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95–914 PDF 2004

THE SUPERSIZING OF AMERICA: THE FEDERAL

GOVERNMENT’S ROLE IN COMBATING OBESITY

AND PROMOTING HEALTHY LIVING

HEARING

BEFORE THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

SECOND SESSION

JUNE 3, 2004

Serial No. 108–201

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpo.gov/congress/house

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

DAN BURTON, Indiana

CHRISTOPHER SHAYS, Connecticut

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

DOUG OSE, California

RON LEWIS, Kentucky

JO ANN DAVIS, Virginia

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

ADAM H. PUTNAM, Florida

EDWARD L. SCHROCK, Virginia

JOHN J. DUNCAN, JR., Tennessee

NATHAN DEAL, Georgia

CANDICE S. MILLER, Michigan

TIM MURPHY, Pennsylvania

MICHAEL R. TURNER, Ohio

JOHN R. CARTER, Texas

MARSHA BLACKBURN, Tennessee

PATRICK J. TIBERI, Ohio

KATHERINE HARRIS, Florida

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

JOHN F. TIERNEY, Massachusetts

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland

ELEANOR HOLMES NORTON, District of

Columbia

JIM COOPER, Tennessee

——— ———

———

BERNARD SANDERS, Vermont

(Independent)

MELISSA WOJCIAK, Staff Director

DAVID MARIN, Deputy Staff Director/Communications Director

ROB BORDEN, Parliamentarian

TERESA AUSTIN, Chief Clerk

PHIL BARNETT, Minority Chief of Staff/Chief Counsel

(III)

C O N T E N T S

Page

Hearing held on June 3, 2004 ................................................................................. 1

Statement of:

Agatston, Dr. Arthur, cardiologist and author, the South Beach Diet;

Dr. G. Harvey Anderson, professor, Department of Nutritional Sciences,

University of Toronto; Dr. Susan Finn, chair, American Council for

Fitness and Nutrition; and Bruce Silverglade, director, legal affairs,

Center for Science in the Public Interest .................................................... 95

Crawford, Dr. Lester M., Acting Commissioner, Food and Drug Administration; Lynn Swann, chairman, President’s Council on Physical Fitness and Sports; and Eric Hentges, Executive Director, U.S. Department of Agriculture, Center for Nutrition Policy and Promotion ............. 15

Trager, Dr. Stuart, chairman, Atkins Physicians Council ............................ 71

Letters, statements, etc., submitted for the record by:

Agatston, Dr. Arthur, cardiologist and author, the South Beach Diet,

prepared statement of ................................................................................... 98

Anderson, Dr. G. Harvey, professor, Department of Nutritional Sciences,

University of Toronto, prepared statement of ............................................ 107

Crawford, Dr. Lester M., Acting Commissioner, Food and Drug Administration, prepared statement of ..................................................................... 17

Cummings, Hon. Elijah E., a Representative in Congress from the State

of Maryland, prepared statement of ............................................................ 155

Davis, Chairman Tom, a Representative in Congress from the State of

Virginia, prepared statement of ................................................................... 4

Finn, Dr. Susan, chair, American Council for Fitness and Nutrition,

prepared statement of ................................................................................... 112

Hentges, Eric, Executive Director, U.S. Department of Agriculture, Center for Nutrition Policy and Promotion, prepared statement of ................ 56

Putnam, Hon. Adam H., a Representative in Congress from the State

of Florida, prepared statement of ................................................................ 157

Silverglade, Bruce, director, legal affairs, Center for Science in the Public

Interest:

Information on global strategy on diet, physical activity and health ... 123

Prepared statement of ............................................................................... 144

Swann, Lynn, chairman, President’s Council on Physical Fitness and

Sports, prepared statement of ...................................................................... 46

Towns, Hon. Edolphus, a Representative in Congress from the State

of New York, information concerning children’s diets ............................... 68

Trager, Dr. Stuart, chairman, Atkins Physicians Council, prepared statement of ........................................................................................................... 74

Waxman, Hon. Henry A., a Representative in Congress from the State

of California, prepared statement of ........................................................... 9

(1)

THE SUPERSIZING OF AMERICA: THE FEDERAL GOVERNMENT’S ROLE IN COMBATING

OBESITY AND PROMOTING HEALTHY LIVING

THURSDAY, JUNE 3, 2004

HOUSE OF REPRESENTATIVES,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The committee met, pursuant to notice, at 11:37 a.m., in room

2154, Rayburn House Office Building, Hon. Tom Davis of Virginia

(chairman of the committee) presiding.

Present: Representatives Tom Davis of Virginia, Shays, RosLehtinen, Ose, Lewis, Putnam, Schrock, Duncan, Murphy, Carter,

Blackburn, Harris, Waxman, Towns, Maloney, Cummings, Tierney,

Clay, Watson, Van Hollen, and Ruppersberger.

Staff present: David Marin, deputy staff director and communications director; Keith Ausbrook, chief counsel; Ellen Brown, legislative director and senior policy counsel; Anne Marie Turner, counsel;

Robert Borden, counsel and parliamentarian; Rob White, press secretary; Drew Crockett, deputy director of communications; Mason

Alinger, Brian Stout, Susie Schulte, Michael Layman, and Shalley

Kim, professional staff members; Teresa Austin, chief clerk; Brien

Beattie, deputy clerk; Allyson Blandford, office manager; Leneal

Scott, computer systems manager; Phil Barnett, minority staff director; Kristin Amerling, minority deputy chief counsel; Josh

Sharfstein, minority professional staff member; Earley Green, minority chief clerk; Jean Gosa, minority assistant clerk; and Naomi

Seiler, minority staff assistant.

Chairman TOM DAVIS. I want to welcome everyone to today’s

hearing. I would note a quorum is here.

The hearing is on the Federal Government’s role in fighting obesity in the United States. Today we will examine the increasing

threat obesity poses to all Americans, what government is going to

do to help people lead healthier lives and how the government can

provide greater health leadership for the public.

As obesity will soon pass smoking as the No. 1 avoidable cause

of death among Americans, a reexamination of our national health

policy is more than warranted. Mr. Waxman, it took us a long time

to get together on a smoking bill and FDA regulation. Maybe we

can work on an obesity bill once we get that through.

The facts are, quite frankly, frightening. Obesity-related disease

kills 400,000 Americans each year. Medical treatment of obesity

and its more than two dozen associated conditions costs nearly

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$100 billion annually according to some estimates with about half

paid by taxpayers through Medicare and Medicaid.

In 2001, obesity was a primary factor in five of the six leading

causes of death among Americans: heart disease, cancer, stroke,

Chronic Obstructive Pulmonary disease and diabetes. One-third of

all Americans are considered obese; another third are overweight

and the trend line is only getting worse. Clearly, all Americans

aren’t eating wisely, they are not exercising enough, but that is too

simple. The root causes of obesity are far too many in number to

adequately address here today. We are a Nation consumed by

work, spending long hours behind desks, favoring fast food meals

and cramming in exercise when we are able, if at all.

While heredity largely determines how a person burns calories

and retains fat, the person’s behavior unquestionably has a greater

impact on weight gain. In the year 2000, women consumed 335

more calories per day than they ate in 1971. Men eat 168 more calories today than they did 30 years ago. At the same time, nearly

half of all American adults reported they engaged in no physical

activity at all.

During its meeting last week, the U.S. Dietary Guidelines Advisory Committee declared that most adults need 30 minutes of moderate physical activity nearly every day. Some require 60 minutes

a day to avoid weight gain. Yet, while there may be consensus that

all Americans should be more physically active and make better

eating decisions, there are numerous and conflicting views on how

to reach those goals.

People are confused. Should they follow the same food pyramid

we all learned in school a long time ago? Is the answer a low carb

or no carb diet? How much daily exercise is enough to make a difference? Today’s hearing will focus on how the Government should

and perhaps should not respond to the obesity epidemic. It is especially timely because several executive branch agencies and departments are reassessing their roles in the fight against obesity. For

example, the Department of Health and Human Services and the

Department of Agriculture are working together on revisions to the

Federal Dietary Guidelines and its well known visual aid, the Food

Pyramid.

The Food and Drug Administration’s Obesity Working Group released a report entitled, ‘‘Calories Count,’’ to reexamine FDA’s responsibilities for reducing obesity. Also, HHS is overseeing the

President’s ‘‘Healthier U.S.’’ Initiative to emphasize the importance

of physical activity, a nutritious diet and making smart health

choices.

All of these programs are thoughtful and well intentioned steps

in the fight against obesity but as officials at all levels of Government contemplate what message to convey to an increasingly overweight U.S. population and how to convey it, the questions we

want to ask today are many and complex. What should Government’s role be in fighting obesity? If we agree the Government

should have a role in advocating healthy living, what should that

role look like? To what degree should we act and at what cost to

our pocketbooks and quality of life? Some favor significantly enhancing Federal regulation to food, diet and consumer choice. Proposals ranging from the ‘‘Twinkie tax’’ to federally mandated labelVerDate 11-MAY-2000 12:21 Oct 20, 2004 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 D:\DOCS\95914.TXT HGOVREF1 PsN: HGOVREF1
3

ing of restaurant menus begs a larger debate on the appropriate

role of Government in our lives.

The question becomes, how do we reconcile the need for Government to participate in the campaign against obesity without implying that Americans should be able to make decisions about what

to eat and drink on their own? To help answer these questions, we

have two panels of distinguished witnesses from the fields of Government, academia, science and law.

I look forward to our discussion today and I again want to welcome our witnesses and their important testimony.

[The prepared statement of Chairman Tom Davis follows:]

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5

6

Chairman TOM DAVIS. I would ask unanimous consent that the

written statement of Marshall Manson, vice president of public affairs, Center for Individual Freedom, be submitted for the record.

Without objection, so ordered.

I would now yield to Mr. Waxman for an opening statement.

Mr. WAXMAN. Thank you, Mr. Chairman, for holding this hearing

on obesity today.

Obesity rates in the United States and abroad are rising at an

alarming rate and a key question is what can the Government do

to fight this epidemic? I believe the Government’s role is to create

opportunities for individuals and communities to address obesity.

Americans need to access meaningful nutritional information about

foods and effective messages about how to maintain healthy

weight. Communities need safe places to exercise, inviting places

to walk and recreational opportunities so that the young and old

can be active.

Ultimately, of course, the decisions are going to be up to the individuals and communities, but let us get as much correct information to people as possible. That is why I was pleased to have been

the author of the ‘‘Nutrition Labeling and Education Act,’’ which

provides the ingredient labeling information on every food product

available for sale that tells people about calories, carbohydrates,

cholesterol and other ingredients.

Many public policies on obesity make a difference. For example,

HHS established the Steps Cooperative Agreement Program to

fund community-based programs that have been effective in controlling chronic illnesses associated with obesity. There are other

cases, however, where Government, especially under the Bush administration, where the priorities seem to be promoting the interests of the food industry over the protection of the public health.

I want to set out some examples of that.

On the food labeling bill that I authored, the ‘‘Nutrition Labeling

and Education Act,’’ the law provided that claims couldn’t be made

on food products about protecting people against disease unless

there was a clear scientific consensus. The FDA now has reinterpreted the law and decided that they are not going to force this

legal requirement about a significant scientific agreement before

the companies can make the health claims about foods. They are

going to let the companies go out and make these claims because

they now know they won’t be called to task by the FDA.

In one of the first decisions under this new policy, the FDA announced it would let companies claim that ‘‘Supportive but not conclusive research shows that eating 1.5 ounces per day of walnuts

as part of a low saturated fat and low cholesterol diet and not resulting in increased caloric intake, may reduce the risk of coronary

heart disease.’’ I don’t know what that means. There may be experts here today who can understand what this message means in

just one reading but for the rest of us, it is quite complex. Maybe

what they expect the bottom line to be is that people should think

eating walnuts may prevent heart disease. That conclusion doesn’t

have scientific agreement behind it and it may be wrong.

The FDA found all the studies submitted to support the claim to

be either irrelevant or of poor to moderate scientific quality and the

FDA’s independent reviewers agreed it is uncertain from the pubVerDate 11-MAY-2000 12:21 Oct 20, 2004 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 D:\DOCS\95914.TXT HGOVREF1 PsN: HGOVREF1
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licly available scientific evidence increasing consumption of walnuts will reduce coronary heart disease. So this claim for walnuts

may help sell more walnuts. The manufacturers and those in the

processing of walnuts can make some more money but I think it

is misleading and confusing for consumers and undermines the intent of Congress in terms of giving accurate information to consumers.

There has been a recent policy action on soft drinks that also exemplifies this administration’s approach. The Department of

Health and Human Services has repeatedly tried to block the

World Health Organization from concluding that there is evidence

linking sugar containing beverages with weight gain. This position

may please the soft drink manufacturers but it certainly contradicts the scientific opinion of the Surgeon General, the Centers

for Disease Control, the U.S. Department of Agriculture as well as

the findings of a number of scientific studies. In effect, we have the

administration putting the interest of the soft drink manufacturers

over the scientific consensus that there is this link.

On nutrition education, the Department of Agriculture decided

that public campaigns funded through food stamp programs may

not be used to convey negative written, visual or verbal expressions

about any specific foods, beverage or commodities. The Department

of Agriculture staff has even been given the right to review the content of each educational campaign to ensure there is no belittlement or derogation of food items. This is a Twinkie protection provision that does not appear to have any scientific justification. The

Department of Agriculture appears to be prohibiting States from

saying anything bad about junk foods, this despite a recent study

showing that junk foods constitute almost one-third of Americans

diets.

What we see, I think, is a troubling patter emerging. When the

manufacturer wants to make misleading health claims, the administration says yes. When public health agencies want to educate the

public about well established health risks of certain foods, the administration says no, don’t tell the consumers. There is a lot at

stake for food companies. As one investment report concluded, any

restrictions on advertising more comprehensible labeling, warnings

that clearly highlight the risk of overindulgence in snacks, soft

drinks and fast food, can only be negative for the industries that

sell those food items.

However, the purpose of Government is not to protect the short

term profits of the food industry, it is to support the health of individuals and communities. Ultimately, healthy eating will provide

many opportunities for companies to provide and market foods, but

we shouldn’t try to keep the consumers from knowing the facts.

I hope as we move forward on the battle against obesity, that our

health agencies will remember that obesity and overweight are

public health issues with public health consequences. People need

to be guided by the best science and must advance the goal of improving health.

8

I thank the witnesses and look forward to hearing what they

have to say today as we try to think through what to do about

what some are describing as an epidemic, particularly among our

children.

[The prepared statement of Hon. Henry A. Waxman follows:]

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Chairman TOM DAVIS. Thank you very much.

Members will have 10 days to make opening statements. Does

anyone really wish to make a statement?

Ms. ROS-LEHTINEN. Mr. Chairman.

Chairman TOM DAVIS. You have an introduction and I know Mr.

Murphy has an introduction. You are recognized.

Ms. ROS-LEHTINEN. Thank you so much, Chairman Davis.

I would like to congratulate you for your outstanding leadership

for holding this timely hearing and my good friend from California,

Mr. Waxman, as well.

I would like to especially thank one panelist for being here today

because he is one of my congressional constituents. That is Dr. Arthur Agatston, right there in the front row. He is going to be bringing his expertise to this vital hearing.

Dr. Agatston will speak on the second panel as you pointed out,

Mr. Chairman. The Doctor, as all of us know, is the author of the

best selling book, ‘‘The South Beach Diet,’’ the best-selling liftestyle

book that has been on the New York Times Bestseller List now for

over a year.

Dr. Agatston brings with him a wealth of experience providing

the public with information about the connection between a good

diet, safe weight loss and disease prevention. He has authored

more than 100 scientific publications as well as reviewed for major

medical and cardiology journals. He is a cardiologist with Mt. Sinai

Hospital located in my congressional district in Miami Beach.

As you pointed out, Mr. Chairman, America’s obesity problem

has reached a critical level. Obesity rates have increased dramatically over the past two decades and the National Center for Health

Statistics estimated that 64 percent of American adults were considered overweight or obese in the years 1990 and 2000 when they

did the study. The physical and economic costs of obesity are astounding. Obesity, as you pointed out, Mr. Chairman, will surpass

smoking as the leading avoidable cause of death among Americans.

It has been linked to cause diseases such as cancer, heart disease,

diabetes, stroke and illnesses that account for over two-thirds of all

deaths in the United States. Since obesity is caused by multiple

large scale factors, no one solution will adequately help Americans

control their weight. Nevertheless, the Federal Government is currently reexamining many of our health and nutrition policies and

I commend your committee, Mr. Chairman, for examining these

critical Government initiatives. It is imperative to assess their impact on whether the Federal Government can or should do more

and I hope we will continue to work together to eradicate this disease.

Thank you again for inviting my congressional constituent, Dr.

Arthur Agatston, to be a witness here today. He is joined by his

wonderful powerhouse of a wife as well.

Thank you.

Chairman TOM DAVIS. Thank you very much.

Mr. Murphy.

Mr. MURPHY. Thank you, Mr. Chairman, for convening this hearing on this important aspect of public health and one that is really

a killer of our children and adults.

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I would like to take a minute to recognize one of the witnesses

testifying before us, Lynn Swann, chairman of the President’s

Council on Physical Fitness and Sports. Lynn, a Pittsburgher now,

although originally from Tennessee, I believe, and spent some time

at a place called USC where he became an All-American, we still

see as one of the best football players the game has ever seen.

With the Pittsburgh Steelers, No. 88 played in four Super Bowl

games in 6 years, was named MPV in Super Bowl X and is in the

Pro Football Hall of Fame. Their Web site says, ‘‘He is blessed with

gazelle-like speed, fluid movements and a tremendous leaping ability which caused him to become a regular wide receiver in his second year.’’

However, football is not Lynn’s only passion. Lynn also has a

heart for helping people reach personal milestones physically, mentally and emotionally. In addition to promoting healthy living

through the President’s Council on Physical Fitness and Sports,

Lynn has also been the National Spokesman and is on the Board

of Directors for the mentoring program, Big Brothers/Big Sisters of

America. Lynn brings a lot of experience to the table. I am glad he

is able to be with us today to discuss the concerns of obesity and

its impact on health in America and it is because of this broad

range of concern, we recognize him as an All-American in every

way.

Thank you, Mr. Chairman.

Chairman TOM DAVIS. Thank you.

Mr. Towns.

Mr. TOWNS. Thank you very much, Mr. Chairman.

Let me also thank you first for having the hearing and I also

thank the witnesses for coming.

We are here at a very crucial point in the stability of our country’s health and well-being. It is time to take a very hard look at

what we plan to do to reverse this terrible trend. Our Nation’s lack

of nutritional conscience is staggering. If we don’t act now, our children and grandchildren are going to continue to eat poorly, exercise

less and suffer adverse health consequences, resulting in premature death and reduced quality of life.

Americans are suffering from a multitude of preventible illnesses

that are a direct result of bad eating habits and a sedentary lifestyle which can lead to diabetes, heart disease, asthma, stroke, gall

bladder disease, osteoarthritis, pregnancy complications, increased

surgical risk, depression and certain types of cancer associated

with obesity.

Over 8 million children and teenagers in the United States are

overweight. Obesity is not just a vanity issue for adults and it is

time to confront that reality. Children have the immediate risk of

Type 2 Diabetes, hypertension, orthopedic problems and psycho-social implications such as discrimination, alienation and bullying.

Moreover, obese children and adolescents are more likely to become

obese adults.

I direct your attention to a graph on the easel. Mr. Chairman,

ladies and gentlemen, this I is why we are here today. This is embarrassing. This chart shows precisely what we are talking about.

We owe our children more than this. It is bad enough that we as

adults are eating this way but our kids don’t deserve this. Take a

13

long look at the numbers. Over 20 percent of babies aged 19 to 24

months have never consumed any food except for soft drinks, bacon

and french fries. That is almost unbelievable but ladies and gentlemen, it is true.

We need to address the economic circumstances affecting food

choice. Disadvantaged, inner city families are surrounded by fast

food restaurants and stores carrying snack foods with little nutritional value. Young Americans need to be able to exercise and play

in safe parks and neighborhoods. They need to have access to regular physical education and schools that not only teach them the R’s,

but teach them nutrition and healthy choices. Employees must implement work site healthy promotion programs that allow employees a small amount of time each day to participate in physical activity.

Healthy food needs to be readily accessible to every citizen. We

cannot afford to wait, Mr. Chairman, for our quality of life and for

our children, we must act now. Failure to do so will result in a Nation too overweight and too sick to sustain.

Thank you again for having this hearing. I think the timing is

right.

With that, I yield back.

Chairman TOM DAVIS. Thank you.

Mr. Schrock.

Mr. SCHROCK. Thank you, Mr. Chairman.

I wasn’t going to make any comments but I think I will make a

brief opening statement and then I have a couple comments on

things I have heard here already.

The current health debates are clearly focusing on health coverage benefits, malpractice and payment levels but one of the most

important health issues cannot be overlooked and that is the actual

health of the American people. Obesity in the U.S. population has

been increasing steadily over the past two decades and unfortunately, plays a major role in disability at all ages. I am delighted

the gazelle and others are here today to discuss this with us.

Until a few minutes ago, I thought I heard everything during the

business meeting, we were having and some of the things I heard

President Bush being blamed for I leaned to Mr. Putnam and said

jokingly, before long, Mr. Bush will be blamed for the Civil War.

Well, I am not far off because a few minutes ago, now he is being

blamed for obesity. How ridiculous does this get? What about personal responsibility? What about families taking control of the eating habits of their families and making sure children stay at home

at night and eat and that dad doesn’t stop by a fast food restaurant

on the way home and pick up junk for them to eat?

That doesn’t mean all fast food is junk because some of these

people are getting their act together and there are healthier things

in the fast food restaurants, but it boils down to personal responsibility. I go into middle schools and high schools and there are

‘‘gedunk machines’’, that is what we used to call them in the Navy,

that is where they can sell Cokes or candy bars or chips. That is

nonsense if we really care about the health of our kids, why are

we allowing that to happen.

Frankly, family oversight I think has to factor into this very well.

My family, my son, my wife and I live in Virginia Beach so we each

14

have a South Beach book that we have been using and it does work

and that is what it is going to take.

Chairman TOM DAVIS. South Beach means South Virginia Beach

where we are from.

Mr. SCHROCK. That is right. That is what I thought it meant

when I bought it.

Let me tell you something that really baffles me around here.

There are a lot of young people that work on a lot of staffs around

here. I think the thing that upsets me more than anything else is

I see some overweight young staffers in their twenties carrying

globs of food from the restaurants around here and they get on an

elevator to go down one floor so they can go to their offices and eat

it. That is nonsense. We ought to lock the elevators and make these

folks walk up and down the steps, walk and do what they are supposed to do. I know there are some members who have cars take

them from their offices to vote. Let them walk. It is all about personal responsibility.

It is good we are having this hearing but when Government gets

involved, it is going to get screwed up. Frankly, I think Government ought to keep their hands out of this and make it the responsibility of the people who are eating the food and their children.

This chart that was just handed to us, this is outrageous when you

think about kids at this age eating bacon, hot dogs and sausage.

No wonder we have this problem. Frankly, it is about personal responsibility and I am very anxious to hear what the witnesses say

today and maybe what they say here today can help the American

people get their act together with their diet and not Government.

Thank you.

Chairman TOM DAVIS. Thank you.

We have a great panel here. We have: Dr. Lester M. Crawford,

Acting Commissioner, Food and Drug Administration; Mr. Lynn

Swann, already introduced by Mr. Murphy, the chairman of the

President’s Council on Physical Fitness and Sports; Dr. Eric

Hentges, Executive Director, U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. They will provide the committee with an overview of the Federal Government’s initiatives to

combat obesity and promote health living. Additionally, these witnesses will offer an update on the process to revise and modernize

the Federal Dietary Guidelines and the Food Pyramid.

[Witnesses sworn.]

Chairman TOM DAVIS. Dr. Crawford, I will start with you and

move straight down.

When the light in front of you turns orange, it means 4 minutes

are up and you have 1 minute and the red is 5 minutes and move

to summary after that but we won’t hold you strictly accountable.

Thank you.

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STATEMENTS OF DR. LESTER M. CRAWFORD, ACTING COMMISSIONER, FOOD AND DRUG ADMINISTRATION; LYNN SWANN,

CHAIRMAN, PRESIDENT’S COUNCIL ON PHYSICAL FITNESS

AND SPORTS; AND ERIC HENTGES, EXECUTIVE DIRECTOR,

U.S. DEPARTMENT OF AGRICULTURE, CENTER FOR NUTRITION POLICY AND PROMOTION

Dr. CRAWFORD. Thank you very much for having us here. I am

delighted to be with Dr. Hentges and also Mr. Swann.

As you know, obesity and weight management has for sometime

been one of the top public health stories in the media. This hearing

is extremely timely in providing a forum to raise awareness not

only of the problem but also of the many initiatives of the Federal

Government to address this epidemic. Today I will cover the Department of Health and Human Services’ initiatives and programs

designed to assist Americans with maintaining a healthy weight.

Obesity has risen at an epidemic rate during the past 20 years.

Nearly two-thirds of adults in the United States are overweight

and 31 percent are obese according to the Centers for Disease Control and Prevention. The prevalence of overweight and obesity varies by gender, age, socioeconomic status, race and ethnicity. Overweight and obesity are associated with increased morbidity and

mortality. Approximately 400,000 adult deaths in the United

States each year are attributable to unhealthy dietary habits, coupled with physical inactivity.

The Government’s role in combating the obesity epidemic I think

is as follows: 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. However, individuals must have the right information to make healthy lifestyle choices.

In June 2002, President Bush launched the healthier U.S. initiatives designed to help Americans, especially children, live longer,

better and healthier lives. HHS Secretary Tommy Thompson built

on President Bush’s Healthier U.S. Initiative to create the Steps to

a Healthier U.S. Program which provides the overall framework for

HHS initiatives addressing obesity and overweight. These initiatives target a variety of populations and 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 Webbased tools.

Two major initiatives I would like to highlight today are the

FDA’s Obesity Working Group and NIH’s development of an Obesity Research Strategic Plan. In August 2003, we at the FDA established an Obesity Working Group to determine how the agency

could address this problem. In March 2004, the FDA released its

comprehensive report to combat obesity with a focus on the message, ‘‘Calories Count.’’ The agency’s proposals are based on the scientific fact that weight control is mainly a function of the balance

between calories consumed and calories expended. For example, the

report recommends FDA reexamine the food label to determine how

the label can better assist consumers in making weight management decisions.

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The following items are highlighted. We will consider changes to

the Nutrition Facts panel that will further emphasize the focus on

calories. We will encourage food manufacturers to revise certain labels as single servings, a voluntary action they can already take to

help consumers make more informed choices about their diet. As

an example, earlier this week, Kraft Foods reported on a range of

initiatives with regard to packaging and labeling helping consumers make informed choices by adding the amount of calories for

total packages. We encourage other companies to move in the same

direction.

Third is to encourage the use of comparative labeling statements

to make it easier for consumers to compare different types of foods

and make healthier substitutions and then finally to evaluate the

nutrient content claims for the carbohydrate content of foods.

FDA has filed three petitions from manufacturers in March of

this year and plans to enter into rulemaking to define terms such

as ‘‘low’’ and ‘‘reduced’’ so that consumers are armed with better

and more accurate information. FDA will conduct consumer studies

this summer and we will publish a document by the end of the

year.

Other major recommendations from this working group include

initiating a Calories County Education Program and encouraging

restaurants to provide nutrition information to consumers. I would

like to express appreciation for the work of the National Restaurant Association and those restaurants that have acted to provide this information at this point.

Strengthening enforcement activities to ensure the accuracy of

the information in the nutrition facts panel is another item. Revising FDA’s 1996 draft guidance for the clinical evaluation of weight

control drugs and increasing collaboration on obesity research are

other items.

With regard to research, the second major initiative, I would like

to mention the NIH Obesity Research Task Force. 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 institutes

and in March of this year, the agency released the draft of its strategic plan. That plan does the following things.

Research will be stimulated toward preventing and treating obesity through lifestyle modification, preventing and treating obesity

through pharmacologic, surgical and other medical approaches,

breaking the link between obesity and its associated health conditions, and cross-cutting topics such as decreasing health disparities

and encouraging technology, fostering inter-disciplinary research

teams, investigative training, translational research and education

outreach.

The last area I would like to mention is HHS’ efforts to work

with the international community are continuing. The World

Health Organization’s global strategy on diet, physical activity and

health holds much promise in the fight against the global epidemic

of overweight and we support that.

Mr. Chairman, these are my remarks. I appreciate the time very

much.

[The prepared statement of Mr. Crawford follows:]

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Chairman TOM DAVIS. Thank you very much.

Mr. Swann, thank you for being with us.

Mr. SWANN. Thank you very much for having me here.

I would be remiss if I didn’t first pay my respects to Ms.

Blackburn from Tennessee. As I was born in Alcoa, TN, the first

organized sports team I played on was a Little League baseball

team in Alcoa.

Also, Mr. Waxman, having grown up in California, the first football team I ever played on was a team called the Peninsula Jets

and the next year, the San Bruno Rams as I was growing up there

and graduating from and playing football for the University of

Southern California before as Mr. Murphy said I went to Pennsylvania and there played for the Steelers for 9 years and having

some success.

Mr. WAXMAN. Have you lived anywhere a member of this committee did not reside?

Mr. SWANN. I should apologize to all members of the committee

that I defeated their teams. It was a paid job and as a professional,

I had to do my duty. [Laughter.]

I would like to say that throughout my life there have always

been opportunities for physical activity, to be a member of a team,

to participate, to be out, to walk eight blocks to a park and play

until the lights went out, to walk to school, to ride my bike to

school. As we canvas our Nation today, we see there are fewer and

fewer opportunities for children to participate. Yes, the better athletes have a chance to be on the varsity football team and basketball team and baseball team but my oldest brother, who is a dentist, 5’ 6’’ and about 135 pounds, kids do not have the opportunity

to do as he did when he was in high school which was play on the

B or C basketball team for those who weren’t the biggest, the tallest and the most talented but still provide an opportunity for them

to participate and play and learn from sports and gain the benefits.

We have seen and heard all the information of obesity rising in

our Nation. We also have probably looked at the numbers and

where they will head in the next 10 years. The numbers are just

ugly. They are preventible. The key word when we look at obesity

and obesity-related illnesses and diseases is preventible and they

are preventible through activity, through more physical activity.

We have to now make physical activity a priority. It is not an elective in our lives. If we are going to establish the well being of a

nation, we have to establish physical activity as a priority, as well

as our intellectual and spiritual well being, we have to make sure

there is a higher level of physical activity so that we can grow,

focus, concentrate and have the endurance to do the jobs we need

to do.

Obesity has come not because people are lazy but because for

many reasons, our own innovation and advances in technology and

growth, the Internet, robotics, we don’t need that large labor force.

Parents are concerned about their children’s safety, so they walk

them to school or they drive them to school more likely, the kids

don’t ride their bicycles. There are ways around this. There are

community organizations that have grants that will put their kids

together and create safe walking paths for them to get to school or

riding paths for them to ride their bicycles to school. That labor

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force we no longer need is going to have to step up in terms of their

own individual choices and how they lead a physical, active life.

The food, the balance is very important. It is all about balance.

It is not just about physical activity, it is about the caloric intake.

I did an interview with a nutritionist at Virginia Tech. She is the

nutritionist for the football team at Virginia Tech, so I asked her,

how many calories a day do the offensive and defensive linemen eat

during a football year to be physically capable of getting the job

done? The bigger guys on the team are eating 6,000 calories a day.

That is a huge amount of food but look at the activity level of these

young men. One hour a day of weight lifting, a 3-hour football practice, walking back and forth across campus to get to classes. It is

unbelievable. There is a balance there.

If you are only exercising up to a point or getting the kind of activity where you are burning up 2,000 calories a day, anything over

that means you are going to increase your weight. It is an individual responsibility to understand this and if Secretary Paige doesn’t

mind if I stick my toe a little bit in his water, if we want our children to understand the proper way to eat, the proper way to exercise, then we have to have better education on the physical fitness

side and that does mean physical education. If we are not going to

have it in the schools, then it is absolutely the priority of our parents, of adults to set the better example. Yes, our children learn

in school but our children learn by example first. If the adults

aren’t taking their kids out for physical activity, then who is. If we

don’t set a better example, then we are all going to lose in the end.

I carry with me a medallion that was given to me by the Surgeon

General of the Air Force. The back of it says, ‘‘Execution is the

chariot of genius.’’ It was written by William Blake. We understand

what we have to do. Now it is time to execute a plan. The plan simply is to get active. You don’t need the best or the most perfect

plan, you just need to get going. I would ask that all of you whenever you go home to your States and your districts, whenever you

are making a speech, as a bipartisan issue, if you would recommend to your constituency, to your followers, to get out and

start exercising, every speech you make will go a long way toward

getting America a little healthier, a little stronger and much more

active.

Thank you.

[The prepared statement of Mr. Swann follows:]

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Chairman TOM DAVIS. Thank you very much.

Dr. Hentges.

Mr. HENTGES. Thank you, Mr. Chairman.

I am pleased to be here this morning to speak about the efforts

of the Department of Agriculture to combat overweight and obesity.

Helping Americans live longer, better and healthier lives is a top

priority of the President’s Healthier U.S. Initiative. In support of

the President’s initiative, we at USDA are in the midst of updating

the Dietary Guidelines for Americans and the Food Guide Pyramid,

our current food guided system.

The National Nutrition Monitoring and Related Research Act of

1990 requires the Secretaries of Agriculture and Health and

Human Services to jointly publish the Dietary Guidelines for Americans at least every 5 years. The guidelines form Federal nutrition

policy, they set standards for nutrition assistance programs, they

guide nutrition education programs and provide dietary advice for

consumers.

Through the Dietary Guidelines, the Federal Government speaks

with one voice on nutrition issues. The Dietary Guidelines Advisory

Committee, comprised of 13 nationally recognized experts, were appointed last year to review the latest scientific and medical research. We expect to receive the committee’s report later this summer. From this report, USDA and the Department of Health and

Human Services will publish the 6th edition of the Dietary Guidelines for Americans. The newly revised guidelines will be released

in early 2005.

On a separate but parallel track, we are in the middle of updating the Food Guide Pyramid. The Food Guide Pyramid was created

as a teaching tool to assist the public in interpreting the Dietary

Guidelines in eating a healthful diet. We placed a notice in the

Federal Register last year asking the public for comment on the

technical underpinnings of the Food Guide Pyramid. Use of the

Federal Register system opened up the process to the public for the

first time. USDA received widespread support for its scientific base

of these revisions, the comments supported using calorie levels for

sedentary individuals as the basis for assessing nutrition adequacy.

Using RDAs and other standards from the National Academy of

Sciences Dietary Reference Intake reports as the nutritional goals,

using common household measures such as cups and ounces rather

than servings and emphasizing increased intake in unsaturated

fats and oils, whole grains, legumes and dark green vegetables. A

second Federal Register notice will be published this summer to obtain public comment on the graphic image and the education messages for the new food guidance system.

The last and most critical stage of the revision process is implementation. That is, the plan to inform and educate Americans. Research tells us that people recognize the pyramid image but don’t

follow it. That is why we are so committed to full implementation

and exploring new and effective ways to reach the public. USDA’s

Food and Nutrition Services also plays a critical role in promoting

healthy diets and lifestyles for the Federal Nutrition Assistant Program participants. These programs touch the lives of 1 in 5 people

in the United States each year. They represent a prime opportunity

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to help low income people change their eating and physical activity

practices to achieve a healthy weight.

Mr. Chairman, I would ask the committee to refer to my prepared remarks for a list of examples of how the Food and Nutrition

Consumer Service mission area is supporting the President’s

Healthier U.S. Initiative by promoting healthier eating and physical activity throughout our nutrition assistance programs.

In conclusion, we appreciate the committee’s interest in nutrition

and its critical role in overall healthy lifestyles. Government has an

essential role in helping Americans adopt a healthy lifestyle. That

includes eating a nutritious diet, being physically active and

achieving and maintaining a healthy weight. We know the Government alone cannot reverse the growing trend in obesity. Meeting

this challenge requires partnerships. These partners include policymakers at Federal, State and local levels, industry, health and advocacy organizations, schools, the media and of course, the American public. USDA is fully committed to doing all it can to address

this issue.

I want to thank the committee for the opportunity to share our

efforts with you.

[The prepared statement of Dr. Hentges follows:]

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Chairman TOM DAVIS. Thank you very much.

I could ask you 2 hours of questions. I have 5 minutes and I

want to do a few. First of all, we are updating the Food Guide Pyramid. Is there any evidence that what we have been told the last

40 years may not have been exactly the right pyramid for a generation of kids who have turned out to be obese?

Mr. HENTGES. Mr. Chairman, I believe the science behind the

Food Guide Pyramid is based upon authoritative consensus science

such as the National Academy of Science reports on the recommended dietary allowances.

Chairman TOM DAVIS. Do the consensuses change over time?

Mr. HENTGES. It is evolutionary. If we look at the last 60 years,

there is new data and one of the reasons for our current revision

is because the National Academy of Science has just gone through

a major revision of the dietary reference intakes, so we need to

come up to stay in touch with where the science is bringing us.

Chairman TOM DAVIS. This has to be lobbied heavily behind the

scenes. You talk about interest groups up here on Capital Hill, you

talk about the sugar lobby, the milk producers, these are well funded groups. How you put together that food pyramid can be devastating to their bottom line. Are you listening to those groups? Are

they having any influence in this or are you just going strictly on

scientific consensus?

Mr. HENTGES. It is scientific, but Under Secretary Boss has definitely set an open door policy for anybody coming in, whether it is

American Dietetic Association or a commodity group or the Institute of Food Technologists, all of them, but indeed, if you look at

the basis for the Dietary Guidelines Advisory Committee and that

Federal policy, everything that comes out in the revision of a Food

Guide Pyramid will be in total harmony with the nutrition policy.

Chairman TOM DAVIS. Mr. Swann you stayed in shape after your

playing days, you look in pretty good shape. The exercise is obviously a critical component, but you can’t exercise your way out of

obesity if you continue to gorge. What is your analysis of that and

how do you stay in shape and what do you counsel others to do?

Mr. SWANN. What I do is I monitor how I eat, when I eat and

I also try and get exercise on a regular basis. That is really an important factor. You have meetings scheduled here, we all schedule

the things that are important to us and we say we don’t have time

for exercise. That is because we don’t schedule it. If you are not exercising, you are not considering it important enough to do it. It is

not an elective. For me it is not an elective not because I want to

be a professional athlete, that is not what it is about. I exercise

more now than I ever did before because I want to have a good

quality of life. If I reach the age of 80 or 90 years of age, I want

those years to be good years. I don’t want them to be feeble, I don’t

want to be frail and fall down and have it be the cause of my death

because I am not physically capable. That is what I do.

We have a Web site, the presidentschallenge.org. It is set up and

designed to give people tools to be physically active, to motivate

and incentivize them to have some kind of workout program. It is

a non-competitive program because we have to be mindful of the

kids who are not athletic and who don’t have the ability to run,

jump and do all those things. There over 100 different forms of

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physical activity on this list where you can get points toward Presidential awards. So we encourage people to go there. It is at that

site, fitness.gov, you can get a tremendous amount of information

and then you can act on it but it has to be in harmony. There has

to be a level of activity and a level of nutrition that goes along with

it. Keep in mind, I have friends and we all have friends who probably eat extremely well or might be vegans or vegetarians. If you

eat 10 times the amount of food you should eat and it is all good

for you, then you have consumed a bad quantity of food and it is

going to have adverse effects, so you have to be mindful of the

quantity and quality and making good individual decisions.

Chairman TOM DAVIS. I think there is universal agreement in

the testimony of the three of you that childhood is really the best

chance to slow the obesity epidemic through food but also through

exercise. Lynn, what are you seeing in the school systems? Are

they promoting physical fitness or do you see mixed results around

the country? Any thoughts on that?

Mr. SWANN. We see very mixed results around the country. Before taking this job, I had an opportunity to talk to Governor

Schwarzeneggar of California about his role. He spent part of his

term when he was chairman of the President’s Council on Physical

Fitness and Sports trying to reach out to every Governor in America to put physical education in the schools. When he started, there

was one State, IL, that mandated physical education as a part of

their educational program. Today there is only one State in the Nation that mandates physical education as a part of the basic curricula, the State of Illinois. It is not California, not Pennsylvania, not

Florida, not Texas, just Illinois.

So when you go around schools you see a variety of programs,

some are very, very good, some are not being taught by physical

education teachers because there isn’t a physical education teacher

on staff but there are programs you can implement. So we have a

variety of programs around the Nation but nothing consistent for

a nation.

Chairman TOM DAVIS. Thank you very much.

Mr. Waxman.

Mr. WAXMAN. I want to thank the three witnesses here today to

help us understand what approaches we can take to be effective in

dealing with obesity. I appreciate your testimony.

Dr. Hentges, let me start with you. Nutritional education

through the Food Stamp Program is an important way to reach a

lot of people. There have been new guidelines by USDA saying that

funds ‘‘may not be used to convey negative, written, visual or

verbal expression about any specific foods, beverages or commodities.’’ It also provides under these guidance that the USDA staff

has the right to review educational campaigns to make sure there

is no belittlement or derogation of such items. Can you explain

whether there is any scientific evidence justifying this provision?

Mr. HENTGES. I am not real familiar with the issue but I know

specifically that one. I know that in the revisions in the current activities, on the Food Stamp Nutrition Education Program, they are

trying to focus more sharply on these current issues. I know within

the review of education materials that are used throughout the

Government for communication, there is a cross agency committee

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that looks for this speaking with one voice and making sure we are

unified in sticking with nutrition policy.

Mr. WAXMAN. Let me ask you, would you be willing to share with

this committee a full explanation of how this provision was developed including all correspondence with the food industry, all examples of State educational programs that were rejected by USDA

staff?

Mr. HENTGES. I would be very glad to provide written comments

on what has occurred on this issue.

Mr. WAXMAN. We want your written comments and also documents and letters as it was developed. I think that would be helpful for us to understand it further.

There is another issue as well I want to ask you about. There

is a framework for nutrition education that was published in May

2004 requiring educational efforts be narrowly targeted at food

stamp recipients. It appears to prohibit States from using the funds

as part of a broad social marketing campaign designed to change

the eating patterns of the entire community. I would like to find

out what evidence justifies this approach and perhaps you can also

submit to us all the information on how that was developed?

Mr. HENTGES. I am vaguely familiar with this and I know from

a regulatory standpoint, there are restrictions on using these funds

with participants, but where there is an overlap of public service

or community announcement aimed at the food assistance participants, there is a broader range of reach to the communit—and I

will provide you the specifics on that.

Mr. WAXMAN. I am concerned about what evidence would justify

this kind of restriction because it would seem that if obesity is a

public health program, we wouldn’t want to say you can only talk

about the obesity issues to the food stamp recipients if a State

wanted to go broader than that and talk about all kids, not just

kids on food stamps. You would agree with that?

Mr. HENTGES. Yes, and I would say our programs at the Center

for Nutrition Policy and Promotion are aimed at the general public

and we work with the Food and Nutrition Service for their specific

programs and what they are allowed to do with the recipients of

food assistance.

Mr. WAXMAN. I find the restrictions about belittling food troubling because, for example, you might say to eat an apple a day is

a good healthy thing to do but you would be prohibited from saying, don’t eat more junk food, isn’t that correct, because that might

be belittling junk food?

Mr. HENTGES. I will have to get back to you on exactly what

those regulations are.

Mr. WAXMAN. Dr. Crawford, I mentioned in my opening comments the false and misleading information that I think may be

made available to the consumers inappropriately under the LEA.

I would like to know how the FDA could say they are not going to

enforce the law on information that doesn’t have a scientific consensus behind it and how the FDA would allow scientists, even

when there is an extremely low level of comfort about the claim,

to be permitted to go ahead and make these claims. Are you familiar with this provision by the FDA and can the FDA justify taking

this action even though it is inconsistent with the law?

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Dr. CRAWFORD. Yes, I am familiar. The concept is this. We had

some adverse court rulings with some positions we had taken on

health claims, so we developed the idea of growing out of that with

some internal consideration of allowing qualified health claims. Basically, this means although scientific consensus might not be 100

percent, it is enough to where we are able to say if the company

or if the organization applying for the health claim would be willing to qualify honestly and directly in terms of how strong the evidence is, we would consider what is called a qualified health claim.

On the walnut issue you mentioned, that grows out of the fact

that walnuts were determined to have Omega 3 fatty acids and

also it was determined that the Omega 3 fatty acids in walnuts

were bioavailable. So it followed that they could get a qualified

health claim if they intended to. There was also some talk earlier,

I am not sure if it was you or someone else talking about what does

this will do for competition? Actually, when a qualified health

claim is granted, any company that produces, sells, or markets walnuts in this case may use it.

Mr. WAXMAN. It allows more than one manufacturer to make

claims that are qualified, but in reality, could be scientifically inaccurate, maybe even misleading, and when the law says proscriptively you ought to have scientific consensus before you could go

out and make these kinds of claims, it seems to me the FDA is rewriting the law. I think one of the dangers is it could start to be

a Tower of Babel of misleading information and the public is going

to doubt the credibility of any of these labels, especially if it is an

FDA label because they will know that it is not based on good

science. Qualified answers may not be based on good science and

may not represent what Congress spoke to, which is there really

is a scientific consensus before these kinds of claims can be made.

It is obviously the advantage of the manufacturer to make claims

that are misleading. We don’t want that to happen. We didn’t want

that to happen when we passed the law. I am afraid the FDA policy undermines that provision.

Dr. CRAWFORD. If I could followup? We don’t think it undermines

the policy. What we find is that there rarely is 100 percent scientific consensus, so the question is whether you allow any exposition of what the health advantages of a food might be in a way

that is qualified so that it is honest and is not misleading. That is

what we are attempting to do.

Chairman TOM DAVIS. Thank you very much.

Mr. Shays.

Mr. SHAYS. Thank you for conducting this hearing and I would

like to put on the record that Mr. Ose would tempt us to take some

of the snacks he has stacked up at his desk and I had a Heath bar

crunch and one Oreo cookie but turned down a lot of other things.

I would like to ask each of you whether you think there is logic

to companies being sued because they offer a menu that people

don’t eat in moderation, blaming the companies instead of their

own children or their own oversight of their own children and so

on? I would like you to speak to that issue.

Dr. CRAWFORD. I do not think that is logic and I think what we

have to do is inculcate individual responsibility, I think the Government has a role and I believe all three agencies represented

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here have a big part of that role to try to get things back on course.

I also think supporting mandatory physical education programs as

Mr. Swann has mentioned is also important but I do not see the

logic of that. If someone wants to sue a fast food company or something like that because of their abrogation of individual responsibility, I don’t think that follows.

Mr. SWANN. I would simply state that I agree. We have to make

sure people are educated to make good individual choices and decisions. I think all of us who are sitting in this room have the foods

we would put in the junk food category that we like to eat and we

enjoy, but it is the decision not to eat the whole bag if you are

going to have a few potato chips, not to eat a dozen doughnuts if

you want to have one and have a proper amount of physical activity to balance it out, and it is individual responsibility. Certainly

we want to make sure the individual knows what he or she is consuming, so labeling becomes very important. I do not see the logic

in suing a company for what we individually decide to eat.

Mr. HENTGES. I would say the challenge before us is really more

effective implementation, whether it is through our food label,

through our dietary guidance, or through our guide system, whether it be a pyramid or whatever and to be able to do that, we need

to have partnerships, not only partnerships amongst the academic

and health organizations, but we need the industry to partner with

us to be able to get this information out so that we avoid some of

these other alternatives.

Mr. SHAYS. I thank all three witnesses. I also want to thank Mr.

Waxman who is not here because in years past he was very involved in labeling issues. I think they are absolutely essential to

provide all the information we can possibly have. I think the FDA

can continue to do a better job. I think you can continue, Doctor,

to find different ways to help educate people.

The bottom line for me is I am absolutely amazed that parents

would have their kids sue someone. They just need to look at themselves and their own responsibilities. I hope our country doesn’t go

down the route of blaming someone else for the responsibility of the

individual.

With that, Mr. Chairman, I thank you for this hearing. I think

it is very important. I appreciate all the witnesses and our second

panel as well.

Chairman TOM DAVIS. Thank you very much.

Mr. Towns.

Mr. TOWNS. Thank you very much, Mr. Chairman. Again, let me

thank you for holding this hearing. I think this is a very important

hearing.

Before I start, I would like to ask, Mr. Chairman, if I could put

the High Calorie, Low Nutrient Children’s Diet in the record?

Chairman TOM DAVIS. Without objection, it will be put in the

record at this point.

[The information referred to follows:]

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Mr. TOWNS. Thank you.

Dr. Crawford, does your department collaborate with the Department of Education?

Dr. CRAWFORD. Yes, sir, we do. With respect to obesity, we have

worked out an agreement with Secretary Paige so that we will

partner with them in terms of the education message because obviously he has more access to the target audiences in the education

message, particularly in the schools. So yes, when we had the Obesity Working Group, he designated a contact person and I designated one and the two of them have been working together. So

we do partner with them, yes.

Mr. TOWNS. Do you have an opportunity to ever look at the

school lunch program?

Dr. CRAWFORD. That is in the Department of Agriculture.

Mr. TOWNS. Yes, but have you ever had the opportunity to look

at them?

Dr. CRAWFORD. I have eaten some of them, yes, sir, but not in

a long time.

Mr. TOWNS. The reason I asked that is when you look at some

of the things they are serving young people today in some of the

schools, I think it is a shame. Nobody is saying anything. That is

the reason I raised this issue. I know it is not directly your jurisdiction but I think when it comes to guidelines and getting out information, it seems to me you would sort of convey to the Department, and we would also raise this issue with the Department of

Agriculture as well, but I think that is the basis. If you start in

the kindergarten and first grade serving these kinds of things to

kids and they think it is OK because after all, the school is doing

it.

Dr. CRAWFORD. I take your point. I think you are exactly right.

What we need to do is start early, as you said, but we also need

to give them a few more tools to work with. For example, if you

look on the nutrition label now, we hope the nutrition label will be

under our agreement with the Department of Education, a mechanism by which young children are trained to take this individual

responsibility at an early age. On the label now, it says what an

item’s calorie content is but it doesn’t relate that to the amount of

calories you are allowed to consume in 1 day on average and maintain your weight.

We are moving toward having on the label, if you drink a milkshake that is 1,000 calories, it now will say in bigger letters that

it is 1,000 calories but in the future it will also say you have just

now eaten 50 percent of what you can eat today and maintain your

weight and not increase weight. You could say it is a simple message but the science of it is elegant really and I think we can use

that as a means to educate students.

I remember in my own case when I was consuming those school

lunch programs, we had mandatory in the State where I grew up

what was called a health book in the third grade. In the third

grade we were taught the basic food groups, we would talk about

calorie dense foods, talk about junk foods and I think it did instill

individual responsibility but we didn’t have many tools in those

days, we didn’t have a nutrition label. It is up to us at FDA and

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the rest of the Government to make it work and also to make it

work for all of the people in America, including the children.

Mr. TOWNS. Thank you.

Would you like to answer that?

Mr. HENTGES. Regarding the school lunch program, by statute it

is required that the School Lunch Program comply with the dietary

guidelines and other criteria set by the Secretary. Those include

the school lunch program not be more than 30 percent of calories

from fat, no more than 10 percent of calories from saturated fat,

that they meet one-third of the RDAs for protein, calcium, iron, Vitamin A and Vitamin C.

I think part of the issue here is that as a local decision, schools

can decide to include competitive foods but when the child gets the

school lunch program meal, it does comply with the dietary guidelines established but there is the issue of competing foods which is

a local level decision.

Mr. TOWNS. Mr. Chairman, just give me a second. I want to ask

Mr. Swann one question.

First of all, thank you for the work that you are doing. How do

we deal with the situation where there are budget cuts and as soon

as you cut the budget, the first thing that goes out is the extracurricular activities such as intramural sports. That is the first

thing they eliminate. How do we get around that because that is

the real problem.

Mr. SWANN. It is a real problem. Mr. Schrock earlier had talked

about individual responsibility and not having too much government but the reality is on our Web site, the

presidentschallenge.org, the President’s Physical Fitness Program

is one that can be implemented in schools and does not require necessarily a physical education teacher. So there are programs that

teachers and school districts can implement. They may not be an

organized sports team that would be competitive in some nature

but they can organize those intramural sports teams on their own,

they can implement a physical education program within their

classroom whatever their curriculum might be. It could be as simple as saying instead of you sitting in this classroom for an hour,

we provide 10 minutes that you get up and stretch, walk around

and move your legs so that you are not sedentary for the entire

school day, any particular age.

I agree with you that when money is tight, the sports programs,

the physical education programs and even the art and music programs are the first to go because they are not mandated by a particular State’s educational program but there are other ways to get

that exercise and we have to seek those other ways because it

should not be an elective, it should be a priority in their lives.

Chairman TOM DAVIS. Thank you.

We have other Members who want to ask questions but we have

a vote and in addition, one of our witnesses on the next panel has

to catch a helicopter and I want to get his testimony before he has

to go.

I would like to call Dr. Stuart Trager from Atkins. Dr. Trager,

if you could give your testimony now?

Mr. OSE. Mr. Chairman, while Dr. Trager is preparing could I?

Chairman TOM DAVIS. Go ahead.

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Mr. OSE. In southern California, for 311⁄2 years, this issue has

existed and we have in front of us a witness today who can finally

put to rest the truth about what happened on December 23, 1972

when the Oakland Raiders were robbed in Pittsburgh. [Laughter.]

Chairman TOM DAVIS. Well, you have him under oath. This is

your shot.

Mr. OSE. I understand. That is exactly my point. Before I get an

answer to that, I also want to examine this. This witness went to

USC and there were a number of occasions in the early 1970’s

when his college team came to the University of California and attempted, attempted I say, to defeat the Cal Bears. I just want to

get on the record some answers to some questions if I could, Mr.

Chairman.

Chairman TOM DAVIS. Quickly.

Mr. OSE. Swanee.

Mr. SWANN. As quickly as possible.

Mr. OSE. Let me ask the question first.

Mr. SWANN. I thought you did. I was going to say we made no

attempt to beat the Cal Bears, we did beat them. [Laughter.]

Mr. OSE. I remind the witness he is under oath.

Chairman TOM DAVIS. Mr. Ose, I would quit while I am ahead

here.

Mr. SWANN. And in 1972 when Franco Harris made his now famous immaculate reception, the official said it was a completed

pass, it was good, it was a touchdown and I, myself being so much

younger, was just a junior at USC playing on the national championship team, so I can’t give you any eye witness testimony.

Mr. OSE. Mr. Chairman, let the record show that the witness had

no knowledge whatsoever of what occurred in Pittsburgh Stadium

that day. [Laughter.]

Chairman TOM DAVIS. Thank you.

Dr. Trager.

[Witness sworn.]

Chairman TOM DAVIS. Thank you for being with us. This is important testimony. Mr. Swann, I think you and Dr. Crawford or Dr.

Hentges are going later but he is going to give a keynote speech

so he has to catch a helicopter ride down there. We would have

moved him up to the panel had I known we would be delayed this

long with the markup but this is important testimony as well because Atkins has revolutionized the way a lot of us look at food and

food products.

Dr. Trager, thank you.

STATEMENT OF DR. STUART TRAGER, CHAIRMAN, ATKINS

PHYSICIANS COUNCIL

Dr. TRAGER. Mr. Chairman, thank you very much for accommodating my schedule.

Members of the committee, I thank you all for asking me to appear today and commend you for addressing the Government’s role

in combating the obesity epidemic and promoting healthy ways for

individuals to fight this critical public health issue.

By way of introduction, my name is Stuart Trager. I am medical

director of Atkins Nutritionals. I too am an avid Atkins adherent

following this approach for the last 4 years of my life. I practice orVerDate 11-MAY-2000 12:21 Oct 20, 2004 Jkt 000000 PO 00000 Frm 00075 Fmt 6633 Sfmt 6633 D:\DOCS\95914.TXT HGOVREF1 PsN: HGOVREF1
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thopedic surgery and I am an eight time Iron Man finisher. Sitting

next to the panel today, it is tough to get much out of that Iron

Man finisher, however, at the time it seemed pretty difficult.

Taken together, this rather unique combination of experiences

has given me great insight into the challenges presented to those

fighting to maintain healthy weight, to those living with medical

complications of obesity and to those frustrated by their own inability to achieve weight loss through exercise. Though the banner at

the finish of the Iron Man says ‘‘Anything is possible,’’ I am afraid

for many running 35 miles to burn the 3,500 calories necessary to

shed 1 pound of body weight is just too great an obstacle to overcome.

To create strategy for success, it is critical that we appreciate the

factors that have resulted in the current epidemic of obesity. Surely

schedules are more hectic than ever, portion sizes are expanding as

rapidly as our waistlines and highly processed, convenient foods

are omnipresent. These circumstances have created a real challenge to the Nation. To begin, we must be willing to move beyond

the one size fits all approach that has dominated the nutritional

dogma for the last three decades.

As we address the challenges of the Nation associated with this

current epidemic, it is worth recalling the words of Dr. Walter

Willett from the Harvard School of Public Health who stated,

‘‘Mainstream nutritional science has demonized dietary fat, yet 50

years and hundreds of millions of dollars of research have failed to

prove that eating a low fat diet will help you live longer.’’ Facing

hard truths is never easy. However, the current obesity crisis is

currently estimated at taking 400,000 lives each year. The dietary

guidelines are clearly not working and prospects for inclusion of alternatives in the rewrite are not entirely promising. There is a

clear need to challenge the status quo and to continue to fight the

nutritional establishment and conventional wisdom if we are going

to stem this epidemic.

When USDA’s survey showed that while 80 percent of Americans

recognize the Food Pyramid, very few heed its advice, it is clear

that we need alternatives. As we move forward, our strategy must

provide real life tools that work in the current environment. For an

increasing number of people, it is becoming clear that controlling

carbohydrates is one such option.

Because promising magic is no more beneficial than prescribing

strategies that are unobtainable, we must always remember that

solutions to this epidemic have to be supported by evidence based

science. Increasing public awareness about the importance of scientific validation of safety and efficacy is important and with Atkins, it is clear this has helped many recognize the benefits of the

strategy.

The consistent stream of supportive clinical research including

these two independently funded studies, one from the American

Heart Association and the other from the National Institute of

Health, have opened many eyes to the safety and efficacy of controlling carbohydrates as an alternative to traditional dietary recommendations.

The recent publication of two additional studies, one from Duke,

the other from the Philadelphia Veterans Hospital, have lent furVerDate 11-MAY-2000 12:21 Oct 20, 2004 Jkt 000000 PO 00000 Frm 00076 Fmt 6633 Sfmt 6633 D:\DOCS\95914.TXT HGOVREF1 PsN: HGOVREF1
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ther support. Simply put, for many, weight loss occurs more rapidly

when following Atkins, more calories can be consumed while on Atkins, compliance is enhanced on Atkins and risk factors as well as

diabetic control improved while on Atkins.

With recent editorials in the annals of Internal Medicine and the

American Journal of Cardiology, it is clear we are making much

progress in changing opinions. It is at times easy to forget that despite the critical importance of science in this debate and that we

must never rely on anecdotal reporting, that this is about helping

people. To that end, I thought it worthwhile reminding everyone

why we are really here. The individuals losing weight and improving risk factors in these studies on Atkins have names and faces.

Real people in the real world are losing weight and improving their

cardiac risk factors by following the Atkins approach, something

Dr. Atkins fought for 30 years to make the establishment pay attention to.

Counting carbohydrates is simply more palatable for many than

eating smaller portions of less satisfying foods. At Atkins

Nutritionals, we feel a tremendous sense of responsibility to assure

that this powerful tool is used correctly, that people obtain the best

possible results and that we truly impact the epidemic of obesity.

We have helped develop the Atkins Food Guide Pyramid to address

the myths and misconceptions put forth by the low fat advocates,

the animal rights activists and the copycats who would have you

believe that Atkins is just about red meat and bacon.

If you look at the Food Guide Pyramid we have distributed, you

see there are lots of fruits, vegetables and the right carbohydrates.

This was Dr. Atkins’ effort put forth in January of last year before

he died. We are actively reaching out to decisionmakers here in

Washington and we are committed to helping to spread our message of carbohydrate awareness to our education and youth initiatives. We are committed to ensure that the public knows the correct way to control carbohydrates, the time tested way that science

has repeatedly validated.

In conclusion, I would like to thank the committee for taking the

time to discuss this very important matter. To make a difference,

we believe Congress should invest in more science and provide additional information regarding this alternative to the low fat, low

calorie dogma of the last three decades and continue to scrutinize

guideline revisions and allow for more seats at this very important

table.

Thank you.

[The prepared statement of Dr. Trager follows:]

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Chairman TOM DAVIS. Dr. Trager, thank you.

We are here at the mercy of the congressional schedule and they

have votes scheduled right now, a series of three votes. One of

them is on anabolic steroids and stopping their use and proliferation, so it is relevant to what we are doing. We will come back in

a half hour.

I would like to dismiss this panel so that you all can get on with

your business. I just want to ask one last question. You heard Dr.

Trager talk about more investment in scientific research. I know

Dr. Atkins always said, it wasn’t hand to mouth but he didn’t have

the millions to invest. Is that a good idea? From an Agricultural

point of view and the FDA, are we putting in enough or could you

use more resources if Congress provided them?

Mr. HENTGES. I would definitely support the administration’s

budget request on research and it is an area that we can’t let fall

behind for sure.

Chairman TOM DAVIS. Thank you.

Dr. TRAGER. Mr. Chairman, there are tens of millions of people

who are choosing this controlled carbohydrate approach that are

following the Atkins’ strategy.

Chairman TOM DAVIS. You see it everywhere you go. The marketplace will overwhelm government if government doesn’t react.

Dr. TRAGER. What we are looking for is more research dollars so

that this can be studied so that we can have the long term studies.

Because we know that it works, we now need to add the science

to it to help these people to make sure the message is clear so they

get the information to do it correctly.

Chairman TOM DAVIS. Thank you.

Dr. CRAWFORD. I agree that we do need the kind of targeted research that this new road map that the National Institutes of

Health has put together because of the funding that Congress has

been able to provide them and we need targeted basic research to

know some of these things, like why does obesity do what it does?

We still don’t really know that.

Chairman TOM DAVIS. Thank you. I know Mr. Swann would say

more research is fine but don’t cut out the PE programs?

Mr. SWANN. Yes.

Chairman TOM DAVIS. This has been great. As I said, I wish we

could go on all day, I could go 2 hours just with my own questions.

I know Mr. Ose has his major question out of the way for this but

we will come back with the next panel. Thank you all very much.

We will recess for half an hour and come back with the next

panel.

[Recess.]

Chairman TOM DAVIS. We have everyone here. The committee

will come back to order.

If you would rise for the oath?

[Witnesses sworn.]

Chairman TOM DAVIS. Thank you very much for being here. We

will have Members drifting back from a series of votes. We will

have another series of votes probably in about an hour, maybe a

little before, so I want to move through the testimony quickly so

we can get to questions.

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I can’t tell you how excited we are about the panel we have here

today, the expertise and the opinions that you bring to this. What

I think I will do, we have Dr. Agatston who had already been introduced by Ms. Ros-Lehtinen; we have Dr. G. Harvey Anderson, professor, Department of Nutritional Sciences, University of Toronto;

Dr. Susan Finn, Chair, American Council for Fitness and Nutrition; and Bruce Silverglade, director, Legal Affairs, Center for

Science in the Public Interest. Doctor, why don’t we start with you

and we will move down the line. Thanks so much for being with

us.

I will just say I had a hot dog and tuna fish for lunch. I don’t

know if it is good or bad.

Dr. AGATSTON. No comment.

STATEMENTS OF DR. ARTHUR AGATSTON, CARDIOLOGIST

AND AUTHOR, THE SOUTH BEACH DIET; DR. G. HARVEY ANDERSON, PROFESSOR, DEPARTMENT OF NUTRITIONAL

SCIENCES, UNIVERSITY OF TORONTO; DR. SUSAN FINN,

CHAIR, AMERICAN COUNCIL FOR FITNESS AND NUTRITION;

AND BRUCE SILVERGLADE, DIRECTOR, LEGAL AFFAIRS,

CENTER FOR SCIENCE IN THE PUBLIC INTEREST

Dr. AGATSTON. Thank you, Chairman Davis. I would like to

thank Representative Ros-Lehtinen for her very kind words.

There is a major untold story currently unfolding in America.

Cardiologists and internists across the country who are practicing

aggressive prevention have largely stopped seeing heart attacks

and strokes in their practices. They just don’t get called to the

emergency room for these events like they used to. The factor that

is changing the cardiac prevention paradigm include non-invasive

imaging to detect and track early, pre-clinical arteriosclerosis, advanced blood testing to determine the cause of pre-clinical disease,

new medications that target causes of disease like laser beams and

finally, a growing consensus on the nutritional factors associated

with the epidemic of obesity.

I am a cardiologist, not a diet doctor. My journey to author a diet

book occurred somewhat accidentally. Until 10 years ago, my primary research interest was in non-invasive imaging of the coronary

arteries. Around that time, it became more and more apparent that

my patients, the country and frankly, me, were rapidly gaining

weight on the nationally recommended low fat, high carbohydrate

guidelines. In fact, there had become a disconnect between the

practical day to day experience of clinicians and the national guidelines. In America, low fat, high carb diets just didn’t work and this

was actually documented in the medical literature again and again.

The low fat, high carb recommendations were made primarily on

the basis of population studies that demonstrated that societies

that consume low fat diets had lower rates of heart attack and obesity than high fat societies. There were exceptions such as Mediterranean populations where high fat intake was associated with

low heart attack and obesity rates.

In the past 5 to 15 years, research has gone a long way to explain what went wrong with our low fat experiment. In particular,

three new perspectives have become widely accepted. First came

understanding of the importance of fiber and glycemic index in our

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diet. The glycemic index is a measure actually pioneered by my colleague, Dr. Anderson and his group at the University of Toronto.

It is a measure of how fast a food causes swings in blood sugar.

Rapid swings in blood sugar cause food cravings soon after a meal,

high fiber foods tend to be low on the glycemic index.

Second came the concept of prediabetes in 1989. We learned that

low fiber, high glycemic diets often resulted in obesity, pre-diabetes

and then diabetes by amplifying those swings in blood sugar.

Third, new research demonstrated that not all fats are equal. Mediterranean oils, particularly olive and Omega 3 oils, have favorable

effects on both cardiovascular and general health.

With this important new information, the causes of our epidemic

of obesity became apparent. No. 1, the type of carbohydrates consumed in the low fat countries was high in fiber and low in glycemic index. That adopted in the United States was low in fiber

and high in glycemic index. The consumption of unprecedented

amounts of high glycemic processed carbohydrates produced swings

in our blood sugar that resulted in frequent cravings and increased

caloric intake leading to the obesity epidemic. Secretary Tommy

Thompson announced recently that over 40 percent of Americans

over the age of 40 are pre-diabetic.

No. 3 was because animal protein in our diets is from corn-fed

cattle and poultry that do not run free and have high levels of saturated fat and insignificant levels of health Omega 3 oils. No. 4, in

an attempt to lessen our intake of saturated fats, trans fats were

introduced and became ubiquitous in our commercial baked goods

and fast foods. We now know that trans fats are worse than saturated fats for both our waistlines and our blood vessels.

In response to my own frustration with the low fat diet, in 1995

I decided to try a different approach. I was also influenced by the

beginning of the low carb diet trend pioneered by Dr. Atkins. While

I found the low carb diet approach fascinating, I felt the scientific

evidence pointed in a slightly different direction. My patients had

already had heart problems and/or were at high risk for heart disease. There was too much evidence that saturated fat was associated with coronary disease. On the other hand, evidence was growing that the healthy Mediterranean oils had favorable effects on

our lipids and on our cardiovascular health.

As far as carbohydrates, it became clear that what was causing

our epidemic of obesity was not carbohydrates per se but the processed rapidly digested high glycemic carbohydrates. The good, nonprocessed carbohydrates were too rich in vitamins and nutrients to

restrict. We developed a simple and flexible diet plan for our patients that followed the principles of good nutrition, dense carbohydrates, healthy fats and lean proteins. There was no counting

calories, grams of fats or grams of carbohydrates.

While calories definitely count, it was our observation that counting calories alone did not work. Carbohydrate choices were made

on the basic of glycemic index. We found that when proper food

choices were made, hunger and cravings diminished and fewer calories were consumed. We also strongly encouraged exercise

throughout for burning calories, for building and maintaining lean

body mass and for cardiovascular health.

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After years of frustration, I was amazed and gratified by our patients’ response to our program. They lost weight, their blood chemistries improved, and they found the diet easy to follow. We began

reporting our findings at national meetings in 1997. Our clinical

experience indicated the diet could truly become a lifestyle. Weight

loss was usually sustained and the manifestations of pre-diabetes

and often of Type 2 diabetes were reversed. In 1999, local TV asked

us to put south Florida on what is now called the South Beach Diet

which we did very successfully for 3 years. This led us from the

clinical and academic realm to the public sector.

The success of South Beach Diet has given me a unique opportunity to help change the way America eats. We have recently established a non-profit research institute to study nutrition and cardiac prevention and are planning a study of school children where

bad eating habits begin.

The following are my recommendations for incorporating the

South Beach Diet principles into the Federal guidelines. The diet

pyramid should be updated as planned; the base should be occupied

by the good carbohydrates, vegetables, whole fruits and whole

grains. The next level should include lean proteins, low fat dairy

products, and good fats. Above the good fats should be saturated

fats and above that, processed carbohydrates and at the apex, trans

fats which we should be absolutely restricting. The benefits of proper diet and vigorous exercise must become part of school curricula.

Continued efforts are necessary to educate the public regarding

healthy food choices.

I believe that the principles of nutrient dense, good carbohydrates, good fats, lean protein and plenty of exercise have recently become the consensus of scientific opinion. If applied successfully to the American lifestyle, our epidemic of obesity and diabetes can be reversed.

Thank you.

[The prepared statement of Dr. Agatston follows:]

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Chairman TOM DAVIS. Thank you very much.

Doctor Anderson.

Dr. ANDERSON. Thank you, Chairman Davis, and thank you for

the opportunity to address your committee on the obesity epidemic.

We all agree that the increase in the prevalence of obesity in the

past 25–30 years is both startling and alarming but the question

is, what is its origin and we don’t have an origin to that question,

or we don’t have a simple answer. Therefore, my message to government is their role must be to keep a steady hand on the helm

and stay the course until we have both evidence for and agreement

on a solution or solutions.

Obesity arises from both environmental and genetic factors, but

it is agreed that the rapid increase in the prevalence of obesity is

primarily environmental. Americans at all socioeconomic levels are

getting fatter and some have attributed this to the toxic environment of inexpensive, readily available food, reduced activity, increased wealth, longevity, stress in the workplace, advertising and

even mother’s diet, just to name a few of the potential factors. The

point is the origins of this obesity epidemic are not defined and are

complex. So how can we offer short term solutions?

In my opinion, the role of Government at the present time is to

stay the established course of providing dietary guidance to the

public and to avoid any dramatic changes in the current dietary

guidelines and food guides. Some argue for change but where is the

evidence? Change in dietary guidance must be based on what we

describe in medicine as evidence-based decisionmaking. This is a

systematic approach to categorizing quality of evidence that is

available. It does not give equal weight to each piece of evidence

and does not arrive at simply a consensus solution. In other words,

the loudest and most articulate speaker does not sway the evidence

and the final decision. Government should have, as a policy, assurance that the principles of evidence-based decisionmaking, is applied to all forms of dietary guides. Current practice is to base dietary guidelines on evidence and consensus, but does not apply evidence-based systems.

I would also like to remind you that dietary guidance is for the

maintenance of health and prevention of disease. Dietary guidelines are guidance statements for government policy and provide

the basis for consumer messages. Food-based guidance to the public

is provided by both dietary guidelines and food guidance, that is

the Pyramid, and if followed by the individual, this guidance will

lead to food choices providing nutrient, adequate diets and will reduce the risk of chronic disease. Of course modification of this general guidance is appropriate for some populations of different cultures or genetic makeup as well as those who develop markers to

the disease process, for example, high blood cholesterol.

I don’t think there is anything fundamentally wrong with current

dietary guidance. The question is why don’t people follow our guidance and select healthier diets, eat less and exercise more? We do

not have the answer but it seems to me we need to make greater

effort to communicate our existing dietary guidance in more effective ways. Shifting dietary guidance without scientific evidence is

irresponsible and will only add to more confusion.

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Because of the presence of the other speakers, I know you know

that the carbohydrate, the base of the pyramid, has been brought

into question. I want to address that specific issue. Many

hypotheses have advanced suggesting carbohydrates are the cause

of obesity and one suggests that sugars and processed carbohydrates bypass food intake regulatory systems thereby causing

obesity. The evidence is to the contrary and this is my area of expertise. My research shows that all sources of energy and diet contribute. Carbohydrates, including sugars, are satiating. Carbohydrates are more satiating than fats and less so than proteins, although I must note that the ranking amongst these depends on

quantity and source.

The real question is what is in the environment that causes people to eat too much food and ignore basic physiological signals?

Why don’t people eat more fruits and vegetables and whole grain

cereals and whole grain products as described in the base of the

pyramid. Why don’t they make the right choices?

Hypotheses on the role of the food supply and obesity epidemic

are abundant and require testing and the application of evidencebased decisionmaking before we are in a position to suggest foodbased solutions that are effective. However, I am convinced that

food-based solutions will not be effective unless we also tackle other

environmental factors contributing to obesity including the low

level of activity associated with our current lifestyles. In the meantime, let us find ways to be more effective in empowering individuals to follow the current dietary guidance.

In closing, I would like to draw your attention to a recent publication on ‘‘Dietary Guidelines: Past Experience and New Approaches,’’ published in the Journal of the American Dietetic Association in December 2003. It was my privilege to serve as co-organizer of that meeting and co-editor of the publication. This international conference strongly advocated the application of an evidence-based approach to modification of food-based guidance for the

public.

Thank you.

[The prepared statement of Dr. Anderson follows:]

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Chairman TOM DAVIS. Thank you very much.

Dr. Finn.

Dr. FINN. Good afternoon, Chairman Davis. Thank you for the

opportunity to discuss the Federal Government’s role in addressing

the Nation’s obesity epidemic.

I chair the American Council for Fitness and Nutrition [ACFN].

I am also the past-President of the American Dietetic Association.

As you have heard this morning, we all agree that obesity is a

growing concern for all Americans. Recognizing the serious nature

of this issue, in January of last year a coalition of food and beverage companies, restaurants and related trade associations founded the American Council for Fitness and Nutrition to work toward

comprehensive and achievable solutions to the Nation’s obesity epidemic. Today, ACFN represents more than 65 diverse organizations

and our work is guided by an advisory board of 27 distinguished

experts in nutrition, physical activity and behavioral change.

The epidemic of obesity did not occur overnight or even within

the last decade. Understanding the contributing factors and the

fundamental driving forces provides a key to solving this complex

and multifaceted challenge. ACFN believes, as do most experts in

the field, that the ultimate solution to obesity is about energy balance, matching calories burned with calories consumed. In order to

accomplish this seemingly simple objective, people must moderate

their calorie intake to match their energy expenditure by eating

less, being more physically active, or ideally doing both.

The Federal Government has an important role to play in helping to solve the Nation’s battle with weight but we recognize the

Federal Government cannot fight this battle alone. It requires the

action of all sectors of society. Toward that end, ACFN is working

with health professionals, educators, policymakers and consumers

to develop lasting approaches to combat obesity. These approaches

focus on improving communication to Americans about the need to

balance nutrition with physical activity.

While it is clear that the problem of obesity is widespread, its impact on America’s youth deserves special attention. We know, for

example, that children who participate in physical education programs fare better academically, personally and physically than

those who are inactive. However, physical education requirements

in our public schools have been declining dramatically over the last

20 years and in only about half of our elementary schools do they

have PE teachers on staff.

ACFN applauds Congress and the Federal Government for numerous important initiatives that seek to address these objectives.

For example, the Improved Nutrition and Physical Activity Act

passed by the Senate last December would provide much needed

funding to develop community-based programs. We urge the House

of Representatives to pass companion legislation sponsored by Representative Mary Bono and 77 other Members of Congress.

ACFN has touted the benefit of PIP grants distributed by the

U.S. Department of Education. PIP grants provide local communities with funding to improve existing physical education programs or launch new youth-focused initiatives. We hope Congress

will continue to fully fund this critical program.

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The Department of Health and Human Services programs including Healthier U.S. and the Small Steps to Better Health campaigns, focus on health, prevention by encouraging Americans to

improve their lifestyles while eating a balanced diet and increasing

their physical activity.

Earlier this year, ACFN responded to HHS’s request for partners

to promote Healthier U.S. initiatives. In a recent report, the Food

and Drug Administration Obesity Task Force proposed a calorie

count campaign and made several recommendations to improve

consumer understanding of appropriate serving sizes. Through the

Grocery Manufacturers of America, the food and beverage industry

is responding to the FDA’s work by conducting consumer research

to better understand how to communicate caloric content, especially for single servings.

Under the auspices of HHS and USDA revisions to the Dietary

Guidelines for America and the Food Guide Pyramid present an

important opportunity to formulate guidelines that can help people

of all socioeconomic and cultural backgrounds improve their health.

While the existing pyramid has recently become the subject of some

debate, one thing is clear, it is one of the most widely recognized

nutrition education tools in the marketplace. ACFN members are

committed to promoting the new guidelines when they are released

next years.

The Five A Day Better Health Program Partnership between the

National Cancer Institute and the Produce for Better Health Foundation showcases the scope and reach of public education programs

can achieve with private sector involvement. In addition, ACFN

strongly encourages the Government to assess what gaps in research exist regarding obesity’s causes and solutions, either

through projects of its own or by partnering with agencies or private sector organizations like ACFN.

In conclusion, the food and beverage industry acknowledges the

role it plays in providing consumers with many foods and beverages that they enjoy every day and is committed to doing its part

to help consumers better understand how they must balance what

they eat with what they do. Clearly, all sectors of society, including

the food industry, must work together to combat obesity. Ultimately, individuals have to make a choice about the foods they eat

and the level of physical activity they engage in. Government can

and should provide information to help consumers make informed

choices. Congress must embrace proposals that are positive, comprehensive and address obesity as an issue rooted in improper energy balance. After all, this discussion is not simply about weight

gain, it is about the health of our Nation.

Thank you.

[The prepared statement of Dr. Finn follows:]

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Chairman TOM DAVIS. Thank you very much.

Mr. Silverglade.

Mr. SILVERGLADE. Thank you, Mr. Chairman, for this opportunity to testify and I commend you for holding these hearings on

this vitally important issue.

The committee has asked us to address several specific questions. I will address each of them in turn. The first and most important question is what is our view of Government’s role in shaping health policy, especially on the subject of controlling weight?

We believe the answer to that is simple. Federal, State and local

public health agencies have a major role to play in ensuring that

the food industry provides consumers with a healthy food environment. This is perhaps a new term but I am going to use it several

times in my testimony. We need a healthy food environment, at the

supermarket, in schools, at the workplace and in public settings.

Presently, consumers face a very hostile food environment. By

this I mean fast food outlets across America heavily promote high

fat, hight salt and high sugar foods and beverages. Vending machines in schools, hospitals and airports offer mostly high fat, high

salt and high sugar snack foods and soft drinks. Food companies

fill the airwaves, magazines and Internet sites with more than $7

billion worth of marketing messages for mostly high fat, high

sugar, high salt foods, often consumed by children. That $7 billion

figure contrasts sharply with the meager $4-$5 million spent by the

U.S. Government on its ‘‘5 fruits and vegetables a day’’ program.

Government is also partly to blame for the hostile food environment. Several members of the committee this morning raised the

question whether Government should be involved in this area.

Well, Government is part of the problem, so it must be part of the

solution. For example, Congress requires that full fat, whole milk

be offered at schools participating in the National School Lunch

Program. This was a requirement passed at the behest of the dairy

industry which lobbied Congress.

Congress also passed legislation at the behest of the beef and

pork industries to enable USDA to operate advertising and promotional campaigns for those industries that are designed to increase consumption of beef and pork products, many of which are

high in fat. Mr. Waxman earlier this morning mentioned congressional meddling with the Food Stamp Program, that limits the ability of States to communicate to food stamp recipients what foods

they should be eating for a healthier diet.

Congress has failed to provide the Department of Agriculture

with authority to regulate so-called ‘‘competitive’’ foods, foods not

part of the official School Lunch Program but that are nonetheless

sold in schools. As we have heard from USDA this morning, competitive foods are not as nutritious as the official School Lunch Program. Congress has failed to provide USDA with authority to control sale of those foods and to add insult to injury, the Federal

Trade Commission has developed an extensive legal and economic

rationale, or apology I should say, for why it should not regulate

advertising of less healthful foods to children.

In such a food environment, it is no wonder that more than 60

percent of adults are overweight or obese. Obesity is not merely a

matter of personal responsibility. Let us think about it. Obesity

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rates have climbed greatly in the last decade or so. Did all of these

Americans suddenly become irresponsible over the last 10–15

years? That would be quite a social phenomenon to say the least.

No, Americans have not suddenly and inexplicably become irresponsible on a societal level.

What has occurred in the last 10–15 years is changes in the way

foods are marketed, changes in the proliferation of less healthful

processed foods, often packaged in huge single serve portions. What

has changed is not a massive social phenomena of where Americans have become socially irresponsible but what has the huge

amount of money spent by the food industry to increase to promote

unhealthful food products.

While individuals are ultimately responsible for what they put in

their mouths, the World Health Organization, the world’s leading

public health agency, has stated in a new global strategy on diet,

physical activity and health, just issued 2 weeks ago, that it is Government’s role to make the healthy choice the easy choice. I will

repeat that because it is really a key element. Government’s role

is to make the healthy choice the easy choice. We are pleased to

see that Dr. Crawford representing the administration who was at

the Geneva, Switzerland meeting of the WHO, said that the administration supports the WHO’s global strategy. Let us see how that

statement compares to what the Federal Government is really

doing.

I think the global strategy is so important that I would like it

considered as an annex to my written statement and incorporated

in the hearing record if possible.

Chairman TOM DAVIS. Without objection, it will be.

[The information referred to follows:]

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Mr. SILVERGLADE. Not surprisingly, the WHO calls for educational programs. That is no surprise, but in addition, the WHO

states that food advertising affects food choices and influences dietary habits and that messages that encourage unhealthy dietary

practices should be discouraged. We, therefore, request Congress

hold hearings on ways to protect consumers, especially children,

and reduce the prevalence of advertising of less healthful foods.

The WHO calls for an examination of food and agriculture policies for their potential health effects on the food supply. In response, for example, USDA could develop policies to reduce the average saturated fat content of beef, pork and dairy products instead

of being mandated by Congress to run promotional campaigns for

the current product lines.

The WHO’s global strategy recommends that governments adopt

policies that support healthy diets at school and limit the availability of products high in salt, sugar and fat in schools. Congress

should take a look at the competitive foods sold in schools that

compete with the school lunch program and give USDA the authority it needs to take the measures recommended by the WHO.

Perhaps most controversial, the WHO report states that prices

influence consumption choices and that public policies can influence prices through taxation, subsidies or direct pricing in ways

that encourage healthy eating and physical activity. The WHO

noted that some countries successfully use fiscal measures including taxes to influence the availability and access to a consumption

of various foods.

No one is calling for a Twinkie tax. My organization has called

for a 1 cent tax on each can of soft drinks sold, that could hardly

be called regressive and certainly would not have an effect on low

income consumers but it would raise hundreds of millions of dollars

for nutrition education campaigns we all agree are necessary. In

fact, more than a dozen States in the United States already tax

soft drinks. It is not a radical proposition.

The gist of the World Health Organization’s strategy is that Government must take a proactive role and not merely act as a passive

information provider. Neither I nor anyone in my organization is

advocating that Government regulate what consumers eat, but

Government must regulate business practices that create hostile

food environment.

In sum, the blueprint has been offered to us by the World Health

Organization. I am glad that the administration has supported it.

It is now time that they take steps to implement it. So far the

Small Steps Program by the Department of Health and Human

Services which includes such recommendations to consumers as to

ask their doctor about taking a multivitamin supplement, to running errands and to drink lite beer—if they drink beer—instead of

regular beer really doesn’t pass the laugh test.

There is legislation pending in Congress that would implement

some of the WHO’s recommendations and we urge this committee

to take a serious look at those bills.

Thank you.

[The prepared statement of Mr. Silverglade follows:]

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Chairman TOM DAVIS. Thank you very much. Thank all of you.

I am going to go to questions. We have a couple of votes and instead of going over and trying to come back, I want to try to get

through.

Dr. Agatston, just explain to me briefly the difference between

good carbohydrates and bad carbohydrates and how they affect the

body?

Dr. AGATSTON. We have evolved for millions of years as hunter

gathers and what we gathered was a great variety of vegetables

and whole fruits, very nutrient rich. Early agriculture was whole

grains, slowly digested. Those are basically the good carbs. We can

describe them as nutrient rich, high fiber is low on the glycemic

index.

When the national recommendations came for low fat, we didn’t

have understanding of those concepts.

Chairman TOM DAVIS. They didn’t take into account the differences?

Dr. AGATSTON. Yes, but the science really wasn’t there and so

what the food industry produced was all the great tasting, zero cholesterol, zero fat processed goodies, big swings in blood sugar, obesity and the timing coincides with our obesity epidemic.

Chairman TOM DAVIS. Dr. Anderson, would you concur with

that?

Dr. ANDERSON. I think you have to be careful about simplistic

categorization of good and bad.

Chairman TOM DAVIS. That was my categorization.

Dr. ANDERSON. The point is that even in my own studies, rapid

release carbohydrates may be perfectly appropriate if you want a

satiety effect, short term, immediately. You feel better, you are

hungry. The question is why do people eat too much of anything,

including the rapid release carbohydrates as well as you can over

eat on a high fat, high other type of carbohydrate as well. I think

there are benefits to all forms of carbohydrates. An athlete at a certain time will need a rapid release, you don’t want a slow release

under those circumstances. Why don’t people make the choices appropriate to their circumstances and empowering people to understand that and make those choices, I believe is important.

Chairman TOM DAVIS. Dr. Agatston, again, in your book you disparage the Heart Association’s high carbohydrate, low fat eating

pattern that is intended to prevent heart disease. Can you elaborate on that?

Dr. AGATSTON. The actual studies of low fat, high carb, when the

Heart Association came out with those recommendations, they did

not do a large prospective study because of the expense. They made

the decision on the best available evidence and long term diet studies are every expensive and very difficult to do. The new Heart Association guidelines are much better than the ones we talked about

in the book. They acknowledge whole grains and what I call the

good carbohydrates. I agree there are times when you want fast release carbohydrates, but for the majority of the population in most

situations, it has been a disaster.

Chairman TOM DAVIS. Professor Anderson, your colleague, Professor David Jenkins, developed the glycemic index concept something like 30 years ago. As the Government reexamines many asVerDate 11-MAY-2000 12:21 Oct 20, 2004 Jkt 000000 PO 00000 Frm 00156 Fmt 6633 Sfmt 6633 D:\DOCS\95914.TXT HGOVREF1 PsN: HGOVREF1
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pects of national dietary policy, what do we need to keep in mind

about glycemic index?

Dr. ANDERSON. It is premature to put it into a public health

mode and please make a distinction between diets that are geared

for the South Beach or the Atkins Diet or whatever it might be,

not criticizing them, but they are a diet aimed at weight loss and

not aimed at prevention. We have to think about prevention.

Low glycemic index diet will assist in the control of blood glucose

excursions and are appropriate for a diabetic but the question that

we have is where do these changes in diet potentially apply for the

prevention of disease? Also, you have to remember the food guide

and the dietary guidance that we give is aimed at making sure people get a nutrient adequate diet as well as select the right foods

to prevent chronic disease. So it has to get both across. That is

where we are failing, in that educational program.

Dr. AGATSTON. Now we are looking at over the age of 40 of 40

percent prevalence of pre-diabetes and obesity, so what we are

talking about, lower glycemic foods and there is a wealth of information on the effect on blood sugar, pre-diabetes and diabetes, we

are talking about a large percent of the population. There are relatively few people who have chosen the right parents and can eat

anything and get away with it but we are really talking about I

think a rather big percentage of the population.

Chairman TOM DAVIS. Dr. Finn.

Dr. FINN. I have been in the field a long time. I have been in

the field of dietetics a long time and our dieticians that are representative of the Dietetic Association, 70,000 of them, battled back

and forth and have for many, many years about what is the best

way to help people or to help patients that have disease. I think

the consensus is pretty much around the idea that we are not going

to come out with one way but some people do better on a South

Beach Diet for prevention, others do better on something that

might be higher in protein and we are coming full circle to say, it

is based pretty much on where that individual is. It is about calories and how we balance those and help people really develop a

healthy lifestyle that is permanent. Losing weight isn’t the problem, keeping it off is the problem.

Chairman TOM DAVIS. So you don’t think Government should advocate a target diet for all people? We need to give them the information.

Dr. FINN. I think, as Dr. Anderson said, we have to inform people

and I think we have to do everything we can as professionals to

empower people to make those choices and that comes from all sectors of society and Government is a piece of that.

Chairman TOM DAVIS. Thank you.

Mr. Silverglade, twice in your testimony you criticized the

schools for serving 2 percent milk or whole milk which is I guess

only 3.5 percent fat. Because of the satiating nature of milk based

on its protein fat ratio, do you have evidence that the children are

gaining weight from drinking milk?

Mr. SILVERGLADE. All I could say is that the American Pediatric

Association recommends that children older than 2 years of age

drink low fat or skim milk and there is a consensus recommendation among public health professionals in the United States, mediVerDate 11-MAY-2000 12:21 Oct 20, 2004 Jkt 000000 PO 00000 Frm 00157 Fmt 6633 Sfmt 6633 D:\DOCS\95914.TXT HGOVREF1 PsN: HGOVREF1
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cal professionals, that children drink low fat or skim dairy products

that provide all the vitamins and minerals that whole milk provides without the unnecessary fat, calories and saturated fat.

Chairman TOM DAVIS. CSPI has a boatload of recommendations

about eating and what you shouldn’t eat but through the 1980’s,

they waged a campaign to force fast food companies to stop using

natural and tropical oils for frying and instead switch to vegetable

oil. I am not sure in retrospect, did they stand by that or did they

have a correction in that area?

Mr. SILVERGLADE. I think you raise a good point. We did urge the

fast food industry to stop the use of tropical oils such as coconut

oil and palm oil that are more highly saturated in fat than lard or

beef fat. What we didn’t know at that time is they were going to

move to vegetable oils and then hydrogenate them which essentially thickened them to make them work like lard or beef fat. We

didn’t know that. It was unfortunate but those are the steps they

took to respond to our campaign to drop the use of tropical oils.

Now we know that these hydrogenated oils are high in trans fatty

acids and we are urging the fast food industry to come up with

safer ingredients to use. French fries can be fried many ways and

in fact in Europe, the European Union, McDonald’s has stopped the

use of oils that are high in trans fatty acids. Why don’t they stop

the use of them here in this country?

Chairman TOM DAVIS. A lot of this is market driven now. If you

go into restaurants around the country, you go to McDonald’s

around the world and they are giving people what they want. You

have the bunless burgers in a lot of places as you walk in now, you

have a kosher McDonald’s, I have been to it in Tel Aviv, you have

a meatless McDonald’s in India, but consumers drive a lot of this

as well. South Beach and Atkins have revolutionized what a lot of

restaurants are offering.

I would love to spend the afternoon but we have votes. Your entire testimony is in the record. I can’t thank you enough for being

with us and sharing this. As we digest it through the committee

and make our reports, I want to reserve the right to get back to

you because I think what you all have contributed is very, very important to us as we formulate policy at this level. Thank you all

for being with us. I will let you go and we will adjourn the hearing.

[Whereupon, at 1:37 p.m., the committee was adjourned, to reconvene at the call of the Chair.]

[The prepared statement of Hon. Elijah E. Cummings and additional information submitted for the hearing record follows:]

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