the seven committee hearings will be called to order and today's hearing is on innovations in addressing childhood obesity and i recognize myself for an opening statement initially the topic innovations in addressing childhood obesity is one of interest of many members of this committee and also members of the house i have to say we're having this hearing today because many members including some that are not on the committee approached me on the floor and asked me to address this this issue in various ways childhood obesity is a huge public health problem in this country that puts millions of american children at risk data from the centers for disease control and prevention the c indicates that over the last three decades the rates of childhood obesity have been skyrocketing in every age category we have seen at least a doubling in some age groups a tripling in the numbers of children who are classified as obese in addition there are millions more who are just at the cost and are in danger of becoming obese as well the rates of the worst among minority populations according to the c d c hispanic boys and african american american girls have the highest rates of obesity with twenty two point one percent of hispanic boys and twenty seven point seven percent of african american girls classified as obese and though the rates are starting to level off there are still too many children in this country who are dangerously overweight childhood obesity can lead to health problem thirty years ago were rarely seen in children a report conducted by the trust for america's health in two thousand and nine highlighted that more and more children being diagnosed with type two diabetes hypertension sleep and when we go around and to the various reservations i've just noticed in the twenty one years that i've been in congress that you know the rate if you will for type two diabetes and the number of people that have it when we go around of the reservations  younger and younger every year and it's just it's just it's really almost of an epidemic nature in my opinion amongst the native american populations and these children are likely to continue having health problems as they age into adulthood some experts have even predicted that if the trends in childhood obesity continue we will for the first time see a generation that live sicker and dies earlier than their parents regardless we know that if left unaddressed this epidemic alone has the potential to cripple our health care system the price of obesity in this country is unsustainable adult obesity is estimated to cost our nation one hundred forty seven billion dollars per year and childhood obesity adds another fourteen billion to that price tag studies have shown that up to eighty percent of children will become obese adults as we watch the number of these obese children skyrocket the quest to our nation will not only increase but an obese and unhealthy nation may very well bring about a number productive nation in my state new jersey thirty one percent of our children are clinically overweight that's nearly seven percent higher than the rate of adult obesity and i'm worried that a time of economic recession and high unemployment rates many of these children will be less likely to have access to healthier more expensive food meanwhile safety net health programs are continuously overextended as the numbers of uninsured and under insured continue to grow posing further risks to children who may not be receiving the medical care that they need there are many factors that contribute to our rising rates of obesity personal habits definitely play some part but many studies have been able to link obesity to unsafe neighborhoods less exercise opportunities and lack of access to healthy our health care system also play some part with millions of children living without preventative health services such as nutrition counseling and screening for obesity related diseases these are all things that we as a nation can work together to address so that we can eventually reverse the trend of childhood obesity and basically we're holding the hearing today because we're trying to find out from our witnesses about innovative work they're doing to address childhood obesity here about how we at the federal level can play a part in curbing this trend and to learn more about what makes obesity intervention successful and i am also here eager to hear a bit about where we need to focus our efforts over the next ten years i'm not you know suggesting to any of you that this is going to be something we're going to be able to solve overnight i know it's i know it's something that needs long term attention in many cases i i was thinking today about when i was growing up in the neighborhood i don't live in the neighborhood anymore my father still there and our congressional offices in the same neighborhood where i grew up and all that almost all the recreational opportunities that existed when i was a kid have disappeared you know the local playgrounds not there anymore they just the y m c a is not there anymore and you know if we live in a small town of about thirty thousand people it's not an urban area per se but you know if you're going to bring back those things it's not something you can but you can do overnight fortunately and i just think that we haven't paid enough attention to a lot of the a lot of these underlying problems whether it's recreation whether it's whether it's supermarket you know these are not things that you can necessarily deal with immediately but they have to be addressed thank you thank you for being here we'll introduce the panel after the rest of the opening statement and the gentleman from have with us on my left dr william dietz who is director of the division of nutrition physical activity and obesity for the centers for disease control and prevention and then next to him is dr terry lang who is director of the obesity research strategic core for the eunice kennedy shriver national institute of child health and human development at the national institutes of health and we welcome both of you thank you for being here today obesity mr chairman you are correct about the problems data sixteen percent of nineteen year olds in the united states are obese and an almost equal number are overweight so about a third of our children and adolescents are obese or overweight you also out correctly to increase prevalence among certain subgroups of the population so the for example in two thousand and six twenty seven percent six to eleven year old male mexican americans were obese and twenty seven percent of twelve to nineteen year old implement so that for example with respect to increasing rates of breastfeeding we need to implement policies and environmental supports in maternity care setting implement policies and environmental supports in the work and develop a national terms of school initiatives in the country and then finally with respect to community initiatives the american recovery and reinvestment act allowed us to begin to invest in community and state level changes that address strateg and at the time of the weight of the nation we released an m w r a morbidity and mortality weekly report entitled commended community strategies and measurements to prevent obesity in the united states and these strategies focus on the increased availability of healthy food decreased access to less helpful and increased access to recreation facilities and increased visible education programs in schools are a total of twenty four of those strategies which we would be happy to share with you  closing children are our most precious resource and obesity is a major threat to their how and of the cost of health care in the united states we're seeing progress but the opportunity now exists through the american recovery and reinvestment act and other innovative programs to begin to reverse this epidemic thank you for this opportunity thank you chairman and members of the committee thank you very much for the invitation to testify today i'm pleased to be here today to share with you some of our recent research and some of our plans for addressing this multifaceted problem as we move forward the  recognizes that to really make a difference on childhood obesity research should address the broader in which children learn levon obtain health care such as systems oriented framework will need to link biological factors of obesity the environmental and policy factors that influence children's diet and physical activity over the last two years research has demonstrated the important impact of the physical social and economic environment on the obesity epidemic for example neighborhoods with other restaurant choices are associated with a higher prevalence of overweight and obesity research has also shown that economic factors such as food marketing and pricing are critical that they can implement the purchase and consumption of nutrient pour but energy national collaborative on childhood obesity research earlier this this year and core it's a design to coordinate and synergize the funding at birth from member organizations to avoid duplication of effort in to pool resources for large ambitious projects that bring us closer to effective and sustainable solution for example and quite recently launched the invasion project which aims to help us understand the complexity of the childhood obesity problem in virtually tied environmental and policy interventions it was sophisticated  recent research programs of note include initiatives on encouraging community based partnerships of obesity researchers with local or state level policy makers and research on school and community policies that impact obesity related behaviors and outcomes funding received by the unite under the american recovery and reinvestment act has also created opportunities for innovative research one night the h t example is a unique weight maintenance study with strong focus on children's social environment that to help children have achieved weight loss to maintain their reduce weight to conclude it is important to note that the childhood obesity problem these playing to not only to children and parents behavior but also more importantly to social and economic a number of policy areas outside the traditional public health care and we need to deal with obesity as a systems issue not just a health issue we need to invest resources into research that it isn't oriented multilevel across disciplinary and include partners from all sectors of our society to generate an effective and sustainable solution a solution to the childhood obesity problem called require a coordinated collaborative multispectral strategy that includes a strong actions from the government industry community and family together we need to create an environment that not only favors straight and economic productivity but it also takes into account a long term health of the population on top of healthy eating and physical activity become naturally embedded in everyday life there is little chance going to say i guess is kind of a cliche but i'm i love to use stories of personal you know stories to sort of make a point when i can what you said dr wang and i totally agree is that you know we need strong action but the question is you know a lot of these things is so personal in nature not necessarily viewed by the american public as something that the federal government gets involved in so i guess my my question always is to what extent can the congress legislate or provide funding that's meaningful and that as a let me just give you my story you know i always think about my grandparents because they were italian american image and and they you know they came from italy and my grandfather who lived to be i think ninety six or ninety eight was always stand and he would literally have a garden in the backyard you know raised the things that he would eat not completely but a lot of the stuff you know my grandmother would canned the goods put the to made is in the peppers and everything in jars i mean so much of what they ate was just grown by them in their backyard and then they would you know even in the winter they'd have it because they'd can then but it just didn't occur ok you know today it's just the opposite like you know when i go home you know we're always looking to go for takeout the kids i have teenage kids are always looking to go to mcdonald's it's just the whole nature of the lifestyle  people and you know that's where i would see every year that i would go that would be lower and lower the kids would get you know diabetes at a younger age and what they would tell me was that you know historically they were a desert people they would gather in the desert everything they ate it was a very different diet now they're eating all processed foods now one of the question really is we can't go back i mean you're not going to pay to take people back to the old days is there things that we can do now though that you know recreate that like for example with the totem that was suggested that they start like a vitamin supplement program and then there was a nonprofit called coca t o c a that started trying to get people to grow some of the traditional foods through a local cooperative so that you know i just example you know we can't go back to what life was like thirty forty years ago when maybe people were healthier in terms of what they but on the other hand you know what's the role of the federal government because so many of these things are personal they're not necessarily you know it's lifestyle and it was a broad question well thank you for your question and comment our environment have changed to result in the lifestyle that we have today so i think what the collection of research is suggesting what we need to do is to really somehow think about making the  so that people can actually exercise personal responsibility if families don't have access to healthy food in their neighborhood because there's no supermarket or wherever there is a lack of variety of food outlets they don't really have the option to even actually do the full range of personal choice so that goes back to the other thing i mentioned you know when i was growing up in the neighborhood where my father still lives there were congressional offices you know there was a school that had a playground the school closed no playground anymore why it closed because even you know have enough money and you know that's what's happening a lot of that in a lot of the urban areas or poor areas and this is a really a poor area i mean i'm not suggesting that but it's not a high income   no a lot of the nonprofits in the and the educational institutions that had these recreational opportunities have sort of dried up for lack of funds you know they're more likely to build a wine a suburban area than they are in an urban area and i think these are promising opportunities we definitely need to do more research to monitor and evaluate what effect these changes while half on people's behavior and health outcomes but i think that there are  promising solutions that are already taking place and there's a lot you know that i think all sectors of society can do from the government all the way down to the individual family and children all right thank you gentleman maybe it's a good time for me to mention that we're going to have four votes but i want to try to get a couple more questionnaires in before we break i wish we knew with some specificity what was accounting for them by way of analogy what we saw the invision project funded a fifteen million dollars project aims to quote understand the complexity of the childhood obesity problem and virtually test environmental and policy interventions through interventions so the idea of the invasion project is to capitalize on our current computing power to try to piece together the different aspects of the obesity puzzle but at the same time to help play with different intervention techniques that are perhaps expensive and difficult to implement because they're adamant about macro level environmental modifications and policy changes of levels and i'm glad to see some attention being focused here let me just open up one subject knowing that we're short on time and ask you both to comment on it my district in northwestern connecticut reflects the diversity of living patterns throughout this country i've got quintessentially rural areas i've got suburban areas and i've got some urban centers and it strikes me that we need different tools and we face different challenges in each one of those settings and so i just want to ask you particularly about that urban setting and about the particular challenges presented to families and kids in urban centers where even if you make a decision as a family to more nutritionally you have a harder time finding that kind of food that that creates the kind of nutritional lifestyle that we're that we're putting forth with these new policies and second with regard to exercise kids are in schools that don't have to have to travel a distance to find any type of open space to run around and play football and baseball and i wonder what you see as the particular challenges and maybe the particular policy responses that we need to attack some of the specific challenges that inner city and urban kids are facing today in my testimony i indicated the publication  and thank you in my testimony i pointed to an m and a morbidity mortality weekly report that we published in july which began to outline strategies for the implementation of better food increases ic model that we ought to point to and try to implement more broadly access is also a factor affecting recreation facilities and and parks for physical activity of children in an adult how  accomplish is that is less certain and that again i think the funds that we have through give us an opportunity to understand those challenges and the impact of making changes in those arenas stop shop at whole foods they're not going to go into those areas because they just don't see a market for it and so you can either work over a period of decades to create the demand and hope that private sector capital follows demand to put those type of full service grocery facilities in those neighborhoods or maybe you're suggesting as pennsylvania has done you actually put some government money behind the financing of those it can be done by putting a supermarket into an uncertain under served area in new york city dr frieden which provided loans or access to facilities for keeping fresh fruits and vegetables cold that where about to launch a nationwide evaluation with a nationally representative sample of communities using different approaches and hopefully in a few years we'll have some good data to point to where  what might be effective and what might be sustainable and i think that that's being ability effort is a really key thing and some of the things that we may need to do in terms of solution you know are putting in place you know the seed for a long term change we're not going to solve the child ought to be a problem overnight and i think we need to have our you know that you know on a long term trajectory and putting in place measures that will  us to where we want to be you know down the route not just for the current generation but the next generation that you're much michelle thank you now we have four votes to take us maybe a little more than half an hour but we'll try to get it right and we still have some more questions of you before we go to the next panel so the committee stands in recess this subcommittee hearing will reconvene and we go to the republican side mr murphy of pennsylvania thank you mr chairman i'm chairman i also ask that my testimony be submitted for the record on this and i thank that objection so order  is this something that given that and also the comments you make later on about or you made other parts of your testimony about the increased cost of health care with obesity are you aware of any studies done or plan dr wang has to do with some insurance plans some health insurance plans actually offer different premium co pays that people keep their weight within certain ranges a seated position to set or are you aware if there was any studies that talk about either of you where there's any study to talk about when those incentives are offered changes in names are called based upon a person's weight within a certain range if it makes a difference and in their health and their morbidity rates and of course ultimately also in that information so i appreciate that and the other i want to ask about just so much of the testimony that we've heard also talks about nutrition and we hope people eat healthy and we talk about such things as activity and we hope they take advantage of activities drop that and many times states say we don't have the time to do this because we have to spend more time with math and reading to get academic scores up i find it in ninety seven percent of freshman aerate a healthy weight compared to the other things we see about young children  students that were heart monitors during their gym class to make sure they stay a target heart rate they're allowed a wide range of activities it isn't just dodgeball with the big kids and where they can stand as a side and also they perform in the top ten percent in the world on standardized math and science test a fascinating link there one of the few to can comment on other studies we might learn from or jump in to the next level should reward quire students to take gym class or at least which is an important concept because not everybody lose weight physical activity is one of those strategies the second benefit is the one you alluded to we published a study two years ago showing that physical activity proved test perform medicine has also released a report in recent years indicating how exposure to advertising leads to influence the consumption of different kinds of foods so i think that the research is  to be hearing from the second panel and i guess there are five or so individuals on that panel i've read most of the testimony i know that were and i'm looking forward to actually hearing from the american academy of pediatrics  and in that testimony there was a recommendation for a real comprehensive approach toward solving this problem in fact a pediatrician is going to testify  school staff social workers and i'm not i'm not disagreeing necessarily with that and i do think that this is a significant problem that we need to try to address and the most cost efficient white but when you get to comprehensive of course every one of these people have to be paid and they're going to be expected to be paid but you know we have a limited amount of money we've been talking about that for the last almost year as were d this comprehensive health reform our health insurance reform plan to spend the dollars affectively i don't know that there is a silver bullet but if there's an arrow or two in the quiver sha rper than the rest of the pack i think we should use it so my question is how important do you think the role of parental behavior is in regard to increased ability are acted upon by the environment and certainly the first environment and one of the most important that young children live in is the home and there's no question that parents can play a significant role and do play a significant role to make the right choices they don't have the right choice and that opens up a broader environmental issue for example you can't very well expect an inner city parent who lives in an unsafe neighborhood to let their child go out and you know  got left i would like to make this comment was chairman when we marked h r thirty two hundred van which became thirty nine and sixty two our health care reform bill there was an amendment made to suggest that employers should be able to incentivize their employees for healthy behavior stop smoking lose weight exercise and in return you know a premium reduction  kind of a reward to get people to buy into that of course so the payback for the employer was better attendance better work has a better skills less accidents in the workplace  d apparently hipaa limits the amount of reduction in premium to twenty percent now in the bill i think we did raise it to thirty maybe fifty percent even on the senate side but the secretary of health and human services would have to approve those type programs and i know you don't have time to respond but what i mean this is a good thing that we ought to continue to push because if these parents get healthy at work they're go come home and pass that on to their children chairman thank you for your indulgence and i thank you gentleman from maryland mr sarbanes thank you very much  important and it's one of the most important hearings i think we've had in this committee all year because and you've heard the discussion so much of it is focused on on our young people and developing in then  the right kind of lifestyle habits so that they can improve their health over the course of their lives i wanted to just mention a couple pieces of legislation that i've been involved with that i think are very much on the mark with some of the testimony we've heard today the first is something called the no child left inside act it's a little bit of a play on words with no child left behind but it the idea of trying to promote more opportunities for environmental education and the integration of outdoor learning experiences and education into the overall instructional program  across the country it would encourage states to establish environmental literacy plans which is sort of their vision for how to make sure that when children graduate from high school they had some  baseline exposure to the environment and incorporated these experiences in it's based on research and we've we've heard some of this already today but research that indicates that these days the average young person is spending four to five hours a day inside on video games television on the internet and about four minutes a day in what we would say is outdoor unstructured rec we've gone from a generation where your mother had to keep calling you when for dinner where parents albeit depending on the particular environment or neighborhood they're in are trying to push their kids more outside because they seem to be spending all their time one on screen time and we've got to get back to a balance so that that's one legislative vehicle to try to bring more attention to this need for a balance the other is something called the foundation for a fit nation there's a council the president's council on physical fitness it was established under president eisenhower and then president kennedy expanded it's it's charge that focuses on physical fitness and tries to keep that kind of high profile but it is currently on able to raise private funds to support its mission so this bill would actually create an opportunity for that to support its its activities i think it gets about one point two million dollars a year now directly in appropriation but could certainly do much more if it had support from the private sector so all these things are designed to bring more attention to the to the issue that you're that you're describing i had two questions one relates to each of those we heard about how this problem of obesity and i want to focus particularly on childhood obesity  can be affected by a combination of diet nutrition genetics to some degree the environment and then the amount of exercise as you think about those components and maybe others i mean do you have a kind of in your own mind do you prioritize one or the other do you find them so inexplicably linked to one another that it's unusual to do that  where would you say we can make huge strides had very little koch arguably if we just improve the kind of exercise component so if you could speak to that and i want other quick question  level with very little you know promising something about results and so i think if we are truly going to make the data on this problem of the population level we really need to begin addressing the environment more aggressively i because of some of the activities at school that they'd begun where they would get out into nature and do these walks and so forth he had convinced his parents on the weekends to go every saturday morning to two or three hour walk with the family and parents are often guided in their priorities for leisure time by what their children want it's not always and so i think you can get this partnership working in a very productive fashion what they need and we can have all the dang federal programs we want but that management has a lot that's why i appreciate what n f l is doing we have to educate these people is calories in calories out you don't gain weight if you burn more  i have my hershey bar my diet coke for my mental health but also go down to the gym and work out as long as i can get to it for maybe an hour to ninety minutes and i'll burn calories so i am concerned that as we pile up on big government try to mager manage the right the roles of the family and the roles of primary education in this country we ought to be incentiv them to do the right thing and encouraging them it's not rocket science it's calories in calories out you burn more calories you don't gain weight if you're genetically predisposed you  regulations let's just empower the local communities to get into their local public school systems and say please diet exercise healthy food and by pre shared time and yell back thank you the gentleman from iowa mr brayley that's your state's the only one that has a visit requirement apparently we haven't we have a statewide requirement  well i want to talk about that because i've been talking about health care for three years i remind everybody that health care is not a disease treatment response that if we got funding for our physical education programs in our schools and if we tried to impose a nine hundred fifty s era physical education curriculum on today's youth we're going to be drastically failing our responsibility to them do you both agree with that because when i was growing up in the sixty's we sugar smacks which had fifty six percent sugar and sugar frosted flakes sugar pops super sugar crisp and i remember looking around my classroom and there may be one or two kids in a class of thirty during the baby boom era who were considered obese so even and i think that if you look at caloric intake back then we probably had a higher caloric intake per capita than students today do but we also were getting more healthy food and some ways on a daily basis and we spent all day outdoors and yet the harsh reality is as a parent who had kids growing up in the ninety's most parents are faced with very different choices than our parents did where you had a mother in many cases living at home and monitoring the behavior of children and children who were faced with much fewer threats out in the world that allowed them to spend all day outdoors the way we did as kids so my question is how do we get society to focus on the challenges of providing lifestyle physical education in our schools on a daily basis that gives them not just dodgeball skills but things that teach them a robotic activities they can carry throughout their lives and how do we provide the type of  nutrition labeling at the point where they're consuming food in the schools which is our best place to reach them outside home to give us a realistic chance of bending this curve upward juvenile obesity down good gym teacher or providing good food and schools you know those are part of the changes in the environment that we are talking about today to make it possible for easier for parents and kids you know to engage in the right behaviors activities with regard to reintroducing healthy food access into some of the neighborhoods around the country so i think there are promising strategies that are consistent with our modern life but it's really important to no that you know we can't just keep telling children and parents that you have to eat better you have to exercise you know we've got to create a larger context to make those behaviors possible to d'sryfoos i get to you i want to frame this a little differently because one of the things we know is kids do behave differently today many of them are focused on access to computer games the inner and they do they are stimulated differently than we were when we could go outside and hang out with our friends all day long without having to be indoors so what i'm interested in is how you take technology like we fit or some of the other computer games that require physical activity and how you use those to motivate kids to get more engaged realizing you've got a much more difficult challenge with today's generation of young children to get them to exercise than we did in the past one example where that promotion first act i hope you'll take a look at it the goal of the bill is to identify ways to help people develop and maintain healthy lifestyles promoting the kinds of living and working environments to encourage people to eat right to be physically active adopt behaviors that improve their house and our bill i think takes innovative approaches requiring collaboration across agencies to identify what the best practices and effective strategies for health promotion would be to help you'll take a look at the other thing i wanted to tell you is last week i met with a woman her name is rochelle davis and she's executive director of the healthy schools campaign in chicago and she has developed along with the public schools a collaboration on the school lunches and the chicago public schools want to be early adopters of the institute of medicine recommendation changes in school meals that require more like way more vegetables and fruits and whole grains but unfortunately current u standards prevent that so what we i think one of the goals that we have to have is look at the policies that exist right now and identify some of the barriers that we have to actually adopting some of the strategies that we actually know will work we want to encourage states and localities to be innovative i just went to  my grandchildren's school and looked at the school lunch program they actually happen to have a kitchen so they can do more innovative things but fewer and fewer schools now have their own kitchen so we're looking more at you know at the central delivery places what kind of work that they're doing parents i think are actually getting more involved than i remember in what the school lunch programs look like that was released in my district and i'm very very encouraged by that and i think once they figure out programs that are cost effective as always cost is an issue that we can can promote those but i wondered if you could talk a little bit about the barriers that we have existing right now in our federal regulations that might prevent these kinds of things from being adopted  two years ago before the food stamp program got more funding it was a dollar a meal essential like three dollars a day and by the time i got to the produce section with some vegetables there don't exist anymore thankfully but you know we have to provide avenues for people to it's enough that you know it's nice to say that families are supposed to do this and little time we have been in trying to delve into some of these concerns but i know that there's a lot more that we have to do but i do appreciate your input and we may have some additional questions that the clerk will send you within the next ten days or so to follow up so now let me introduce our second panel and starting on my last is ron jaworski who is with the jaws youth fund and the national football league play sixty these are both organizations that you either started or have been involved with is president and c e o of the reinvestment fun merry selfless who is senior vice president of government affairs for the grocery manufacturers association and  mori who is a doctor and president and c e o of the robert wood johnson foundation thank you i appreciate all of you for being here i know you have innovative ideas about how to deal with some of germans alone and members of the subcommittee on health it's great to be with you here this morning good morning everyone i'm out and so much fun here's what i'm a hanger on and cover a football game on monday night why not been a great great state thus far i really want to thank you for the opportunity to fly on an issue of great great importance to me to my foundation and to the national football league the epidemic on childhood obesity i'm proud to testify before you today in two capacities first i represent the united way jaws on a partnership my family created more than ten years ago with united way of camden county new jersey to united way jaws youth gone i am proud of delivered close to three million dollars to more than nonprofit organizations providing service to children children ranging from ages seven to eighteen in addition i'm also testifying on behalf of the national football league and its signature community relations initiative the place sixty campaign launched in two thousand and seven the place sixty campaign is a national youth health and fitness campaign focused on increasing the health and wellness of young fans and combat in childhood obesity by encouraging you to be active for at least sixty minutes a day mr chairman the facts surrounding child obesity in this country are startling they are startling nearly one in three children and teens in the u are obese or overweight that's one in three more than twenty three million new in the one that's twenty three million obese or overweight starting numbers in the last two decades the rate of overweight children has doubled we know that youth who are overweight or obese are more likely to have health risk factors associated with cardiovascular disease such as high blood pressure high cholesterol and type two diabetes  contrast the benefits of good health translate to the classroom were studies show that bit students are less likely to have disciplinary problems healthy students also perform better on standardized tests it is possible these facts while shocking should not come as such a surprise when we consider that more than sixty percent of children ages nine to thirteen do not to participate in any organized activity during school hours the number of idle children is increasingly significant when schools around the country find it challenging to offer physical education classes sadly very sadly fifty percent of the schools do not provide physical education grades one through five even more startling seventy five percent do not provide physical education for grade six through eight this is not a new issue for me unfortunately  philadelphia seventy six ers president and part owner along with ed solomon a legislator in new jersey and we defeated that proposal we were successful and physical education remained a requirement in new jersey public schools it's amazing here we are twenty one years later still talking about the same thing i'm pleased also announced that i'll be joining the united way's national board in two thousand and ten last year the united way system established a ten year health goal to increase by one third the number of youth in adults who are healthy and avoiding risky behavior in order to achieve its ten year help goal i always made combat in child obesity a priority which requires the resources and commitment of all of us working together one of the best examples of the type of health and wellness activity that one supports club in camden new jersey in addition to being the most dangerous city in the country camden's child obesity rate is a staggering sixty percent united way's job one is proud to help one steve's club an organization that provides fitness training to camden it's giving them a place to get their bodies healthy and stay off the street with a young man that's what joining me here today jose henriquez a former gang member turned fitness guru it's a great story great story to be bought a band from so we could drive around and sell but it's the kids in camden and trust me they need it and a real good friend of his great leadership and inspiration of jose lost fifty pounds there is a real example of the good work being done in our initiative fantastic program and ascribe for you some of the terrific work they and all the member n f l clubs do in our community play sixties a multimedia disciplinary campaign that addresses the issue of child obesity through the national outreach and online programs as well as grassroots and implemented the n f l in school and after school and team based programs and the players the leadership the n f l does a magnificent job l play sixty was assigned to build on the league's and teams longstanding commitment to health and fitness the n f l decided to focus on the issue of child obesity because it recognized not only the public health crisis facing our nation but also the n getting sixty minutes of physical activity per day that's it sixty minutes just give us sixty minutes kids are encouraged to find their own ways to get active whether the local playground which have been rebuilt playing in the schoolyard or just walking around with some friends having play sixty represents organized sports including you as a very good way to get active but certainly not the way another story through the leagues play sixty super bowl contest twelve year old jared out from erie pennsylvania took his family arizona for the super bowl two years ago enjoyed the experience live or the football for the kickoff but when he went home he went back and started working outside on a regular basis sister also plays soccer a covering the pro bowl we're going to plug in for that we'll be covering the pro bowl and we will be out in the city i will be out of the committee with the pro bowl players players national football league surrounding miami and all the communities in the area promoting how important it is i look on childhood obesity and i'm proud to represent the american academy of pediatrics allow me to share with you a story janey is a nine year old patient of mine and when she first came to us her b m i was thirty five that means her weight was would have called her grandma's house and was drinking six and several glasses a day janie did her homework at her grandmother's house but she didn't go outside often because the neighborhood wasn't she was having five to six hours of screen time each the factors that impact the concentric circles of this model show the issues related to the individual family community and a larger social structure that either promote good nutrition physical activity and overall health any meaningful attempt to stem the rising tide of obesity must address many of these issues simultaneously over a prolonged period of time in order to produce sustainable change the health care community is currently engaged in a race to learn what types of intervention we can employ in medical practice to reduce pediatric overweight and obesity a number of common elements among successful interventions have begun to emerge the medical home every child much must have access to a medical home that will provide continuity of care and coordinate the services from various sources without a medical home the child and family receive fragmented and inconsistent advice and services in the case of obesity where progress must be tracked methodically a medical home is critical to the success of any health care intervention levels of care the expert committee on obesity in two thousand and seven recommended that patients have access to four levels or stages of care or explained in my written testimony these health care practitioners to tailor their approaches to the child and family based upon their current health status readiness to change and other special needs public and private health insurers must provide appropriate payment based upon the complexity of the child and the level of service required family centered care successful interventions cannot focus upon the child to the exclusion of the rest of the family children have limited control over the foods they eat or  the amount of physical activity in which they engage and other key factors that determine their how the engagement of the entire family and behavior change is critical to the success of a practice intervention practice based interventions are vital tool we must also recognize that health is profoundly affected by the community in which a child lives without equal attention to community based policy interventions practice based approaches have a much reduced likelihood of success child nutrition programs several child nutrition programs should require all participating schools childcare providers and other institutions to follow the dietary guidelines in serving meals and snacks to children the secretary of agriculture should have authority to regulate competitive food strongly supports the recent update packages and breastfeeding promotion which is an important component of a stablished good nutrition and appropriate feeding habits at the beginning of life the reinstatement of compulsory daily quality physical education classes is vital to children's health and can also impact their ability to learn in the classroom screen time for children should be limited to less than two hours a day are physical environment the built environment determines to a large extent how children travel move and play modern communities have been created for cars not children recommendations for the design of communities to provide healthy active living sugar sweetened beverages are a significant reducing consumption and raising revenue for other children's health priorities finally the supports a ban on junk food advertising during programming that is viewed by young children and calls upon congress and the interactive advertising years we have changed our packaging to promote portion control and we have reformulated more than ten thousand products to reduce or remove saturated fat trans fat calorie sugar and sodium changes in advertising practices have resulted in a significant shift in the product mix of advertising you by children and by adults as companies continue to respond to consumers desire for healthy products and a healthy lifestyle we think that the key to helping individuals achieve and maintain a healthy weight lies with developing the habit and skills to incorporate energy balance into our daily lives something dr wang referred to as well this means balancing calories consumed as part of a healthful diet with calories expended through physical activity we think this should be the focus of our collective effort we're beginning to see what works and the importance of this energy balance message three years ago g n a s member companies helped create the healthy schools partnership and partnership of the american dietetic association foundation for life and the american council for fitness and nutrition the h s p integrate a nutrition curriculum into the p c for live physical education classroom training registered dietitian to be nutrition coaches to coach and motivate students alongside the for life teachers and i would say that p for life is the organization that documented the statistics that mr mercer congressman murphy was talking about on the improvements in academic performance and discipline the initial evaluations of the nutrition component of this program undertaken by u c berkeley have been extremely positive although they started out roughly the same after coaching students in the intervention schools had scored significantly higher than those of students in control schools particularly in understanding how to maintain a healthy body weight and recognizing the value of eating more fruits and vegetables after r d nutrition coaching twice as many students from intervention schools thirty one percent compared to the control group seventeen percent were eating vegetables in school and as we know consumption of fruit and vegetables is one of the key indicators of a healthy weight in children it's programs like healthy schools partnership that are making a difference in children's lives i would note that the original schools which are in kansas city missouri are in the urban core and seventy five percent of the student population is eligible for free or reduced price lunch this year and next we will be expanding the healthy school partnership in two additional schools in the kansas city metropolitan area into des moines iowa and a tribal community and i was school in chicago and four schools in washington d c this expansion is being made possible by an eight and a half million dollar grant from the healthy weight commitment foundation which was launched in october of this year it is a coalition of forty retailers non governmental organization and food and beverage manufacturers who have launched a twenty million dollars national multi year effort designed to reduce obesity particularly childhood obesity by twenty fifteen the h w c will promote healthy ways to help people achieve a healthy weight through energy balance in the places where people spend most of their time schools workplace and the marketplace and because it's very important that solutions be evidence based all the initiatives the healthy weight commitment foundation including our include the use of objective outside expert evaluators notably the robert wood johnson foundation will be serving as outside expert evaluator on the marketplace and particularly with respect to calories in and calories out and we very much appreciate their engagement and the national business group on health will evaluate the workplace initiative finally early next year the healthy weight commitment foundation will launch a public education campaign aimed at children ages six to eleven their parents and caregivers to help raise awareness about the importance of ben being a healthy diet with physical activity mr chairman our industry will do more to meet this complex challenge and we look forward to updating you on the activities of a healthy weight commitment foundation and a healthy school partnership in the coming months and congress and brayley when you are of the realm i noted that this unique partnership in the schools we're bringing to des moines iowa and tribal community and iowa this year and over the next several years in particular we ur congress to increase investment in physical education nutrition education and to encourage changes in the built environment and to support workplace wellness programs that recognize and reward improvements in health among employees we think these are shown to be among the most promising strategies and where additional investments that we can bring the pilot programs to scale is desperately needed and where to actually produce significant results thank you i think you need me to turn around and move a closer to here we go i think it's on you ok chairman thank you and other members of the committee for this opportunity to testify about innovative solutions and strategies to address the epidemic of childhood obesity the robert wood johnson foundation invests has committed to invest over five hundred million dollars in reversing the epidemic of childhood obesity by two thousand and fifteen we focus our approaches on research that suggests how to use nutrition and physical activity which are both required in order to reverse this epidemic areas that we think are important for change first providing only healthy beverages for students at school improving the availability of healthy and healthy in all communities increasing physical activity before during and after school improving access to places where children can play and regulate marketing to children in my written testimony i gave a number of examples of projects across the country that we are funding in the however at this time i want to tell you a story about a young man whose picture is shown here is an african american teenager who has a family history of diabetes and heart disease all of us but there are a lot of kids in neighborhoods across the country who get discouraged when they don't have the help and the means to overcome the environmental barriers that make it hard for them to live well  that's happening in baldwin park california under a program that we're funding and community coalitions work to improve access to improving schools that connect schools also connected neighborhoods and also provided job training and employment opportunities for young people who could be healthy park ambassadors happening in chicago  and communities worked in partnership to provide direct transportation routes between neighborhoods that have supermarkets and those well that's actually happening in nashville affect community change the responsibility of families of schools of health providers of industry of government of really the entire community by solving epidemic we're going to have to rely on the leadership in the coordination at the federal level but also across departments and agencies at the state and local level as well transportation housing education agriculture policy along with health policy will have an impact on the kind of help that our kids will have by giving them access to healthy nutritious food and streets and environment together we must ensure that every community in order to reverse this epidemic and ensure that all of our children can be healthy and grow up to be healthy adults i thank you again for the opportunity to testify today and look forward to your question thank you and let me thank you all we'll take questions from the from the members and i'll start with myself as i mentioned the real purpose of this hearing was to try to get your innovative ideas and see if we can use them somehow in a broader way through government private sector whatever and of course being that we're in congress i new jersey several times and so my questions to the two of you are related to this whole issue that another words like mr george who you particularly talked about well you mentioned you know keeping visit requirement in new jersey and i mean that's a government function in that case the state you mention the innovative program in camden i was i've been actually go to camden quite a lot even though it's you know like an hour and a half away from my district  because there's a ministers association there called pico p i c o i forget what it stands for and when we were doing the i remember particularly we're doing the s chip you know which is expanded children's initiative which we passed and the president signed it earlier this year before we got into the larger health care reform and they were very supportive and they asked me to come down and show you know what a difference it would make if we had the s chip program expanded is called family care in new jersey and i was really struck by a number of things just in my couple days visiting camden you know a lot of the drugs being sold openly on the streets so tell me a little more i mean this is what you mentioned steve what was it steve club that was the it's like a gym that you fund is there is there any way that that can be expanded or we could do something like that you know beyond what you do i take it it's all privately funded by you from what i can understand city it's on the outskirts and they did a study of some of these local corner grocery stores there were no groceries there were no fresh fruits there were no fresh vegetables those things that we're hearing about here so real living example that there are probably hundreds of other but there are needs our community not only following up on what he said but you mentioned that your pennsylvania initiative now you're doing this in a number of cities in new jersey mention quite a few  and you said it was a public private partnership again same essential question is how do we replicate this is there a federal role or something we can do to to expand this and tell us a little more about it  georgia and i was on a school board started my political career actually on the local school board and there was every time something got cut in there was always struggling to have enough dollars it was talking the first panel and you heard heard my question to them and i know when your testimony is testimony and very very comprehensive you do seem to put a strong emphasis on the use of by  definition taxpayer dollars to promote a social norm of good health a very comprehensive approach but as i said earlier these folks have to be do you think do you think that parents can provide that social norm think that's one of the reasons why introduce the healthy choices for kids act earlier this year to promote the idea of a label labeling the schools being served in school cafeterias with nutritional information which would authorize a pilot program in one hundred schools to label the foods being served with nutritional and caloric information at the point of decision and i would i would there's a recent study that has actually shown that students were more likely to make healthier food selections when the nutritional information was available next to the food item being served and that was a two thousand and five issue of the journal of child nutrition management which found that students choices for more healthy entrees increased after reading nutritional content label next to the food items and my hope the healthy for food choices for kids will be included with the child nutrition programs reauthorization and i've been working with the education labor committee and chairman miller to include this legislation in that  program i also want to comment more on your comment about safe routes and the importance for kids who increasingly face difficult environments getting to school and the transportation committee which i previously served on has jurisdiction over the safe routes to schools program which is federal dollars being used to enhance the security of routes to schools for kids and when i was in denver last summer for the democratic convention i went to an elementary school in denver that is combining a lot of the aspects of what we've been talking about here today were kids who rode their bikes to school would be given a bike helmet with a barcode on it and they would ride past this computer  terminal which made a clanging noise to reinforce auditorily with the kids they'd written their bike to school and that would automatically then recorded in the school computer and that the more days they rode or walked to school they would get points and at the end of the school year they got some kind of prize maybe an i pod or something depending on the level of participation here was the biggest complaint that they got because parents got more engaged in writing their  with kids when it started to snow in boulder they were getting complaints from parents who were being forced to ride in the snow they're kids who are obsessed with scoring points and getting physical activity so i think that's a good problem that we have in this country then we need to have more of those problems but one of the things that i've also heard today and that is that that recreational time for kids is increasingly gotten  l which was a great thing to attract interest in the program but part of the problem we have with youth activities is that a lot of kids and a lot of parents seem to have bought into the concept that unless you're in a structured  team sports activity there is no value to participation so can you tell us some of the things that your foundation and the n f l is doing to take a broader message to kids about the need to engage in unstructured play a robotic activities that have nothing to do with team participation and get us to the where we have a balanced comprehensive approach to team and team building and exercise recess and yet that has been identified as the single biggest opportunity for children to have activity during the day we fund a program called play works that brings kids young people into the playground help young children who may not have learned those games that we all are children that not only teaches them how to mediate their differences but how to have a good and structured play that we've been talking about that is a kind of program that starts locally how to improve their own fitness and then taking that and learning skills that they can then take outside the school and into the family to continue and we think that that is a key aspect of what we're going to have to do to reach a broader audience of children funding a number of programs in illinois and chicago in particular that are bringing community based organizations together across sectors to try to create innovative solutions that build on the assets of the community so for that i think there are three key things there one is to make sure that there are opportunities for communities that are innovators to learn from one another they're clearing houses that will allow them to share best practices and information and have funding opportunities at the state and federal level that can take these to scale and some of the ones that have already been mentioned like fresh food financing started as a local and innovation that now brings together put public private financing and is looking to have more federal financing to take that truly to scale that kind of model as robert wood johnson a clearinghouse for that or we have a project to actually provide a clearing house for our grantees but that's only one part of it clearly there are many other organizations that are working and a good clearinghouse that includes not only the work we're doing but beyond that would be very useful american dietetic association founded a m a sponsoring some of those ads that are saying don't don't tax soft drinks and those kinds of things on television we have supported the american beverage association effort in that regard we haven't provided financial support you know i mean i just think that you know it's sort of give and take give and take here that you know for serious about promoting healthy foods we have to be serious about it i saw that general mills was lowing the amount of sugar in its products i hope that they find that commercially viable and i hope that school districts like chicago will encourage that by purchasing the lower cost the lower sugar friend that you know we want to make sure that these things also make money but you know it's just a pointing to me that you're supporting that that effort because i think we need to be discouraging these high sugar drinks  i think there's been a tremendous amount of innovation and improvements in the nutrition profiles of products that's been a focus of our industry and i think that you'll see that continue the american beverage association has a unique partnership with the alliance for a healthier generation to remove soft drinks from from that full of full strength offerings from schools so i think the industry is doing a great deal to help ensure that us within the next ten days and we've been getting back to us and we are going to take these ideas and look at possible legislative initiatives so thank you and without objection the hearing of the subcommittee is a