be obese or live in unhealthy environments than others.
Lower-income individuals, Blacks, Latinos, American Indians, and those
living in the southern part of the United States are among those
affected more than their peers.
The changes in our environment and our eating patterns have
impacted the weight and health of our children.
In some communities, parents aren't able to purchase
healthy foods because they don't have access to a local supermarket.
Communities of color have access to fewer supermarkets than do
predominantly white communities.
These same communities are significantly less likely to
have places where children can be physically active, such as parks,
green spaces, and bike paths and lanes. This makes it difficult for
children and adolescents to meet experts' recommendation that they have
60 or more minutes of physical activity daily.
On top of that, in 2006, only 2.1 percent of high schools,
7.9 percent of middle schools and 3.8 percent of elementary schools
provided daily physical education or its equivalent to all students for
the full school year.
Our children's physical and social environments affect their
health. How kids live and what they have access to directly impacts
their behavior and health. When our communities provide affordable
healthy foods and safe places to play and exercise, our children are
healthier.
In Pennsylvania, the Fresh Food Financing Initiative
(FFFI) serves the financing needs of supermarket operators to operate
in underserved communities. The FFFI funded 52 stores in underserved,
lower-income communities, and helped to create 3,333 local jobs.
A flea market may not be the first place people think of
when they want to buy fresh fruits and vegetables. But after doing a
community food assessment, Fresno Metro Ministry in California learned
that many people in its community shopped for produce at the Selma Flea
Market. So they worked with local, State, and Federal Government
partners to allow families to use their food stamps to buy nutritious
food at a place in their community where they feel welcome and
comfortable.
In Columbia, MO, a group of grassroots advocates, public
health officials, public schools, academics and leaders from government
and the faith-based community pushed new street and sidewalk design and
school wellness policies and are now using multilayered GIS mapping to
combine population and community data to better analyze where grocery
stores, walking paths and bus routes are located--this work is guiding
the community's future development to improve health.
Baldwin Park, CA knows that working only with health
advocates is not the answer. So this community has created a ``Smart
Streets Task force' which is hosting workshops to discuss walkability
and mobility to downtown and increased opportunities for exercise and
healthy food access. Their target audience is broad: parents,
neighborhood watch leaders, childcare providers and county
commissioners in the areas of housing, planning, and parks and
recreation.
These are the stories of communities and government coming together
as a team to change their neighborhoods so children and families have
access to fresh fruits and vegetables and safe places to play, but
preventing childhood obesity requires change on many levels, and the
Federal Government cannot do this alone. It will require the help of
many in both the public and private sectors.
School officials need to make quality physical education
and active recess a regular part of the school day, and ensure that the
foods and drinks they're providing in cafeterias and vending machines
are healthy and nutritious. Junk food doesn't belong in our schools.
Government leaders need to consider carefully how their
decisions affect children's activity levels and eating habits. That
means rethinking policies they might not associate with obesity
prevention--like zoning, which helps determine which businesses move
in, and school location and design, which affects whether students can
walk or bike to school.
The food and beverage industries should look closely at
the nutritional content of the products they offer, provide nutritional
information that's easy for parents and youths to find and understand,
and refrain from marketing unhealthy products to children.
Parents need to lead by example and create healthy
environments at home. And they need help--they need to make it clear to
community leaders and elected officials that having access to
affordable healthy foods and safe places for their kids to play is
important to them, so these leaders are motivated to act.
It is clear that in our Nation we have an environment that fosters
rather than prevents childhood obesity. We did not intentionally get
here, but we must intentionally find our way forward. The environments
in which people live, learn work and play affect their health and the
health of their communities. These environments can be changed--as
these communities are demonstrating--and we can support our children in
living healthy and active lives.
______
Senator Harkin, Senator Enzi, members of the committee, thank you
for inviting me to testify on one of the most important health threats
facing our children today--obesity.
I am Dr. Joe Thompson, Director of the Robert Wood Johnson
Foundation Center to Prevent Childhood Obesity, Surgeon General of the
State of Arkansas and a pediatrician. The center is a cornerstone of
RWJF's $500 million commitment to reverse the epidemic of childhood
obesity by 2015 by changing community environments and public policies
to help children be more active and eat healthy foods. Both the center
and the Foundation place special emphasis on reaching children who are
either at greatest risk for obesity and related health problems or have
limited access to healthy foods and safe places to play: Black, Latino,
American Indian, Asian/Pacific Islander children, as well as children
living in lower-income communities. Through policy analysis, leadership
development, and communications with a broad network of advocates, the
center is working to create healthier communities, prevent obesity, and
improve the lives of our Nation's children and families.
This is a true epidemic; one that every family is susceptible to.
Simply put, children are consuming more calories than they burn. To
restore ``energy balance'' in our children's lives, we need to ensure
that the places where they live, learn and play support healthy eating
and physical activity. We need to make healthy choices the easy choice
for children and families.
Within my home State, we are in our seventh year of trying to
reverse this epidemic through policy change, increased awareness, and
support for parents and families. Many families come with stories of
success in addressing a risk they initially didn't recognize but
overcame. Sarah was an elementary school student about to go to junior
high when we sent out our first health reports in 2004. Her mother had
recognized her weight because at dress-up parties in elementary school
she didn't fit in. As she gained weight, she showed signs of depression
and social withdrawal that led to more eating. With the health report,
the family started making changes--not eating in front of the TV,
limits on soda and increased family levels of activity. Over the next 2
years, Sarah regained her health, normalized her weight, and became a
social butterfly. This success story is being repeated and reinforced
by the changes we are making in schools and communities. But it isn't
enough.
Obesity rates have soared in the United States over the past three
decades. Today more than 23 million children and teenagers are
overweight or obese--nearly one in three young people.\1\ And obesity
is becoming a problem at an earlier age, with 24.4 percent of children
ages 2 to 5 already obese or overweight.\2\
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\1\ Ogden CL, Carroll MD, Curtin LR, Lamb MM and Flegal KM.
``Prevalence of High Body Mass Index in U.S. Children and Adolescents,
2007-2008.'' Journal of the American Medical Association, 303(3): 242-
249, January 2010.
\2\ Ibid.
---------------------------------------------------------------------------
The childhood obesity epidemic cuts across all categories of race,
ethnicity, family income and locale, but some populations are more
likely to be obese or live in unhealthy environments than others.
Lower-income individuals, Blacks, Latinos, American Indians, and those
living in the southern part of the United States are among those
affected more than their peers.
Obesity threatens the health of our young people--and their future
potential. Obese children miss more days of school than their healthy-
weight peers.\3\ They're at increased risk for a variety of serious
health conditions, including asthma, heart disease and type 2
diabetes.\4\ Some experts warn that if obesity rates continue to climb,
today's young people may be the first generation in American history to
live sicker and die younger than their parents' generation.\5\
---------------------------------------------------------------------------
\3\ Geier, A, Foster G, Womble L, et al. ``The Relationship Between
Relative Weight and School Attendance Among Elementary
Schoolchildren.'' Obesity, 15(8): 2157-2161, August 2007.
\4\ Overweight and Obesity, Health Consequences. Centers for
Disease Control and Prevention, 2009. www.cdc.gov/obesity/causes/
health.html (accessed June 2009). (No authors given.)
\5\ Olshansky S, Passaro D, Hershow R, et al. ``A Potential Decline
in Life Expectancy in the United States in the 21st Century,'' New
England Journal of Medicine, 352(11): 1138-1145, March 2005.
---------------------------------------------------------------------------
Obesity is affecting our military readiness, crippling State and
national budgets, and putting U.S. businesses at a competitive
disadvantage by reducing worker productivity and increasing health care
costs.\6\
---------------------------------------------------------------------------
\6\ Christeson W, Taggart AD, Messner-Zidell S. Ready, Willing, and
Unable to Serve. Washington, DC: Mission: Readiness, 2009.
---------------------------------------------------------------------------
Arkansas has examined the cost of obesity among our own State
employees--and it's something every employer should consider. The
yearly claims cost associated with obesity now exceeds that of tobacco,
with obese employees costing over 50 percent more than their
counterparts who don't smoke, have a normal BMI and do some
exercise.\7\
---------------------------------------------------------------------------
\7\ Unpublished data, Arkansas Center for Health Improvement.
---------------------------------------------------------------------------
These costs start early in life. We've looked at the cost impact in
our Medicaid and SCHIP program and see higher rates of illness, more
doctors' visits, and increases in costs as early as 10 to 14 years of
age.\8\ For the Nation, childhood obesity is associated with annual
prescription drug, emergency room, and outpatient costs of $14.1
billion, plus inpatient costs of $237.6 million.\9\
---------------------------------------------------------------------------
\8\ Card-Higginson P, Thompson JW, Shaw JL, Lein S. Cost and health
impact of childhood obesity among Medicaid/SCHIP enrollees. 2008
AcademyHealth Annual Research Meeting, Washington, DC, June 9, 2008.
\9\ Cawley J. ``The Economics of Childhood Obesity.'' Health
Affairs, Volt. 29 (No. 3): 364--371, 2010.
---------------------------------------------------------------------------
How did we get to this point?
The changes in our environment and our eating patterns have
impacted the weight and health of our children.
In some communities, parents aren't able to purchase healthy foods
because they don't have access to a local supermarket. Communities of
color have access to fewer supermarkets than do predominantly white
communities.\10\
---------------------------------------------------------------------------
\10\ Moore L and Diez Roux A. ``Associations of Neighborhood
Characteristics with the Location and Type of Food Stores.'' American
Journal of Public Health, 96(2): 325-331, February 2006.
---------------------------------------------------------------------------
And these same communities are significantly less likely to have
places where children can be physically active, such as parks, green
spaces, and bike paths and lanes.\11\ This makes it difficult to meet
experts' recommendation that children and adolescents have 60 or more
minutes of physical activity daily.\12\
---------------------------------------------------------------------------
\11\ Powell L, Slater S and Chaloupka F. ``The Relationship Between
Community Physical Activity Settings and Race, Ethnicity and
Socioeconomic Status.'' Evidence-Based Preventive Medicine, 1(2): 135-
144, 2004.
\12\ 2008 Physical Activity Guidelines for Americans. U.S.
Department of Health and Human Services, 2008. http://health.gov/
paguidelines/pdf/paguide.pdf (accessed May 2009).
---------------------------------------------------------------------------
On top of that, in 2006, only 2.1 percent of high schools, 7.9
percent of middle schools and 3.8 percent of elementary schools
provided daily physical education or its equivalent to all students for
the full school year.\13\
---------------------------------------------------------------------------
\13\ SHPPS 2006: Overview. Department of Health and Human Services:
Centers for Disease Control and Prevention, 2007. www.cdc.gov/
HealthyYouth/shpps/2006/factsheets/pdf/FS_
Overview_SHPPS2006.pdf (accessed May 2009).
---------------------------------------------------------------------------
It is clear that we have created an environment that fosters rather
than prevents childhood obesity. We did not intentionally get here, but
we must intentionally find our way forward. The environments in which
people live, learn work and play affect their health and the health of
their communities. For example, when children have access to safe
parks, they are more active. When local stores sell affordable healthy
foods, families eat better. But when communities are dominated by fast
food and lack places for children to play, it changes how those
children live--for the worse.
You can't say to a parent, ``your child should exercise more'' if
there's no PE in school and the only nearby park is so dangerous and
run-down that no one dares visit. You can't say to a family ``eat more
fruits and vegetables'' when the only stores in the neighborhood sell
six kinds of chips, and 12 kinds of soda, but not a single piece of
fresh produce.
Research tells us that our children's physical and social
environments affect their health. How kids live and what they have
access to directly impacts their behavior and health. When our
communities provide affordable healthy foods and safe places to play
and exercise, our children are healthier.
We can learn from the communities throughout the Nation. From the
many communities being funded by RWJF, to the CDC's and YMCA's ACHIEVE
Communities, to the new communities being funded through the stimulus
bill and countless others, I am hopeful we will create models to enact
real change nationwide.
The good news is change is already happening on the ground today.
Trends show that, even in a tough economic climate, States are more
and more focused on enacting measure to support and promote healthy
eating and physical activity. States are aware of the key role they can
play and are keeping the momentum up.
The annual F as in Fat report, released by the Trust for America's
Health and RWJF, examines childhood obesity prevention efforts across
the Nation: Recent findings demonstrate some progress toward creating
healthier environments:
In 2004, six States had nutritional standards for
competitive foods that are sold a la carte in school cafeterias,
vending machines, or school stores. Today, it's 27.
In 2004, only four States required school screenings for
body mass index or some other weight-related assessment. Today it's 20.
In 2004, four States had nutritional standards for school
lunches and breakfasts that were stricter than the current USDA
standards. Today, it's 19.\14\
---------------------------------------------------------------------------
\14\ F as in Fat: How Obesity Policies are Failing in America,
2009, pg. 5. http://healthyamericans.org/reports/obesity2009/
Obesity2009Report.pdf (accessed February 2010).
I have seen this change first hand.
In my home State of Arkansas, Act 1220 of 2003 required changes and
enabled recommendations to be adopted by the Arkansas Board of
Education strengthening nutrition and physical activity policies for
all schools. Confidential body mass index (BMI) reports required by
this act have helped parents understand the risks of obesity to their
children and increased knowledge about their children's health. Through
these changes and many other community activities we have seen
improvements in the food offerings for our students, improvements in
their purchasing patterns in vending machines, and increased levels of
activity. Most promising, though, is that through the BMI assessments
we have observed a halt in the epidemic--we are not increasing the
number of overweight and obese children. But we must do more to reverse
the epidemic and eliminate the risk to our children.
We are extending our work from the schools out into the communities
within which our families live and grow. A statewide coalition is
supporting communities to improve access to healthy foods, address the
built environment, engage early childcare and after-school programs in
healthy eating and physical activity, encourage employers through
worksite wellness, and partner with health care providers. It has now
established a Growing Healthy Communities program to support selected
communities working to enact broad-scale environmental changes to
enhance healthy eating and active living opportunities for their
residents.
In Pennsylvania, the Fresh Food Financing Initiative (FFFI) was
started in response to research that showed high rates of diet-related
disease in underserved communities with poor access to grocery stores
and farmers' markets. The initiative serves the financing needs of
supermarket operators who plan to operate in underserved communities
where infrastructure costs and credit needs cannot be filled solely by
conventional financial institutions. The State of Pennsylvania
appropriated $30 million over 3 years to the program, and The
Reinvestment Fund leveraged the investment to create a $120 million
initiative. As of 2008, the FFFI funded 52 stores in underserved,
lower-income communities, and helped to create 3,333 local jobs. Even
in the recent blizzard that temporarily shut down much of Philadelphia,
the new Fresh Grocer on North Broad Street was able to stay open
because so many of its employees live in the immediate
neighborhood.\15\
---------------------------------------------------------------------------
\15\ The Food Trust and Pennsylvania's Legislation to Finance Fresh
Food Markets in Underserved Communities, http://
www.reversechildhoodobesity.org/sites/default/files/files-wfm/files/
The%20Food%20Trust%20and%20Pennsylvania%20FFFI.pdf (accessed February,
2010).
---------------------------------------------------------------------------
In Dallas, TX, traffic volume and congestion, coupled with a lack
of sidewalks along streets, made pedestrian travel and recreation
inefficient and dangerous. In 2002, a group of citizens and
organizations joined together to create the Friends of the Trinity
Strand Trail. The goal was to create a city-wide plan to connect all of
the trails in the Dallas trail system to allow people to travel from
one side of the city to the other without intersecting traffic. They
raised over $12 million in public and private funds, and tapped into
some existing natural resources to tie commercial, residential, and
recreational areas together with easy access to public
transportation.\16\
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\16\ Texas Bringing Healthy Back: Growing Community, pg. 2, http://
www.reversechildhood
obesity.org/webfm_send/114 (accessed February, 2010).
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And change isn't just happening to physical environments, it is
also happening in the areas of healthy foods. A flea market may not be
the first place people think of when they want to buy fresh fruits and
vegetables. But after doing a community food assessment, Fresno Metro
Ministry in California learned that many people in its community
shopped for produce at the Selma Flea Market. Unfortunately, when
California switched to Electronic Benefits Transfer (EBT) cards for
access to Supplemental Nutrition Assistance Program (SNAP) and SNAP
benefits, individuals and families were no longer able to use food
stamps at the market. To process the EBT cards, merchants needed high-
tech machinery and a phone line. They had neither.
Fresno Metro Ministry worked with local, State and Federal agencies
to change that. Now, market staff use a single wireless electronic
device to swipe the EBT card and deduct an amount from the
participant's food stamp account in exchange for tokens that they can
then use to shop at eligible food vendors at the flea market. Families
are now able to use their food stamps to buy nutritious food at a place
in their community where they feel welcome and comfortable. The EBT
flea market program has expanded to two additional flea markets in
Fresno County, and a third may soon be added.\17\
---------------------------------------------------------------------------
\17\ Using Food Stamps to Buy Fresh Produce at a Local Flea Market,
http://www.reversechildhoodobesity.org/sites/default/files/files-wfm/
files/Using%20Food%20Stamps%20at%20Flea%20Mkts.pdf (accessed February,
2010).
---------------------------------------------------------------------------
I'd also like to share some early examples of success from RWJF's
Healthy Kids, Healthy Communities program--one of the Foundation's
largest and most ambitious community-action initiatives ever. It's
working to create communities where children and their families have
access to affordable healthy foods and safe places to play and
exercise.
In Columbia, MO, a group of grassroots advocates, public health
officials, public schools, academics and leaders from government and
the faith-based community pushed new street and sidewalk design and
school wellness policies and are now using multilayered GIS mapping to
combine population and community data to better analyze where grocery
stores, walking paths and bus routes are located to help guide future
development.\18\
---------------------------------------------------------------------------
\18\ Healthy Kids, Healthy Communities: Supporting Community Action
to Prevent Childhood Obesity, Columbia, MO, http://
www.healthykidshealthycommunities.org/communities/columbia-mo (accessed
February 2010).
---------------------------------------------------------------------------
Baldwin Park, California knows that working only with health
advocates is not the answer. So this HKHC community has created a
``Smart Streets Task force' which is hosting workshops to discuss
walkability and mobility to downtown and increased opportunities for
exercise and healthy food access. Their target audience is broad:
parents, neighborhood watch leaders, childcare providers and county
commissioners in the areas of housing, planning and parks and
recreation.\19\
---------------------------------------------------------------------------
\19\ Healthy Kids, Healthy Communities: Supporting Community Action
to Prevent Childhood Obesity, Baldwin Park, CA, http://
www.healthykidshealthycommunities.org/communities/baldwin-park-ca
(accessed February 2010).
---------------------------------------------------------------------------
These are the stories of communities and government coming together
as a team to change their neighborhoods so children and families have
access to fresh fruits and vegetables and safe places to play.
Never have I seen such momentum to reverse this epidemic. I am
pleased that the First Lady has made this her signature issue and that
Federal agencies are already working together to develop a plan to
solve the problem of obesity among our Nation's children within a
generation. Congress is poised to reauthorize several key laws this
year and in the coming years, and States and local governments are
primed and ready to make change.
But because preventing childhood obesity requires change on many
levels, the Federal Government cannot do this alone. It will require
the help of many in both the public and private sectors.
Everyone has a role to play in helping to reverse the childhood
obesity epidemic.
School officials need to make quality physical education
and active recess a regular part of the school day, and ensure that the
foods and drinks they're providing in cafeterias and vending machines
are healthy and nutritious. Junk food doesn't belong in our schools.
Government leaders need to consider carefully how their
decisions affect children's activity levels and eating habits. That
means rethinking policies they might not associate with obesity
prevention--like zoning, which helps determine which businesses move
in, and school location and design, which affects whether students can
walk or bike to school.
The food and beverage industries should look closely at
the nutritional content of the products they offer, provide nutritional
information that's easy for parents and youths to find and understand,
and refrain from marketing unhealthy products to children.
Parents need to lead by example and create healthy
environments at home, so the television or computer isn't always on and
healthy foods are available. And they need to make it clear to
community leaders and elected officials that having access to
affordable healthy foods and safe places for their kids to play is
important to them, so these leaders are motivated to act.
I look forward to working with all of you, the leaders in your
States and in the towns where you come from to reverse this epidemic--
for the future of all our children and the future of this country.
The Chairman. Well, Dr. Thompson, thank you very, very
much.
Now, we turn to Mr. Mendenhall. And, Mr. Mendenhall, you
can establish your credentials right away with this committee
by being forthright and saying that the toughest games you ever
played were against the Hawkeyes at the University of Iowa.
[Laughter.]
The Big Ten--this is the Big Ten Offensive Player of the
Year, so I'm well aware of Mr. Mendenhall, believe me.
Welcome.
Mr. Mendenhall. Well, I'm not going to lie to Congress to
start off, so I'll just go into my speech.
[Laughter.]
STATEMENT OF RASHARD MENDENHALL, PITTSBURGH STEELERS RUNNING
BACK, NATIONAL FOOTBALL LEAGUE, PITTSBURGH, PA
Mr. Mendenhall. Chairman Harkin, Ranking Member Enzi, and
members of the committee. As stated, my name is Rashard
Mendenhall. I recently completed my second season as a running
back with the Pittsburgh Steelers. I appreciate the opportunity
to testify today on an issue of great importance to the
National Football League and to me personally, and that's the
epidemic of childhood obesity.
Launched in 2007, the NFL PLAY 60 campaign is a national
youth health and fitness campaign, focused on combating
childhood obesity by encouraging kids to be active for at least
60 minutes a day. NFL PLAY 60 builds on the League's
longstanding commitment to health and fitness. The NFL
recognized that childhood obesity is a great public health
crisis facing our Nation, and that the NFL has a unique ability
in our culture to influence attitudes and behaviors, especially
among young fans.
NFL PLAY 60 promotes the importance of getting 60 minutes
of physical activity per day. Kids are encouraged to find their
own ways to get active--whether it's taking advantage of the
local playground, playing four-square in the school yard, or
establishing a walking club with friends.
PLAY 60 presents organized sports, including youth
football, as a way to get active, but certainly not the only
way. The NFL doesn't necessarily ask kids to play football for
60 minutes a day; we simply just ask kids to play for 60
minutes.
The inception of PLAY 60 in 2007, the NFL has committed
more than $200 million in resources to youth health and fitness
through media time for public service announcements,
programming, and grants. Last year alone, more than 700 events
were hosted by all 32 NFL teams who implement PLAY 60 in their
local markets.
I am committed to supporting the NFL's goal of combating
childhood obesity. I see this epidemic around the country, in
our schools, and in my community, as well. As a professional
athlete, I feel I have a responsibility to be involved in this
issue. This is why I am active in PLAY 60 through the Fuel Up
to PLAY 60 program.
In January, I attended an event for the Fuel Up to PLAY 60
program at the Central Park East Middle School in Manhattan.
Fuel Up is a joint effort between the NFL, the U.S. Department
of Agriculture, and the National Dairy Council designed to
create healthier environments in schools.
Commissioner Roger Goodell, and Agriculture Secretary
Vilsack, a Steelers fan, attended, as well. Fuel Up currently
has a presence in 60,000 schools across the country. This
program empowers youth to make their schools healthier and to
develop lifelong healthy eating and physical activity habits.
I had a chance to interact with more than 100 kids in the
6th through 8th grades. Along with others in attendance, I
spoke to them about healthy living and staying active. I
described for kids what I did outside of football to maintain
my health--this is walking, riding a bike, dancing,
rollerskating and playing basketball. I also discussed all of
the sports, in addition to football, that I participated in,
and how important those were to me.
I also had the opportunity to participate in the PLAY 60
activity stations with the kids. We worked on football
activities as well as a number of running, climbing and agility
drills.
The facts surrounding childhood obesity are startling.
Nearly one in three children and teens in the U.S. are obese or
overweight. That's more than 23 million youth. And in the last
two decades, the rate of overweight children has doubled.
We know that youth who are overweight or obese are more
likely to have health risk factors associated to cardiovascular
disease, such as high blood pressure, high cholesterol, and
type 2 diabetes. In contrast, the benefits of good health
translate to the classroom, where studies show that fit
students are less likely to have disciplinary problems. Healthy
students also perform better on standardized tests.
It is possible that these facts, while troubling, should
not come as such a surprise. Schools around the country find it
challenging to offer physical education classes. Reports show
that 50 percent of schools do not provide physical education in
grades 1 through 5; 75 percent do not provide classes for
grades 6 through 8. This trend makes it even more difficult for
kids to learn the value of physical exercise.
Recently, the NFL has been honored to participate with
First Lady Michelle Obama on her Let's Move campaign. Just this
fall, representatives of the NFL were also proud to join the
President in filming a public service announcement supporting
PLAY 60 and President Obama's community service initiative. It
is exciting to see the White House and their commitment and
passion to this issue.
I am hopeful that the NFL's efforts complement the work of
the White House and the Congress in addressing this public
health crisis.
Mr. Chairman, I commend you on holding this hearing and
focusing congressional attention to this vital issue of public
health, and I look forward to answering any questions.
[The prepared statement of Mr. Mendenhall follows:]
Prepared Statement of Rashard Mendenhall
Chairman Harkin, Ranking Member Enzi, and members of the committee,
my name is Rashard Mendenhall. I recently completed my second season as
a running back with the Pittsburgh Steelers. I appreciate the
opportunity to testify today on an issue of great importance to the
National Football League, and to me personally--the epidemic of
childhood obesity.
Launched in 2007, the NFL PLAY 60 campaign is a national youth
health and fitness campaign focused on combating childhood obesity by
encouraging kids to be active for at least 60 minutes a day. Sixty
minutes is the physical activity recommendation of the Centers for
Disease Control and Prevention.
NFL PLAY 60 was designed to build on the league's long-standing
commitment to health and fitness. The NFL decided to focus on the issue
of childhood obesity because it recognized not only the public health
crisis facing our Nation, but also the NFL's unique place in our
culture and its ability to influence attitudes and behaviors--
especially among young fans.
NFL PLAY 60 promotes the importance and fun of getting 60 minutes
of physical activity per day. Kids are encouraged to find their own
ways to get active--whether it's taking advantage of the local
playground, playing four-square in the school yard, or establishing a
walking club with friends. PLAY 60 presents organized sports--including
youth football--as a great way to get active, but certainly not the
only way. The NFL does not necessarily ask kids to play football for 60
minutes a day. We simply ask kids to play for 60 minutes.
Since the inception of PLAY 60 in 2007, the NFL has committed more
than $200 million in resources to youth health and fitness through
media time for public service announcements, programming, and grants.
Last year alone, more than 700 events were hosted by all 32 NFL teams
who implement PLAY 60 in their local markets. NFL PLAY 60 is also
supported year round by many of the NFL's most prominent players,
including Drew Brees, Eli Manning, DeMarcus Ware, Jason Witten and my
teammates, Hines Ward and Troy Polamalu.
In January, the NFL hosted the Pro Bowl in South Florida. The NFL
asked all of its All Star players to fan out across the community on a
single day to complete youth health and wellness-oriented projects. The
NFL PLAY 60 Pro Bowl Community Blitz involved NFL Pro Bowl players
building playgrounds, hosting youth football clinics, and leading
healthy cooking demonstrations. This day is just one example of a year-
round effort--during the football season and in the off-season--to
promote youth health and activity.
I am committed to supporting the NFL's goal of combating childhood
obesity. I see this epidemic around the country, in our schools, and in
my community. As a professional athlete, I feel I have a responsibility
to be involved in this issue, which is why I am active in NFL PLAY 60
through the Fuel Up to PLAY 60 program.
In January, I attended an event for the Fuel Up to PLAY 60 program
at the Central Park East Middle School in Manhattan. Fuel Up is a joint
effort between the NFL, the U.S. Department of Agriculture and the
National Dairy Council designed to create healthier environments in
schools. Fuel Up currently has a presence in 60,000 schools across the
country. This program empowers youth to help make their schools
healthier and to develop life-long healthy eating and physical activity
habits. Agriculture Secretary Vilsack, NFL Commissioner Roger Goodell,
former Surgeon General Dr. David Satcher, and many others were in
attendance.
I had a chance to interact with more than 100 kids in the 6th
through 8th grades. Along with the others in attendance, I spoke to
them about healthy living and staying active. I described for the kids
what I did outside of football to maintain my health--dancing, roller
skating, and playing basketball. We also discussed all of the sports--
in addition to football--that I participated in as a kid and how
important that was to me.
I also had the opportunity to participate in the PLAY 60 activity
stations with the kids. We worked on football activities like learning
how to correctly throw a football, but also a number of running,
climbing and agility drills.
The facts surrounding childhood obesity are startling. Nearly one
in three children and teens in the United States are obese or
overweight. That is more than 23 million youth. In the last two
decades, the rate of overweight children has doubled.
We know that youth who are overweight or obese are more likely to
have health risk factors associated to cardiovascular disease such as
high blood pressure, high cholesterol, and type II diabetes. In
contrast, the benefits of good health translate to the classroom where
studies show that fit students are less likely to have disciplinary
problems. Healthy students also perform better on standardized tests.
It is possible that these facts, while shocking, should not come as
such a surprise when we consider that more than 60 percent of children
ages 9-13 do not participate in any organized physical activity during
non-school hours. The number of idle children is increasingly
significant when schools around the country find it challenging to
offer physical education classes. Sadly, 50 percent of the schools do
not provide physical education in grades 1-5; 75 percent do not provide
classes for grades 6-8.
Recently, the NFL has been honored to participate with First Lady
Michelle Obama on her Let's Move campaign. Just this fall,
representatives of the NFL were also proud to join the President in
filming a public service announcement supporting PLAY 60 and President
Obama's community service initiative. It is exciting to see the White
House add their commitment and passion to this issue.
I am hopeful that the NFL's efforts complement the work of the
White House and the Congress in addressing this public health crisis. I
have attached to my testimony descriptions of some of the programs the
NFL supports in its PLAY 60 initiative.
Mr. Chairman, I commend you on holding this hearing and focusing
congressional attention on this vital issue of public health. I look
forward to working with you and members of the committee and look
forward to answering your questions.
Key NFL PLAY 60 programs are outlined below:
NFL PLAY 60 Challenge is the NFL PLAY 60 in-school curriculum,
created in partnership with the American Heart Association. The NFL
PLAY 60 Challenge teaches educators and children to integrate health
and fitness into daily classroom lessons. The NFL PLAY 60 Challenge
provides 50 short activities that teachers can weave in throughout the
school day and kids can implement at home.
NFL Take a Player to School allows kids to bring the ultimate
``show-and-tell'' to their classrooms each year. Lucky students in 34
cities nationwide win the chance to arrive at school with an NFL player
and to design the Ultimate NFL Gym Class with that player. Together,
the NFL player and the winning student lead classmates in fitness
activities and talk about the importance of good health and smart food
choices.
Mini ReCharge! is a youth fitness program produced by the NFL and
Action for Healthy Kids. Packed with action and loaded with fun, Mini
ReCharge! kits are full of activities designed to get kids on their
feet and energized. The kits are distributed nationwide to schools,
after-school programs, and local community groups.
Fuel Up to Play 60 is an NFL and National Dairy Council program
that supports student-fueled efforts to bring about healthy changes
within their schools. This program shows student teams how they can
responsibly and effectively engage key school and community leaders to
create healthy school environments.
Keep Gym In School is the NFL Network's PLAY 60 program, working
with Verizon Fios, Comcast and Cox Cable to adopt and deliver high
quality, daily physical education opportunities to schools in four
school districts across the United States. Keep Gym In School provides
support as needed to upgrade facilities, hire certified Physical
Education instructors, and supply equipment for Physical Education
classes. In addition, schools nationwide can compete for 10 $1,000
grants to support physical education in their school.
The NFL PLAY 60 Super Bowl Contest allows young fans to explain how
staying active helps them live better lives. One lucky child who
submits a short essay about the role of health and fitness in his/her
life will win the ultimate prize--a chance to run on field with the
game ball and hand it to the referee in front of millions right before
kickoff at Super Bowl.
NFL Flag Football, NFL Punt, Pass and Kick, and the NFL Girls Flag
Football Leadership Program encourage all young fans to be active and
fit. In addition to these year-round programs, special NFL PLAY 60
Youth Football Festivals during major events such as the Draft,
Kickoff, Super Bowl and Pro Bowl allow thousands of children to get
active alongside NFL superstars. Kids in underserved areas of NFL
markets also get the chance to engage in PLAY 60 activities through new
and refurbished fields, courtesy of the NFL Grassroots field grant
program.
Hometown Huddle is the NFL's annual league-wide day of service held
in October in partnership with United Way. All 32 teams--including
players, coaches, owners and staff--host a service project in their
local community. Since 2007, these projects have reflected the NFL's
commitment to getting kids active and healthy; teams use this day to
build playgrounds, refurbish gymnasiums and teach kids about the
importance of healthy living.
All 32 NFL teams are heavily engaged in PLAY 60. Players make
school visits to talk about the importance of health, host youth
fitness events, construct youth fitness zones, and film public service
announcements. Whatever forms the community outreach may take, the
message is the same: NFL teams and their players know the importance of
youth health and fitness.
The Chairman. Well, thank you very much, Mr. Mendenhall.
Thank you all for your testimonies and for your involvement
in various aspects of this national issue of obesity.
Mr. Mendenhall, I'll just, if I can, start with you. First
of all, let me commend you for your involvement in PLAY 60. I'm
familiar with--I was with a group of them, about a year ago, at
an event we had here in Washington. Let's face it, kids look up
to you and people like you who have been successful and are
extremely good at what you do. How do we get more sports
figures involved in this? I mean, let's face it, there's just
not a lot of them doing what you're doing. How do we get more
involved in this? They could be a great example to our kids.
Mr. Mendenhall. I think, with the NFL PLAY 60, it's pretty
new, it's fairly new. A few years ago, I really hadn't heard
much about it, but, as time has gone on, it's starting to pick
up more and more, and more people are getting involved. I feel
as that goes along, it'll start to spread into other sports,
because we are recognizable figures. For kids just to see our
face and our jersey; they see us on TV all of the time. I'm
pretty sure not too many kids are watching C-SPAN, so it's a
lot harder for you guys.
[Laughter.]
But, I think, as this is becoming more of an issue, it's
starting to pick up. With us and other sports, and just in the
country as a whole.
The Chairman. Yes. We've just got to get more sports
figures like you involved in this.
The second thing is, I think it's important, again, to send
a signal to kids that not everyone can be a Rashard Mendenhall.
Let's face it, you are a unique individual. As Senator Enzi was
saying--and when I was younger, some sports I just wasn't very
good at. No matter how hard I tried, I wasn't. But maybe there
was something else I could do. So, I think it's important to
tell kids, they don't have to be a running back but, they can
do other things, just to be active. And that's why we need
athletes like you to be talking about other things they can do.
Mr. Mendenhall. Yes, I think it's very important that kids
understand that it's not just about playing sports, it's about
doing what you're interested in, whatever that is, whether
that's jumping rope or even--with me, something I'm personally
interested in a lot is dancing. And I've taken numerous dance
classes as a way to move myself. I've actually taught a couple
of dance classes to high schools in my area and things like
that. So, I think, as far as physical exercises, you're doing
what you enjoy.
And with the food, too--even when I was younger, I didn't
like vegetables, and when somebody tells you to eat healthy,
they kind of force, ``Oh, you should eat celery,'' and this and
that. And I don't think it's as much as finding things that you
like and enjoy. You know, I mean, you can find fruits or yogurt
or something that you enjoy, and I think it's just pushing that
to kids, where it's not forcing you to eat something, but just
finding a way to do something that you like.
The Chairman. Well, I appreciate your involvement and I
look forward to working with you and the NFL more on this.
Dr. Hassink--and Dr. Thompson didn't talk too much about
it, but there was a lot in your written testimony that I read
last night about the disparities that are happening out there.
There's rural, there's urban, Hispanic Americans, African-
American kids, upper-middle income, low income--cutting across
all racial and ethnic lines. There seems to be kind of a
hodgepodge out there. How do we get a handle on this, in terms
of who is at the most risk? I see these Hispanic Americans seem
to be at the most risk as young people. And how do we get at
the root causes of this, and how do we get the parents
involved, you know? The Hispanic American community, for
example, the African-American community--how do we get them
involved at an early time on this?
Dr. Hassink. Well, a couple of things. When the Expert
Committee on Obesity wrote the recommendations, they really
considered all children at risk so that preventative efforts
should go across the board, across all populations. I think if
you look at each child, even, each child and family have their
own constellation of risk factors, and then you expand that
out, and there are groups that have their own risk factors, and
I think we're starting to really understand, in what
environment is that family and child, or is that ethnic group
living? Are they living in a food desert? Did they have good
prenatal care? Was their mother healthy during the pregnancy?
Are we communicating effectively?
That little 2-year-old that came in to see me, the mom
wanted somebody to talk to. What I didn't say is, the mom
didn't speak English, so I had my translator with me and could
talk to her at length about her concerns about her child. But,
she'd been looking for a place to have that discussion. So, we
have to understand what some of the barriers are to people who
really want to have healthy children.
I think it's understanding that model of the child and
family in the wider community and environment, and what the
forces are acting upon them. And they'll be different, but
there are similarities that we can start to tease apart and
understand.
Dr. Thompson. Senator, there's no question that lower-
income communities and communities of color have been
disproportionally affected by this epidemic. And if you think
about the causes that we talked about, they have been greater
in contributing in those communities that are lower income and
communities of color, and isolated geographically. So, it's not
surprising that they have more burden. It's not because the
parents made poorer choices, it's that the environment within
which those families have grown up is more hostile to the
health of the family.
So, I think as you--and at the State level and local
level--look for solutions, we need to disproportionally invest
in those communities that have been more affected, and make
sure that we're bringing everyone along as we address the
epidemic.
The Chairman. Thank you very much, that's sort of what I
was getting at.
Thank you, Dr. Thompson.
Senator Enzi.
Senator Enzi. Thank you, Mr. Chairman.
This panel's been extremely helpful. And I, too, will start
with the football player, because I really appreciate your
comments and the program and especially the emphasis you're
placing on dancing. There are so many ways out there of having
physical activity that kids kind of shy away from. And part of
what I think we do with the obesity conversation is embarrass
some kids, too. And there's nothing worse than embarrassing
anybody; they will never forgive you.
I had a son that was 6-foot-6 in junior high, and the coach
said that he tripped over the free-throw line. But, he worked
with him, anyway, and he grew to 6-foot-8, and he wound up
playing a little basketball for the University of Wyoming. So,
some kids develop later, and it takes some patience with people
to really get them to that point.
Are you finding the NFL program to be very transferable to
others? And what percentage of the kids would you say are doing
something besides football?
Mr. Mendenhall. I would say I feel like it's very
productive, because when you're wearing your jersey and you
walk into a kid's school, it leaves a lasting impact on them.
When you tell them that you enjoy, eating healthy, you enjoy
the feeling of being active, I feel like that kind of sticks.
And, when you tell them things you do outside of sports,
because--and, too, it's a topic not just for the young boys,
but young girls, too, who don't play sports. I think when you
tell them other things that you like to do, and that there's
other things you can do, I think that kind of sticks a little
more, just you being recognizable.
So, as far as a percentage, I don't know, you know
everybody seems excited when you're there. But, I really do
think it sticks.
Senator Enzi. I think it is a good program. There's a kid
from Wyoming on the practice squad for the Redskins, Clint
Oldenburg, and my daughter, who is a teacher, talked him into
calling and talking to the class about what it was like to be
in the NFL and what sorts of things they ought to be doing if
they're interested in any kind of professional sports. And it
had more of a lasting impact on them than anything that she
ever tried. So, I really appreciate what you're doing, and I do
think it makes a tremendous impact, and particularly when
leaders like you are involved in it.
Mr. Thompson, you did some studying on this urban-versus-
rural. How is the Center for Childhood Obesity using this data
to be sure that they're targeting the communities with the
greatest need?
Dr. Thompson. Well, one of the things that we've identified
is, anywhere that you've got isolation--it can be geographic
isolation in rural communities, where there really is not a
grocery store, there's not a food source, as we heard earlier.
The school may have been located on the opposite side of the
highway from where the neighborhood is, so that the built
environment is not conducive to being able to walk to school
anymore. And then, in our inner-city urban areas, where we've
had economic blight and lost some of the resources, in terms of
food availability, grocery stores and so forth, we're trying to
invest in people, in programs, in policy change so that we
reinforce the reclaim of those areas, looking at ways that we
can stimulate local food produce, that we get farm-to-school
initiatives back in place, that we stimulate farmers' markets,
that we help local growers be able to put electronic debit card
capabilities so that we can use the Supplemental Nutrition
Assistance Program, Food Stamp Program, for lower income folks.
We have programs in communities across the Nation that are
really taking on new, innovative strategies--Safe Routes to
School is an important program, the Complete Streets Program--
we've looked at the Alliance for a Healthier Generation, that
Dr. Hassink mentioned, trying to get schools to challenge, to
have healthier options in their cafeteria and integrate
physical activity back into their daily set of activities.
These are all programs across the Nation that are going
on--innovative, coming from the grassroots up--and if we, at
the State level, can help reinforce and support, and, at the
Federal level, take the opportunities that you're going to have
forthcoming, we could really make a big difference on this
childhood obesity epidemic.
Senator Enzi. Well, I appreciate the work that both you and
Dr. Hassink are doing.
I was a speaker at Buffalo High School graduation, and the
thing that really struck me was, out of all of the graduates
there, there were none that were obese. And it's an aberration
in Wyoming, and I have no idea why that is. So, I appreciate
that somebody is studying these things and finding them out.
Dr. Hassink, have there been some studies that show whether
there's a relationship between whether the parents are obese
and the kids are then obese? I know, in math classes, that
there are parents that did badly in math, and they allow their
kids, then, to be bad in math by saying, ``Well, you've
inherited it, so you don't stand a chance, you're going to be
bad in math, too.'' But that's easy to overcome. Can that be
overcome in the obesity thing, as well?
Dr. Hassink. Yes, it can be. I think that children who are
in families that have obesity are more predisposed, and we
often say that, you know, genetics and heredity are the
predisposition, but the environment is often the trigger for
the predisposition. And I think that's why we've seen the
epidemic grow so rapidly in the last 25 years. The family
genetics haven't changed as much as the environment has.
So, parents who have this in their family need to be aware
of the same things everybody does, and be vigilant about the
environments that are in the home and in the community and in
the schools--to help their children. I think it can be
overcome. It takes some support to help those families. And in
communities like our Native American population, where obesity
is just incredibly prevalent, that's an example of populations
that originated in situations of scarcity, moved into a
situation of abundance, developed obesity. It's heritable, it's
environmental, and we have to pay attention to that risk, among
the other risks, and help those environments get healthier, to
support what those parents need to do for their children.
So, I think we have predisposition, and the environment
tends to trigger it off.
Dr. Thompson. Senator Enzi, if I could add, you know,
there's never a stronger advocate for a child than the parent.
And I think one of the things that we have failed to do is
raise awareness and offer support. One of the things we tried
to do in our State is wrap everything we were doing around
families to give that support and to make the environment not
be as hostile. And parents really pick that up. In the first
years when we were giving the health report, I saw, in front of
my house, a mom with three teenaged boys on a forced march. And
the third day that I saw them, I stopped her, and I said,
``Well, what was the trigger?'' And she goes, ``Well, my mom
died of diabetes, I've got a touch of diabetes, and my son got
a health report that said he might get it in the future, and
we're not going to have that happen.'' So, wrapping support
around parents really can make a huge difference.
Mr. Mendenhall. And speaking from a young generation, to
kind of add to the environment--I think, it was brought up
earlier--a real big part of this epidemic, I think, is
technology--the Internet and cell phones--because when I was
younger, none of that was around, and to even see your friends,
you had to go outside, you had to go to the park, you had to
run or ride your bike to somebody's house to see if they were
home and to try and find them. So, I think everything's so
accessible at home, with the social networks and with cell
phones and with things of that nature, where you really kind of
don't have to leave. And in order to see my friends, you kind
of had to leave.
And when you acted up, when you didn't do good in school,
your mama grounded you. You had to be in your room, where there
wasn't a TV, there wasn't anything in there. So, it's a lot
easier to be home now, and tougher to go outside, that's what
I'm saying.
Senator Enzi. Yes, a lot of families only had one TV, too,
so they even had to negotiate that time.
You three have been, just, a tremendous resource, and I
hope we can continue to call on you and--as I came in, I
noticed that there were a whole bunch of television people out
there, so I was, ``Oh yes, Pittsburgh Steelers.''
[Laughter.]
I appreciate your C-SPAN comment, you probably increased
the viewership today.
[Laughter.]
Thank you, Mr. Chairman.
The Chairman. Senator Enzi.
I don't have any followup--just again, I hope that we can
call upon you as we move forward. As I said, this is the first
of a series of hearings; we've just started this. The First
Lady--we had a meeting, we were all down at the White House to
meet with the First Lady--twice, as a matter of fact--on this
issue, and she has really taken this on. That gives us a nice
bully pulpit. She's really committed to this and with the
Surgeon General, I think we can really start to make some
differences here.
Now we have the Child Nutrition Reauthorization bill coming
up. I mentioned the Elementary and Secondary Education Act.
And, as you pointed out, Dr. Thompson--I think it was you--that
there's a lot of things happening in communities around the
country, there are all isolated kinds of things going on in
different places.
You don't mind coming back to Iowa sometime, Mr.
Mendenhall--in a nicer capacity than what you have in the past,
and more gentle capacity. We have a high school that is just
doing great stuff in Iowa. In Grundy Center, IA--I had Arnie
Duncan out there to look at it--every kid, when they come
into--not just high school, grade school--when they first enter
grade school, they get measured--BMI, weight, blood pressure,
all of that kind of stuff. And they're tracked all the way
through grade school and high school. And every kid has to
exercise. Every kid. Even kids with disabilities have to
exercise. So, they fit the program around individual kids. And
it's amazing what they have done there, and they have
incorporated it into their school system. The parents are
supportive, the community has been supportive of it. If that
can happen in a little town like Grundy Center, IA, it can
happen anywhere. But, it takes some leadership to do this.
My point is that there's little things like this happening
all over the country, so we've got to find these and put them
together in a network, and take their expertise and try to get
it out to the rest of the country. And, you know, again, we
need support from this government, local governments. School
boards need to be involved in this.
I'm just saying that, as we move ahead, all of you--each of
you, in your own capacity, can be very helpful in helping us
think about what we do, how we do it, helpful to the First Lady
in terms of her efforts and what she's doing.
I hope that we can continue to consult with each of you and
have you involved in this effort.
Dr. Thompson. I look forward to being here.
The Chairman. You bet.
Thank you all very, very much. Any last things before we
leave?
Dr. Thompson. I think the only thing I would add is, this
is an epidemic, it is a real threat. It's not, kind of, on the
margin.
The Chairman. Yes.
Dr. Thompson. And if we can encourage and support you, and
others, to think about health in all policies, we'll reverse
this epidemic and we'll safeguard the future of our children.
The Chairman. It's just like you said, no parent wants
their kid to be educated and unhealthy, or healthy and
uneducated. Parents want both of those things. And we've got to
do everything we can to help parents meet that goal.
Mr. Mendenhall. I think, with what you were saying earlier,
and in that school, at the end of the day we're just trying to
encourage kids to do what they naturally want to do, and that's
just play.
The Chairman. That's right. That's right.
Mr. Mendenhall. I think we've kind of gotten away from that
with--well, for numerous reasons--but just encouraging kids to
play, I'm sure they really want to.
The Chairman. Right. We need more parks, more playgrounds,
more recreational--supervised, safe--things like that.
Yes?
Dr. Hassink. I don't think there's anything more important
to any parent or any community or any country as the health of
its children. Nothing more important. That's our future.
The Chairman. Yes.
Dr. Hassink. I think that it's wonderful to get together
and to start this effort, all together, to really reinforce
that value, that they're important. That's our future.
The Chairman. Good note on which to end.
Thank you again, everyone.
The committee will stand adjourned.
[Additional material follows.]
ADDITIONAL MATERIAL
Prepared Statement of Senator Murray
Chairman Harkin, Ranking Member Enzi, and members of the
committee, thank you for holding today's hearing on childhood
obesity.
Like many Senators I am extremely concerned about the
raising rates of childhood obesity. Over the past three
decades, childhood obesity rates in the United States have
tripled, and today, one in three children in America are
overweight or obese. While the committee will soon reauthorize
the Child Nutrition Act, which will provide us with an
opportunity to improve the nutritional content of meals served
through the Head Start and school lunch programs, I believe we
must do more. Nutrition and diet can make a big impact on
decreasing obesity, but children's physical activity must be
increased in order to help combat childhood obesity. Research
shows that children need 60 minutes of active and vigorous play
every day to grow to a healthy weight, but only a third of high
school students get the recommended levels of physical
activity.
I applaud the recent creation of the Presidential Task
Force on Childhood Obesity and Let's Move program. For several
consecutive Congresses, Senator Snowe and I have introduced the
High School Sports Information Collection Act (S. 471). I
believe the enactment of this bill would help decrease
childhood obesity by helping to ensure that schools are
providing all their students with equal opportunities to
benefit from school sports programs. This bipartisan
legislation would require high schools to collect athletic
participation rates broken down by gender, race, and ethnicity
and expenses per team; this data would then be reported to the
Department of Education. Much of this information is already
collected by schools, but is not publicly available. Equitable
athletics opportunities will also impact more than childhood
obesity; statistics have shown that girls thrive when they
participate in sports and are less likely to get pregnant, drop
out of school, do drugs, smoke, or develop mental illness.
In addition to undermining children's health, obesity is
expensive to a nation that already has spiraling health care
costs. A recent study put the health care costs of obesity-
related diseases at $147 billion per year, but it doesn't have
to be that way. The New York Times recently highlighted
research that found that the ``increase in girls' athletic
participation caused by title IX was associated with a 7
percent lower risk of obesity 20 to 25 years later, when women
were in their late 30s and early 40s.'' The study notes that
while a 7 percent decline in obesity is modest, ``no other
public health program can claim similar success.'' Simply put,
properly enforcing title IX and increasing children's physical
activity can lower obesity risks even into adulthood.
Unfortunately, girls are currently losing out on athletic
opportunities. While girls comprise half of the high school
population, they receive only 41 percent of all athletic
participation opportunities--1.3 million fewer participation
opportunities than male high school athletes. In my home State
of Washington, over 82,000 boys played high school athletics
while only 58,000 girls play at the high school level. The High
School Sports Information Collection Act can help close this
gap by increasing awareness of disparities and encouraging
schools to improve athletics for girls.
The importance of reporting data required under the
legislation gets at the heart of title IX enforcement. Women
are now actively participating in collegiate sports in large
part due to the accountability requirements provided under the
Equity in Athletics Disclosure Act of 1994. This law requires
colleges and universities to account for how their athletics
opportunities, resources, and dollars were allocated among male
and female athletes. This reporting requirement is, in large
part, the reason behind the narrowing of the athletics gap at
the college level. While women's athletics continue to lag
behind men both in opportunities to participate and in dollars
spent, women's athletic participation at the college level has
increased by 403 percent since 1971, proving that interest
follows opportunity.
It has been a significant obstacle to equitable
participation in sports that no such accountability requirement
exists at the high school level. While colleges must be
transparent about their athletic opportunity and funding, high
schools are not required to report opportunity and funding
statistics to any higher authority. As a result, high school
girls are being deprived of the critical opportunity to play
sports.
Chairman Harkin and Ranking Member Enzi, I am so glad that
you called this hearing today to examine the daunting problem
of childhood obesity. As we continue to consider this issue
during the 111th Congress, I look forward to the High School
Sports Information Collection Act serving as a part of the
solution.
Thank you for the opportunity to submit my statement.
Prepared Statement of Senator Casey
Mr. Chairman, thank you for leading today's hearing on the
childhood obesity epidemic. This is the first step in an
ongoing discussion of one of the most serious health challenges
facing our Nation today.
We all know the statistics on overweight and obesity: two
out of every three Americans are overweight or obese, and 20 to
30 percent of children are overweight. The prognosis for these
children is grim: 80 percent of overweight 10- to 15-year-olds
are obese by the time they turn 25.
The cost of overweight and obesity is another reason to
address this crisis: we spend almost 10 percent of our health
care dollars treating people who are overweight or obese. The
indirect costs of obesity are much higher, resulting in lost
income due to decreased productivity, restricted activity,
absenteeism and premature death.
Going forward, we must think about the tools that parents
and families need to help our children become and stay healthy.
We need to think creatively about healthy food and exercise,
and how we can remove the barriers that families face to
providing nutritious food and encouraging physical activity.
Congress has already begun addressing the issue of
childhood obesity. I also sit on the Agriculture, Nutrition and
Forestry committee, which will soon reauthorize the Child
Nutrition Act and will have the opportunity to positively
impact the nutritional quality of school meals. The Institute
of Medicine's research-based recommendations for new
nutritional requirements include setting limits on calories and
sodium, requiring more whole grains and vegetables, and
limiting milk to low-fat and skim varieties.
Our children deserve the whole grains and green vegetables
needed to develop healthy minds and bodies. I am a co-sponsor
of Chairman Harkin's bill, the ``Child Nutrition Promotion and
School Lunch Protection Act'' because establishing nutrition
standards for a la carte food items will enable children buying
cafeteria lunch or choosing a vending machine snack to know
they are making a healthy choice. Feeding our children healthy
food is a priority and must be funded as such.
I am pleased today to welcome Rashard Mendenhall, a running
back with the Pittsburgh Steelers, who has joined us today to
talk about the NFL's outreach activities to children and the
role the NFL can play in helping to address the obesity
epidemic.
I look forward to the testimony from our other witnesses as
well, as we come together to develop a strategy to confront
this critical issue facing our children and our Nation.
Prepared Statement of Senator Hagan
I would like to thank Chairman Harkin for holding this
hearing today. I would also like to thank the Surgeon General
and our other witnesses for coming before our committee.
The childhood obesity epidemic in this country is shocking.
It is unfathomable that we have regressed so much in just 30
years; and the ramifications of this epidemic will affect our
society for several generations.
In North Carolina, 34 percent of children ages 10 to 17 are
either obese or overweight. Studies show that children who are
obese tend to become adults who are obese. Obesity leads to
heart disease, diabetes, and a whole host of other health-
related problems which result in premature death.
And each year, this epidemic costs our society billions of
dollars. In North Carolina alone, the Centers for Disease
Control estimates that obesity-related expenses add up to more
than $2.1 billion each year.
Because of this alarming trend, a few years ago, North
Carolina took some drastic steps to try to curb childhood
obesity. Specifically, the State adopted three proposals.
The first was that the State Board of Education
voted unanimously to adopt a daily 30-minute physical activity
requirement for all students, K-8. North Carolina was the first
State in the Nation to pass such a policy at the State Board
level and began being implemented in the 2006-7 school year.
Over 29,000 North Carolina K-8 public school teachers have been
trained in how to provide healthier, more active classrooms.
The North Carolina State legislature also
established a statewide nutrition standard for all school
meals, a la carte items, beverages and the After School Snack
Program in elementary, middle and high schools. The standards
decreased foods high in total fat, trans fat, saturated fat and
sugar; while increasing foods containing fruits, vegetables and
whole grain products.
Finally, the State legislature banned soft drink
and snack vending sales in elementary schools altogether;
Prohibited sale of sugared carbonated beverages in middle
schools; Restricted sale of soft drinks in high schools to no
more than 50 percent of drinks offered; and required that by
the 2006-7 school year, 75 percent of snacks in middle and high
schools have no more than 200 calories per package. Not only
has this effort had a positive impact on North Carolina, but
this initiative prompted similar efforts nationwide.
North Carolina is also testing innovative ways to improve
nutrition in children. We have a pilot program called IN4Kids
that is integrating registered dietitians (RDs) who provide
nutrition counseling in eight primary care practices. Duke is
managing this pilot, but we have buy-in and participation with
all 4 major medical schools in North Carolina.
With so much of our youths' future at stake, addressing
childhood obesity is something very important to me. I think
North Carolina is attempting some very creative solutions to
address the problems of diet, exercise, and community
empowerment.
I encourage folks to take a look at what North Carolina is
doing.
I'm also interested to hear about other solutions today,
because I don't believe this is a one-size-fits-all solution.
Thank you.
Prepared Statement of Senator Franken
Thank you, Mr. Chairman, for holding this hearing on an
issue that's critical to the health of our Nation, and our
economy. We're going to hear a whole lot of scary statistics
today. Many of them are mind boggling. All of them are
important. And all the numbers distill down to two key facts:
our kids are eating more and moving less. It's a simple
formula--and fortunately, one we can change.
There are many reasons kids are eating more and moving
less--more access to unhealthy foods and less access to healthy
foods, more time in front of the TV and less physical
education, more concerns about public safety and less kids
riding bikes in their neighborhoods.
The reality is that our investments in public health are
not what they should be. We should fully fund programs like
CDC's Healthier Communities, which has supported nine Minnesota
communities to be healthier through things like walking clubs,
cooking classes, and farmer's markets.
I'm very proud that in Minnesota--even in these tough
times--the State legislature invested $47 million in the
Statewide Health Improvement Program--also known as SHIP. SHIP
reaches 87 counties and eight tribal governments to improve
Minnesotans' health by thinking upstream--recognizing that
health begins with healthy behavior and communities.
There are many anti-obesity efforts taking place across
Minnesota. Cate Bellevue at Cass Lake Bena Elementary has a
kids-led Healthy Kids Club after school, so students can get
nutrition education and go snow-shoeing and skating. These are
winter-friendly activities that we need in Minnesota.
Another example is Karen Blanchard, a Registered Dietician
who works with teens at North High School in Minneapolis to
teach them healthier alternatives like baked chicken instead of
fried chicken, and how to control portions.
My point with these examples is to show that it's important
for any national anti-obesity strategy to include community-
based initiatives. Because even though food is part of the
obesity equation, food is also a vital part of our lives and
cultures. In Minnesota we are proud to be home to many diverse
communities--Scandinavian, American Indian, Hmong, Somali,
Ethiopian, Vietnamese, Tibetan, and many others. So as we move
``upstream'' to address childhood obesity at its source, we
need to make sure we incorporate culturally specific elements
in all of our programs. Thank you.
The Surgeon General's Vision for a Healthy and Fit Nation (Fact Sheet)
Today's epidemic of overweight and obesity threatens the historic
progress we have made in increasing American's quality and years of
healthy life. The hard facts:
Two-thirds of adults and nearly one in three children are
overweight or obese.
Seventy percent of American Indian/Alaskan Native adults
are overweight or obese.
The prevalence of obesity in the United States more than
doubled (from 15 percent to 34 percent) among adults and more than
tripled (from 5 percent to 17 percent) among children and adolescents
from 1980 to 2008.
An obese teenager has over a 70 percent greater risk of
becoming an obese adult.
Obesity is more common among non-Hispanic black teenagers
(29 percent) than Hispanic teenagers (17.5 percent) or non-Hispanic
white teenagers (14.5 percent).
To stop the obesity epidemic in this country, we must remember that
Americans will be more likely to change their behavior if they have a
meaningful reward--something more than just reaching a certain weight
or dress size. The real reward has to be something that people can feel
and enjoy and celebrate. That reward is invigorating, energizing,
joyous health. It is a level of health that allows people to embrace
each day and live their lives to the fullest--without disease,
disability, or lost productivity. To be a nation that is Healthy and
Fit.
Key actions outlined in The Surgeon General's Vision for a Healthy
and Fit Nation include:
Individual Healthy Choices and Healthy Home Environments. Change
starts with the individual choices Americans make each day for
themselves, their families and those around them. To help achieve and
maintain a healthy lifestyle, Americans of all ages should: reduce
consumption of sodas and juices with added sugars; eat more fruits,
vegetables, whole grains, and lean proteins; drink more water and
choose low-fat or non-fat dairy products; limit television time to no
more than 2 hours per day; and be more physically active.
Creating Healthy Child Care Settings. It is estimated that over 12
million children ages 0-6 years receive some form of child care on a
regular basis from someone other than their parents. Child care
programs should identify and implement approaches that reflect expert
recommendations on physical activity, screen time limitations, good
nutrition, and healthy sleep practices. Parents should talk with their
child care providers about changes to promote their children's health.
Creating Healthy Schools. Each school day provides multiple
opportunities for students to learn about health and practice healthy
behaviors such as regular physical activity and good nutrition. To help
students develop life-long healthy habits, schools should provide
appealing healthy food options including fresh fruits and vegetables,
whole grains, water and low-fat or non-fat beverages. School systems
should also require daily physical education for students allowing 150
minutes per week for elementary schools and 225 minutes per week for
secondary schools.
Creating Healthy Work Sites. The majority of the 140 million men
and women who are employed in the United States spend a significant
amount of time each week at their work site. Because obesity reduces
worker productivity and increases health care costs, employers are
becoming more aware of the need to help promote health within the
workplace. Employers can implement wellness programs that promote
healthy eating in cafeterias, encourage physical activity through group
classes and stairwell programs and create incentives for employees to
participate.
Mobilizing the Medical Community. Doctors and other health care
providers are often the most trusted source of health information and
are powerful role models for healthy lifestyle habits. Medical care
providers must make it a priority to teach their patients about the
importance of good health. When discussing patients' Body Mass Index
(BMI), providers should explain the connection between BMI and
increased risk for disease and, when appropriate, refer patients to
resources that will help them meet their physical, nutritional, and
psychological needs.
Improving Our Communities. Americans need to live and work in
environments that help them practice healthy behaviors. Neighborhoods
and communities should become actively involved in creating healthier
environments. Communities should consider the geographic availability
of their supermarkets, improving resident's access to outdoor
recreational facilities, limiting advertisements of less healthy foods
and beverages, building and enhancing infrastructures to support more
walking and bicycling, and improving the safety of neighborhoods to
facilitate outdoor physical activity.
[Whereupon, at 11:40 a.m., the hearing was adjourned.]