**Department of Health and Human Services**

**Secretary's Roundtable on Obesity/Nutrition**

**Wednesday, July 20, 2003**

**[Public Docket 2003N-0338]{.underline}**

**Submitted by Nancy M. Childs, Ph.D.**

**Professor of Food Marketing\
Erivan K. Haub School of Business**

**Saint Joseph's University, Philadelphia PA 19131**

Secretary Thompson's Obesity Roundtable is a strong start for
determining a multi-focused action plan to address America's obesity
epidemic. The following thoughts are presented to complement and refine
the plans under consideration by Secretary Thompson and the DHHS staff.

Based on my expertise in food labeling and health claim marketing the
suggestions presented below focus on needed aspects of consumer
communication, especially through the food label and dietary guidance.
The emphasis on consumer communications in this document is not meant to
exclude the need for programs that promote physical activity and
suggestions to expand medical research on obesity through the
coordination of NIH structure. These also represent powerful weapons in
the obesity war.

Suggestions below are presented from the general to the specific with
corresponding application from the public sector to the private sector.

1.  ***Consumer education on metabolism -*** Communicating the
    relationship shown below (fig. 1) which determines net weight gain
    or loss is both simplistic and comprehensive. It is a valuable
    message for consumers with the added benefit of intuitive logic with
    previous public health and nutrition messages.

Figure 1

> Of the three factors impacting weight maintenance, consumer
> understanding of the role of metabolism is least understood,
> especially the phenomenon of decreasing metabolic rate with age. The
> understanding that one's metabolism will naturally decline with age,
> thereby resulting in weight gain when energy intake and physical
> activity are held constant, is an important message for weight
> management.

2.  ***The urgency of "pre-obese" vocabulary*** - Language needs to be
    explored and consumer perceptions researched to see if changing the
    vocabulary of "overweight" (BMI 25-29.9) to "pre-obese" has more
    urgent impact on consumer behavior towards toleration of weight
    gain. Similar vocabulary change is occurring with consumers with the
    introduction of "pre-hypertensive" to represent the blood pressure
    range formerly labeled "normal high" and "borderline" (120-139
    systolic and 80-89 diastolic).

3.  ***Aligned portion sizes and individualized numbers of servings***
    -The respective nutrition agencies, public and private, need to work
    towards a more unified, consolidated and aligned set of messages
    directed to consumers on dietary guidance. And this needs to be
    presented with the recognition of individual determination for
    nutrition and caloric intake. Of particular importance is the
    alignment of uniformly recognized portion size as a consumer's
    measure for consumption. This establishes the base for an
    individualized number of recommended servings determined by age,
    BMI, gender, lifestyle and appropriate variables. Agreement is this
    area will lay a common foundation to enable a more comprehensive
    nutrition education and labeling campaign that references both food
    label portions and food service portions.

4.  ***The food label allows healthier food choices and drives industry
    innovation*** - The FDA's recent strategy to share nutrition
    information with consumers via increased access to emerging
    nutrition discovery is significant. Through the provision of a
    measured assessment (grade) of the cited science for a qualified
    health claim, the label enables more informed consumer decision
    making for healthier food choice. Research shows consumer
    inclination to use label information for informed food choice, with
    both qualified health claims and additional Nutrition Facts panel
    information as represented by inclusion of trans fat content.
    Continued research is needed in this area of consumer choice to
    ascertain label language and placement for maximum benefit in
    preventing over consumption. The label represents a powerful vehicle
    for delivering a metric of comparison for food energy density and
    portion size for consumer use.

> Also, label regulation drives food industry innovation and formulation
> as already evidenced by label attention to trans fat content. Likewise
> health claim use has dramatically motivated increased message use and
> formulation of added nutrients in the food supply as exhibited by
> calcium and soy in the marketplace, both the subject of approved
> health claims. This market behavior bears favorably for low calorie
> food development when led by label messages and access to qualified
> health claims. These subjects represent important areas for pursuit of
> consumer communications research.

5.  ***Communicate information for healthier food choice at food
    service*** - Recent consumer research suggests that health claim and
    food label messages show potential for food service application,
    indirectly, by being available on packaged food labels and
    advertising which influences healthier menu selection by consumers.
    Research is needed to advance understanding of how to best
    communicate appropriate information for healthier food selection in
    the food service environment, both directly and indirectly.
    Consumers continue to shift their portion of food consumption to the
    food service arena.

6.  ***Research functional ingredients*** ***for weight management*** -
    Beyond the pursuit of consumer communication research, several
    proposed functional ingredients for satiety and metabolic function
    need additional research for safety, efficacy, and mechanistic
    identification. These would include nutrients such as calcium, whey
    proteins, conjugated linoleic acid, omega 3 and 6, fenugreek,
    inulin, chitosan, chromium, and L-carnitine among other potential
    nutrients. Broadening the range of research documented ingredients
    that impact weight maintenance will further enable private industry
    to respond with products enhancing consumer choice for weight
    management.

7.  ***Moderate consumer expectations*** - Lastly, care should be taken
    to manage expectations and to promote attainable success. The weight
    loss arena is historically fraught with over-promise and lack of
    credibility. Any message or program promoted should be done so with
    expectation for realistic consumer reception and success. Programs
    focused on preventing weight gain rather than securing weight loss
    may have more likelihood of success from a cost-benefit perspective.

A focused and concentrated pursuit of obesity with the scope and
leverage represented by the DHHS portends a promising attack to stem the
accelerating epidemic of obesity and chronic disease. The pursuit of
scientific understanding and informed consumer behavior towards obesity
and pre-obesity, together with programs for physical activity and
focused research priorities, are potentially powerful weapons at the
DHHS's disposal . Within the marketplace, the application of meaningful
consumer communication through the use of the food label and general
dietary guidance will motivate the creativity and innovation of the food
industry to meet consumer needs in this arena.