[Senate Hearing 119-40]
[From the U.S. Government Publishing Office]
S. Hrg. 119-40
OPTIMIZING LONGEVITY:
FROM RESEARCH TO ACTION
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
FEBRUARY 12, 2025
__________
Serial No. 119-03
Printed for the use of the Special Committee on Aging
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
59-971 PDF WASHINGTON : 2025
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SPECIAL COMMITTEE ON AGING
RICK SCOTT, Florida, Chairman
DAVE McCORMICK, Pennsylvania KIRSTEN E. GILLIBRAND, New York
JIM JUSTICE, West Virginia ELIZABETH WARREN, Massachusetts
TOMMY TUBERVILLE, Alabama MARK KELLY, Arizona
RON JOHNSON, Wisconsin RAPHAEL WARNOCK, Georgia
ASHLEY MOODY, Florida ANDY KIM, New Jersey
JON HUSTED, Ohio ANGELA ALSOBROOKS, Maryland
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McKinley Lewis, Majority Staff Director
Claire Descamps, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator Rick Scott, Chairman................ 1
Opening Statement of Senator Kirsten E. Gillibrand, Ranking
Member......................................................... 2
PANEL OF WITNESSES
Dr. Rhonda Patrick, Ph.D., Founder, FoundMyFitness, San Diego,
California..................................................... 3
Dr. Eric Verdin, MD, President, and CEO Buck Institute for
Research on Aging, Novato, California.......................... 5
Dr. Sarah C. Nosal, MD, FAAFP, Physician, President-Elect,
American Academy of Family Physicians New York, New York....... 7
Dan Buettner, Founder, Blue Zones Miami, Florida................. 12
APPENDIX
Prepared Witness Statements
Dr. Rhonda Patrick, Ph.D., Founder, FoundMyFitness, San Diego,
California..................................................... 29
Dr. Eric Verdin, MD, President, and CEO Buck Institute for
Research on Aging, Novato, California.......................... 31
Dr. Sarah C. Nosal, MD, FAAFP, Physician, President-Elect,
American Academy of Family Physicians New York, New York....... 33
Dan Buettner, Founder, Blue Zones Miami, Florida................. 39
Questions for the Record
Dr. Eric Verdin, MD, President, and CEO Buck Institute for
Research on Aging, Novato, California.......................... 43
Dr. Sarah C. Nosal, MD, FAAFP, Physician, President-Elect,
American Academy of Family Physicians New York, New York....... 45
Statements for the Record
James C. Appleby Testimony....................................... 49
The Alzheimer's Association & Alzheimer's Impact Movement
Testimony...................................................... 51
Dr. George C. Shapiro Testimony.................................. 54
OPTIMIZING LONGEVITY:
FROM RESEARCH TO ACTION
----------
Wednesday, February 12, 2025
U.S. Senate
Special Committee on Aging
Washington, DC.
The Committee met, pursuant to notice, at 3:34 p.m., Room
106, Dirksen Senate Office Building, Hon. Rick Scott, Chairman
of the Committee, presiding.
Present: Senator Scott, McCormick, Justice, Johnson, Moody,
Husted, Gillibrand, and Alsobrooks.
OPENING STATEMENT OF SENATOR RICK SCOTT, CHAIRMAN
The Chairman. The Senate Special Committee on Aging will
now come to order. I want to thank all of you for being here
today. Every member of this Committee is a parent, and most of
us, well, some of us are grandparents, I'm a grandparent and
living a long and healthy life is something that is very
important to me, and I'm sure to all of our members on this
Committee, but having more time with our loved ones is only
half the issue.
My hope is your focus on today is extending not just our
lifespans, but the number of years we live but also our health
spans; the number of years we live free of disease or
disability. I'm trying to make sure I have none of those.
It's no secret that we're facing significant health issues
in our country. Americans are plagued by preventable chronic
diseases, cancers, and other illnesses, and these are, not all
of them, but many of them are preventable. Heart disease,
cancer, diabetes are the leading causes of death and disability
in the United States. It's a massive problem. Six in ten
Americans have at least one chronic disease, and four in 10
have two or more chronic diseases according to CDC.
Here's the good news, healthy life choices can mitigate, in
some cases, completely prevent these illnesses, and if you
start anytime in your life, you can change your life. I believe
that the American people make smart choices when they have good
information. In Florida, we see that ahead of every hurricane
season, when families understand the dangers of inaction, they
make the decision to do what is best for themselves and their
loved ones. With hurricanes, we say that preparedness saves
lives, and it does. It's no different for our health.
Think about this way, preparedness happens when education
is met with action. Just having the information is not enough,
you got to take action with it. Unfortunately, the American
people are being underserved in both categories, education, and
action.
Too much of the conversation around health these days is
reactive instead of preventative, we spend a lot of time
talking about how to deal with health issues and not enough
time talking about the simple ways to prevent these illnesses
in the first place.
Even more frustrating is that there is a huge amount of
research out there showing how Americans can live longer,
healthier lives, but an inexcusable lack of action to put these
best practices in place. That's what today's hearing will be
about-turning research into action that improves the health and
wellness of Americans, so we can all enjoy living longer,
healthier lives, and spend our senior years enjoying time with
family.
It's time to put a lot more focus and action on wellness
and prevention. As our witnesses here, will discuss, it's not
too late for anyone, even our seniors, to start making informed
choices that lead your healthier, happier, and longer lives.
That's why I'm proud to be part of the MAHA Caucus here in the
Senate. I look forward to working with RFK Jr. and Mehmet Oz to
create a healthier country.
The issue of longevity is also something our government
should be more focused on. When Americans live healthier lives,
healthcare costs come down. The chronic diseases I mentioned
before, also leading drivers of America's $4.5 trillion in
annual healthcare costs according to CDC. We're all fiduciaries
of the American taxpayers, and we can do something that helps
people live healthier lives while saving taxpayer money.
Everybody wins.
I look forward to an insightful discussion today on how we
can advance good research, take action that improves wellness
for American seniors today and for generations to come. Now let
me turn it over to the Ranking Member, Senator Gillibrand.
OPENING STATEMENT OF SENATOR
KIRSTEN E. GILLIBRAND, RANKING MEMBER
Senator Gillibrand. Thank you, Chairman Scott for calling
today's hearing. We all want to live a long and full life.
Longevity brings people so many wonderful things like
opportunities to spend time with their family, to travel, and
to continue to thrive. Ensuring that we remain healthy as we
age is our utmost importance.
Today we'll hear from four witnesses who represent four
components of healthy aging, research, nutrition, exercise, and
medicine. We all know that we should eat a healthy diet, remain
active, seek preventive care, and avoid habits that contribute
to disease. As we'll hear from Dr. Nosal, so many Americans do
not have access to affordable healthcare, stable housing,
financial security, or even walkable communities, so we need to
address some of those impediments and some of those challenges.
We also know that these factors, often called social
determinants of health, are often key to understanding how we
can then allow for people to make those healthier choices.
Those structural barriers often make it hard to achieve health
at any age.
Congress has to do more to ensure that all people are able
to meet their basic needs so that they can learn how to
optimize their longevity and their health. It's why I've
introduced the strategic plan for aging in the last Congress.
This bill would provide states with critical funding to
transform their infrastructure and build communities that meet
the needs of older adults and future generations.
It would address everything from housing to healthcare to
food insecurity, to make sure these systems are able to support
our aging population, and I'm proud that my home State of New
York is in the process of developing a strategic plan. These
are positive steps to helping older adults achieve longevity.
We are all aging, which is not in and of itself a disease,
but a natural process, and we have a duty to ensure all
Americans can age well and age gracefully. I look forward to
hearing from today's witnesses.
The Chairman. Thank you, Ranking Member Gillibrand. I'd
like to welcome our witnesses here today. Before we introduce
our first witness, I'd like to ask each of you to be mindful of
our limited time here today and keep everyone's opening
statements to five minutes.
First, I'd like to introduce Dr. Rhonda Patrick. Dr.
Patrick is a scientist and health educator recognized for her
leadership and nutrition, aging, and disease prevention. Dr.
Patrick earned her Ph.D in biomedical science, conducting her
graduate research at St. Jude Children's Research Hospital.
She completed her postdoctoral fellowship at Children's
Hospital Oakland Research Institute and has also conducted
research on aging at the Salk Institute for Biological Studies.
Dr. Patrick's goal is to challenge the status quo and encourage
the wider public to think about health and longevity using a
proactive preventive approach.
As the founder of FoundMyFitness, she shares expert
evidence-based insights on aging and disease prevention with
her own unique brand of scientific rigor, engaging millions
through her website, podcast, and YouTube channel, where she
has a combined following of more than two million people across
the world. Dr. Patrick.
STATEMENT OF DR. RHONDA PATRICK, PH.D., FOUNDER,
FOUNDMYFITNESS, SAN DIEGO, CALIFORNIA
Dr. Patrick. Thank you, chairman Scott. Yes, my name is
Rhonda Patrick. I'm happy to be here today, and is this just an
introduction I'm doing or is this my opening statement?
The Chairman. We're glad you're here. If you want to do
your opening statement now. Yes.
Dr. Patrick. Okay. We have to ask ourselves if we can call
ourselves the greatest nation in the world, while 70 percent,
nearly three out of four adults, are overweight or obese. While
we spend about 18 percent of our GDP on healthcare, more than
any other nation, and yet we rank 55th in life expectancy.
Our children are getting type two diabetes at unheard of
rates. This is not just a health crisis; it is a cultural
crisis. Obesity is not inevitable. It is not an act of God. It
is something that can be prevented, it is a choice that has
been compounded by bad habits over time. It is reinforced by a
culture that does not foster good decisionmaking and self-
discipline.
We have created a culture where these difficult truths have
become personal attacks, where physicians are afraid to talk
about a patient's weight because it's too taboo. If we can't
have a conversation about obesity, how can we ever solve the
obesity crisis?
Obesity is associated with 13 different types of cancers.
It takes between three to ten years off of life expectancy. It
damages DNA, causes double stranded breaks to DNA, which is the
precursor to oncogenic mutations, and it fundamentally
accelerates the aging process, and yet, it is the principal
difference between our Nation and the longest-lived nations.
We are overfed but undernourished. About 60 percent of
daily total calories consumed by the average American come from
ultra processed foods. These foods are caloric rich, they are
nutrient poor, they do not increase satiety so people do not
get satiated. They continue to overeat, they gain weight.
They're cheaper than whole foods, so people are economically
incentivized to eat unhealthily, and they activate the dopamine
reward pathways in our brain causing addiction.
This trifecta of no satiety, low cost, and addiction really
kind of spiral us into this process of poor health outcomes and
runaway healthcare costs, and overconsumption of calories is
actually not the only problem, we are also micronutrient
deficient.
The food we eat is supposed to provide us with essential
vitamins and minerals that run our entire metabolism. Omega-3-
about 80 to 90 percent of Americans have low Omega-3 levels. We
now know that low Omega-3 levels have the same mortality risk
as smoking.
Vitamin D deficiency-easily corrected. Vitamin D gets
converted into a steroid hormone that basically runs about five
percent of our protein encoding human genome. Everything from
immune function to brain function to cancer. Very important,
easily corrected.
Magnesium-about half the country does not get enough
magnesium from their diet. Magnesium is essential for over 300
enzymes in the body, including repairing damage to our DNA.
DNA damage is happening every day. It's not something you
can see in the mirror; it's not something that you're going to
know about on a day-to-day basis, but it is what promotes
cancer, so decades later, it rears its ugly head.
The real problem is simpler, we actually need to start
thinking about physical inactivity as a disease. We now know
that it carries the same mortality risk as smoking,
cardiovascular disease, and type two diabetes. Yet when the
average American reaches age 50, they lose about 10 percent of
their peak muscle mass, by the time they reach age 70, they're
losing about 40 percent of their peak muscle mass, and this
isn't just about looking strong, it's about physical
independence. It's about survival, so higher muscle mass is
associated with a 30 percent lower all-cause mortality. Grip
strength is actually a better predictor of cardiovascular
related mortality, the number one killer in United States than
high blood pressure, and yet nobody talks about it, and
strength is also associated with a 42 percent lower dementia
risk, and yet, we think of resistance training as an add-on as
a luxury. It is not, it is a fundamental pillar of aging. It
increases muscle mass, muscle strength, and bone mineral
density.
Fractures are a death sentence between 20 to 60 percent of
Americans that have a hip fracture die within a year, and yet,
resistance training can lower fracture risk by 30 to 40
percent. This is preventable. We have the information, we have
the data we need to take action and resistance training,
exercise, getting the right foods are the most important things
that we can do to prevent disease and make a difference in our
country, so thank you.
The Chairman. Thank you. Next, I'd like to introduce Dr.
Eric Verdin. Dr. Verdin is the president and Chief Executive
Officer of the Buck Institute for Research on Aging, the
world's only research institution singularly focused on the
biology of aging, yielding insights into age-related diseases
before they start.
Dr. Verdin received his Doctorate of Medicine from the
University of Liege and complete additional clinical and
research training at Harvard Medical School. Dr. Verdin has
published more than 300 scientific papers and holds more than
23 patents. He has held faculty positions at the University of
Brussels, the National Institutes of Health, the Picower
Institute for Medical Research, and the Gladstone Institutes.
He's also a professor of medicine at University of California
San Francisco. Dr. Verdin.
STATEMENT OF DR. ERIC VERDIN, MD, PRESIDENT,
AND CEO BUCK INSTITUTE FOR RESEARCH ON
AGING, NOVATO, CALIFORNIA
Dr. Verdin. Good afternoon, Chair Scott, Ranking Member
Gillibrand, and members of the Committee. Thank you for the
opportunity to speak today.
As Chair Scott mentioned, my name is Eric Verdin. I run the
Buck Institute for Research on Aging in Northern California.
This Buck is the leading research organization in the world
focused on the biology of aging. Our mission is to eliminate
the threat of chronic disease by addressing the aging process
itself.
Over the past century, public health advances and medical
breakthroughs have nearly doubled lifespan. This incredible
success has come with a number of challenges. We live longer,
but not healthier. The end of our long lives is now
characterized by a whole series of debilitating diseases,
including Alzheimer's, Parkinson's, heart attacks, strokes,
type two diabetes, cancer, osteoarthritis, macular
degeneration.
By the time an American reaches age 65, most have at least
one chronic disease of aging, and 70 percent have two. We call
these conditions the chronic diseases of aging.
Our current healthcare system is focused on treating these
conditions when they occur, not in preventing them in the first
place. This approach is expensive, inefficient, and ultimately
ineffective. The cost of managing these illnesses is actually
staggering, increasing as our population ages and places an
unsustainable financial and emotional burden on our healthcare
system, our citizens, and their families.
In the 20th century, we dramatically reduced death from
infections, from heart disease and from cancer, extending life
expectancy in the process, but progress is slowing. Even if we
cure cancer tomorrow, the average lifespan would increase by
less than three years. The reason is simple: Aging itself and
its associated complications continue unchecked.
Aging is the greatest risk factor and the main driver for
these chronic diseases. The good news is that we now know from
research from the past 20 years, that aging can be slowed, and
we have preliminary evidence that it can actually be somewhat
reverted in some cases, thereby extending a healthy lifespan
and delaying disease in animal model systems. There is not a
single reason why these findings should not apply to humans as
well.
By focusing on aging and its mechanisms, we can compress
the period of illness associated with aging so that our later
years are spent in good health. The economic and public health
benefits of a shift from a reactive healthcare system to true
preventative healthcare based on our understanding of aging,
are enormous. Studies suggest that delaying aging will generate
trillions of dollars in economic gains, reduce medical costs,
and increase productivity, just as vaccines and antibiotics
revolutionized medicine in the past, aging science is the next
great frontier in preventive healthcare.
The science is at a turning point, and as policymakers, you
will play a critical role in ensuring that we realize its
benefits. Investing in aging research must be your priority.
The NIH should increase funding on the molecular pathways of
aging, with a new emphasis on translating discoveries into
human applications.
We also need a much greater focus on lifestyle
interventions, nutrition, exercise, sleep, stress management,
and social connections. These variables account for more than
90 percent of our health-span and our lifespan and should be an
essential part of our health policy and our research.
We must also rethink how we allocate healthcare dollars.
Right now, we spend trillions on treating diseases after they
arise. A shift toward prevention, one that targets aging
itself, would be far more productive and effective. The FDA
needs clear guidelines for therapies targeting aging.
Biotech and pharma companies are investing in this field,
but without a defined regulatory pathway, progress is slowed.
Finally, we need stronger public private collaborations.
Translating discoveries into real world application will
require coordinated efforts between industry, government, and
regulatory agencies.
This is a pivotal moment. The 21st century has the
potential to witness one of the most profound medical
breakthroughs in history, not just treating age-related
diseases, but preventing them. The goal is not just to extend
lifespan, but to ensure those extra years are spent on health,
dignity, and independence.
I applaud the Committee for recognizing the urgency of this
issue. Aging research is at an inflection point, and with the
right policies, we can transform public health for generations
to come. I look forward to working with you to make this vision
a reality. Thank you.
The Chairman. Thank you, Dr. Verdin. I'd like to recognize
Ranking Member Gillibrand to introduce her witness. Thank you.
Senator Gillibrand. Dr. Sarah Nosal is a family medicine
physician who practices at a federally qualified health center
in the South Bronx. She's also the President elect of the
American Academy of Family Physicians. Thank you for being
here, Dr. Nosal.
STATEMENT OF DR. SARAH C. NOSAL, MD, FAAFP,
PHYSICIAN, PRESIDENT-ELECT, AMERICAN ACADEMY OF
FAMILY PHYSICIANS NEW YORK, NEW YORK
Dr. Nosal. Thank you so much. Chairman Scott, Ranking
Member, Gillibrand, and members of the Committee. Thank you for
the opportunity to testify today. My name is Sarah Nosal and
I'm a practicing family physician in the South Bronx. As the
President-elect of the American Academy of Family Physicians,
I'm honored to be here today representing more than 130,000
physicians and student members of the AAFP.
I currently work at the Institute for Family Health, a
network of federally qualified health centers with more than 27
locations across New York State. I am proud to be a family
physician. In my office I have the honor and privilege of
taking care of not just patients, but families and communities.
Last month, Chairman Scott laid out his priorities, which
identified four aspects of someone to be well: having their
physical health, financial security, a safe community to live
in, and family and community support. Each of these are rooted
in the very fundamentals of family medicine.
I have practiced for more than two decades in a community
that ranks last for health outcomes in New York. My personal
patient panel approaches nearly 90 percent Medicaid
beneficiaries. A typical patient of mine presents with cane in
hand, living with HIV, diabetes, hypertension, and chronic
kidney disease. Patient tailored counseling on diet and
exercise is something I do on every visit.
Unfortunately, while I talk about the importance of eating
healthy whole foods, the reality is most of them are often out
of reach, financially or otherwise inaccessible to most of my
patients. This is only one of the health-related social needs
that impact them. A lack of stable housing, reliable
transportation, safe places to exercise and financial security
also make it difficult, if not impossible for my patients to
afford medications and even make it to medical visits.
Research has consistently shown that health related social
needs can worsen health outcomes. On more than one occasion
when I've asked a patient why they were not taking their
insulin as I directed, I would learn that they did not have
electricity in their apartments for the last few weeks when
they fell behind on rent. Patients at our rural clinic have
been known to walk long distances along roadsides without
walkways.
At our urban clinic, patients with walkers face four
flights of stairs at the subway. Many of my patients experience
food insecurity for which the USDA SNAP program is a lifeline.
Congress can strengthen to ensure it better serves those in
need. However, that alone will not solve my patients'
challenges. While diet and exercise are important to health and
wellness, we cannot ignore that many communities are designed
with them out of reach. Food and exercise can only be medicine
if they're easily accessible.
As a family physician, I recommend a healthy diet and
working out, but it is up to you, our elected leaders, to
ensure the resources are in place to fill that prescription.
Congress must support promising innovative policies to address
health related social needs, such as expanding Medicaid
coverage for reimbursable services.
For example, some states have used existing Medicaid
authorities to provide medically tailored meals to whole
households, not just the eligible beneficiary. This recognizes
that a food insecure parent will often give their meal to a
hungry child rather than feed themselves.
Many of my younger middle-aged patients are caregivers for
both young children and older relatives. Any reforms that
affect their healthcare coverage may impact their employment,
their ability to help their mother make rent, to take their
grandma to the laundromat or contribute to any productive,
meaningful way in their community. Insurance does not help
patients if there is no access to care.
Community health centers provide care to those in
underserved areas and are often the only accessible care
setting for many. CHCs have a significant economic impact and
are incredibly efficient in terms of healthcare spending.
Further, many CHCs are training the next generation of family
physicians through HRSA's Teaching Health Center Graduate
Medical Education Program.
Thanks to THCGME, our system has multiple family medicine
residency programs. THCs have the highest success rate of any
program for retaining residents in communities of need.
Unfortunately, CHS and THCGME rely on a patchwork of
inconsistent temporary federal funding. Right now, both
programs are only funded through March 31st.
To support and improve the quality of life for all patients
and in all communities, I urge Congress to make long-term
funding for CHCs and the THCGME a priority. In closing, thank
you again for this opportunity to testify, and I look forward
to answering your questions.
The Chairman. Thank you. We do have one more witness
coming, but he's had some travel issues, so he'll be here in
just a few minutes, so we'll go ahead and go to questions and
I'll start.
First off, thanks to all of you for being here. Thanks for
caring. Dr. Patrick, our healthcare system is broken. It's
reactive, not preventative. How do we get more longevity
focused care into mainstream medicine and what's standing in
the way?
Dr. Patrick. Well, I think that the most important thing
that we can do right now for longevity medicine is actually
move more, and I think that the federal exercise guidelines are
sort of out of date, to be honest. We don't focus at all on
resistance training, it says two days a week. What does that
mean? I mean, to be honest, people might just start doing some
bicep curls, and I mean that there's not information there.
You need to give people specific information, actionable
information. I think resistance training. OK, well, you can do,
you know, seven or eight-or fifteen workouts throughout the
week, and that's as good as doing three 45-minute workouts in
terms of gaining muscle mass and strength, so giving some more
specifics in terms of like types of exercise also, compound
lifts, like you want to basically make people be physically
independent, so you don't want biceps, you want people to be
doing squats or you want them to be doing you know, rows or,
dead lifts. Things like these that are multi-joint, right.
I also think exercise snacks is a big one, so there's
nothing in the guidelines about how people can get exercise
benefits by doing these short bursts of physical activity. Tons
of research coming out on this, I mean, we're talking, a recent
study just showed that doing 10 body weight squats every 45
minutes over a seven-and-a-half-hour work week was better at
improving blood sugar regulation than a 30-minute walk. I mean,
that's like two and a half minutes a day.
There are also tons of evidence coming out on these
unstructured exercise snacks, and that's also something that
can be recommended, so these are the kind of things that you
take the stairs instead of the elevator or you walk briskly
instead of, you know, taking a car to work.
There have been studies showing that people wearing these
accelerometers are able to reduce their cancer mortality by 40
percent, their cardiovascular related mortality by 50 percent.
If they're doing nine minutes a day of these unstructured
snacks where they're just basically taking advantage of
everyday situations to get physically active.
It doesn't cost money to do body weight squats. You don't
have to have a gym membership, so I think that's one important
way that I think information can be improved and more targeted.
The Chairman. Thanks. Dr. Verdin, what's the most important
breakthrough in aging research that we should be paying
attention to, and how can we use it to actually help people
live healthier longer lives?
Dr. Verdin. There's been an explosion of understanding of
the biology of aging, and in particular, the identification of
what we call molecular targets. We now understand that
targeting unique molecules can actually have profound effects
on the whole aging process and its associated diseases.
I also want to expand on what Rhonda just talked about,
this idea of lifestyle factors. We talked about exercise, but
there's a group of lifestyle factors that we all know about:
nutrition, physical activity, sleep, human-connections that are
really the critical determinant of your longevity. Actually,
more than 90 percent of our longevity for most people is
determined by the way we live.
What's really important is to know also each of these
variables are stackable. That is, if you are eating well,
you're going to live longer, but if you actually exercise on
top of it, you're going to live even longer, and if you have
good human connections, you're going to live longer.
Today, most of us in this country could expect to live to
90 to 95 in good health if we were to do everything right, so
that's today, and there are communities within the U.S. who
live today close to 90 years old on average, and I can
guarantee that not all these communities are actually optimized
in terms of doing everything.
Right now, as a Nation, as someone who studies aging, I'm
struck by the divide, the lack of knowledge of some of the
things that we know are conducive to good health are not
actually implemented, and I want to add one last point about
exercise. A 15-minute walk in the morning and at night will
lead to a reduction of heart attack, stroke, cancer, all of
these chronic diseases of aging by 40 percent, that's 30
minutes of walking every day.
I defy anyone, no matter what their lifestyle is, to tell
me that they do not have the time to walk 15 minutes in the
morning and 15 minutes at night. This is the type of
information that people are not aware of. It could have a
profound effect on the health of our population, so I'm pretty
passionate about lifestyle.
Next will be of course the additional interventions that
the research is pushing forward, but for me, the foundation has
to be these lifestyle factors. Drugs that target the aging
process will come in the future; we're working on them. There
are some really promising leads, but there should not be a
replacement for reestablishing a healthy lifestyle in
ourselves, in the population at large.
The Chairman. Thanks. Let me turn over for questions to
Ranking Member Gillibrand.
Senator Gillibrand. Thank you, Mr. Chairman. Dr. Nosal, how
do you say it?
Dr. Nosal. You said it perfectly from the beginning.
Senator Gillibrand. Sometimes there's barriers to the
things that we know are needed for longevity, healthy eating is
one. Obviously, there's barriers to affordability, there's
barriers like food deserts when it's not easy to get to a
grocery store. Sometimes, it's just mobility, if you're at a
fifth store building and you're not very mobile and you can't
walk to the grocery store and you don't have a car, and, and
it's hard to get on the bus, the many barriers.
One of the barriers I want to talk about with you is the
nutritious aspect of it. A lot of people don't even know what's
nutritious. Our doctors don't really study it in medicine. It's
not common knowledge in culture. It's really, it's not well
known what's nutritious and what's good for you.
One of the things that you talked about in your testimony,
a four-year nationwide pilot program through Medicare to
provide medically tailored meals to eligible Medicare
beneficiaries with diet impacted conditions. Now this is
innovation. We know that a medically tailored meal for somebody
with diabetes is going to be extremely healthy for them. It'll
have a lot more fruits and vegetables in it, it will have whole
grains, it will have lean proteins, it will have no processed
foods.
Medically tailored meals really is pretty powerful. Can you
talk about that a little bit and how could we implement it as
just one of the barriers?
Dr. Nosal. Thank you so much. As I said, I'm a practicing
family doctor. I was seeing patients this week, and I actually
saw a patient who I really wish this was one of the services I
was able to prescribe her as part of her Medicare coverage. She
gave me permission to share her story.
This is a woman I've taken care of for quite a number of
years and has done a really great job at being physically
active to the best of her ability. She uses a rolling walker
with chair and she has really well controlled her diabetes, as
well as it can be controlled, reduced her risk of
complications, and then came in this week and saw me and her
diabetes was fully uncontrolled, and I asked her what was going
on and she said her apartment had moved.
Previously where she lived, she knew where the local soup
kitchen was and the food pantry. She used her SNAP benefits, as
I work with my patients to use their SNAP benefits for fruits
and vegetables, use the other resources which are more likely
to give you more processed foods or carbohydrates, get those
other foods there, but save your benefits and you can get some
extra incentives.
This is really a patient who cannot find in her community
where she is, the resources to have the healthy meal that she
needs, that it will be part of her remaining well and full, and
the idea that I could have prescribed her an appropriate low
calorie, diabetic diet full of whole plant you know, protein
and foods, would be the complete difference in her entire life.
I agree with those speakers before me that, your ability to
move and your ability to eat healthy and have access to those
nutritious food resources, this could be groundbreaking and
life changing for our older adults, and this can be done right
through our health centers, through our community health
centers that are in the depths of the communities where we can
do this for a whole family and prevent the outcomes.
I don't need to take care of people in a state of disease.
We are ready and willing and able in our health centers to care
for communities that we know their risk is greater, but our
ability to provide these medically tailored meals, we'll change
both cost and outcomes in that community.
Senator Gillibrand. Along the lines of impediments to
access to nutritious meals, we have SNAP benefits. With SNAP
benefits you go to the grocery store and buy your groceries and
cook whatever you want, but for older people who aren't cooking
as much anymore, again, who can't carry the two bags of
groceries, of all those fruits and vegetables, and the whole
grains that they're going to then cook appropriately to eat.
What do you think about the idea of being able to use SNAP
benefits for congregate meals or for organizations like Meals
on Wheels that deliver hot meals? Like is that a way to get
over some of these barriers to the nutritious or Medically
Tailored Meals that people need?
Dr. Nosal. It would be tremendous if we could both increase
funding for SNAP benefits. I can tell you they don't meet the
needs even right now, but the kinds of creative programs I know
that we've done where I live, where we have been able to
increase funding for fruits and vegetables, but absolutely.
My elderly patients are often only eating a hot meal if a
family member comes to help care for them and cook for them,
they often have nutritional deficiencies because they are in
fact eating things that either come in a bag or a box, which
are my top list of things I tell patients to try to not eat,
but that really isn't feasible or possible for them. It would
be astounding if they could actually use those benefits and
have that kind of food delivered at their home. It would be
life changing.
The Chairman. Thank you. Now I'd like to recognize our last
witness. I guess he had some travel issues, so we are glad you
made it, Dan Buettner. Dan is an explorer, national Geographic
Fellow, an award-winning journalist and producer, New York
Times bestselling author and founder of Blue Zones.
The term Blue Zones was first coined by Dan in 2004 and
refers to areas with high concentrations of centenarians?
Individuals who live to be over a hundred years old. His team
uses research to highlight and promote specific life lifestyle
habits that are tied to extended longevity and vitality. Thanks
for being here, and we are looking forward to hearing your
presentation.
STATEMENT OF DAN BUETTNER, FOUNDER,
BLUE ZONES MIAMI, FLORIDA
Mr. Buettner. I am honored to be here. My goal over the
next four minutes and 54 seconds is to convince you that most
of what we think works for healthy aging and longevity is
either in effective or just plain wrong.
I know most of you know these statistics, but we're
spending $4.9 trillion on healthcare per year. About 85 percent
of that money is spent on people with chronic conditions, most
of them are avoidable chronic conditions. Another $300 billion
on exercise and diet programs, and then another 42 billion on
anti-aging industry that has failed to produce even one pill
supplement or interventions that's been shown to stop reverse
or slow aging, so if that doesn't work, what does?
Twenty years ago, working with National Geographic and a
team of demographers, we found five areas in the world where
people are living statistically longest. Something called the
Danish Twin Study established that only about 15 percent of how
long we live is dictated by our genes, 85 percent is something
else.
The reason we find that something else among these five
populations who are living about 10 years longer at middle age-
our age. The reason they're living 10 years longer is because
they're avoiding the diseases that foreshorten American's lives
and are kind of bankrupting us in many ways.
What are they doing? Well, none of them are dieting or
exercising or running down to Latin America for stem cell
treatments. Every time they go to work or a friend's house or
out to eat on occasions they walk, they're getting eight to
10,000 steps per day mindlessly. The cheapest and most
accessible foods for them are peasant foods. Their whole
grains, their tubers, the cornerstone of every longevity diet
in the world is beans. They're eating about a cup of beans a
day.
They're not spending time on Facebook, instead, they're
spending time in face-to-face conversations, living in extended
families, connecting with their neighbors. They have vocabulary
for purpose. Now, there's an idea, purpose. We know that people
have a sense of purpose live about eight years longer than
people who are rudderless. They manifest their purpose usually
in family, but also with religion.
We know people who show up to church or temple or mosque
live about four years longer than people who don't show up at
all, so taking this insight that where people are living the
longest, it's not because they try, it's not because they
pursue longevity. We tend to think that health is a result of a
pursuit in this country, actually, it ensues. It's a result of
an environment that makes a healthy choice, the easy choice.
We're not relying on poor mothers to make the right choice, and
then sending them out into an environment where 97 out of a 100
food choices are bad.
About 15 years ago, working with AARP and the University of
Minnesota, we set out to manufacture Blue Zones by working with
municipal governments where you can get policy done to help
them decide on policies that favor healthy food over junk food
and junk food marketing. To favor the human being over the
motorists, to favor the non-smoker over the smoker, and to
certify all the restaurants, grocery stores, workplace,
schools, and churches who agreed to optimize their designs and
their policies so that people are nudged into moving more,
eating better, and socializing more.
The proof is in the pudding, our very first town, Albert
Lea, Minnesota, we saw a 30 percent drop in healthcare cost
among city workers, that was in 2009. In the beach cities of
California, we saw about a 25 percent drop in obesity in the 10
years we were there, and in Fort Worth Texas, they themselves
reported about a quarter of a billion dollars in healthcare
cost savings after the five-years we were there. We succeeded,
not because we came in telling people what to do, came in with
an agenda. We simply came in with policy options and place
options that made the healthy choice an easy choice.
We set people, we set Americans up for success. Right now,
our food environment and our built environment sets people up
for failure. We have about 25 times more fast-food restaurants
than we did in 1980, when we had a third the rate of obesity
that we have right now.
The big idea I'd ask you to think about, is shifting the
focus from changing people's behavior and individual
responsibility and setting Americans up for success by
designing our cities so the healthy choice is not only the easy
choice, but the unavoidable choice.
The Chairman. Thank you. Yes. I live in Naples, Florida,
and they're working
Mr. Buettner. That's right. We have Blue Zone City in
Naples and Jacksonville, Florida. I salute them.
The Chairman. They're doing a good job. Let me turn it over
now to Senator Johnson
Senator Johnson. Thank you, Mr. Chairman. It's very good
hearing, very interesting testimony. I held an event at the end
of September with RFK Junior, with Dr. Casey Means, who'd
written a book that interested me, "Good Energy," talking about
metabolic health. Awful lot of the testimony here relates to
that in some way, shape or form, I think to the most
significant parts of that testimony, Dr. Chris Palmer, he's a
psychiatrist that does a lot of work in terms of nutrition,
relates to mental health issues, said they don't want to know
the root cause of chronic illness.
Dr. Casey Means talked about it in her medical education.
They didn't spend an hour talking about nutrition and Mr.
Buettner, you're talking about, you know, trying to design a
city for the right food choices, but again, what are those
right food choices? I think it's becoming pretty obvious, and I
think that's one of the questions I have for you know, Dr.
Patrick.
We've known about this for quite some time, right? I mean,
the food pyramid was a marketing, but there's nothing
scientific about that. It was just a marketing deal. We've gone
to seed oils. Again, the problem we have as a consumer is you
have all the books out there, you have all these different
theories, who do you believe? It's a very confusing thing.
Unless you just go completely simple, all whole foods, no ultra
processed food, try and approach it that way, but Dr. Patrick,
just kind of comment on that.
Dr. Patrick. Well, I do think that going whole Foods and
trying to reduce your ultra processed foods as much as possible
is the way to go, and I think we have a lot more information
now than we did, you know, 30, 40 years ago. We know that these
ultra processed foods are not causing satiety. That is, we know
that they're activating this addictive reward pathways in our
brain, so I think that information is a little more in depth.
I also think that some of the information on like, why do
we eat? Okay, if we have nutrition in primary and secondary
school, definitely medical school, you're right. I mean, one
class in nutrition, it's absurd, right? I mean, if we can start
educating at an early age, children why they eat, what are they
supposed to get from their food? Why do you want to eat leafy
greens, magnesium's there? What does magnesium do? What happens
if you don't get magnesium? What is cancer?
There's even some data out of Japan, they have that program
in Japan where they have in primary schools? Nutrition
education, and they've shown longitudinal studies that people
that were educated with nutrition in childhood are much more
likely to eat healthy, nutritious later in life.
Senator Johnson. You know, part of the problem is just our
medical education, our medical establishment. They call it
Rockefeller medicine, all based on pharmaceuticals, and it's
awful appealing, all we have to do is get a shot, or all we
have to do is take a pill and you know, we're going to be well,
when we think probably the exact opposite is true.
Eighty-five percent of our $4.9 trillion spend is on
chronic illness, it's about preventing that chronic illness.
Dr. Verdin, you talked about the basics, right? Nutrition,
exercise and not necessarily--and there's all kinds of
different opinions on the right type of exercise. Being active
makes sense, getting good sleep, stress management, I mean, all
those things make perfect sense.
How do we break through, how do we reeducate our doctors?
How do we reeducate our public policy here? One thing we could
probably do is with our SNAP program not allow certain foods to
be purchased. The really highly ultra processed, the ones that
we really are pretty convinced are not good for you. I mean,
that would be a good switch, wouldn't it, Dr. Verdin?
Dr. Verdin. Thank you for the question. I think first, let
me completely agree with you on the idea that the foundation
has to be there, the lifestyle factors, and the drugs should
only come on top or in a subset of the population that is a
increased risk of accelerated aging.
That being said, there is something that is happening in
the aging field, which I think is going to allow us to work
through the noise that you described, which diet, paleo diet,
ketogenic diet, Atkins, I mean, there's proliferation, people
are completely confused. The same about exercise. What are you
supposed to do? Is it a strength training? Is it yoga? Is it
endurance, aerobic, anaerobic? People essentially throw up
their arms in the sky and say, I don't know what to do. The
same about sleep. Well, how much should you sleep? What is
optimal?
The whole field of aging right now is in the process of
developing what we call these biomarkers of aging, which allow
us to measure and to predict the effect of interventions in the
long term, so instead of doing a clinical trial, where you
would take a group and have some exercise and do strength
training and another one do flexibility and follow them for 30
years to see what happened to them, these novel markers allow
us within a much shorter period within one year to actually
detect a signature.
There is the promise that comes with further developing
these tools. I think we need support to be able to actually
test these interventions against one another so that we can
actually make the best recommendation to people in terms of
what is really the optimal way to actually live and to optimize
your health. That's where the field is.
Again, there's a bottleneck in terms of the funding. These
are not cheap studies, but they could have massive implications
in terms of public policy recommendations in terms of what is
the optimal way to exercise. I mentioned the point of you know,
walking 30 minutes a day, that's already good. It's a 40
percent reduction. Can we get to an 80 percent reduction by
adding another modality? To what degree are these interventions
going to be in individual? That's a whole other area and field
is studying.
Senator Johnson. Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Johnson. Senator Husted.
Senator Husted. Thank you, Mr. Chairman. I appreciate the
testimony, the thoughts, and the conversation. I listen, you
can read, its exercise, its diet, it's lifestyle choices. If we
just made better decisions and more active on those things we
would drive down costs, we'd improve quality of life. I heard a
lot of talk about longevity, it's not just the number of years,
it's the quality of those years that also are almost
immeasurable in terms of their value of terms of your
productivity, your joy, your ability to contribute to your
family, to your community, if you have those things.
I was also thinking when you were talking about the access
to food, I was also thinking about when you live in a high
crime neighborhood, how much harder it also is to be active and
to live a healthier life.
I want to ask any of you that has have a thought on this,
what about this: our technologies, they seem to be driving
isolation and idleness, and has there--as we look at the
difficulty we've had as Americans of getting healthier, even
though we know all of these things, is there any evidence that
you've seen about how our technology is driving isolation or
idleness that would affect our health in a negative way versus
a positive way? I'm just interested if any of you have thoughts
on that.
Dr. Patrick. I have thoughts on the opposite. I mean, so
most of us have an Apple Watch or a Fitbit or some sort of
wearable device where we can get to measure our heart rate,
resting heart rate or during exercise, a lot of different
health parameters, and yet I think there's a lot of regulations
there that don't allow those devices to help give us medical
advice.
I mean, we have like AI coming out with this. AI is now
being shown to be as good as or better at predicting, disease
and illness and looking at all the variables and contribute to
that than physicians are, and yet we can't use that
information, that health information for anything, and it seems
like it's something that would be very useful for physicians
Senator Husted. Let me challenge you a bit on that. I agree
that those things are valuable, I'm not sure that most of us
have those things, though. I read in the last couple of years
that the average prisoner spends more time outside a day than
the average child.
I'm just wondering, when you read things like that and you
see the amount of the way that social media's affecting
particularly young people and that fewer of them are
participating in sports, it seems like from the very beginning
that we are getting children off to the wrong start as it
relates to this, so I see some heads nodding. Others might have
thoughts on that.
Dr. Nosal. As a family physician, I take care of people in
pregnancy, newborns, small children, I get to see great
grandparents and the entire family. I think it's an interesting
perspective across technology. I'm also the Chief Medical
Information Officer at my organization, so overseeing the
rollout of our electronic health record and patient portals in
English and in Spanish.
I am right with you. I really worry about my young people
in school. When I'm seeing the kids in my practice, I find out
what sports they're doing, how much physical activity is in
their afterschool activity? How often do they have recess? We
know, particularly for young people, and it's a little
different for adults about obesity and weight for young people,
it really, really matters that activity level that they're
doing.
We have models where schools will not have cell phones for
during the school day, and you'll get rid of your cell phone at
the start of the day and you'll get it back later, but I'm not
seeing paired with that, the kind of investment in making sure
we have that funding and education, that teaching staff and the
supervision and expertise to make that physical activity
possible there, and that is a wonderful place for prevention.
I want to come to the other part of technology for our
older adults, our rural communities that don't have broadband
access, that can't communicate or take advantage of things like
telehealth, which are critical when we're following up complex
medical issues or preventing falls and trying to really make
sure we keep our older adults safe, that it's actually really
critical.
Not only that we have infrastructure that makes access
possible, but our isolated, older adults and helping and
teaching and finding ways both to connect with your physician
and with your community, that there's worthy investment there
as well.
Senator Husted. Yes, no doubt. We've made a lot of progress
on telehealth and allowing particularly for elderly, others
thought.
Dr. Verdin. Maybe if I can add something as a parent. I
clearly have seen, and I think all of us who have children have
seen the effect of portables on social isolation and inactive
physical inactivity.
I do not know, as a scientist working on aging, how to
solve this problem. Clearly there are other countries that have
installed a number of regulations that limit the use of these
portables and iPhones and so on by younger individuals who are
obviously more vulnerable.
One thing to note is that these are the formative years
where critical habits are formed that will last a lifetime. I
Just wanted to amplify the point about wearables. Wearables
are, I agree with you, today are the remit of a subset of the
population that is generally more well to do and able to afford
it and more interested in its health.
I can see the day changing though, where wearables are
going to be part of the tools used by physicians especially in
areas that are remote in combination with telemedicine for
increasing the health in those populations that might be more
isolated and not have access to everyday physicians.
The wearable technologies are rapidly accelerating. They
are actually, I predict that within the next five years, they
will be valuable, recognized, medical tools in terms of
assessing your rates for chronic disease, simply by measuring
your movements, looking at your blood sugar, looking at a whole
series of variables that I see under your blood pressure and so
on, so I think they will become important tools and with their
democratization, we can expect the prices to go down and the
value to go up.
I think this is something if I were a regulator that I
would keep my eyes on as a potential changing factor in the
landscape of medicine. Thank you.
Senator Husted. Thank you
The Chairman. Senator Justice.
Senator Justice. First of all, to our panel and our great
witnesses, I didn't have the opportunity to hear you, but I'm
sure that we're all singing from the choir, that's all there's
to it. I've got to say just this, I'm from West Virginia, and
West Virginia has surely got some really tough issues going on.
To say the very least, we're the third oldest State in the
country. You know, we have a life expectancy of 72.8 years,
which is the second lowest, 20 percent of our folks in West
Virginia are 65 and older.
We do have affordable housing in West Virginia, and that
helps a bunch, but we've got risk factors like you can't
imagine, whether they be social isolation or the risk of falls,
you know, they could very well be food insecurity, the lack of
broadband, transportation issues or medical care issues and
obesity. Obesity, absolutely the worst of the worst.
Now, I don't look at by any stretch of the imagination, but
I'm trying real hard, and between baby dog and I together, we
continue to try really hard. I've lost 55 pounds, and I'm
really proud of that, and I've got a long way to go.
Now, baby dog isn't subscribing to the same theory that I'm
subscribing to, but for those of you that know her, she's a
little brown, 62-pound watermelon, and she's a little bulldog
and she absolutely loves everybody, but let me just tell you
this, in West Virginia, we do have some things that are going
on and are really, really neat stuff. We have the fact that
we're a community, and it is so important, absolutely from the
standpoint of family and community, it's so important to our
seniors.
I just think about this beautiful little girl that's here
and everything and if you could tell me her name, please, I
can't--well, Addison, you are absolutely spectacularly
beautiful, and I will promise you, if you'll look up online or
whatever, baby dog, and look up and just know how much she
would love you too.
I tell everyone, and I tell you this, just speaking from my
heart, I tell you that in many ways, we are here for Addison.
Not only are we here for all those of our seniors, all those of
our aging, but we're here for Addison, because somehow, we've
got to change the path of what we are doing today.
For that reason, and I don't want this to be such a
political issue, but for that reason, that's why I will vote
for RFK Junior because I believe he is at least trying to bring
more awareness to all of us.
In all honesty, there's so many in my state that need help
in every single way, but more than anything, we need knowledge.
We need absolutely us to step up. I'll never forget my dad;
I'll never forget him ever saying just this. He was trying to
figure out where to build a road, and really and truly, he kept
listening to engineers all around him, and finally the lead
engineer's name was Kirby Bragg, and he looked at Kirby and
said, "Kirby, I don't know what the right answer is, but this
dead gum well isn't it."
Now, if you just think about just that, what we're doing in
America today, isn't it. That's all there is to it, and we got
to do better, and we got to do better for all of us, for
myself, believe it or not, for baby dog, but more than anything
for Addison, so Addison, thank you for being here, and thank
you so much, Mr. Chairman. I'll yield back to you.
The Chairman. Thank you, Senator. Senator Moody.
Senator Moody. Thank you, Senator Scott. I agree with you,
Senator Justice. I think we're all sitting up here thinking
that we can do better, especially with us Senators who sit
around a lot. I am only three weeks into this tenure, and I'm
noticing that we sit around a lot.
Thank you for being here today, thank you, Chairman Scott
and Ranking Member Gillibrand, for holding this important
hearing. I think it's important not just for those of us that
are learning more about it on the Aging Committee, but those
who may be watching and sharing this information around the
country.
I agree with Senator Justice, becoming more aware and
making sure that others within our states are aware, it's an
incredible first step to making America healthy again, and so,
thank you for taking the time to be here. I know it isn't
always easy to break away from a practice or travel from
another State across the country. I really appreciate it. I
know some of you are residents. I am the newest senator from
Florida. I know some of you are my constituents, so I'm
grateful.
One of the things that I think our longstanding reactive
approach to healthcare means is we spend a lot more money than
we probably need to, and I was most fascinated by your work,
Mr. Buettner. I've actually watched some of the documentaries
that you've helped on. In fact, I've recommended my own parents
watch those, and I'm fascinated.
I'm from a state that is growing exponentially, and there
are many new communities being built. There's also those that
are going back and trying to readdress how they might rethink
their existing communities, and I was really taken with some of
the statistics that you included within your written testimony
and some of the places that you've worked with reported annual
savings.
Cities reported not just a drop in their physical BMI, but
an actual drop in cost to their cities. I think it was in
Minnesota you saw a town that saved 30 percent of their city
worker healthcare costs since they started.
I was just wondering, in terms of existing communities that
are trying to go back and reconfigure or new ones that you're
working with to kind of build a city to highlight health and
community and healthier options. Have you done a study that
shows how much might be saved versus what the input of cost to
a community or city would be?
Mr. Buettner. If you drop the BMI or the obesity rate in a
city of a million people, it saves about 19,000 heart attacks
over time. Average heart attack costs about $120,000, so you
don't have to have a big movement to make a big difference, but
essentially what I'm pitching to all you guys is the notion
that we tend to think in silver bullets, there's going to be
this one magical intervention that's going to save us.
Meanwhile, we're surrounded by what I call silver buckshot,
these small nudges, and defaults.
In all due respect to the Federal Government, it's a slow-
moving tanker, it's hard to move, but city governments,
municipal governments, they could move in a hurry. A mayor and
a city council in coordination with the business community,
they can get a lot done and simple things, and by the way,
we've done this in Naples, Florida, and we're doing it in
Jacksonville, something called a Complete Streets policy.
Do you know you can raise the physical activity level of an
entire city by 20 percent, by just building streets? They
invite pedestrians, they invite people to socialize, they
invite cyclists instead of just cars. That doesn't cost any
extra money. Once every seven years, a street needs to be
redone, and when you redo that street, you can just as easily
build it for humans and cars rather than just cars, so it's
seen clearly.
We know there's a clear correlation between the number of
fast-food restaurants permits and the obesity rate of a city.
If you live in a neighborhood with more than seven fast food
restaurants within a half mile of your home, you're about 35
percent more likely to be obese than if there are fewer than
three. In the hands of a city council member, they may decide,
well, our children's health is more important than another
burger joint, and make the changes appropriately.
Billboard advertising: we know that two identical
neighborhoods and one neighborhood has billboard advertising,
the other one doesn't. The neighborhood with billboard
advertising has about 15 percent higher BMI, so what we try to
do is, rather than telling cities what to do, we show them the
evidence, we give them about 30 different policies in each of
smoking-built environment and food, things that cost them
nothing, and we ask them, would this be effective for you?
Would this be feasible for you? And if they say so, then we
help them get it done.
The wrong thing to do is to come in and say there's a
silver bullet. The wrong thing to do is to come in and tell
people what to do, but when you show them the evidence,
America's smart, it's a lot of very smart mayors and city
council people who are tired of seeing their children grow up
overweight and tired of seeing their neighbors die prematurely
of heart disease and type two diabetes, and this is something
we can act on right now.
I guess the pitch for Federal Government is to think about
empowering, designing cities for health rather than continuing
to look for just a silver bullet.
Senator Moody. Thank you, chairman.
The Chairman. Thank you, Senator. Mr. Buettner, we hear a
lot about diet and exercise, but you've said social connections
and purpose are just as important. What can we do without more
government spending to encourage stronger communities and
healthier lifestyles?
Mr. Buettner. My name's Buettner. This is a small detail
for the congressional.
Senator Moody. I started that, I'm sorry, that was your
fault. Well, it's my fault. I own that. I apologize.
Mr. Buettner. What's that?
Senator Moody. I said I started that. I apologize.
Mr. Buettner. Oh, no, no problem. You guys are important.
Believe it or not, it is encouraging people to eat at home.
Every time we go out to eat, we consume about 300 more calories
than we would if we ate at home, and those calories are going
to be more laid in with sodium, ultra processed food, and
sugar. You can control the calories when you live at home.
We think about educating people. One of my fellow
testifiers here that had a very good point about teaching
children how to cook at home, I know it sounds so hard. I quote
from for National Geographic, I studied a place in, in Finland
called North Karelia, had the highest rate of cardiovascular
disease in the world in 1972, they brought it down by 50
percent. How did they do it?
They did it by changing the environment, making healthy
choices easier, and one of those was using church basements to
teach mothers how to cook with plants rather than just with
meat, and that's an approach that works.
Once again, you know, if you take a person, a couch potato
who is getting zero physical activity and get them to walk 20
minutes a day, you raise their life expectancy by three years.
There's no pill, no pharmaceutical in the world that'll raise
life expectancy by 3 years.
If you just get people to go from zero to 20 minutes, we
can achieve that by designing our streets and our sidewalks so
it's easy for people to go to the grocery stores, easy for
people to pick up their coffee, easy for kids to walk to
school. It's a very simple solution. It's within our grasp, and
it can potentially cost nothing.
The Chairman. I think now we'll turn it over to Senator
Alsobrooks. By the way, I have to go to a budget hearing, so
I'll turn it over to Senator Moody, and I think you had some
more questions Senator Gillibrand. Thank you, each of you for
being here, and I love what you're doing.
Senator Alsobrooks. All right, thank you so much Mr. Chair
and Ranking Member for hosting this important hearing today,
and thank you so much as well to our witnesses who have been
here.
Advancing research on healthy aging is key to helping
seniors live longer lives, and Congress must ensure, I believe,
that we take action to improve the quality of life for our
seniors, so my first question is for Dr. Verdin. As someone
who's worked at NIH and continues to engage in aging related
research, the question is, would you speak to the role of the
National Institutes on Aging and advancing research on
longevity and health span?
Dr. Verdin. Thank you, Senator. I came to this country 42
years ago with a suitcase and a MD degree from Belgium, and I
was attracted at that time by what I knew about the NIH and the
vision and the biomedical research enterprise that had been
created in this country, and I must say that I never looked
back and one day became an American citizen, made this country
my home, and still at this point directing a whole institute,
focused on the biology of aging is my dream job.
I think the NIH has been instrumental in creating what has
been called the crown jewel of the American government, and
frankly, the crown jewel of all biomedical research
organizations in the world. The U.S., thanks to the work and
the support of the NIH, has created the best biomedical
research institute anywhere.
Remarkably, every dollar that is being invested in the NIH
yields two of economic output, which is a remarkable outcome
for our society. This has yielded countless cures. It has
created millions of jobs, created a whole new industry, the
whole biotechnology industry, and has given the U.S. a
leadership position in the world. We still attract the very
best to come and do research and conduct their careers here.
I think from a personal point of view, but also for the
country, I think the output from the investment of Congress in
the NIH has been nothing short of remarkable.
Senator Alsobrooks. I could not disagree with you, Dr.
Verdin. I agree, especially your characterization that it's a
crown jewel. I think it's also very important to aging research
and to cures, so would you say that they are right now, NIH as
you may know, is subject to a number of cuts that have been
proposed, and would you say that cuts to NIH funding threaten
the progress that we have made in research on the aging brain,
on Alzheimer's disease and on dementia research?
Dr. Verdin. Dramatically so, and I do worry about the
institute that I direct and I worry about this leadership
position that we are in right now. It's a comfortable position;
we are leading by far every other country in the world. China
is making great strides in terms of very pushing into biology.
A recent JP Morgan meeting in San Francisco about a month
ago saw very strong presence from China. I think there's a
danger that we are going to be relinquishing this leadership
position, that we are going to be missing out on new
opportunities to develop new treatments, especially in the
field of aging, and that we are going to be basically losing a
lot of jobs.
There's no way around this from a personal point of view in
terms of the institute that I direct. If these cuts actually
come into effect the way we have seen them, we will have
layoffs. We will have a difficult time, a difficult road ahead,
and I think this will be replicated across the whole country,
red and blue states.
Senator Alsobrooks. I agree. Thank you so much, Dr. Verdin.
Just quickly, my time is winding. Also wanted to ask Dr. Nosal
and the question for you is regarding research and preventative
care, or actually the question I want to ask you about, since I
just have a few moments, is about marginalized communities and
Federal research funding that's helped make significant
advances and understanding aging and age-related diseases, and
ask you how should NIH ensure that its aging research includes
diverse populations particularly for historically marginalized
communities? And I know that's a longer, we don't have very
much time, but whatever you can say to that would be helpful.
Dr. Nosal. It is critical that research is happening in our
communities and my communities that have black and brown
individuals of various backgrounds, ethnicities from around our
world. That how they are impacted and what needs to be done to
really prevent the heavy cost of care in the future is
different because of the dynamics of the communities that we're
in.
Research into connections with faith-based organizations,
connection with communities and we really see that those are
opportunities within communities like mine that aren't being
leveraged for research, where we know trust and strength is
already in the community and it's a real place where we could
make those benefits to health and outcomes possible.
Senator Alsobrooks. Thank you so much.
The Chairman.Thank you, Dr. Nosal. Ranking Member
Gillibrand, I heard you had a few more followups?
Senator Gillibrand. I have a couple more questions for Dr.
Buettner. I really liked your testimony. What I really liked
about what you talked about was that you were talking to cities
and communities and leaders about much more of a strategic plan
for what they could do for the health and well-being of their
citizens.
What I really liked about your approach; it was no silver
bullet; it wasn't even silver buckshot. It was, you have to do
all these things, and you mentioned transportation, making sure
people could walk, walkable cities, so they could ride bikes. I
would imagine as part of that, you'd want some kind of mass
transit or some kind of public transit, so an older person
could actually get somewhere. Because an older person might not
be able to walk for a mile or a long distance.
Did you talk to them about access to fresh fruits,
vegetables, whole foods? Like if you go to the Bronx today,
it's a food desert in some areas where it's just not accessible
to get to a grocery store. You might be able to get it to a
bodega or a corner store, but you might be charged, I don't
know, two for an Apple. You know, it's so expensive. It's not
accessible and affordable. Did you look into those types of
barriers as well? Did you make recommendations? Because I have
legislation to incentivize to build grocery stores in food
deserts so that we can get those quick fruits and vegetables
for a lower cost price.
Then did you hear my conversation with Dr. Nosal about
using the Federal benefits that we do have better. You know, we
made the change in SNAP, this is important for you because
you're just new to the Committee. We made the change to SNAP to
make it easier to use the SNAP benefit at what do we call them
like a farm stand.
To go into a farm stand and to be able to buy the fruits
and vegetables directly from the farmer, better for farming,
better for people and using maybe the SNAP benefits to get the
congregate meals, so instead of eating by yourself in front of
a television as an 85-year-old, you actually can go to the
senior center and have two meals a week that are congregate
with community members. Do you have thoughts on that too?
Mr. Buettner. Yes, so we've worked in 70 cities and I've
learned that every community thinks they're different and in
that they're all alike, so what we've done we have boards of
academic advisors and we've compiled, we call them policy
menus, in food, built environment and tobacco, and these menus
are evidence-based, and there's usually 30 different policies
that have worked elsewhere at creating a healthier eating
environment and more physically active community and a place
where it's a little bit harder to smoke, so in other words,
they've been improved health.
We measure with Gallup, so it's not just anecdotal. We take
a measure, the well-being index metric at the beginning, and
then in order for us to come in, the city council and the mayor
have to pledge to go through this consensus process, and we go
through every one of these menu items, every one of these
policies, and we score it for feasibility.
Can we get it done in this community in five years? For
effectiveness, do we believe it's effective? Do I believe that
taxing sodas will lower the amount of sodas that children will
drink? Yes, but to lead with that, you'll often be shown the
door, but we keep it on the menu so they discuss it, so with
each of these areas, we have 30 or so policy items. It's hard
to mess with SNAP, but you, you can sometimes get us sell the
idea of a pilot program, but SNAP, as you know, is a Federal
program and it's very hard to----
Senator Gillibrand. We are the federal lawmakers, so when
we are riding the farmville, we could improve that program. We
could make it better and more accessible, more usable.
Mr. Buettner. Let me take you to Jacksonville, Florida and
I'll show you some opportunities for the SNAP, but the bottom
line is, again, trying to come in and tell people what to do
doesn't get you far, but showing them how they can be
successful within the parameters of what's important in their
city, you can get a lot done and it's a different way of
thinking about things, and SNAP, you know, my big criticism is
it allows people to buy the same food that's making them sick.
Senator Gillibrand. Ideally, you'd like some nutrition
dollars to be on education about what's nutritious?
Mr. Buettner. Teaching people how to cook with whole plant-
based food.
Senator Gillibrand. Yes.
Mr. Buettner. You know, we were talking about this before,
if you want to know what a healthy hundred-year-old ate to live
to be a hundred, you have to know that what she was eating as a
little girl in middle and lately, and I worked with Harvard's
Walter Willett, and we did a meta-analysis, 155 dietary surveys
done in five blue zones over the past a hundred years, and
without a shadow of a doubt, they're eating mostly whole food,
about 90 percent whole grains, garden vegetables, tubers, nuts,
and beans.
Senator Gillibrand. Access to those foods is key.
Mr. Buettner. Yes. Showing them how to make it taste
delicious.
Senator Gillibrand. Correct.
Mr. Buettner. You can't guilt them into eating. They have
to want to eat that more than----
Senator Gillibrand. Our most successful food banks in New
York are the ones that have cooking classes at them, so they
can teach the whole family how to make these vegetables that
they may never have seen, they don't own any recipes for, and
that's been really effective.
Also, along the lines of our earlier conversations,
teaching pediatricians and even prenatal doctors, providers,
when they get the pregnant woman in to say, when you have your
baby, this is the best nutrition for you. This is the best
nutrition for your baby, teaching it right away. You know, this
is not a hearing on ed reform, but again, if you had the
benefit of exercise every day in our schools and nutrition
education, you'd be helping the next generation for sure.
Well, thank you so much, all of you. This has been an
excellent hearing. I think we've had a very lively conversation
about ways to improve and I just appreciate you Madam
Chairwoman for hosting us, but all of you for the contribution
you made to today's discussion.
Senator Moody. All right. Thank you again for being here.
The Committee hearing is adjourned.
[Whereupon, at 4:52 p.m., the hearing was adjourned.]
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APPENDIX
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Prepared Witness Statements
=======================================================================
U.S. Senate Special Committee on Aging
"Optimizing Longevity: From Research to Action"
February 12, 2025
Prepared Witness Statement
Dr. Rhonda Patrick
Chairman Scott, Ranking Member Gillibrand, and Members of
the Committee, thank you for the opportunity to speak.
We have to ask ourselves: Can we call ourselves the
greatest nation in the world while 70% - nearly three in four
American adults - are overweight or obese?
While we spend 18% of our GDP on healthcare-more than any
other nation-yet rank 55th in life expectancy? While our
children are developing type two diabetes at rates once unheard
of?This is not just a health crisis. This is a cultural crisis.
Because let's be clear: obesity is not inevitable. It is
not an act of God. It is a choice-compounded over time,
reinforced by a system that fails to foster- even from a young
age - self-discipline and sound decision-making.
We have created an environment where difficult truths are
treated as personal attacks, where doctors feel discussing a
patient's weight is too taboo.
This is a disaster. If the devastating consequences of
obesity are too uncomfortable to discuss, how can we expect
people to change?
We must foster a culture where direct conversations are
expected, not feared.
Obesity alone is linked to 13 types of cancer and cuts life
expectancy by 3-10 years, depending on severity. It promotes
DNA damage and accelerates our fundamental aging process-often
measured by epigenetic age. It's one of the principal
differences between the U.S. and many of the world's longest-
lived nations.
We're overfed but undernourished. 60% of all calories
Americans consume come from ultra-processed foods that:
Fail to induce proper satiety, pushing us to overeat.
Remain cheaper than whole foods, economically
incentivizing the least healthy choices.
Hijack our dopamine reward pathways, reinforcing addictive
eating behaviors.
This trifecta-no satiety, low cost, and built-in
addictiveness-keeps us in a cycle of poor health outcomes and
runaway healthcare costs.
Caloric excess is only part of the problem-we are also
nutrient-deficient.
Low omega-3 levels-affecting 80 to 90% of Americans-carry
the same mortality risk as smoking. Vitamin D deficiency-easily
corrected-compromises immune function, cognition, and
longevity. Nearly half of Americans don't get enough magnesium-
impairing DNA repair and increasing the risk of cancer.
We are not solving these problems-we are medicating them.
The average American over 65 takes five or more prescription
drugs daily-stacking interactions that compound in
unpredictable ways.
Polypharmacy is a crisis. We are not buying health-we are
buying complexity.
The real problem is simpler. We must start treating
physical inactivity as a disease. It carries the same mortality
risk as smoking, heart disease, and diabetes. Going from a low
cardiorespiratory fitness to a low normal adds 2.1 years to
life expectancy.
By age 50, many Americans have already lost 10% of their
peak muscle mass. By 70, many have lost up to 40%.
This isn't just about looking strong. It's about survival.
Higher muscle mass means improved insulin sensitivity - it
means a 30% lower mortality risk.
Grip strength is a stronger predictor of cardiovascular
mortality - the number one cause of death in the Unites States
- than high blood pressure.
The strongest middle-aged adults have a 42% lower dementia
risk.
Yet, we treat resistance training as optional. It is not.
It is the most powerful intervention we have against aging
including increasing muscle mass, strength and bone density..
Hip fractures alone kill 20-60% of older adults within a
year. This is a death sentence we can prevent with resistance
training - which has been shown to lower fracture risk by 30-
40%.
The current RDA for protein is too low for older adults.
Studies have shown when it's increased by half this reduces
frailty by 32%, while doubling it, combined with resistance
training, increases muscle mass by 27% and strength by 10% more
than training alone. If we want to prevent muscle loss and
frailty, we must update our protein recommendations and
prioritize strength training.
We must foster a culture of American exceptionalism built
on daily, effortful exercise. Not as an afterthought. Not as a
luxury, but as a non-negotiable foundation for aging, but also
clear thinking, resilience, and even leadership.
We must start by holding ourselves to a higher standard.
We should ask: Can a doctor struggling with their own
weight truly counsel us on ours?
We should ask: Can a leader who neglects their own health
make the best decisions for the constituents they serve?
If we don't like the answers, we must demand better.
The body and brain are not separate. The consequences of
poorly regulated blood sugar, sedentary living, and muscle loss
are not just physical-they affect cognition, judgment, and
resilience. If exercise enhances focus and decision-making,
then we should expect those in power to prioritize it most of
all.
A strong nation starts with strong individuals. Strength is
not inherited-it is built. It is earned. It is trained.
We cannot medicate our way out of what we have behaved our
way into.
If we truly want to lead the world, we must first lead
ourselves.
No law, no policy, no government program can make a nation
strong. Only its people can.
Strength is a choice-compounded over time and earned
through effort.
Now the question is - will we have the discipline?
U.S. Senate Special Committee on Aging
"Optimizing Longevity: From Research to Action"
February 12, 2025
Prepared Witness Statement
Dr. Eric Verdin
Good afternoon, Chair Scott, Ranking Member Gillibrand, and
members of the Committee.
Thank you for the opportunity to speak today. My name is
Eric Verdin, and I am the CEO of the Buck Institute for
Research on Aging-the world's leading research organization on
the biology of aging. Our mission is to eliminate the threat of
chronic disease by addressing aging itself.
Over the past century, public health advances and medical
breakthroughs have nearly doubled the human lifespan. This
incredible success has come with challenges. We live longer but
not healthier. The end of our long lives is now characterized
by debilitating diseases such as Alzheimer's, Parkinson's,
heart attacks, strokes, type two diabetes, cancer,
osteoarthritis and macular degeneration. By the time an
American reaches age 65, most have at least one chronic
condition and more than half have two.\1\ We call these
conditions the chronic diseases of aging.
---------------------------------------------------------------------------
\1\ https://pmc.ncbi.nlm.nih.gov/articles/PMC6873710
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Our current healthcare system is focused on treating these
conditions when they occur, not in preventing them in the first
place. This approach is expensive, inefficient, and ultimately
ineffective. The cost of managing these illnesses is staggering
- increasing as our population ages - and places an
unsustainable financial and emotional burden on our healthcare
system, our citizens and their families.
In the 20th century, we dramatically reduced deaths from
infections, from heart disease, and from cancer, extending life
expectancy in the process, but progress is slowing. Even if we
cured cancer tomorrow, the average lifespan would increase by
less than three years.\2\ The reason is simple: aging itself
continues unchecked.
---------------------------------------------------------------------------
\2\ https://www.science.org/doi/10.1126/science.2237414
---------------------------------------------------------------------------
Aging is the greatest risk factor and main driver for these
chronic diseases. Research from the past 20 years clearly
indicates that aging can be slowed, thereby extending healthy
lifespan and delaying disease in animal models. There is not a
single reason why these findings should not apply to humans as
well. By focusing on aging and its mechanisms, we can compress
the period of illness and frailty so that more of our years are
spent in good health.
The economic and public health benefits of a shift from a
reactive healthcare system to true preventative healthcare
based on our understanding of aging are enormous. Studies
suggest that delaying aging will generate trillions of dollars
in economic gains, reduce medical costs and increase
productivity.\3\ Just as vaccines and antibiotics
revolutionized medicine in the past, aging science is the next
great frontier in preventive healthcare.
---------------------------------------------------------------------------
\3\ https://pmc.ncbi.nlm.nih.gov/articles/PMC4743067
---------------------------------------------------------------------------
The science is at a turning point, and as policymakers you
will play a critical role in ensuring that we realize its
benefits. Investing in aging research must be a priority. The
NIH should increase funding on the molecular pathways of aging,
with a new emphasis on translating discoveries into human
applications. We also need a much greater focus on lifestyle
interventions-nutrition, exercise, sleep, stress management,
and social connections. They account for more than 90% of our
healthspan and lifespan and should be an essential part of our
health policy and our research.\4\
---------------------------------------------------------------------------
\4\ https://pubmed.ncbi.nlm.nih.gov/30401766/
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We must also rethink how we allocate healthcare dollars.
Right now, we spend trillions on treating diseases after they
arise. A shift toward prevention-one that targets aging itself-
would be far more effective. The FDA needs clear guidelines for
aging-targeted therapies. Biotech and pharma companies are
investing in this field, but without a defined regulatory
pathway, progress is slowed. And finally, we need stronger
public-private collaboration. Translating discoveries into
real-world applications will require coordinated efforts
between industry, government, and regulatory agencies.
This is a pivotal moment. The 21st century has the
potential to witness one of the most profound medical
breakthroughs in history-not just treating age-related
diseases, but preventing them. The goal is not just to extend
lifespan, but to ensure those extra years are spent in health,
dignity, and independence.
I applaud the Committee for recognizing the urgency of this
issue. Aging research is at an inflection point, and with the
right policies, we can transform public health for generations
to come. I look forward to working with you to make this vision
a reality.
Thank you.
U.S. Senate Special Committee on Aging
"Optimizing Longevity: From Research to Action"
February 12, 2025
Prepared Witness Statement
Dr. Sarah C. Nosal
Chairman Scott, Ranking Member Gillibrand, and
distinguished members of the Committee, thank you for the
opportunity to testify today. My name is Sarah Nosal, MD, FAAFP
and I am a practicing family physician in the South Bronx. As
the President-elect of the American Academy of Family
Physicians (AAFP), I am honored to be here today representing
the more than 130,000 physician and student members of the
AAFP.
I currently serve as the Vice President for Innovation &
Optimization and Chief Medical Information Officer at The
Institute for Family Health, a federally qualified health
center (FQHC) network with more than 27 locations in the Mid-
Hudson Valley, Bronx, Manhattan, and Brooklyn. I am also an
assistant professor in the Mount Sinai Department of Family
Medicine & Community Health, where I focus on care of
marginalized communities and the uninsured and share the role
of medical director for Einstein Community Health Outreach, New
York's oldest student-run free clinic.
While I am proud to now think of myself a New Yorker, I
actually grew up just outside Washington, D.C. I always knew I
wanted to be a doctor, and my journey to family medicine
started as a grade schooler in the 80's, when I was troubled
witnessing unhoused individuals - disproportionately veterans
during that time in history - sleeping on sidewalks and street
grates in the very heart of our nation's capital. I felt called
to serve them but was not sure how. My mother, a social worker,
told me that I could grow up to become the kind doctor who
takes care of them. And so, I set my life's course to do just
that.
While on my rotations in medical school, it became clear
that to meet the needs of our most under-resourced patients and
communities I needed to be the kind of physician who could do
patient-centered, continuous, compassionate care for patients
of all ages, across the life span, with them never aging out of
my ability to care for them. The kind of medicine that allows
me to do that is family medicine.
I am proud to be a family physician. I get to provide
continuous, comprehensive medical care, health maintenance and
education, and preventive services to patients across their
entire lifespan - regardless of age, health goals, or
challenges. Through enduring partnerships, family physicians
lead care teams and help patients set goals; strive for
wellness; prevent, understand, and manage acute and chronic
illness; and navigate the complexities of the health system.
Last month, Chairman Scott laid out his priorities for this
Committee which identified four key aspects for someone to be
considered "well:" having their physical health; financial
security; a safe community to live in; and family and community
support. Each of these are rooted in the very fundamentals of
family medicine, and I applaud this Committee for recognizing
their significance in ensuring that an individual is not just
living longer but living longer and better. That mission is one
shared by all family physicians.
I have practiced for more than two decades in an extremely
under-resourced area of the South Bronx. Health outcomes in my
county are ranked 62 of 62 in all of New York state. My
personal patient panel approaches nearly 90 percent Medicaid
beneficiaries. In my office, I have the honor and privilege of
taking care of not just patients, but families and communities.
When I first started in my current clinic, my patients, like I
was, were primarily younger women. As I planted my roots and
affirmed to them I was going to stay, they started to seek care
for their pregnancies, bringing their babies and toddlers,
aunts and brothers, parents, grandparents, and great
grandparents. Caring for patients across the lifespan also
means caring for families across generations, often seeing a
family history play out before me rather than just reading or
documenting it.
Family medicine's uniqueness as a specialty means that,
while working with patients towards wellness goals or managing
chronic illness, we can anticipate barriers or risks due to
social drivers of health, personal medical history, or family
or genetic history that might be pre-disposing them to worse
outcomes. These histories can manifest in complex needs;
frequent among them are dietary needs for patients managing
risks, predisposition and multiple complex diseases. A typical
patient of mine presents with cane in hand, living with HIV,
diabetes, hypertension, and chronic kidney disease. Patient-
tailored counseling on diet and physical activity is something
I do in every visit. One tool that my clinic has developed to
help guide patients with diet-influenced conditions and help
them visually embrace and understand healthy, plant-forward
eating is a series called "Healthy Plates Around the World."
These culturally appropriate plates engage my patients in a
familiar context to best portion their meals using foods they
are accustomed to.
However, no matter how well-illustrated, the unfortunate
reality is that fresh, whole, healthy foods are out-of-reach
financially or otherwise inaccessible to most of my patients.
This is but one of the health-related social needs (HRSN) that
impacts them. A lack of safe and stable housing, reliable
transportation, safe places to exercise, financial security, in
addition to access to nutritious foods, all make it difficult -
if not altogether impossible - for many of my patients to
simply afford necessary medications and reliably make it to
medical appointments is my office.
Research has consistently shown that unaddressed HRSN can
influence the onset or worsening of many health conditions,
including chronic diseases.i On more than one occasion when I
asked a patient why they were not taking their insulin as
directed, I would find out they did not have electricity in
their apartment for weeks at a time after falling behind on the
rent. A neighbor was allowing them to store their medications
that require refrigeration, but that also meant they did not
have it readily accessible.
The empirical evidence backs this lived experience. Housing
instability - difficulty paying rent, eviction, and living in
overcrowded conditions - is associated with delayed medical
care, medication nonadherence, and increased emergency
department visits. When we screen across our patient community,
housing is consistently the most commonly identified social
need of our patients with the fewest resources readily
available. Another top identified need is safe transportation,
from our rural clinic where patients have been known to walk
long distances along roadsides without walkways to our urban
clinics where a patient with walker in hand faces four flights
of stairs at the subway up and back. The lack of safe,
accessible transportation in both rural and urban areas makes
health and health care equally inaccessible. Unsafe,
inconvenient transportation impacts a person's ability to
access medical care and is also associated with higher rates of
unemployment, poverty, and chronic illness.ii
The majority of the older adults I see in my practice fall
into the group of low-income seniors who are eligible for both
Medicaid and Medicare, known as dual eligibles, and have an
average of 2.2 HRSN compared to 0.9 for non-dual eligibles.iii
What that means in real life is they have a rolling walker with
chair due to severe osteoarthritis, are unable to use public
transportation, are forced to piece together the healthiest
meals they can from soup kitchens, pantries and limited food
assistance benefits, while doing laps around their daughter's
living room as their most accessible form of exercise.
Medicaid serves a critical need, providing coverage for
patients and sustaining community health centers delivering
care to these struggling communities. Those same Medicaid
beneficiaries with diet-related conditions experience higher
levels of food insecurity. One study found that nearly one-
third of Medicaid enrollees with diabetes were food insecure,
in comparison to seven percent of those enrolled in private
insurance.iv In another study, more than half of dual eligibles
reported food insecurity.v
The U.S. Department of Agriculture's Supplemental Nutrition
Assistance Program, otherwise known as SNAP, is a lifeline for
those experiencing food insecurity. The program provides food
benefits to low-income families to supplement their grocery
budget. SNAP's healthy incentives programs (HIP) also help
increase healthy food consumption by providing enrollees with a
coupon, discount, gift card, bonus food item or extra funds.
Program evaluations have shown that HIP participants consumed
almost 1/4 cup more fruits and vegetables per day and had
higher total household spending on fruits and vegetables than
non-participants.vi Additionally, participants in one program
redeemed more than $20 million dollars in nutrition incentives
and produce prescriptions with the program generating an
economic impact of about $41 million dollars.
However, there remains a gap in the nutrition needs of many
individuals who are not enrolled in or eligible for SNAP
benefits. An earlier cited study found that 29 percent of
people with diabetes were not receiving SNAP benefits, and over
two-thirds of uninsured individuals were not receiving SNAP
benefits. Further, over 40 percent of Medicaid enrollees with
diabetes who were receiving SNAP benefits remained food
insecure. There is undoubtedly room for improvement to ensure
SNAP and related programs better serve my patients who need
them; to start, greater coordination and streamlined enrollment
across safety-net programs such as SNAP and Medicaid, increased
funding for benefits, improving public awareness about HIPs,
and making it administratively easier for individuals to
navigate and use said benefits. However, that alone will not
solve my patient's challenges with accessing and adhering to
healthy lifestyle choices.
While diet and exercise are critically important to health
and wellness, we cannot ignore that these are not accessible
choices for those who live in communities designed with them
out of reach. Food and exercise can only be medicine if they
are equitably and easily available, safe, and accessible. As a
family physician, I can recommend working out and having a
healthy diet - but it is up to you, our elected leaders, to
ensure the resources and support are in place to fill that
prescription. Congress has the opportunity to advance
additional policies to address food insecurity, unstable
housing, and other health-related social needs and improve
health outcomes at the community, family, and individual level.
For instance, policies that support free or reimbursable public
transit or improve the safety and accessibility of sidewalks
and bike lanes help improve transportation access and can
influence better health outcomes for both individuals and
communities.
In our free clinic, we provide free, whole, plant-forward
food to patients on Saturday mornings. Patients will often come
even during the weeks that they do not have a medical
appointment. I encourage you all to explore federal investments
such as additional grants or more sustainable funding streams
to expand these types of community-based resources,
particularly in communities like mine that remain food deserts.
Many states have utilized existing Medicaid authorities to
begin addressing HRSN, including state plan authorities,
section 1915 waivers, managed care in lieu of services and
settings and section 1115 demonstrations. In December 2022, the
Centers for Medicare and Medicaid Services announced that
states can use section 1115 demonstrations to cover nutrition
supports and HRSN case management, among other services, as
reimbursable benefits under Medicaid for certain populations.
Nutrition support may include nutrition counseling and
education; medically tailored meals; meals or pantry stocking
for children under 21 or pregnant patients, including two
months postpartum; fruit and vegetable prescriptions; and
protein boxes. For example, under Massachusetts' section 1115
waiver, medically tailored meals may be provided to the whole
household, not only the Medicaid beneficiary eligible for the
service. This policy recognizes that a food-insecure parent
will often give their nutrition supports to a hungry child,
rather than feed themselves. Expansion of these types of
policies would be life-changing and make wellness and longevity
possible for my patients.
Some states have used other levers, such as community
reinvestment requirements for Medicaid managed care contracts.
Examples of community reinvestments addressing nutrition needs
include building and maintaining community gardens, farmers
markets, community-supported agriculture, farm partnerships, or
grocery stores in food deserts. Federal policymakers could
explore opportunities for expansion of these types of community
investment requirements at the national level or ways to
support ongoing state initiatives. To truly be successful and
community-centric, any such policies must include appropriate
guardrails with a clear definition of community reinvestment
and transparency and accountability reporting requirements.
Plans or other entities subject to community reinvestment
requirements should also be required to solicit local input to
ensure that the investments are culturally appropriate and
address true community needs.
Much of this work in the states is just getting off the
ground. Therefore, I strongly urge Congress and the
Administration to support and further invest in these
promising, innovative efforts that seek to address the root
causes of poor health outcomes.
Beyond Medicaid, the AAFP has supported legislation that
would expand Medicare coverage of nutrition services for
seniors with certain diet-impacted chronic conditions, such as
diabetes, HIV, and hypertension. We have also supported
legislation that would establish a four-year nationwide
demonstration program through Medicare to provide medically
tailored meals to eligible Medicare beneficiaries with diet-
impacted conditions. I strongly encourage the Committee to
consider these policies as you continue to explore
opportunities to improve health across the lifespan.
There is also an opportunity for Congress to improve uptake
of services that are newly covered but underutilized,
particularly chronic care management (CCM). In 2015, Medicare
began paying physicians for delivering non-face-to-face CCM
through separate codes. These services are fundamental to the
delivery of patient-centered, comprehensive primary care,
including for seniors with diet-impacted conditions.
Unfortunately, operational challenges such as patient cost-
sharing requirements limit uptake by patients who would truly
benefit from this type of additional support. A 2022 study
found that Medicare billing codes for preventive medicine and
care management services are being underutilized even though
primary care physicians were providing code-appropriate
services to many patients. The median use of the preventive and
care coordination billing codes was 2.3 percent among eligible
patients.vii
Put otherwise: patients are informed of a copay and shared
costs as required by Medicare, so subsequently many patients
opt out of these services because of the financial barriers. In
my experience, it is often the ones who stand to benefit most
from these services. This rings true for many of the other new
codes Medicare has implemented, including G2211, social
determinants of health risk assessments, and community health
integration services. Patients are living on fixed incomes and
have not anticipated paying for these services and,
understandably, are resistant or unable to do so. If we want to
incentivize usage of these high-value services, we must waive
patient cost-sharing.
Removing cost-sharing for chronic care management and other
primary care services increases access without increasing
overall health care spending.viii Evidence indicates that
reducing or removing cost barriers to primary care increases
utilization of preventive and other recommended primary care
services, which improves both individual and population health
with long-term cost savings. While cost-sharing for most
preventive services is currently waived across payers, many
patients do not access all the preventive care recommended for
them because they do not know what is or is not covered or they
are concerned they might be charged for raising other health
issues in the same visit. Therefore, the AAFP urges Congress to
consider legislation that would waive patient cost-sharing for
chronic care management and other primary care services.
As has been acknowledged by this Committee, we are all
aging. Therefore, we must explicitly recognize the impact of
health-related social needs across the lifespan and how they
influence outcomes later in life. In particular, access to
affordable health care coverage has positive long-term effects.
Expanded Medicaid eligibility for pregnant women has been shown
to increase their children's economic opportunity in adulthood
through increased educational attainment and higher incomes.ix
Children covered by Medicaid also pay more in cumulative taxes
by age 28 compared to their peers who are not Medicaid-
enrolled.x
If we want to give everyone the chance to age healthily and
well, it is imperative Congress supports those programs which
make it possible, regardless of a person's socioeconomic status
or other demographics. In particular, cutting Medicaid does not
just take away an individual's coverage and harm their health.
It hurts entire families, has economic consequences, and
jeopardizes community outcomes. Many of my young or middle-aged
patients are caregivers for both children and older relatives.
Any reforms that impede or altogether cut their health care
coverage are likely to impact their employment, their ability
to help their mother make rent, to take their grandma to the
laundromat or her cardiologist appointment, or contribute in
any productive, meaningful way to their community. If we want
to truly improve our nation's health to optimize longevity, it
must start with investing in Medicaid and other safety-net
supports - not cutting them.
Health insurance coverage does not help patients if there
is no access to care, however. Community health centers (CHCs),
including FQHCs and rural health clinics, provide care to those
in medically underserved areas and are often the only
accessible health care setting for many individuals, including
Medicaid beneficiaries and the uninsured. Nationally, Medicaid
makes up 43 percent of community health center revenue.xi As a
result, cuts to Medicaid would be a direct cut to CHCs and the
communities they serve as well.
CHCs have a significant economic impact. In 2021, they
supported more than 500,000 direct or indirect jobs nationally
with nearly $85 billion in economic output. Both New York and
Florida, which are proudly represented by this Committee's
leadership, are in the top five of states that economically
benefit from CHCs; the economic output is $6.1 billion in New
York and $4.2 billion in Florida.xii Community health centers
are also incredibly efficient in terms of health care spending.
Research has consistently shown that health care costs for all
patients served by CHCs - including Medicaid beneficiaries -
are lower than costs for patients not served by CHCs.xiii
Further, many CHCs are working to combat our nation's
primary care workforce shortage and training the next
generation of family physicians by serving as Teaching Health
Centers. The Health Resources and Services Administration's THC
Graduate Medical Education (THCGME) program funds the
development and implementation of residency programs in
outpatient community-based settings in rural or medically
underserved communities. Since the program's inception, it has
trained more than 2,000 new primary care physicians and
dentists - 61 percent of whom have been family physicians.
Thanks to the THCGME program, our FQHC system has multiple
family medicine residency programs across our region. Many of
residents stay to continue serving these communities upon
graduation.
Unfortunately, CHCs and THCGME are reliant upon a patchwork
of inconsistent, temporary federal funding to stay afloat. At
the moment, funding for both programs is only guaranteed
through March 14. This, in addition to recent executive actions
which have stoked confusion about what federal funding is or is
not available, is an existential crisis for our nation's safety
net. CHCs operate on such thin margins that even a threat to
funding can paralyze our ability to deliver all of the care
that is essential to meeting our patients' and community's
needs.
For THCs, uncertainty about future funding for the academic
year has led to some programs either closing their doors
entirely or accepting fewer residents. To support and improve
the quality of life for patients of all ages and in all
communities, I urge this Committee and your colleagues in
Congress to make stable, long-term funding for CHCs and THCGME
a priority and to ensure that access to other key programs and
community-level interventions is not disrupted. Failure to do
so would run counter to the Committee's stated goals.
In closing, thank you again for the opportunity to provide
this testimony. On behalf of the AAFP and as a family
physician, I look forward to working with the Committee to
advance policies that invest in the health and wellbeing of
individuals across the lifespan at the person, family, and
community level. We all have the same goal: to improve the
lives of the people we serve.
References
i Heller CG, Rehm CD, Parsons AH, Chambers EC, Hollingsworth
NH, Fiori KP. The association between social needs and chronic
conditions in a large, urban primary care population. Prev Med.
2021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752. Epub
2021 Aug 1. PMID: 34348133; PMCID: PMC8595547.
ii Centers for Disease Control and Prevention, "PLACES: Health-
Related Social Needs." Accessed online at: https://www.cdc.gov/
places/measure-definitions/health-related-social-needs.html.
iii Peikes, D. N., Swankoski, K. E., Rastegar, J. S., Franklin,
S. M., & Pavliv, D. J. (2023). Burden of health-related social
needs among dual- and non-dual-eligible Medicare Advantage
beneficiaries. Health Affairs, 42(7). https://doi.org/10.1377/
hlthaff.2022.01574.
iv Kirby JB, Bernard D, Liang L. The Prevalence of Food
Insecurity Is Highest Among Americans for Whom Diet Is Most
Critical to Health. Diabetes Care. 2021 Jun;44(6):e131-e132.
doi: 10.2337/dc20-3116. Epub 2021 Apr 26. PMID: 33905342;
PMCID: PMC8247495.
v Peikes, D. N., Swankoski, K. E., Rastegar, J. S., Franklin,
S. M., & Pavliv, D. J. (2023). Burden of health-related social
needs among dual- and non-dual-eligible Medicare Advantage
beneficiaries. Health Affairs, 42(7). https://doi.org/10.1377/
hlthaff.2022.01574.
vi U.S. Department of Agriculture, Food and Nutrition Service.
(n.d.). Healthy incentives for SNAP participants. U.S.
Department of Agriculture. Retrieved February 8, 2025, from
https://www.fns.usda.gov/snap/healthy-incentives.
vii Sumit D. Agarwal, Sanjay Basu, Bruce E. Landon The Underuse
of Medicare's Prevention and Coordination Codes in Primary
Care: A Cross-Sectional and Modeling Study. Ann Intern
Med.2022;175:1100-1108. [Epub 28 June 2022]. doi:10.7326/M21-
4770
viii Ma, Q. Sywestrzak, G. Oza, M. Garneau, L. DeVries, A.
"Evaluation of Value-Based Insurance Design for Primary Care."
(2019). The American Journal of Managed Care. 25: 5. https://
www.ajmc.com/view/evaluation-of-valuebasedinsurance-design-for-
primary-care.
ix Kaiser Family Foundation. (2022, December 13). Medicaid
spending growth compared to other payers. Kaiser Family
Foundation. Retrieved February 8, 2025, from https://
www.kff.org/report-section/medicaid-spending-growth-compared-
to-other-payers-issue-brief/.
x Ibid.
xi Kaiser Family Foundation. (n.d.). Community health center
revenues by payer source. Kaiser Family Foundation. Retrieved
February 8, 2025, from www.kff.org/other/state-indicator/
community-health-center-revenues-by-payer-source/
?currentTimeframe0&sortModel=%7B%22colId%22:%22Location%22sort%2
2asc7D.
vii National Association of Community Health Centers. (2023).
Economic impact of community health centers in the United
States: 2023 report. National Association of Community Health
Centers. Retrieved February 8, 2025, from https://
www.nachc.org/wp-content/uploads/2023/06/Economic-Impact-of-
Community-Health-Centers-US--2023--final.pdf.
xiii Ibid.
U.S. Senate Special Committee on Aging
"Optimizing Longevity: From Research to Action"
February 12, 2025
Prepared Witness Statement
Dan Buettner
My goal here is to convince you that most of what Americans
think will lead them to a long, healthy life is misguided or
just plain wrong.
I've spent the past 20 years partnered with National
Geographic to identify, verify, and understand populations
around the world with the greatest longevity. These "blue
zones," as they're known, are places where people live up to a
decade longer than the rest of us with a fraction of the
chronic diseases that eat up most of the $4.9 trillion our
nation spends annually on healthcare.
The famous Danish Twin Study established years ago that
only about 20% of how long we live is dictated by our genes.
Another 10-15% is dictated by our health care system. That
means at least two thirds of our longevity comes from something
else.
So, with an advisory board of academics, my team and I set
off to find the correlates and common denominators driving
longevity.
On the Italian island of Sardinia, for example, our
demographers found a cluster of six mountain villages that
produced centenarians at a rate many times that of the U.S.
People there ate a mostly whole-food, plant-based diet-cheap
peasant foods like fava beans, barley, and potatoes. They
prioritized family and friends over status and wealth. They
prayed. (Did you know that people who go to a faith-based
community four times a month live four years longer than people
who don't?) And every time these villagers went to work,
school, or to visit friends, it occasioned a walk. They got in
their 8,000-12,000 steps a day without even thinking about it.
The Big Secret here-and the one we miss-is that health and
longevity are rarely successfully pursued. They ensue.
We spend nearly a half trillion a year trying to chase
health with diet, exercise, and pills. They're all great
business plans, but they fail for almost everyone all of the
time. If you start with 100 people on a diet, you lose more
than 95% in two years. Exercise programs have similar drop
offs.
Similarly, the $47 billion a year Americans spend on
antiaging products has not delivered a single pill, supplement,
or stem cell treatment that has been shown to reverse, stop, or
even slow aging.
In the blue zones, longevity ensues because people live in
an environment where the healthy choice is the easy choice. The
cheapest, most delicious foods are the simplest foods. It's
easier to walk places than to drive. You can't avoid face-to-
face contact with your neighbors, your fellow worshipers, or
the extended family that lives with you. And you have a
vocabulary for your purpose in life, so it's easier to pursue
it. In other words, people in the blue zones don't have to
muster the resources, the daily discipline, and the presence of
mind to make the healthy choice. Their environment does it for
them.
If we want a healthier America, we should shift our focus
from the folly of trying to convince 340 million people to
follow a diet or health plan and instead we should strive to
set them up for success. My company, Blue Zones, has helped
more than 70 American cities shape polices that favor healthy
foods over junk foods, to build streets for human beings, not
just for cars, which can increase physical activity for the
whole city by 20%, and to encourage non-smokers over smokers.
We also offer Blue Zones certification for all schools,
restaurants, workplaces, and places of worship that optimize
their designs and policies to nudge people into moving more,
socializing better, and eating healthier. The key is optimizing
our living environments.
The proof is in the numbers. Using our approach, Fort
Worth, Texas, reported a drop in obesity and a quarter of a
billion dollars in annual healthcare savings. The Beach Cities
of Southern California reported a 15% drop in BMI. Our first
Blue Zones Project city, the town of Albert Lea, Minnesota, has
saved 30% of their city worker health care costs since they
started-and they're still making their city healthier 15 years
later.
The secret to longevity does not lie in any silver bullet.
The secret is to shift the focus of public policy from trying
to change individual behaviors to setting up all Americans for
success by making the healthy choice the easy one.
=======================================================================
Questions for the Record
=======================================================================
U.S. Senate Special Committee on Aging
"Optimizing Longevity: From Research to Action"
February 12, 2025
Questions for the Record
Dr. Eric Verdin
Senator Raphael Warnock
Question:
Access to affordable healthcare is essential and allows
seniors across the country to age with dignity. Federally
funded research, facilitated by hardworking federal workers,
helps healthcare providers better understand aging-related
diseases, such as Alzheimer's. In Fiscal Year 2024, Georgia
received $782,913,345 in federal funding to support 1,557 grant
awards through the National Institutes of Health (NIH).\1\
Additionally, the Centers for Disease Control and Prevention
(CDC), which is headquartered in Georgia, supports valuable
research to combat infectious diseases and public health
threats. However, the Trump Administration's executive orders
and funding cuts have affected life-saving research that could
improve the health and longevity of seniors.\2\
---------------------------------------------------------------------------
\1\ NIH Awards by Location & Organization, National Institutes of
Health, www.report.nih.gov/award/
index.cfmot=fy=2024state=GAic=fm=orgid=distr=rfa=om=npid=view=statedetai
l.
\2\ Sheryl Gay Stolberg and Christina Jewett, Judge Temporarily
Blocks Trump Cuts to Medical Research Funding, The New York Times (Feb.
2025), https://www.nytimes.com/2025/02/10/us/politics/nih-trump-
lawsuit-medical-research.html.
---------------------------------------------------------------------------
How will cuts to the federal workforce and funding at
research agencies, like the CDC and NIH, affect efforts to
support research into age-related diseases?
Response:
At a time when we are on the verge of significant
breakthroughs in the fight against age-related chronic disease
- breakthroughs that could ease untold human suffering and
achieve trillions of dollars in savings in healthcare costs -
cuts to the NIH would be devastating.
On February 7, the National Institutes of Health (NIH),
under direction from the Trump administration, announced a plan
to cap indirect cost recovery on federally funded biomedical
research grants at 15% of direct costs. While a federal judge
has extended an order temporarily blocking implementation, this
policy - which means little to the average American - could
have devastating consequences for the future of American
biomedical research.
NIH is the largest funder of biomedical research in the
U.S., supporting thousands of projects at academic and medical
institutions. The rationale for this proposed cut is a familiar
one: the assumption that IDC represents unnecessary
bureaucratic waste. That assumption is dangerously misguided.
Since the 1950s, NIH has divided research costs into two
categories: direct costs-salaries, lab supplies, and equipment-
and indirect costs, which cover essential infrastructure and
administrative expenses necessary for conducting federally
funded biomedical research. This includes lab space, utilities,
security, compliance, IT support, equipment maintenance, and
administrative staff for grants management, HR, and regulatory
oversight. These indirect expenses are not arbitrary; they are
calculated based on documented institutional costs and are
subject to rigorous audits every four to five years.
Institutions cannot simply inflate these rates at will.
Despite claims of excessive spending, indirect cost rates
vary between 40% and 70%, depending on real institutional
costs. And even that figure is often misunderstood. An indirect
cost rate of 50% does not mean half of a grant goes to
overhead; rather, it means that for every $100 in direct costs,
$50 is allocated to necessary facilities and administration,
making the actual overhead share of the grant just 33%.
What would slashing IDC reimbursements to 15% mean in
practice? For most universities, research institutes, and
medical centers, it would make large-scale research
unsustainable. Some institutions would be forced to cut
programs; others might abandon their research mission
altogether. Our economy in general, and the biopharmaceutical
sector in particular, would suffer. In FY 2023, every $1 of NIH
funding generated approximately $2.46 of economic activity. The
long-term damage would be profound: the U.S., which has led the
world in biomedical innovation for decades, would see its
scientific preeminence erode.
The timing could not be worse. America faces a healthcare
crisis, with annual costs exceeding $4.9 trillion. Biomedical
research, largely funded through NIH, forms the foundation for
innovations that drive the pharmaceutical and healthcare
industries. Yet the NIH budget stands at just $47 billion, a
mere 1% of total healthcare spending. By comparison, technology
industries routinely invest 8-12% of revenue into R&D, and the
U.S. military spends over $143 billion annually on research-
three times the entire NIH budget.
Cutting indirect cost support will not save taxpayer
dollars; it will sabotage the very research that leads to life-
saving treatments and drives economic growth. Policymakers must
recognize that this change is not a bureaucratic tweak-it is an
attack on the future of biomedical discovery. If implemented,
it will set American science back for a generation.
U.S. Senate Special Committee on Aging
"Optimizing Longevity: From Research to Action"
February 12, 2025
Questions for the Record
Dr. Sarah C. Nosal
Senator Raphael Warnock
Question:
Access to affordable healthcare is essential and allows
seniors across the country to age with dignity. Most older
adults in the United States are living with at least one
chronic health condition, and many seniors face barriers, like
lack of access to transportation, that impede their access to
quality health care.\1\ Medicare telehealth flexibilities have
allowed providers to deliver quality care to seniors who might
otherwise be unable to access certain services. I was proud to
join my colleagues to approve an extension of telehealth
flexibilities in the American Relief Act, 2025; however, these
flexibilities will expire on March 31, 2025.\2\
---------------------------------------------------------------------------
\1\ Social Determinants of Health and Older Adults, Office of
Disease Prevention and Health Promotion, https://odphp.health.gov/our-
work/national-health-initiatives/healthy-aging/social-determinants-
health-and-older-adults.
\2\ Telehealth Policy Updates, Department of Health and Human
Services, https://telehealth.hhs.gov/providers/telehealth-policy/
telehealth-policy-updates.
---------------------------------------------------------------------------
How does expanding access to health care, such as through
extending Medicare telehealth flexibilities, optimize longevity
for seniors?
Response:
Expanding access to health care across modalities, be it
in-person, audio-only, or video telehealth, is essential to
delivering accessible, patient-centered care and improving
health outcomes. On many occasions my older adult patients,
often living alone or simply alone during the day while family
is at work, rely on visiting grandkids or the few hours a home
attendant is present in order to connect with a video visit. On
their own, the only successful access to telehealth may be via
audio-only. One study of Federally Qualified Health Centers
(FQHCs) found that, by mid-2022, one in five primary care
visits and two in five behavioral health visits were audio-
only, and audio-only visits were still more common than video
visits. Yet the lack of payment parity and numerous
restrictions placed on these visits have made them
unsustainable post-COVID.
The COVID-19 pandemic shown a spotlight on what a lifeline
telehealth and audio-only services are for keeping patients,
including seniors, connected to care. It demonstrated that
enabling physicians to virtually care for their patients at
home can not only reduce patients' and clinicians' risk of
exposure and infection but also increase access and convenience
for patients, particularly those who may be homebound or lack
transportation. For our patients in rural and suburban
communities, transportation is cited as the number one reason a
patient is unable to attend their in-person visit, canceling
important preventive and disease management care. I remember a
patient who had been unable to make it into the office due to
lack of family support for transportation and physical
disability that prevented travel on her own. On our video visit
I had her walk about and realized she was lightly holding on to
the furniture as she did. The patient had skipped her follow up
eye evaluation and had had a marked decrease in vision that
required urgent follow up. This much more timely telehealth
visit made it possible to evaluate this patient in her home and
observe things we normally cannot during an in-office visit.
For this patient, both clinical deterioration and obvious home
safety issues with her diminishing vision were observed via
video visit and made it possible to connect her to the
personalized specialty and community services to address her
low vision needs and high priority care.
For these reasons, I urge Congress to prioritize passage of
permanent telehealth flexibilities to provide greater certainty
and stability to both physicians and patients and ensure that
we can care for our communities via whatever modality is
accessible and appropriate - not just based on arbitrary rules.
Question:
Community Health Centers (CHCs) play a vital role in
addressing provider shortages, especially in rural and
underserved communities.\3\ Following President Trump's
executive order to freeze federal funding and pause external
communications at federal agencies, CHCs in Georgia and safety-
net providers across the country faced delays in funding, which
threatened access to affordable care for millions of Americans,
including seniors, who rely on CHCs.\4\
---------------------------------------------------------------------------
\3\ America's Health Centers: By the Numbers, National Association
of Community Health Centers (Oct. 2024), https://www.nachc.org/
resource/americas-health-centers-by-the-numbers.
\4\ Shannon Pettypiece and Bracey Harris, Health Clinics Face Cuts,
Closures as Trump's Funding Fight Ripples Outside of Washington, NBC
News (Feb. 2025), https://www.nbcnews.com/politics/donald-trump/health-
clinics-face-cuts-closures-trumps-funding-fight-ripples-washing-
rcna191014.
---------------------------------------------------------------------------
Why are investments in federal funding for Community Health
Centers important for seniors across the country, especially
those living in medically underserved areas?
Response:
In 2023, community health centers across the country served
nearly four million patients 65 years of age or older. This
number has been steadily increasing over the years,
demonstrating a growing reliance upon CHCs by our nation's
seniors. As noted in my written and oral testimony, CHCs are
often the only care setting available to individuals living in
rural (caring for one in five rural residents) and medically
underserved areas (caring for one in three people living in
poverty) and thus play a critical role in connecting seniors
and others to necessary primary care and other medical
services. We take seriously our commitment to supporting
wellness and ensuring our patients live well and longer. In the
vein of this hearing's topic, CHCs are essential to optimizing
longevity for seniors and other populations as we also provide
supportive services to directly address health-related social
needs that negatively impact an individual's ability to be
well.
Nearly two-thirds (65%) of adult patients who seek care at
CHCs reported receiving certain medical-related assistance
services and 22% reported receiving economic-related assistance
through their health center. Housing, transportation and food
assistance are some of the most common medical-related
assistance services sought at my clinic. We identify needs on
intake screening and case managers just this week have been
able to help my patients with medical-related assistance
services including help arranging external medical appointments
for critical screening care not available onsite; connecting
patients to appropriate health education; free and discounted
medication resources; arranging transportation to appointments;
providing interpretation services; and conducting home visits
to evaluate the environment and better determine health needs.
These same patients benefited from the collocation of
evaluation for economic-related assistance including help
applying for government benefit programs like Medicaid or
nutrition assistance; obtaining food; finding housing; getting
clothing or shoes; and finding employment.
Unfortunately, CHCs for far too long have been reliant upon
a patchwork of inconsistent, temporary federal funding to stay
afloat. This approach creates an existential crisis for our
nation's safety net and clinics like mine. CHCs are truly non-
profit, operating on very thin margins and putting every dollar
back into the community for which they care. The freeze that
occurred earlier this year and the subsequent delay in
accessing funds paralyzed our ability to deliver all of the
care that is essential to meeting our patients' and community's
needs. Proposals being floated to cut Medicaid are also deeply
concerning. Nationally, Medicaid makes up 43 percent of
community health center revenue. As a result, cuts to Medicaid
would be a direct cut to CHCs and the communities they serve
aswell.
To support and improve the quality of life for patients of
all ages and in all communities and most impactfully our rural
and under resourced communities, I urge Congress to make
stable, long-term funding for CHCs a priority and to protect
invests in Medicaid and other safety-net programs so that we
can continue to deliver the whole-person, community-level
interventions that are necessary to improving longevity.
=======================================================================
Statements for the Record
=======================================================================
U.S. Senate Special Committee on Aging
"Optimizing Longevity: From Research to Action"
February 12, 2025
Statements for the Record
James C. Appleby Testimony
On behalf of the Gerontological Society of America (GSA),
thank you for a holding a hearing on longevity and healthy
aging and the opportunity to provide the U.S. Special Committee
on Aging this statement for the record. Since 1945, GSA members
have been at the forefront in researching innovative
interventions leading to greater health outcomes and more
meaningful lives as we age. We appreciate the conversations the
Committee and panelists had, notably discussions recognizing
the importance of our healthspan as we live longer lives and
our approaches to the treatment and prevention of chronic
disease.
GSA seeks to serve as a resource in working with you and
members of the Committee to inform public policy with evidence-
based research to advance improved health outcomes. Attached to
this letter we included a sample of resources and research
briefly covered in the hearing. GSA publishes five peer-
reviewed journals with research that can advance the focus on
biomedical research, as well as more than 60 interest groups
formed around a topic or issue that cuts across disciplines.
GSA has developed several resources based on evidence-based
research for managing obesity in older people. Access to
comprehensive obesity care can lower the severity of these
diseases and, in some cases, cure them entirely. This includes
a useful framework for primary care providers to help older
people with obesity challenges recognize their condition and
take action to maintain a healthy weight.
In 2023, GSA hosted a roundtable discussion in Washington,
DC with researchers, clinicians, and advocates who were asked
to address key questions about obesity as a disease of body
weight regulation and how outdated paradigms and perceptions
about obesity can be improved among health professionals,
policymakers, and the public. That discussion produced valuable
information on key aspects of obesity care across the lifespan
and particularly in clinical care for older adults. The report,
titled "Bringing Obesity Management to the Forefront of Care
for Older Adults: Seven Strategies for Success," presents the
roundtable s insights, which are discussed in the framework of
seven strategies for addressing barriers to quality obesity
care for older people.
In 2024, GSA submitted a letter as part of the National
Institute of Health s Request for Information on Research
Strategies for Addressing Obesity Heterogeneity. In this
letter, GSA discussed our understanding of obesity
heterogeneity and how obesity presents differently for every
patient.
We know that access to comprehensive obesity care can lower
the severity of the disease of obesity and many other diseases,
and in some cases cure them entirely. Current federal policy
unfairly denies coverage and access for people over the age of
65 to vitally important evidence-based treatments for obesity,
both preventing older people from starting these treatments
while on Medicare and disrupting treatment for those who lose
access as they age into Medicare. GSA believes it is crucial
that Congress and the Centers for Medicare and Medicaid
Services (CMS) take the steps necessary to end the current
unjust policy and ensure that Americans have access to the
holistic and comprehensive obesity care necessary to ensure
healthy lives. GSA supports the Center for Medicare and
Medicaid Services (CMS) rule that would expand access to AOMs
for Medicare and Medicaid beneficiaries. These treatments can
prevent and treat the development of cardiovascular disease,
type 2 diabetes, sleep apnea, and more.
GSA supports a comprehensive approach to treating the
chronic disease of obesity, and this includes behavioral
interventions. Counseling patients on nutrition, physical
activity and behavior change at frequent clinic visits, as
proposed by intensive behavioral therapy (IBT), is an
effective, proven approach to treating obesity treatment and
can reduce the risk of co-morbidities. We support this approach
when AOMs are part of treatment for obesity.
The GSA KAER framework Kickstart, Assess, Evaluate, and
Refer (KAER) supports primary care teams to better meet the
needs of older people with obesity and overweight. Using this
framework and the tools and resources in the GSA Toolkit for
the Management of Obesity in Older Adults, care teams can
kickstart the discussion of body size with older people and
their families; assess the presence of altered body fat amount,
distribution, and/or function; evaluate treatment options for
older people with overweight and obesity; and refer older
people to community resources.
The mission of GSA is to foster excellence, innovation, and
collaboration to advance aging research, education, practice,
and policy; our vision is meaningful lives as we age. GSA's
6,000 members include gerontologists, health professionals,
behavioral and social scientists, biologists, demographers,
economists, and many other disciplines. These experts study all
facets of aging with a life-course orientation. The
multidisciplinary nature of the GSA membership is a valued
strength, enabling us to provide a 360-degree perspective on
the issues facing our population as we age.
GSA wishes to be a resource to you and your staff in your
role serving in the Senate and on the Senate Special Committee
on Aging. We would enjoy meeting with you and/or your staff in
the coming weeks to discuss our work. In the meantime, if you
have any questions, please contact Patricia D'Antonio, Vice
President of Policy and Professional Affairs.
We look forward to continuing to work with you on improving
the health of all of us as we age.
Sincerely,
/s/
James C. Appleby, BSPharm, MPH, ScD (Hon), Chief Executive
Officer
U.S. Senate Special Committee on Aging
"Optimizing Longevity: From Research to Action"
February 12, 2025
Statements for the Record
The Alzheimer's Association & Alzheimer's Impact Movement Testimony
The Alzheimer's Association and Alzheimer's Impact Movement
(AIM) appreciate the opportunity to submit this statement for
the record for the Senate Special Committee on Aging hearing on
"Optimizing Longevity: From Research to Action." We thank the
Committee for its continued leadership on issues crucial to
individuals living with Alzheimer's and other dementias. This
statement underscores the critical role of family caregivers
and research on modifiable risk factors in addressing cognitive
impairment, including the need for greater risk reduction
strategies and awareness to improve individuals' quality of
life and longevity.
Founded in 1980, the Alzheimer's Association is the world's
leading voluntary health organization in Alzheimer's care,
support, and research. Our mission is to eliminate Alzheimer's
disease and other dementias through the advancement of
research, to provide and enhance care and support for all
affected, and to reduce the risk of dementia through the
promotion of brain health. AIM is the Association's advocacy
affiliate, working in a strategic partnership to make
Alzheimer's a national priority. Together, the Alzheimer's
Association and AIM advocate for policies to fight Alzheimer's
disease, including increased investment in research, improved
care and support, and the development of approaches to reduce
the risk of developing dementia.
The Impact of Family Caregivers
Caregivers of individuals living with Alzheimer's or
another dementia play an essential role in maintaining the
quality of life for their loved ones and helping them live
independently in their homes and communities for as long as
possible. They are the backbone of our nation's health care
system, providing essential care to loved ones at great
personal, physical, and financial sacrifice. In 2023 alone,
over 11 million dedicated caregivers provided a remarkable 18.4
billion hours of unpaid care for individuals living with
Alzheimer's or another dementia, valued at nearly $350 billion.
One in three dementia caregivers has been providing care for
five or more years. In fact, of the total lifetime cost of
caring for someone with dementia, 70 percent is borne by
families - either through out-of-pocket health and long term
care expenses or from the value of unpaid care. As a result of
this financial strain, many families significantly cut back on
savings contributions and other spending, with some reporting
eating less due to care costs.
It is evident that Alzheimer's takes a devastating toll on
caregivers. Amid these challenges, there is an urgent need to
alleviate the overwhelming costs faced by caregivers. We
strongly support the bipartisan Credit for Caring Act, which
would create a new, nonrefundable federal tax credit of up to
$5,000 for eligible working family caregivers of individuals,
regardless of age, with certain functional or cognitive
limitations. The tax credit would help alleviate some of the
financial strain on these selfless caregivers nationwide and
could be used to offset some of the costs of caregiving,
including the costs of respite care, transportation, lost
wages, and more. Providing these dedicated caregivers with
financial relief would not only improve their own quality of
life but would also allow for greater access to caregiver
education and resources essential to ensuring adequate care and
long-term quality of life for their loved ones. In addition,
prioritizing home-based care through a family caregiver tax
credit can reduce reliance on costly long term care facilities,
saving taxpayer dollars while improving the health and well-
being of individuals living with Alzheimer's and other
dementias. We look forward to working with Congress and members
of the Committee to advance the bipartisan Credit for Caring
Act and other legislation to support caregivers, as they
enhance longevity and quality of life for our aging population.
The Science Behind Dementia Risk Reduction and Brain Health
As of 2024, nearly seven million Americans are living with
Alzheimer's, a number expected to rise to nearly 13 million by
2050. With many more at risk of developing the disease or
another form of dementia, the need for effective dementia risk
reduction strategies that help all communities increases by the
day. Two-thirds of Americans have at least one major potential
risk factor for dementia. As the prevalence of dementia
continues to rise, addressing modifiable risk factors is
essential not only to reduce the number of new cases but also
to prevent current projections from worsening.
Population-based and epidemiologic studies show that
certain modifiable risk factors can increase the risk of
cognitive decline and possibly dementia. A growing body of
evidence shows that healthy behaviors can protect and promote
brain health. Given the growing evidence that lifestyle factors
play a significant role in cognitive health, larger studies are
essential to further understand how we can effectively reduce
the risk of cognitive decline and help individuals live longer,
happier lives. The Alzheimer's Association U.S. Study to
Protect Brain Health Through Lifestyle Intervention to Reduce
Risk (U.S. POINTER) is a two-year clinical trial to evaluate
whether lifestyle interventions that simultaneously target many
risk factors protect cognitive function in older adults who
have an increased risk for cognitive decline. U.S. POINTER is
the first such study to be conducted on a large group of
Americans across the United States. Approximately 2,000
volunteer older adults who are at increased risk for dementia
have been enrolled and will be followed for two years. Two
lifestyle interventions will be compared, which vary in
intensity and format. Eligible volunteers are randomly assigned
to these interventions to evaluate whether cognitive benefits
from a structured program differ from a self-guided program.
Lifestyle interventions combining multiple behavior components
show promise as a therapeutic strategy to protect brain health.
We look forward to sharing the results of this groundbreaking
study soon.
Alzheimer's Association Public Health Center of Excellence
on Dementia Risk Reduction
The prevention of aging-related cognitive impairment and
dementia is a major and urgent public health priority as well
as a priority for individuals, families, and communities.
Because evidence for the effectiveness of specific health-
related behaviors and practices has begun to emerge, in 2018,
Congress passed the Building Our Largest Dementia (BOLD)
Infrastructure for Alzheimer's Act (P.L. 115-406) to empower
public health departments to develop and implement effective
dementia interventions in their communities. We are deeply
grateful for the bipartisan, bicameral support that led to the
reauthorization of this vital law in December 2024, through the
passage of the BOLD Reauthorization Act (P.L. 118-142),
allowing this great work to continue for an additional five
years.
Sustained funding for the BOLD Act's implementation over
the years has allowed the CDC to award funding to three Public
Health Centers of Excellence (PHCOE) and make 66 awards to 45
state, local, and tribal public health departments. The PHCOEs
are working to increase the education of public health
officials, health care professionals, and the public on public
health strategies that promote brain health, and support people
living with dementia and their caregivers. These investments
are critical to advancing public health strategies that not
only promote brain health but also support longer, healthier
lives. The PHCOEs are working to increase the education of
public health officials, health care professionals, and the
public on public health strategies that promote brain health
and longevity, while also supporting people living with
dementia and their caregivers. We look forward to continuing
working with Congress throughout the appropriations process to
ensure this vital work may continue.
With support from the CDC, the Alzheimer's Association is
proud to lead the PHCOE on Dementia Risk Reduction, which works
to help state, local, and tribal public health agencies address
risk factors for cognitive decline and dementia. Launched in
2020, the Center serves as a national resource in translating
the latest science on dementia risk reduction into tools,
materials, and messaging that public health agencies can use to
reduce dementia risk for all people. More specifically, the
Center offers one-on-one engagement with public health
officials to encourage action in their communities; provides
technical assistance to help public health officials design,
implement, and evaluate risk reduction activities; and
publishes online resources on dementia risk factors and what
public health can do to address them. By identifying and
mitigating key dementia risk factors, these efforts directly
contribute to the goal of increasing a healthy lifespan.
The Alzheimer's Association PHCOE on Risk Reduction has
also partnered with Wake Forest School of Medicine to convene a
panel of nationally and internationally renowned scientists
with expertise in specific areas of dementia and cognitive
impairment prevention research. The panel's charge was to
review, evaluate, and synthesize the current knowledge on
preventing or delaying the onset of cognitive decline and
dementia. In the report "Reducing Dementia Risk: A Summary of
the Science and Public Health Impact," the panel ultimately
identified eight modifiable risk factors based on the level of
research support and strength of evidence, to inform emerging
efforts by public health agencies throughout the United States
to address the risk for cognitive decline and dementia:
diabetes and obesity, physical activity, social engagement,
diet and nutrition, vascular health, sleep, smoking and
alcohol, and sensory impairments. Addressing these risk factors
not only reduces the risk of dementia but also enhances overall
longevity, enhancing the aging population's independence and
vitality.
While new treatments may slow the progression of cognitive
decline, steps can be taken now to reduce the risk of
developing it and, in turn, optimize individuals' quality of
life. As illustrated above, the science on dementia risk
reduction is quickly evolving, and the evidence linking certain
behaviors and conditions and long-term cognitive health and
dementia is growing stronger.
Conclusion
By prioritizing policies that support caregivers and
investing in risk reduction strategies, we can help the aging
population live longer, healthier lives. The Alzheimer's
Association and AIM deeply appreciate the Committee's continued
commitment to advancing issues vital to the millions of
families affected by Alzheimer's disease and other dementias.
We look forward to working with the Committee in a bipartisan
way to enhance longevity and improve quality of life for those
impacted by dementia.
U.S. Senate Special Committee on Aging
"Optimizing Longevity: From Research to Action"
February 12, 2025
Statements for the Record
Dr. George C. Shapiro Testimony
Thank you for the opportunity to submit this statement on
behalf of Fountain Life. Our mission is to extend healthspan by
identifying and addressing chronic disease before symptoms
arise, using cutting-edge diagnostic technology and precision
medicine. We fully support the Committee's efforts to ensure
that innovative research leads to actionable solutions that
improve the health and quality of life of older Americans.
The Need for a Proactive Approach to Longevity
Chronic diseases, driven by inflammation, metabolic
dysfunction, and lifestyle factors, account for over 90% of
healthcare costs and significantly reduce quality of life in
aging populations. Traditional healthcare models focus on
reactive treatment rather than early detection and prevention.
At Fountain Life, we believe the future of medicine lies in
proactive, data-driven care that empowers individuals to take
control of their health before disease manifests.
Fountain Life's Precision Health Model
Fountain Life integrates advanced diagnostics, AI-driven
analytics, and regenerative therapies to optimize healthspan
and longevity. Our approach includes:
Whole-Body MRI & Multi-Cancer Early Detection with AI
overlay: Non-invasive imaging technologies detect asymptomatic
cancers and early-stage disease, allowing for timely
intervention.
AI-Powered Cardiovascular Screening: AI-driven imaging
predicts heart disease risk with unmatched accuracy, leading to
targeted preventive strategies.
Epigenetic & Multi-Omic Analysis: Assessing biological
aging markers, inflammation, and metabolic health to tailor
personalized longevity plans.
Regenerative & Cellular Therapies: Utilizing precision
interventions, such as stem cell therapies and peptide
treatments, to reverse age-related decline.
Real-World Impact: Case Studies & Data
Fountain Life's model is already demonstrating significant
outcomes:
A 58-year-old asymptomatic male underwent our
comprehensive screening, revealing early-stage pancreatic
cancer. Prompt surgical intervention led to a full recovery,
avoiding the typically grim prognosis of late-stage diagnosis.
A 63-year-old woman was identified with critical
coronary artery disease through AI-powered imaging, despite
normal cholesterol levels and no symptoms. Early intervention
prevented a potentially fatal heart attack.
In a recent internal study, 14% of asymptomatic
individuals screened at Fountain Life had undiagnosed cancer or
significant cardiovascular disease, highlighting the critical
need for proactive detection.
Bridging Research & Action for Better Outcomes
To translate longevity research into real-world impact, we
advocate for policies that:
1. Promote Preventive & Precision Healthcare:
Incentivizing proactive diagnostics and biomarker-driven
treatments to delay or prevent disease onset.
2. Expand Access to Advanced Screening: Increasing
insurance coverage for early-detection technologies to make
longevity-focused care widely available.
3. Support Data-Driven, AI-Powered Healthcare:
Encouraging the integration of AI in diagnostics to improve
accuracy, efficiency, and scalability.
Commitment to Collaboration
Fountain Life welcomes the opportunity to collaborate with
policymakers, researchers, and healthcare leaders to advance
longevity-focused healthcare. We look forward to participating
in future hearings or roundtable discussions to further explore
solutions for optimizing healthspan and reducing chronic
disease.
Thank you for your leadership in this critical area. We
appreciate the Committee's dedication to ensuring that
longevity research translates into meaningful, actionable
improvements for aging Americans.
"In addition to the insights shared here, Fountain Life has
compiled comprehensive data demonstrating the economic impact
of our precision medicine and longevity strategies. This data
highlights the cost savings associated with early disease
detection, proactive interventions, and improved healthspan. We
would welcome the opportunity to present these findings in
detail at your next meeting to further illustrate how our
approach aligns with the committee's mission of translating
research into action that enhances public health outcomes."
Respectfully submitted,
George C. Shapiro, MD, FACC
Chief Medical Innovation Officer, Fountain Life
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