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| ![](media/i   | **Testimony**                                        |
| mage1.wmf){wi |                                                      |
| dth="1.388194 | ### Before the Subcommittee on Human Rights          |
| 4444444445in" |                                                      |
| hei           | ###  and Wellness                                    |
| ght="1.426388 |                                                      |
| 888888889in"} | ### Committee on Government Reform                   |
|               |                                                      |
|               | **United States House of Representatives**           |
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| Conquering Obesity:                                                   |
|                                                                       |
| The U.S. Approach to Combating this National Health Crisis            |
|                                                                       |
| ##### Statement of                                                    |
|                                                                       |
| #### Ed Thompson, M.D., M.P.H.                                        |
|                                                                       |
| ***Chief, Public Health Practice***                                   |
|                                                                       |
| ***Centers for Disease Control and Prevention***                      |
|                                                                       |
| ***U.S. Department of Health and Human Services***                    |
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![](media/image2.png){width="1.8743055555555554in"
height="1.6930555555555555in"}

> **For Release on Delivery**

**Expected at 2:00PM**

**Wednesday, September 15, 2004**

**[Introduction]{.underline}**

Mr. Chairman, Members of the Committee, thank you for the opportunity to
participate in today's hearing. I am Dr. Ed Thompson, Chief of Public
Health Practice at the Centers for Disease Control and Prevention (CDC).
Today, I will present an overview of the overweight epidemic in our
nation; describe the scientific information available on effective
interventions to prevent overweight among various populations; and
identify a number of Department of Health and Human Services (DHHS)
initiatives and programs designed to combat this epidemic.

Number range CHAPTER**[Overview of Obesity Epidemic in
U.S.]{.underline}**

In the United States, obesity has risen at an epidemic rate during the
past 20 years. Nearly two-thirds of adults in the United States are
overweight, and 30 percent are obese according to the National Center
for Health Statistics 1999-2002 National Health and Nutrition
Examination Survey (NHANES). Particularly disturbing are the dramatic
increases in the prevalence of overweight children and adolescents of
both sexes, with approximately 15.8 percent of children aged 6 to 11
years and 16.1 percent of adolescents aged 12 to 19 years considered
overweight. The prevalence of overweight and obesity varies by gender,
age, socioeconomic status, and race and ethnicity.

The prevalence of overweight and obesity varies by gender, age,
socioeconomic status, and race and ethnicity.

While the increases in overweight among children and adolescents cut
across all regions of the Nation, ages, and racial and ethnic groups,
the prevalence of overweight is growing at a much faster rate among
certain populations. A higher percent of African-American and
Mexican-American youth are overweight when compared to white youth, and
this disparity has grown dramatically over the past two decades.
Additionally, an economic disparity in the prevalence of overweight is
seen among white adolescents: those from lower income families have a
greater prevalence of overweight compared with white adolescents from
higher income families.

Overweight and obesity are associated with increased morbidity and
mortality. Overweight and obesity are considered risk factors for other
chronic conditions such as diabetes and certain cancers, including
cancers of the breast, colon, kidney, esophagus and endometrium. An
estimated 400,000 adult deaths each year in the U.S. are associated with
obesity. Total costs (medical costs and days lost from work because of
illness, disability or premature death) from obesity in 2000 were
estimated to be \$117 billion.

Number range CHAPTERThe primary concern of overweight and obesity is one
of health and not appearance. We have already begun to see the impact of
the obesity epidemic on the health of young people. While most of the
death and disease associated with overweight and obesity occurs in
adults, overweight children often develop risk factors for diseases such
as type 2 diabetes, high blood pressure, and elevated cholesterol
levels. Sixty percent of overweight children have at least one risk
factor for cardiovascular disease, in addition to overweight, and 25
percent have two or more. Type 2 diabetes, which is strongly associated
with obesity, was virtually unknown in children and adolescents 10 years
ago; today, it accounts for almost 50 percent of new cases of diabetes
among youth in some communities. A CDC report predicted that one in
three Americans born in 2000 will develop diabetes during his or her
lifetime. Number range CHAPTER Childhood overweight is also associated
with discrimination, poor self-esteem, and depression.

Furthermore, overweight adolescents have a 70 percent chance of becoming
overweight or obese adults. This increases to 80 percent if one or both
parents are overweight or obese. Adults who are overweight or obese are
at increased risk for premature death, heart disease, type 2 diabetes,
certain types of cancer, breathing problems, arthritis, and
psychological problems, such as depression. One final concern is that
childhood overweight that persists into adulthood is typically more
severe than overweight or obesity that develops during adulthood.

Overweight and obesity represent a major long-term public health crisis.
If it is not reversed, the gains in life expectancy and quality of life
seen in recent decades will erode, and more health-related costs will
burden the Nation.

**[Government's Role in Combating the Obesity Epidemic]{.underline}**

Eating a healthy diet and increasing physical activity reduces weight
which is shown to reduce the risk for many chronic diseases. Often small
changes -- such as physical activity for 30 minutes a day or consuming
100 fewer calories a day -- can result in large health benefits.
Individuals must have the right information to empower their lifestyle
choices. The government can support individual action by doing the
following:

-   Providing leadership;

-   Establishing a framework for understanding issues related to
    overweight and obesity;

-   Coalescing and coordinating efforts to address the issues;

-   Developing clear, coherent and effective health messages to ensure
    that consumers have accurate and adequate information to make
    informed decisions about improving their health;

-   Identifying and addressing research gaps;

-   Bringing diverse stakeholders together to address the epidemic
    (e.g., food industry, consumer organizations and the medical
    community);

-   Coordinating private/public campaigns;

-   Providing training and education materials to address the epidemic;
    and,

-   Working to improve the health-promoting nature of the environments
    in which individuals make their decisions

Secretary Tommy Thompson has made addressing the problems of overweight
and obesity a top priority. Current initiatives include programs in
education, communication and outreach, intervention, diet and nutrition,
physical activity and fitness, disease surveillance, research, clinical
preventive services and therapeutics, and policy and web-based tools.
These programs target a variety of populations including infants and
breastfeeding mothers, children and adolescents, women, minorities, the
elderly, the disabled, rural, and the general population.

DHHS has adopted a comprehensive, multi-component approach to address
the complex epidemic of overweight among children and adolescents. DHHS
strategies include:

-   Providing strong, national leadership;

-   Developing and delivering clear, coherent, and effective health
    messages to ensure that consumers have accurate and adequate
    information to make informed decisions about improving their health;

-   Monitoring the problem and programs to address the problem so that
    we can better understand its causes, consequences, and how it
    changes over time;

-   Identifying and addressing research gaps;

-   Synthesizing research findings to identify effective policies and
    programs;

-   Developing and disseminating tools to help schools and
    community-based organizations implement effective policies and
    programs; and

-   Helping national, state, and local agencies and organizations
    implement effective programs.

**[Steps Initiative]{.underline}**

In June 2002, President Bush launched the *HealthierUS* initiative
designed to help Americans, especially children, live longer, better,
and healthier lives. The President's *HealthierUS* initiative helps
Americans take the initiative to improve personal health and fitness and
encourages all Americans to:

-   Be physically active every day;

-   Eat a nutritious diet;

-   Get preventive screenings; and

-   Make healthy choices concerning alcohol, tobacco, drugs and safety.

In 2003, Secretary Thompson further advanced the President's initiative
by introducing *Steps to a HealthierUS (Steps)*. At the heart of this
program lies both personal responsibility for the choices Americans make
and social responsibility to ensure that policy makers support programs
that foster healthy behaviors and prevent disease. The *Steps*
initiative envisions a healthy, strong, U.S. population supported by a
health care system in which diseases are prevented when possible,
controlled when necessary, and treated when appropriate.

The *Steps* Cooperative Agreement Program is part of this initiative.
This program aims to help Americans live longer, better, and healthier
lives by reducing the burden of diabetes, obesity, and asthma and
addressing three related risk factors -- physical inactivity, poor
nutrition, and tobacco use. In FY 2003, \$15 million was provided to 23
communities to support innovative community-based programs that are
proven effective in preventing and controlling chronic diseases. In FY
2004, \$44 million will be used to increase funding to existing Steps
communities, fund new communities, and fund one or two national
organizations to enhance the capacity of *Steps* communities.

As part of the *Steps* initiative, DHHS also recently released a report
titled *Prevention: A Blueprint for Action*, which outlines simple steps
that individuals and interested groups can take to promote healthy
lifestyles and encourage healthy behavior. efforts to promote health and
prevent disorders such as obesity rests, in large part, on developing
effective messages tailored to different individuals and groups. An
example of this is the CDC's youth media campaign demonstration, "*VERB.
It's what you do*." *VERB's* goal has been to promote social norms that
support physical activity and portray fitness as fun and healthy. CDC
has enlisted partner organizations in the campaign, such as 4-H, Boys
and Girls Clubs and the National Hockey League to brand the *VERB*
message and make it appealing to its pre-teen audience. *VERB* also
reaches out to parents and other adults influential to young people,
encouraging them to support and participate in physical activity with
pre-teens.

Campaign strategies include multimedia advertising and marketing
promotions using television, radio, print, and Web sites; contests and
community events; and partnerships with youth organizations, schools,
national professional associations, and entertainment media that are
popular with youth. Reported awareness of VERB is high at 74 percent,
with 90 percent of these youth understanding the campaign's messages.
After one year, campaign impact has been demonstrated by reports of
increased free-time physical activity among several important population
subgroups, including the nation's 10 million pre-teen girls, 8.6 million
9-10 year olds, and 6 million tweens from low- to moderate-income
households. For example, after one year of the campaign, the average
9-10 year old in the nation engaged in 34 percent more sessions of
free-time physical activity when compared to children who were unaware
of VERB.

Other important programs that communicate nutrition and physical
activity messages to the American public are the National Cancer
Institute's 5-A-Day for Better Health Program and the President's
Council on Physical Fitness and Sports.  The 5-A-Day program seeks to
increase to five or more the number of daily servings Americans eat of
fruits and vegetables.  In addition to its widely known slogan, the
5-A-Day program reaches many individuals through health care provider
networks, the internet, and print media. It also has sponsored the
development and evaluation of a number of school-based interventions to
promote fruit and vegetable consumption among children and adolescents.

The President's Council on Physical Fitness and Sports promotes physical
activity for all ages, backgrounds and abilities with information and
publications ([www.fitness.gov](http://www.fitness.gov/)) and physical
activity/fitness motivational awards programs
([www.presidentschallenge.org](http://www.presidentschallenge.org/)).
The Council advises the President and the DHHS Secretary about issues
related to physical activity, fitness, and sports, and recommends
programs to promote regular physical activity for the health of the
nation.

Human health and disease are also influenced by factors in the overall
environment. At a time when obesity is rising among children, designing
and implementing environmental design solutions might help with this
health challenge. Research increasingly suggests that children benefit
from the opportunity to play outdoors. Planning parks near residential
areas with playgrounds and sports facilities and safe routes leading to
and from them can be an invaluable part of a community design strategy
that is healthy and nurturing for children.

NIH and CDC have recently released a Request for Applications (RFA) on
\"Obesity and the Built Environment.\" This initiative will support
studies in two specific areas related to the built environment and
obesity:

-   Understanding the role of the built environment in
    causing/exacerbating obesity and related co-morbidities; and,

-   Developing, implementing, and evaluating prevention / intervention
    strategies that influence parameters of the built environment in
    order to reduce the prevalence of overweight, obesity and
    co-morbidities.

**[CDC Surveillance Efforts]{.underline}**

CDC's surveillance efforts through the National Health and Nutrition
Examination Survey (NHANES) have offered unparalleled scientific
contribution to public health by producing the principal source of
clinical data for the Nation with detailed interviews and physical
examinations. The detailed interview includes demographic,
socio-economic, dietary, and health-related questions. The examination
component consists of medical and dental exams, physiological
measurements and laboratory tests administered by highly trained medical
personnel

The Behavioral Risk Factor Surveillance System (BRFSS) is our nation's
premier system for measuring and tracking state-level data on critical
health problems and a wide variety of health-related behaviors in the
U.S. The data underpin many public health policy and program decisions
in states and for the nation. The BRFSS is a cross-sectional telephone
survey conducted by state health departments, the District of Columbia,
Puerto Rico, the Virgin Islands, and Guam. CDC provides technical
assistance to participating states and territories. For 20 years, this
unique state-based system (the largest telephone-based surveillance
system in the world) has provided flexible, timely, and ongoing data
collection that can be tailored to meet individual state needs.

Addressing the increasing demand for local health information, CDC
analyzed 2002 BRFSS data for metropolitan and micropolitan statistical
areas (MMSAs). "SMART BRFSS" yielded prevalence estimates for 98 MMSAs,
as well as many counties within those areas. This allows us to find out
a wide range of information on different chronic diseases. For example,
obesity prevalence ranges from 12.8 percent in the
Bethesda-Frederick-Gaithersburg, Maryland MMSA to 29.4 percent in the
Charleston, West Virginia MMSA.

The Youth Risk Behavior Surveillance System (YRBSS) was developed in
1990 to monitor priority health risk behaviors that contribute markedly
to the leading causes of death, disability, and social problems among
youth in the United States. Such behaviors include inadequate physical
activity. The YRBSS includes national, state, and local school-based
surveys of representative samples of 9th through 12th grade students.
These surveys are conducted every two years, usually during the spring
semester. The national survey, conducted by CDC, provides data
representative of high school students in public and private schools in
the United States.

CDC uses the data gathered from these surveillance systems to gain
critical insight into identifying the obesity burden. In 2002, three
states had obesity prevalence rates of 25 percent or more and all but 15
states had obesity prevalence rates of 20 percent or greater. In the
state of Utah, 59.5 percent of high schools students attended a physical
education class one or more days in a regular school week in 2003. In
most states, less than half of high school students receive at least one
day of physical education.

**[CDC's National Nutrition and Physical Activity Program to Prevent
Obesity]{.underline}**

With 2004 funding, CDC supports obesity prevention programs in 28
states. Of these, 23 states will be funded at the capacity-building
level to hire staff with expertise in public health nutrition and
physical activity, build broad based coalitions, develop state plans,
identify community resources and gaps, implement small-scale
interventions, and work to raise public health awareness of changes
needed to help state residents achieve and maintain a healthy weight.
The other five states are funded at the basic-implementation level to
put their state plans into action, conduct and evaluate nutrition and
physical activity interventions, train health care and public health
professionals, provide grants to communities, make environmental
changes, and strengthen obesity prevention programs in community
settings. CDC also provides funding to 23 states for the implementation
of school-based policies and programs to help young people avoid
behaviors that increase their risk for obesity specifically unhealthy
eating and inadequate physical activity.

Additionally, CDC is developing a mechanism to quickly deploy staff into
communities, worksites and schools to facilitate evaluation of promising
strategies aimed at improving nutrition, increasing physical activity,
and preventing obesity. Each team will collect baseline data, and
provide evaluation consultation and technical assistance, identify
methodological gaps, and provide recommendations to improve the quality
of program evaluation.

**[Other DHHS Efforts]{.underline}**

Working groups within DHHS have recently evaluated current programs and
activities, made recommendations to better coordinate these efforts, and
identified areas of opportunity for new initiatives. Two recent major
initiatives tied to obesity are the Food and Drug Administration's (FDA)
Obesity Working Group, which will advise the Agency on innovative ways
to deal with the increase in obesity and identify ways to help consumers
lead healthier lives through better nutrition, and the National
Institute of Health's (NIH) development of an Obesity Research Task
Force, to develop a strategic plan for obesity research.

This past year the FDA made a major change in the nutrition label on
foods to include a separate listing of trans fatty acids. This was the
first significant change in the Nutrition Facts panel since it was
established in 1993.

The FDA has also undertaken a broad effort to crack down on misleading
information and/or unsafe dietary supplements, and has proposed new
regulations to establish good manufacturing practice requirements for
dietary supplements. FDA has focused its enforcement efforts over the
past year to ensure consumers are not being harmed as a result of claims
that overstate the effectiveness of dietary supplement products. The
Agency took steps to remove dietary supplements containing ephedrine
alkaloids from the market. These products were extensively promoted for
aiding weight control and boosting sports performance and energy. The
totality of the available data showed little evidence of benefit from
dietary supplements containing ephedrine alkaloids except for modest,
short-term weight loss insufficient to improve health, while confirming
that ephedrine alkaloids raise blood pressure and otherwise stress the
circulatory system. These effects are linked to significant adverse
health outcomes, including heart attack and stroke. In March of this
year, the Agency announced various efforts to crack down on products
containing androstenedione, or "andro." This class of products poses
substantial safety risks to all Americans, particularly our nation's
youth and athletes.

One of the key messages of this effort is that there are no safe quick
fixes when it comes to losing weight and improving athletic performance,
and it is only through proper diet, nutrition and exercise that we can
improve our physical performance and, more importantly, maintain and
improve our health.

Also, in the school setting, the Health Resources and Services
Administration's (HRSA) Healthy Schools, Healthy Communities program
promotes and establishes comprehensive school-based health centers to
improve the health of at-risk school aged children. Services provided by
the centers include nutrition education and counseling, support groups
for overweight children, dietary surveillance, and nutrition screening.

**[National Dietary Guidelines]{.underline}**

DHHS is collaborating with the U.S. Department of Agriculture (USDA) to
review the Dietary Guidelines that were published in 2000 and to draft
new 2005 Dietary Guidelines for Americans. In light of the growing
number of overweight and obese Americans, a major focus of the new
guidelines will be providing guidance to the public on maintaining a
healthy weight and creating lifestyles that balance the number of
calories eaten with the number of calories expended. These guidelines
must: (1) contain nutritional and dietary information and guidelines for
the general public, (2) be based on the preponderance of scientific and
medical knowledge current at the time of publication, and (3) be
promoted by each Federal Agency involved in a Federal food, nutrition,
or health program.

**[Number range CHAPTERNIH's Obesity Research Task Force]{.underline}**

Through its research mission, NIH is seeking to capitalize on recent
scientific discoveries to further understand the forces contributing to
obesity and develop strategies for prevention and treatment. The
increase in obesity over the past 30 years has been fueled by complex
interplay of environmental, social, economic, and behavioral factors,
acting on a background of genetic susceptibility. As a result, NIH
supports a broad spectrum of obesity-related research, including
molecular, genetic, behavioral, environmental, clinical, and
epidemiologic studies.

As the problems of overweight and obesity have grown the need for new
action and research has become more evident. In response, NIH assembled
a Task Force to identify areas for new research across its many
institutes, and in August 2004 released the Strategic Plan for NIH
Obesity Research
([http://www.obesityresearch.nih.gov/About/strategic-plan.htm](http://www.obesityresearch.nih.gov/)).
This report identifies key areas for research, goals for research and
strategies for achieving the goals.

The report highlights areas of research to better understand, prevent,
and treat obesity. The strategic plan's goals, and strategies for
achieving them, are organized into chapters organized around the
following four themes:

-   Research towards preventing and treating obesity through lifestyle
    modification;

-   Research towards preventing and treating obesity through
    pharmacologic, surgical, or other medical approaches;

-   Research towards breaking the link between obesity and its
    associated health conditions; and,

-   Cross-cutting research topics, including health disparities,
    technology, fostering of interdisciplinary research teams,
    investigator training, translational research and education/outreach
    efforts.

The planning process was informed by input from external experts through
meetings and workshops, through circulation of a draft of the Strategic
Plan, and through posting of a draft of the Strategic Plan on the
Internet for a public comment period prior to publication of a final
version. The National Institute of Diabetes and Digestive and Kidney
Disease's (NIDDK) Clinical Obesity Research Panel (CORP) is an important
advisory group that provides expert input on obesity to the NIH. This
group is composed of leading external obesity researchers and
clinicians. Further, NIH's National Advisory Councils, which are groups
of prominent external scientific experts and lay leaders, review and
discuss strategies, in the form of initiatives, which are designed to
achieve the goals of the Strategic Plan.

**[Tools to help schools and community-based
organizations]{.underline}**

In addition, DHHS agencies are developing important new tools, to be
released in the coming months that will help schools promote healthy
eating and physical activity.

-   Making It Happen -- School Nutrition Success Stories, a joint
    product of HHS, USDA, and ED tells the stories of 32 schools and
    school districts that have implemented innovative strategies to
    improve the nutritional quality of foods and beverages offered and
    sold on school campuses. The most consistent theme emerging from
    these case studies is that students will buy and consume healthful
    foods and beverages---and schools can make money from healthful
    options.

-   The Health Education Curriculum Analysis Tool is a user-friendly
    checklist designed by CDC to help schools select or develop
    curricula based on the extent to which they have characteristics
    that research has identified as being critical for leading to
    positive effects on youth health behaviors. The companion Physical
    Education Curriculum Analysis Tool will help school districts
    develop state-of-the-art physical education curriculum based on
    insights gained from research and best practice.

-   Media Smart Youth: Food, Fitness, and Fun is a curriculum with
    supporting materials developed by the National Institute of Child
    Health and Human Development for youth ages 11-13 years old. It is
    designed to create awareness of the role that media play in shaping
    values concerning physical activity and nutrition, while building
    skills to encourage critical thinking, healthy lifestyle choices,
    and informed decision making, now and in their future.

    **[Programs to help older citizens]{.underline}**

    The Administration on Aging's (AoA) National Policy and Resource
    Center on Nutrition, Physical Activity and Aging was created for the
    purpose of increasing and improving food and nutrition services to
    older Americans through their caregivers at home, with
    community-based service providers, and in long-term care systems.
    The Center focuses on linking proper nutrition and physical activity
    as key themes in the healthy aging process. One strategy for making
    this link has been the development and publication of a community
    guide entitled, "*You Can! Steps to Healthier Aging"*, that details
    a 12-week program to help older Americans "eat better" and "move
    more." The Center is awarding 10 mini-grants to local communities to
    implement the *You Can!* Program in 2004.

    AoA provides funding to states to implement health promotion and
    disease prevention activities. Educational information is
    disseminated through Senior Centers, congregate meal sites, and
    home-delivered meal programs. Health screening and risk assessment
    activities including hypertension, glaucoma, hearing, nutrition
    screening, cholesterol, vision, diabetes, bone density, and others
    are also provided. Physical activity and fitness programs are
    provided along with education about the prevention and reduction of
    alcohol, substance abuse, and smoking. Further, this AoA program
    emphasizes the importance of appropriately managing medications.

**[Conclusion]{.underline}**

Successfully combating the overweight epidemic in our nation will
require the involvement of many sectors and levels of society. Although
national initiatives can play an important role, they are not sufficient
by themselves. Community-based initiatives are critical for reaching
Americans where they live, work, go to school, and play. State-level
programs are critical for supporting and disseminating community-based
activities. DHHS is implementing a comprehensive approach to reach the
American people through these various levels.

There is a great deal more that we need to learn about intervention
strategies to prevent overweight among children and adolescents. Key
research questions that need to be addressed include:

-   Which are the most important behaviors to target to influence
    overweight and obesity?

-   Which mediating variables should be targeted to influence
    obesity-related behaviors?

-   Which are the types of interventions that have the greatest impact
    on the most critical mediating variables and behaviors?

-   How do we translate efficacy study findings into real-world policies
    and programs?

-   How do we effectively and efficiently disseminate effective policies
    and programs?

-   Do the effects of overweight and obesity prevention policies and
    programs last over time?

DHHS agencies will lead the Nation in conducting the research necessary
to answer these questions. In October, DHHS and USDA will host the
National Obesity Prevention Conference addressing this important public
health concern. The objective of the conference is to learn from past
and current research identifying steps we can take to prevent further
increase in the prevalence and severity of obesity, and to lead to
behavioral changes for a healthier U.S.

We are learning a great deal about effective strategies for promoting
physical activity and healthy eating. We know that no one strategy alone
will be sufficient. Our chances for success will be greatest if we use
multiple strategies to address numerous factors that contribute to
caloric imbalance and if we involve various sectors of society at the
community, state, and national levels. DHHS is leading the national
effort to combat the overweight epidemic in our nation through a
comprehensive, multi-faceted, multi-level approach. We are committed to
doing all that we can to help our nation enjoy good health now and for a
lifetime.

I thank you for your interest and the opportunity to share information
about strategies to combat the overweight epidemic and would be happy to
answer your questions.