U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001

98–212 PDF 2005

CONQUERING OBESITY: THE U.S. APPROACH TO

COMBATING THIS NATIONAL HEALTH CRISIS

HEARING

BEFORE THE

SUBCOMMITTEE ON HUMAN RIGHTS AND

WELLNESS

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

SECOND SESSION

SEPTEMBER 15, 2004

Serial No. 108–268

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

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

BETTY MCCOLLUM, Minnesota

———

BERNARD SANDERS, Vermont

(Independent)

MELISSA WOJCIAK, Staff Director

DAVID MARIN, Deputy Staff Director/Communications Director

ROB BORDEN, Parliamentarian

TERESA AUSTIN, Chief Clerk

PHIL BARNET, Minority Chief of Staff/Chief Counsel

SUBCOMMITTEE ON HUMAN RIGHTS AND WELLNESS

DAN BURTON, Indiana, Chairman

CHRIS CANNON, Utah

CHRISTOPHER SHAYS, Connecticut

ILEANA ROS-LEHTINEN, Florida

DIANE E. WATSON, California

BERNARD SANDERS, Vermont

(Independent)

ELIJAH E. CUMMINGS, Maryland

EX OFFICIO

TOM DAVIS, Virginia HENRY A. WAXMAN, California

MARK WALKER, Chief of Staff

MINDI WALKER, Professional Staff Member

DANIELLE PERRAUT, Clerk

RICHARD BUTCHER, Minority Professional Staff Member

(III)

C O N T E N T S

Page

Hearing held on September 15, 2004 ..................................................................... 1

Statement of:

Bost, Eric, Under Secretary for Food, Nutrition, and Consumer Services,

U.S. Department of Agriculture; and Ed Thompson, M.D., M.P.H.,

Chief, Public Health Practice, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services ............................. 11

Kretser, Alison, director of scientific nutrition policy, Grocery Manufacturers of America; Hunt Shipman, executive vice president, government

affairs and communications, National Food Processors Association;

Morgan Downey, executive director, American Obesity Association; Dr.

Daniel Spratt, director, reproductive endocrinology, Maine Medical

Center, Endocrine Society of America; and Dr. Thomas Wadden, vice

president, North American Association for the Study of Obesity ............. 57

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

Bost, Eric, Under Secretary for Food, Nutrition, and Consumer Services,

U.S. Department of Agriculture, prepared statement of ........................... 14

Burton, Hon. Dan, a Representative in Congress from the State of Indiana, prepared statement of .......................................................................... 4

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

of Maryland, prepared statement of ............................................................ 105

Downey, Morgan, executive director, American Obesity Association, prepared statement of ........................................................................................ 76

Kretser, Alison, director of scientific nutrition policy, Grocery Manufacturers of America, prepared statement of ................................................... 59

Shipman, Hunt, executive vice president, government affairs and communications, National Food Processors Association, prepared statement

of ..................................................................................................................... 70

Spratt, Dr. Daniel, director, reproductive endocrinology, Maine Medical

Center, Endocrine Society of America, prepared statement of ................. 88

Thompson, Ed, M.D., M.P.H., Chief, Public Health Practice, Centers for

Disease Control and Prevention, U.S. Department of Health and

Human Services, prepared statement of ..................................................... 24

Wadden, Dr. Thomas, vice president, North American Association for

the Study of Obesity, prepared statement of .............................................. 93

(1)

CONQUERING OBESITY: THE U.S. APPROACH

TO COMBATING THIS NATIONAL HEALTH

CRISIS

WEDNESDAY, SEPTEMBER 15, 2004

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON HUMAN RIGHTS AND WELLNESS,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The subcommittee met, pursuant to notice, at 2:10 p.m., in room

2154, Rayburn House Office Building, Hon. Dan Burton (chairman

of the subcommittee) presiding.

Present: Representatives Burton, Watson, and Waxman.

Staff present: Mark Walker, chief of staff; Mindi Walker, Brian

Fauls, and Dan Getz, professional staff members; Nick Mutton,

press secretary; Danielle Perraut, clerk; Kristin Amerling, minority

deputy chief counsel; Karen Lightfoot, minority senior policy advisor and communications director; Anna Laitin, minority communications and policy assistant; Josh Sharfstein and Richard Butcher, minority professional staff members; Earley Green, minority

chief clerk; and Cecelia Morton, minority office manager.

Mr. BURTON. Good morning. A quorum being present, the Subcommittee on Human Rights and Wellness will come to order.

I ask unanimous consent that all Members’ and witnesses’ written and opening statements be included in the record. Without objection, so ordered.

I ask unanimous consent that all articles, exhibits, and extraneous or tabular material referred to be included in the record.

Without objection, so ordered.

In the event that other Members from Congress attend the hearings today, I ask unanimous consent that they may be permitted

to serve as a member of the subcommittee for today’s hearing only.

Without objection, so ordered.

The reason we are convening today is because we are going to

talk about a subject that is very, very important not only to the

people of this country, but to the Government of the United States.

Obesity is an ever-increasing concern of everybody. We just found

out recently, when we started looking into this, that 31 percent of

adults over the age of 20 in the United States are considered obese.

That is almost one out of three. In addition, the data that we found

also shows that 65 percent, almost two out of three people in this

country, are overweight.

Now, why is that important? The reason it is important is because of the tremendous costs and burdens that it puts on the

2

health care system. Right now, 129.6 million adults who are currently living here in the United States have an unhealthy weight

level, and that is an increase of 54.9 percent, almost 55 percent in

the last decade alone. So we are eating ourselves into the grave.

That is a terrible thing to say, but it is the truth.

The health concerns related to overweight and obesity: high

blood pressure, high cholesterol levels, diabetes, heart disease, increased probability of having a stroke and certain types of cancer

such as breast, colon, and prostate cancer, not to mention, as I

said, premature death.

Now the Federal Government is classifying obesity not just a behavioral problem, but a disease as well, and HHS is conducting indepth research into the underlying causation of obesity, not discounting a genetic or predetermined basis for the disease.

A study of the national costs attributed to both overweight and

obesity-related services specify that medical expenses accounted for

9.1 percent of the total U.S. medical expenditures in 1998, and that

reached a total dollar amount of roughly almost $79 billion. So we

are not talking about chump change here. That would equate

today, in 2003 or 2004 dollars to almost $95 billion. And approximately half of those costs were compensated for by funds allocated

to Medicare and Medicaid. So the Government and the taxpayers

have a vested interest in finding solutions to this problem.

Now, this is very interesting. In Indiana, my home State, according to information released by the Behavioral Risk Factors Surveillance System at CDC, over $1.6 billion is spent annually by the

taxpayers of Indiana due to health implications linked directly to

obesity. Now, for my colleague from California, Mr. Waxman, it is

$7.7 billion, which is over 10 percent of the total obesity costs in

the United States. So we have a problem in Indiana; you have a

bigger problem in California.

Fortunately, the Federal Government and private organizations

have created several programs to combat and bring awareness to

obesity. The Division of Nutrition and Physical Activity at the CDC

has developed and designed a program to help States improve their

efforts to present obesity by promoting good nutrition and more

physical activity.

Currently, 20 States are involved in that program, but we need

to be more involved. And the people of this country need to be

aware that obesity is not only a burden to them, but a burden to

everybody, their neighbors and every taxpayer across this country.

And physical activity is really important to good diet.

We need to also be talking to our fast food restaurants and the

people who package foods and put them in the supermarkets, to

make sure that they create food stuffs that we can consume that

are nutritious and taste good, but aren’t going to kill us. And that

is one of the reasons why we are having this hearing today.

To speak on these and other initiatives to prevent and combat

obesity, we will hear today testimony from Dr. Ed Thompson, Chief

of Public Health Practice at CDC. And as the Federal agency

charged with ensuring the safe production of food and the management of Federal food assistance programs, the U.S. Department of

Agriculture is also concerned, and they have one of their representatives here. We have the pleasure of receiving testimony from Eric

3

Bost, the Under Secretary for Food, Nutrition, and Consumer Services at USDA. And he is going to be testifying about the current

USDA outreach programs.

As I said before, it is imperative that the Government of the

United States work with the private sector to find solutions to this

problem. I don’t mean to be facetious, but it is growing at a very

rapid rate, and we have to do something about it.

[The prepared statement of Hon. Dan Burton follows:]

4

5

6

7

8

9

10

Mr. BURTON. With that, I would like to yield to a gentleman that

really does watch his weight, and I go down to the gym and I will

see him on the workout equipment, working for hours at a time;

and his heart beat, I think, is three beats per minute, so I know

he is in good health, Henry Waxman, the ranking member of the

committee.

Mr. WAXMAN. Thank you, Mr. Chairman, for your kind words

and for holding this hearing.

Rising rates of obesity in the United States represent a public

health crisis. Obesity causes heart disease and diabetes, it is associated with premature death, and it is responsible for billions of

dollars in health care costs.

The burden of obesity will affect every corner of our society, but

it will not be spread equally. Obesity harms the poor more than the

well-off, threatens certain racial and ethnic groups more than others, and in any given area can be concentrated among those who

have fewer opportunities to exercise and less access to nutritious

food. It is a special responsibility of Government to address disparities in health, and today I would like to focus on Government’s efforts to address especially high rates of obesity among the disadvantaged communities in our society.

We all know that the Food Stamp Program prevents malnutrition and hunger for millions of Americans each year. Food stamps

also play an important role in promoting good nutrition. Each year

the Federal Government sends more than $150 million to the

States to provide nutritional education and services that help to

address obesity. In my home State of California, these funds support more than 190 programs in 4,000 low-income schools and communities.

This spring the U.S. Department of Agriculture proposed major

changes in nutrition education funded through the Food Stamp

Program. Instead of encouraging community-wide education in

schools, churches, and other settings, USDA is now asking that

programs narrowly target women who are food stamp participants

and applicants. I also understand that USDA is discouraging programs from focusing on the nutritional needs of particular highrisk groups such as obese of individuals with Type 2 diabetes.

California is objecting to USDA’s proposal. According to the

State’s leading public health officials, the planned changes will reduce the number of Californians served by more than 80 percent,

will eliminate programs in churches and community centers across

the State, and will lead to a loss of as much as $80 million in Federal funding. California’s leading public health official has stated

that USDA’s new strategy would support ‘‘inefficient approaches.’’

He also told USDA that, if enacted, the proposal would devastate

the State’s successful efforts to provide nutrition education to poor

and minority communities.

I am pleased that Under Secretary Bost is here today to discuss

these issues with the committee. It is my hope that we can have

a productive conversation about how to resolve these serious concerns about USDA’s proposals.

I would also like to thank all of the witnesses for coming, and

I look forward to their testimony.

Thank you, Mr. Chairman.

11

Mr. BURTON. Thank you, Congressman Waxman.

We will now hear from the Under Secretary for Food, Nutrition,

and Consumer Services at the USDA, the Honorable Eric Bost; and

also the Honorable Ed Thompson, M.D., M.P.H. He is the Chief of

Public Health Practice Centers for CDC, U.S. Department of

Health and Human Services.

As is our custom, would you please rise so you can be sworn in?

[Witnesses sworn.]

Mr. BURTON. We will start with Under Secretary Bost. And what

I would like, because we have another meeting at 4, I would like

to try to hold the opening statements, if possible to 5 minutes.

Thank you very much.

STATEMENTS OF ERIC BOST, UNDER SECRETARY FOR FOOD,

NUTRITION, AND CONSUMER SERVICES, U.S. DEPARTMENT

OF AGRICULTURE; AND ED THOMPSON, M.D., M.P.H., CHIEF,

PUBLIC HEALTH PRACTICE, CENTERS FOR DISEASE CONTROL AND PREVENTION, U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Mr. BOST. Good afternoon, Mr. Chairman and Congressman

Waxman. It is indeed a real pleasure for me to be here. For the

record, I am Eric Bost, Under Secretary for Food, Nutrition, and

Consumer Services at U.S. Department of Agriculture. I am here

today to speak about our efforts to combat the national obesity crisis.

We currently administer 15 nutrition programs, serving one out

of every five Americans, including the Food Stamp Program, the

National School Lunch Program, Breakfast Program, and WIC—

Women, Infants and Children. We are also responsible for food

guidance, currently the Food Guide Pyramid and, in cooperation

with our colleagues at Health and Human Services, the Dietary

Guidelines for Americans.

I have two main points in my testimony that I would like to

share with you. One, as the chairman noted, we have a serious obesity epidemic that is currently existing in this country in both

adults as well as children, and we have several initiatives to combat it, but it is real important to know that we cannot do it alone.

Just a couple of statistics. Over 400,000 deaths a year related to

poor diet and physical activity; it is, right now, the second leading

cause of preventable death, after smoking, and soon will surpass

deaths from smoking; diabetes has increased by 49 percent in the

last 10 years; one in three persons born in 2000 will develop diabetes if there is no change in the current health habits; alarming

trends among children in the past 20 years, the percentage of children who are overweight has doubled and the percentage of adolescents who are overweight has more than tripled. Most importantly,

this may be the first generation of children not to live as long as

their parents as a direct result of this issue. You talked about the costs. I do want to note one thing: $117 billion a year in 2000 in direct and indirect costs; also, obesity as it

relates to the individual.

If you are overweight, it will probably take 3 years off of your

life. Obese persons will probably take 7 years off of their life. And

if you are obese and smoke, you are shortening your life by probVerDate 11-MAY-2000 09:50 Feb 03, 2005 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6633 D:\DOCS\98212.TXT HGOVREF1 PsN: HGOVREF1
12

ably 13 years. Why? The immediate reasons appear to be somewhat

simple. We eat too much, we eat too many of the wrong things, and

we get too little physical activity. It seems very simple, but in

terms of addressing it, it is really not because of a couple of things.

One, we have some of the best food in the entire world: the widest

variety, the highest quality, the most safe and most affordable food

anywhere. Also, as Americans, we love a good deal. Super-sizing is

just a few cents more; all-you-can-eat buffets. And, last but not

least, one of the struggles that we are having is it has to be rooted

in a behavior change and, as Americans, we hate to have someone

tell us what to do.

Children are a very special challenge for us. Kids’ choices are

shaped by their surroundings: at home, in school, and in the wider

community. Also, television and computers draw children away

from sports and physical activity. In terms of some of our efforts

to address this issue at USDA, which we believe is very important,

first of all, there is a conference that Health and Human Services

will participate with us next month to talk about the leading research regarding what we can do to address this issue. As part of

our nutrition promotion and education, as a part of our WIC Program, we are currently reviewing the WIC food package. Also, we

have a breastfeeding promotion, and breastfeeding is directly related to children that are healthy and, for whatever reason, don’t tend

to be as obese when they grow up.

Also, we have programs that are focusing on school-aged children: our HealthierUS Initiative, in coordination with Health and

Human Services and also the Department of Education; our Eat

Smart. Play Hard. Campaign which is in school; also, Changing the

Scene, which is a nutrition education in the school; also, our Team

Nutrition Program; Fruits and Vegetables Galore; Making it Happen; and also one of the things that we are starting is HealthierUS

Challenge, where we will identify schools that have done an outstanding job in terms of providing healthier alternatives to children

in schools.

Across all of our populations, we have a 5 A Day Program, in

partnership with the National Cancer Institute and CDC; and our

Food Stamp Nutrition Education Program that Congressman Waxman made note of. We are currently in a review of the Food Guide

Pyramid or Food Guide Guidance, and also the development and

review of the Dietary Guidelines.

Just recently, June 30th of this year, the President signed the

Child Nutrition bill, which was just reauthorized. Right now almost

29 million children are served in the National School Lunch Program and reauthorization in terms of working with Congress, we

were able to ensure that children have improved access to school

meals for eligible children by requiring direct certification through

the Food Stamp Program, streamlining the process so that all children in households can apply at one time, and making certification

valid for the entire year. Also, the act provides funding to work

with schools to establish their own health, nutrition education, and

physical activity goals and initiatives, and also it extends and expands the Fresh Fruit and Vegetables pilots that distributed free

fruits and vegetables to schools to encourage health alternatives to

13

non-nutritious foods and snacks in eight schools and on three Indian reservations.

Why are schools so important and why are our programs so critical? The research indicates that kids who eat school lunch eat

nearly twice as many vegetables. Kids who eat school breakfast eat

twice as many servings of fruit. In terms of the food that is provided in the National School Lunch Program, the total fat has been

reduced from 38 percent to 34 percent over the last several years.

In conclusion, Government, we believe, has a critical role to play

in addressing the obesity issue in this country and in promoting

and moving Americans toward a healthier lifestyle, and I think

that is the issue for me that I really want to stress. It is not only

obesity that we are talking about, it is the issue of ensuring that

people make wise and informed decisions about what they eat, how

much they eat, some level of physical activity.

It is also important, I believe, to realize too that we cannot do

this by ourselves. We need the partnership with media, researchers, industry, teachers, administrators, and especially with parents

in terms of being role models for their children. And last but not

least, we need individuals to accept some level of personal responsibility to make healthy choices. Regardless of the information that

we provide, regardless of the changes that we make, it still comes

down to a person and a parent making an informed decision and

choice for their children, and I think that is very important.

Thank you very much. I would be happy to answer any questions

that you may have.

[The prepared statement of Mr. Bost follows:]

14

15

16

17

18

19

20

21

22

Mr. BURTON. Thank you, Mr. Secretary.

Dr. Thompson.

Dr. THOMPSON. Mr. Chairman, members of the committee and

committee staff, I thank you for the opportunity to participate in

today’s hearing. I am Dr. Ed Thompson, Chief of Public Health

Practice at the Centers for Disease Control and Prevention, an

agency of the Department of Health and Human Services. Today

I will present an overview of the overweight epidemic in our Nation

and identify a number of Department of Health and Human Services initiatives and programs designed to combat these epidemics

in poor nutrition, physical activity, and obesity.

If you look at the chart to my left and to your right, you see

maps showing the percentage of the population of each State in

1994, 1999, and 2003 who were obese as measured by our behavioral risk factor surveillance system. Nearly two-thirds of adults in

this country are overweight or obese, with nearly 30 percent overall

being obese, as you have correctly noted, Mr. Chairman.

What you see there in lighter blue, that is 10 to 14 percent of

the population being obese; not overweight, but obese. And the

lighter blue which appears in 1994 disappears after 2001. The

darker blue is 15 to 19 percent. Beginning in 1997 you see some

red, and on that chart there you see it in 2003; it appears first several years before. That means that 20 percent of the adults in that

State, one out of every five, are obese.

Finally, in 2003 we have had to introduce a new color, and that

is gold. In 1999 it appears in many States. I am sorry, the gold is

20 percent are obese; the red is the new color introduced in 2003,

and that represents 25 percent or more of the population. One out

of every four adults in those States is obese, and in 2003, as you

can see, five States had one in four adults who were obese.

Overweight and obesity and associated risk factors of poor diet,

physical activity, and other contributing factors contribute to

chronic conditions such as heart disease, stroke, diabetes, and certain cancers. A recent study estimates that 4,000 adult deaths each

year in the United States are associated with poor diet and physical inactivity. That is as many Americans as died in all of World

War II.

We have already begun to see the impact of the obesity epidemic

on the health of young people. Type 2 diabetes, strongly associated

with obesity, was virtually unknown in children and adults 10

years ago. Today it accounts for almost 50 percent of new cases of

diabetes among youth in some communities.

A CDC report predicts that one in every three Americans born

in 2000, that is, the children now entering kindergarten, will develop diabetes during his or her lifetime. Successfully combating

the overweight epidemic in our Nation requires the involvement of

many sectors and levels of society. Although national initiatives

can play an important role, they are not sufficient by themselves;

community-based initiatives are critical for reaching Americans

where they live, work, go to school, and play. State level programs

are critical for supporting and disseminating community-based activities.

DHHS is implementing a comprehensive approach to reach the

American people through these various levels. CDC uses multiple

23

approaches to address obesity and its risk factors, including funding State health departments, school-based programs, a national

media campaign, and community-based programs. The Steps to a

HealthierUS cooperative agreement program is designed to promote programs that reduce the burden of chronic disease and address the associated risk factors.

Steps targets diabetes, overweight, obesity, and asthma, and addresses the associated risk factors of physical inactivity, poor nutrition, and tobacco use. CDC funds 28 State Health Departments to

prevent and reduce obesity, and we fund 23 State Departments of

Education to implement coordinated school health programs to help

ensure that students receive instruction on nutrition, physical activity, and tobacco use prevention.

CDC’s youth media campaign, called ‘‘VERB. It’s what you do,’’

is the largest national multicultural campaign designed to increase

levels of physical activity among youth. After 1 year, the impact

has been demonstrated by substantial improvements, including the

average 9 to 10-year-old American child in the Nation, after the

campaign, who was exposed to the VERB campaign, engaged in 34

percent more sessions of free time physical activity when compared

with children who were unaware of the VERB campaign.

Two recent major initiatives tied to obesity within the Department of Health and Human Services are the Food and Drug Administration’s Obesity Working Group, which will advise the agency on innovative ways to deal with the increase in obesity and identify ways to help consumers lead healthier lives, and the National

Institutes of Health development of an Obesity Research Task

Force to develop a strategic plan for obesity research.

In October DHHS and USDA will host a national obesity prevention conference. The conference’s objective is to learn from past and

current research, identifying steps we can take to prevent further

increases in the prevalence and severity of obesity.

We are learning a great deal about effective strategies for promoting physical activity and healthy eating. We know that no one

strategy alone will be sufficient. Our chances of success will be

greatest if we use multiple strategies to address numerous factors

that contribute to caloric imbalance. DHHS is helping lead the national effort to combat the epidemic of overweight and obesity

through a comprehensive, multifaceted, multilevel approach. We

are committed to doing all we can to help our Nation enjoy good

health now and for a lifetime.

We thank you for your interest and for the opportunity to share

information about these strategies with you, and we will be happy

to answer your questions at the appropriate time.

[The prepared statement of Dr. Thompson follows:]

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

Mr. BURTON. Thank you very much, doctor.

We have been joined by the ranking member of the subcommittee, Ms. Watson.

Did you have an opening you would like to make, Ms. Watson?

Ms. WATSON. Yes. Thank you so much, Mr. Chairman. I especially want to commend you because of your strong leadership on

the issue of America’s health and well being time and time again.

The prevalence of obesity in the United States in both adults and

children is increasing at an alarming rate. Currently, about 127

million Americans are labeled overweight and about 60 million of

the population is considered obese. On top of that, about 9 million

individuals are considered extremely obese. In addition, a 2004

study released by the Department of Health and Human Services

Centers for Disease Control and Prevention shows that deaths due

to poor diet and physical inactivity rose by an astounding 33 percent over the past decade. Several experts speculate that obesity

may soon overtake tobacco as the leading preventable cause of

death.

Mr. Chairman, I must emphasize again that obesity in the

United States has reach epidemic proportions. The CDC has

ranked obesity as the No. 1 health threat facing America. In a larger perspective, obesity is global, not just a problem of the United

States. Recent estimates are that about 300 million worldwide are

affected by obesity. Up to 20 percent of men and 25 percent of

women in European countries are considered obese. According to

the National Institutes of Health, overweight refers to increased

body weight that is at least 10 percent over a recommended weight

relative to the individual.

These recommended weight standards are generated based on a

sampling of the U.S. population or by body mass index [BMI], a

calculation that assesses weight relative to height. The NIH states

that all adults age 18 or older who have a BMI of 25 or greater

are considered at risk for premature death and disability as a consequence of their fat to lien muscle mass ratio. Obese is commonly

referred to as any individual with a BMI greater than 30.

Mr. Chairman, there are two specific concerns that I would like

to highlight, in addition to those that our witnesses will provide

today. The areas are health and financial concerns regarding obesity. First the health concerns. To name a few, overweight and

obese people are at an increased risk of developing any of the following: cardiovascular disease, diabetes, stroke, hypertension, angina, gout, fatty liver disease, sleep apnea, fertility complications,

psychological disorders, cancer of the kidney, breast, colon cancer,

rectum cancer, esophagus, prostate cancer, and gallbladder.

Americans with low income levels and minorities are disadvantaged in gaining treatment due to the disparities in our health care

system. More attention must be directed into prevention and

awareness of obesity long before related illnesses and diseases attach.

In addition to the health impact of obesity, there are also great

economic consequences on the U.S. health care system. Direct medical costs include preventative, diagnostic, and treatment services

relative to obesity. Indirect costs relate to morbidity and mortality

costs. There is an opportunity to reduce costs because obesity is a

49

preventative condition. Socioeconomically, lower income groups and

minorities tend to be more obese.

Another economic situation that should be brought to the subcommittee’s attention may have serious consequences in my State

of California. In May, USDA proposed major changes to nutrition

education funded through the Food Stamp Program. This program

provides major funding to State public health efforts to combat obesity. The proposed changes would dramatically restrict what States

can do with the money, forcing them to abandon community-wide

efforts to do targeted counseling to women with children who are

on food stamps.

On July 27, 2004, California strongly objected to the proposed

changes. The chief public health officer wrote: ‘‘For USDA to reserve directions contradicts all that we know about effective strategies.’’ California said the new proposal would result in fewer lowincome people being served and undermine hunger prevention.

If this framework becomes effective in 2006, few of today’s inkind contributions would continue to qualify for Federal financing

participation. California would lose most, if not all, of its more than

$80 million in Federal matching funds. Financially, the $21.3 billion spent in 2000 on health care and lost productivity attributable

to physical inactivity, obesity, and overweight, and the $1.7 billion

attributable to obesity in the Medi-Cal program would continue to

rise unchecked. Rather than being a partner with States, this

framework would abandon them, abdicating USDA’s responsibility

for good nutrition, nutrition education of low-income Americans,

and helping to reverse the Nation’s obesity epidemic.

So, Mr. Chairman, I look forward to the continuing testimony of

today’s witnesses and the positive solutions that our witnesses can

provide.

I yield back the balance of my time. Thank you.

Mr. BURTON. Thank you. It is nice to have you with us, as usual.

You look like a fashion plate that just stepped out of one of the

magazines.

Did I understand you to say that there were 400,000 deaths that

could be prevented a year if we watched our weight? Is that correct?

Mr. BOST. Yes.

Mr. BURTON. 400,00 a year.

Mr. BOST. That is correct.

Mr. BURTON. I hope everybody who is paying attention to this

will listen; 400,000.

Mr. BOST. And increasing all the time.

Mr. BURTON. Yes. And you said it is $117 billion in direct or indirect costs?

Mr. BOST. That is correct. That is based on 2000 figures that we

got from CDC.

Mr. BURTON. That is based on 2000 figures.

Mr. BOST. Yes.

Mr. BURTON. So it is probably higher now.

Mr. BOST. Well, the most recent figures, if you extrapolate, would indicate it is up to $123 billion.

Mr. BURTON. $123 billion.

Mr. BOST. Yes. That is correct.

50

Mr. BURTON. And a lot of that is paid through Medicare and

Medicaid.

Mr. BOST. Yes.

Mr. BURTON. So the taxpayers are funding a lot of that.

Mr. BOST. Yes.

Mr. BURTON. I am reiterating this because I think it is very significant. You said children born today, one out of three will get diabetes?

Mr. BOST. That is correct. If they keep eating like they are eating, that is correct.

Mr. BURTON. And that is preventable if they had a balanced diet

and watched their caloric intake and the fat intake.

Mr. BOST. That is correct, along with some level of physical activity.

Mr. BURTON. Right. You said something about sleep apnea.

Which one of you said that?

Ms. WATSON. I did.

Mr. BURTON. You did.

Mr. BOST. Congresswoman Watson said something about sleep

apnea.

Mr. BURTON. As one of the causes. Well, the reason that rang a

bell with me is I have to tell you a story, and this will be humorous, but it is true. When I was a boy, we lived across the street

from the schoolyard, and we didn’t have much money, so mom fixed

foods that were quick and fast. She was a waitress and she would

come and fix dinner; a lot of them have a lot of caloric problems

and fat problems.

And my brother, who is 7 years my junior, I would say at dinner,

I am finished, can I go play basketball across the street. And she

would say, you eat like a bird; you are going to die. And then she

would say, OK, go ahead and play. And then as I walked out the

door, she would say, look at your little brother. He was in a

highchair and she was shoveling food into him, saying, he is a good

eater; he is going to be real healthy.

Well, the reason I bring that up is because it is like a record

playing in people’s head. And my brother today has a very serious

weight problem that he has to fight all the time, as well as ancillary problems including sleep apnea. And the reason I say that, because if anybody is paying attention besides the people in this

room, what parents teach their kids in their formative years or

very early years does stay with them for a lifetime, and if you

force-feed a child like my mom did—and she was well intentioned,

a wonderful lady—then what you are doing is creating that record

in their brain that is going to be playing over and over again that

they are going to be using throughout their life, and it is going to

cause them to eat more than they should.

Now, that may seem like a very simple thing to state, but I am

absolutely convinced that is why my brother has had this weight

problem throughout his life. And I think that is why I didn’t, because I was fortunate enough to be a little older and be able to run

across the street without eating all that food and play in the

schoolyard. So I just thought I would throw that out as an object

lesson.

51

I don’t have a lot of questions, but I think it is extremely important, and I guess I would suggest this as a charge to the health

agencies, that the education of the American people need to be increased through public service announcements, through all kinds of

ways that you can think of. We need to be telling parents don’t feed

your kids too much. When they are ready to quit eating, let them

quit eating, like they should have done with my brother. And, also,

teach them, like you said, that vegetables and fruits are not something that you should just have as an ancillary part of the meal,

because they don’t have a lot of calories and they won’t put on a

lot of weight.

So I really appreciate your being here today. You guys have a big

job on your hands, especially when you look at the growth in obesity in this country, but I do appreciate your hard work.

With that, I will yield to my colleague, Mr. Waxman.

Mr. WAXMAN. Thank you, Mr. Chairman.

Public health experts believe that social marketing campaigns

are a critical part of the efforts to reduce obesity. These campaigns

aim to change community norms about nutrition and food. Yet

USDA’s proposal withdraws support from virtually all social marketing efforts in favor of one-on-one counseling sessions. California’s leading public health official in the Schwarzenegger administration has said that this proposal would lead to the adoption of ineffective approaches.

Mr. Bost, do you disagree with public health experts who say it

is important to address obesity at a community level?

Mr. BOST. Well, Mr. Waxman, let me put my response in terms

of your question in some framework in terms of this issue of the

Food Stamp Nutrition Education Program, because I had the opportunity last week of going to California and meeting with the

leadership there about this specific issue.

In May we issued a draft framework so that we could start a dialog and seek public comment on what we believe we could do with

the States and our partners to improve the Food Stamp Nutrition

Education Program. We were looking at several things: one, how to

organize it more effectively and more efficiently to maximize the

outreach efforts and the impact it may have on low-income people;

and, also, how could it be better coordinated, more effectively coordinated with all of the other efforts that we were attempting to

implement.

In addition to that, and with that in mind, this was not, and I

repeat, not an effort about reducing funding or nutrition education,

or reducing access to the Food Stamp Program, or rejecting social

marketing or eliminating school-based efforts. For whatever reason,

many of the folks in California took it to mean that, but it wasn’t

that at all.

In addition to that, we had received over 1,000 comments. The

vast majority came from California, and they repeated many of the

things that you did say. However, we did have some States who did

not necessarily agree with the position that California took. The

point that we are interested in making is that we have X amount

of dollars to reach a targeted group of people, those who participate

in the Food Stamp Program, and we sent the draft framework out

to receive input how could we more efficiently and effectively adVerDate 11-MAY-2000 09:50 Feb 03, 2005 Jkt 000000 PO 00000 Frm 00055 Fmt 6633 Sfmt 6633 D:\DOCS\98212.TXT HGOVREF1 PsN: HGOVREF1
52

dress this specific target population. It was by no means to eliminate any of the things that you noted in your comments, not at all.

Mr. WAXMAN. Since you sent it out and you are getting comments, does that mean that you are open to hearing the criticisms

that we are hearing overwhelmingly from Californians, democrat

and republican people, in the administration in Sacramento?

Mr. BOST. Absolutely. That is why I went to California, to meet

with the leadership to talk about it, because so many of the comments did come from California. And the thing that I would also

like to leave you with is that no final decision has been made, and

I left it with the folks in California to discuss it.

Mr. WAXMAN. Well, I am happy to hear that. Let me just ask you

some of the underlying philosophy that public health experts are

raising as you consider your proposal. Health experts have argued

that it is better to try to change the culture of a community, how

they look at nutrition, than just one-on-one counseling. As I understand it, it is hard to convince an individual to buck what the rest

of the community is doing, it is a difficult message to sell, and they

believe the most effective approach is to change the norm and improve the health of the whole community. Do you see that as a reasonable approach?

Mr. BOST. Oh, absolutely. However, with food stamp nutrition

education money, the money is specifically designated to address

those people who participate in the Food Stamp Program. So for us

to say or for me to say that I am going to use that money and that

we may, just by happenstance, address people who participate in

the program, but I am going to get everybody else, I can’t do that.

Congress says I can’t do that. The statute is very clear about how

I can use that money. What we were interested in doing was to

talk with the States about we can more efficiently and effectively

address that, and do it without adversely affecting what California

is doing.

Mr. WAXMAN. Well, that is the key, because California is trying

to take a much more broad approach than going specifically to individuals, because the public health experts there believe that is the

only way you are going to really be effective, and we want a program that is effective. USDA’s proposal prioritizes nutrition education for women with children. California is concerned this priority would jeopardize funding for many specific educational programs, including those geared to children in the LA unified school

district and those geared to diabetics.

Does the USDA believe that a one-size-fits-all approach is better

than strategies designed at the community level?

Mr. BOST. No, absolutely; and the framework didn’t say that. In

addition to that, when we looked at the approximately 24——

Mr. WAXMAN. Well, I am not arguing about what the framework

says, but these are the questions that are being raised as to whether it fits in with that framework, and I suppose you are going to

evaluate it. Given the scientific evidence about escalating rates of

obesity in children, shouldn’t USDA be prioritizing children as

well?

Mr. BOST. Well, we have, because if you look at the number of

people who participate in the national Food Stamp Program, of the

24 million, over 50 percent are children.

53

Mr. WAXMAN. Given the tight link between obesity and Type 2

diabetes, is there anything wrong with States trying to reach out

to diabetics for nutrition education?

Mr. BOST. No, not at all.

Mr. WAXMAN. California has said it would lose up to $80 million

in Federal funding because of the limitations on nutrition education that they thought USDA is proposing. Yet these limitations

do not appear to be well justified. I think what we are asking on

a bipartisan basis in the congressional delegation, what the people

in California on a bipartisan basis are also asking, is that you take

a look at this, because they feel that what is being suggested would

undermine California’s efforts through these revisions. So I want to

give you that message; you got it in California. And as you look at

the revisions, please keep it in mind. Is that fair?

Mr. BOST. Absolutely. And we will do so and we have done so.

Mr. WAXMAN. Good.

Could I just continue with one last question?

Mr. BURTON. Sure.

Mr. WAXMAN. The new USDA guidance states that food stamp

nutrition education funds may not be used to convey negative written, visual, or verbal expressions about any specific food, beverage,

or commodity. USDA staff has the right to review educational campaigns to make sure that there is no ‘‘belittlement or deregation’’

of such items. Can either of you explain the origin of this policy?

What scientific evidence supports this policy and how many educational campaigns have been rejected because they belittled specific foods or beverages?

Mr. BOST. One, that preceded me, and the only one that I can

think of was one that was using the money to talk about soft

drinks in a specific State. But it is also in statute. And I think you

read exactly from statute.

Mr. WAXMAN. And the statute says that you cannot belittle——

Mr. BOST. If it is, it is very close.

Mr. WAXMAN [continuing]. Or have deregation of a food product?

Mr. BOST. If it is not, it is very close to that, if memory serves

me correct.

Mr. WAXMAN. Well, I would like to——

Ms. WATSON. Can you yield?

Mr. WAXMAN. Sure.

Ms. WATSON. On that very specific point, if we have a particular

cola drink that we know has caffeine in it, if that is pointed out

as a risk, is that considered—I don’t know the definitions of belittling.

What was the other word?

Mr. WAXMAN. Deregation.

Ms. WATSON. Deregation. I don’t know what the definitions are.

Is there a definition in the statute?

Mr. BOST. Congresswoman Watson, I don’t know, I will have to

look at it and see. I think the issue is about being able to target

a particular food or food group. I think that is what the issue is,

especially with public funds.

Mr. WAXMAN. Well, let me ask you this, if you can get us for the

record a full explanation of how this provision was developed. If it

is our fault, let us know. And then a correspondence with the food

54

industry and all examples of State educational programs that were

rejected by USDA staff based on this definition. So that will allow

us to know how big a problem this is in the States’ efforts to deal

with it.

Thank you, Mr. Chairman.

Mr. BURTON. Let me, before I yield to Ms. Watson, just say that

I am one of the biggest free enterprise advocates that there is in

the Congress, I am sure, but if we are taking exception and we are

making exceptions to certain companies or certain industries because we are afraid it will hurt their sales, while at the same time

it is hurting the American people by creating more obesity and

more health problems, then we have our horses going backward

here.

The fact of the matter is if there is something that is causing a

health problem, and it is in legislation that we can’t say anything

about it because we might hurt in some way that industry, then

we need to re-evaluate that. I don’t want to hurt any industry because, as I said, I believe in free enterprise, but, at the same time,

if caffeine or if too much sugar or too much fat in a product is going

to be detrimental to the American public and the taxpayers and the

health of this Nation, then we have to re-evaluate and start telling

people, hey, if it is this kind of a sandwich or this kind of a cola

that is causing a problem, then we have to have it changed. And

we need to attack that problem, because the growth of this problem

is unbelievable.

Ms. Watson.

Ms. WATSON. I want to follow kind of in that train as well. As

a teacher and school psychologist and a member of the school

board, first thing I did is go into our kitchens and find out what

we were preparing for our youngsters to eat. We might have found

a product that we felt was detrimental to their health. In describing the detriment, you have to describe the product and what is in

the product.

So what I would like to see is some definition of what you mean

by belittling or degrading. We need to have a definition, because

I am reminded of a bill—you know, California is unique, we do it

first—and we had a bill that would tax junk food. It sunsetted because we could not decide what junk food really was. You know,

is caramel popcorn junk food or is there a nutritional value?

So I don’t know how we would really make this work if we didn’t

have some definitions or some standards when we point out the

problems with a particular food. So can you respond to that?

Mr. BOST. Yes. But, Congresswoman Watson, in terms of the

very specific example that you gave in terms of schools, the foods

that are reimbursable have to meet the dietary guidelines, and

other foods that are served that are a la carte are determined by

the schools. So the schools themselves can make a determination

of what they believe is appropriate or not appropriate, and would

not necessarily fall in our purview. But, like I said, for those foods

that are reimbursable on the national school lunch program, they

have to meet certain guidelines. So the very specific example that

you gave me is not applicable in this specific instance.

Ms. WATSON. But maybe you can clear it up for me. If the schools

determine, can they also point out a product that would be injuriVerDate 11-MAY-2000 09:50 Feb 03, 2005 Jkt 000000 PO 00000 Frm 00058 Fmt 6633 Sfmt 6633 D:\DOCS\98212.TXT HGOVREF1 PsN: HGOVREF1
55

ous to someone’s health? Would that fall under your reference to

belittling?

Mr. BOST. No. It is left to the discretion of the school. There are

two forms of food that are served in schools: one, a la carte, that

the school decides to serve, actually, maybe three, those that are

in the vending machines, and foods that are reimbursable by us.

There are three categories of foods. Those foods that are reimbursable have to meet certain guidelines that we spell out; the other

two are left entirely at the discretion of the schools.

Ms. WATSON. Well, the reimbursable foods, can a school district

say these foods, and particularly some of them, are detrimental,

and would that be considered belittling?

Mr. BOST. Well, that is difficult for me to answer because since

I have been Under Secretary I don’t think that has ever occurred.

Ms. WATSON. I said we do it first in California.

Mr. BOST. Well, no. The school has the discretion whether they

want to serve it or not. They don’t have to say it is detrimental.

If it is a reimbursable food, then they have the choice of whether

they are interested in serving it or not. So they don’t have to say

it is detrimental, because they can choose not to serve it. They can

do what they want.

Ms. WATSON. OK, would you write me a letter as to what the

standards for belittling or detrimental, whatever the other was?

Mr. BOST. Yes, we will.

Ms. WATSON. So I will have a clear understanding. Thank you

very much.

Mr. BOST. You are quite welcome.

Mr. BURTON. Before we let you go, it seems to me that maybe

your agencies could recommend to the Congress, after doing a little

bit of research, what we could do to better define what is a food

with too much fat, too much sugar, or too much something else in

it. No, I am serious. I am serious, because we are not just talking

about school foods here. You look at the huge increase in the

amount of obesity among adults and huge increase in the amount

of people who are overweight that are not considered obese among

adults, and you consider the health risk factors connected with

that, and we really need to do a better job of educating in addition

to just the schools in this country.

I mean, I am not going to name products here because I will be

shot before I get out of the building, but the fact of the matter is

you go into a supermarket and you look at packages of various

products that you want to take home and eat while you are watching a football game, and the fat content is huge. But the people

don’t think about that because they haven’t been educated about

that. And I think that we ought to be educating them about that,

and we need to have some kind of a definition here in the Congress

so that we can set the proper parameters on how your agencies can

illuminate the issue for the American people. Right now it seems

to me like you have all kinds of restrictions on you, and we need

to lift those restrictions so we can better educate the American people.

Mr. BOST. Well, Mr. Chairman, to some extent we are in the

process of doing that. We are currently reviewing the dietary guidelines for American, both USDA and Health and Human Services,

56

and also the Food Guide Pyramid is currently under review. So to

some extent we are in the process of doing that.

Mr. BURTON. Well, manufacturers of these various products, it

seems to me, also ought to get the message, and maybe if we eliminated some of the barriers that you have to deal with legislatively,

you could probably talk to them in a little stronger way. Not that

I like to see Government sticking its nose into the private sector,

but when you start talking about these astronomical health care

costs related to obesity, you realize that something has to be done,

especially when you are talking about one out of every three kids

born today are going to have diabetes if we don’t do something.

I just got back from Guam and Saipan not too long ago, and they

don’t have enough dialysis machines to take care of the population

over there, American citizens who are dying from diabetes. We

don’t need to have one out of three kids growing up in the next 25

years that have diabetes; we won’t have enough money to buy dialysis machines and keep them alive. So anything you can recommend that we can do legislatively to help and to educate the

American people, I am sure Representative Watson and Waxman

and myself would be happy to do.

Ms. WATSON. Mr. Chairman, Representative Waxman wanted to

submit these two letters for the record.

Mr. BURTON. Sure. Without objection, so ordered.

Thank you, gentlemen. We will go to our next panel now.

Our next panel consists of Ms. Alison Kretser, the director of scientific nutrition policy at the Grocery Manufacturers of America;

Mr. Hunt Shipman, executive vice president, government affairs

and communications for the National Food Processors Association;

Mr. Morgan Downey, executive director of American Obesity Association; Dr. Daniel Spratt, director of reproductive endocrinology,

Maine Medical Center, Endocrine Society of America; and Dr.

Thomas Wadden, vice president of North American Association for

the Study of Obesity.

Would you please stand so you can be sworn?

[Witnesses sworn.]

Mr. BURTON. Let me just say it is 5 after 3, and I think many

of my colleagues have left because we have adjourned for the week

because of the religious holidays. I will probably be the only one

here for this panel, but I can assure you the rest of the committee

will be getting this information. The reason I bring that up is we

have another meeting that I have to go to at 4, so I would like for

you to limit your comments, if you would, to 5 minutes so we can

get to the questions.

Ms. Kretser.

57

STATEMENTS OF ALISON KRETSER, DIRECTOR OF SCIENTIFIC

NUTRITION POLICY, GROCERY MANUFACTURERS OF AMERICA; HUNT SHIPMAN, EXECUTIVE VICE PRESIDENT, GOVERNMENT AFFAIRS AND COMMUNICATIONS, NATIONAL

FOOD PROCESSORS ASSOCIATION; MORGAN DOWNEY, EXECUTIVE DIRECTOR, AMERICAN OBESITY ASSOCIATION; DR.

DANIEL SPRATT, DIRECTOR, REPRODUCTIVE ENDOCRINOLOGY, MAINE MEDICAL CENTER, ENDOCRINE SOCIETY OF

AMERICA; AND DR. THOMAS WADDEN, VICE PRESIDENT,

NORTH AMERICAN ASSOCIATION FOR THE STUDY OF OBESITY

Ms. KRETSER. Thank you for the opportunity to discuss the efforts of the food and beverage industry to help combat obesity in

America. My name is Alison Kretser. I am a registered dietician

and I am the director of scientific and nutrition policy for the Grocery Manufacturers of America.

As the leading voice of the food and beverage industry in the obesity and nutrition debate GMA has established a long-term commitment to arrest and reverse obesity in America, and to provide

consumers with the information and resources they need to establish healthy dietary habits for life.

As the companies that make the foods Americans choose every

day, GMA member companies recognize their role in not only offering choices that meet consumer demand for taste, quality, and convenience, but also, just as importantly, health.

On GMA’s commitment I can assure you that I am speaking for

the leadership of the industry. The CEOs on the GMA board have

adopted a global strategy on food and health that states our resolve

in no uncertain terms. As you know, we are supporting the efforts

that Congress has undertaken to combat obesity. GMA was an

original and enthusiastic supporter of Congressmen Wamp and

Udall’s Congressional Fitness Caucus. We also support passage of

the Improved Nutrition and Physical Activity Act [IMPACT], introduced by Congresswoman Mary Bono.

We applaud Congress for its initiatives, but there is a great deal

more that everyone, including the food industry, can do. We recognize that food is the energy input side of the healthy weight equation, and numerous efforts are underway to help consumers better

understand how they can balance what they eat with what they do.

For example, companies are formulating products to meet the

health demands of consumers. Efforts include: reformulating products to reduce calories, fat, and sugars; introducing new products

with increased fiber and whole grains; and offering new choices for

smaller product serving sizes.

However, one of our challenges is to provide and promote products that make eating not only healthy, but enjoyable. Having introduced numerous healthy products that do not pass the consumer

taste test, we know that people will not buy foods they do not

enjoy. In the coming months consumers will see many more of

these products that meet their demand for both health and taste.

Just as importantly, GMA has provided USDA and HHS with

numerous recommendations on how to make the dietary guidelines

for Americans and the Food Guide Pyramid relevant and useful for

all consumers, while also incorporating the latest science. SpecifiVerDate 11-MAY-2000 09:50 Feb 03, 2005 Jkt 000000 PO 00000 Frm 00061 Fmt 6633 Sfmt 6633 D:\DOCS\98212.TXT HGOVREF1 PsN: HGOVREF1
58

cally, we have urged USDA to retain the shape of the Pyramid, a

well-recognized brand among consumers. However, to increase its

utility, we have recommended that USDA link both the size and

number of servings to the Nutrition Facts panel, which is based on

a 2,000 calorie diet. While a single image of the Pyramid cannot

educate consumers about all aspects of the Government’s dietary

recommendations, it can, when used on food labels and elsewhere,

serve as a reminder of what a healthy diet looks like.

However, the Nutrition Facts panel is not always a well understood tool among consumers. For that reason, GMA and its member

companies are funding research regarding consumer perception

about calories and serving sizes on the Nutrition Facts panel. The

goal is not just to educate consumers, but to improve the labels to

meet their needs.

In addition to offering new products and improved nutrition information, GMA and many of our member companies founded the

American Council for Fitness and Nutrition to promote the critical

balance between nutrition and physical activity for a healthy lifestyle. Now representing 91 companies and organizations, the Council’s work is guided by an advisory board of 27 experts in the fields

of nutrition, physical activity, and behavior change.

This year the Council launched two pilot programs targeting the

specific needs of the Hispanic and African-American populations,

which are disproportionately impacted by obesity and related diseases. One of this subcommittee’s members, Congressman

Cummings, was at the launch of the Council’s Summer Fun Food

and Fitness Program in Baltimore and is familiar with its goals

and the children’s achievements. Both programs incorporated

healthy eating and cooking segments, and an emphasis on making

physical activity a daily habit.

In conclusion, with the intense public focus on obesity, healthy,

and nutrition, we have an unprecedented opportunity to combat

obesity and to improve public health. Through improved nutrition

information and product innovation, we can give consumers the

tools they need to build healthy diets and to maintain a healthy

weight. Thank you.

[The prepared statement of Ms. Kretser follows:]

59

60

61

62

63

64

65

66

67

68

Mr. BURTON. Thank you.

Mr. Shipman.

Mr. SHIPMAN. Thank you, Mr. Chairman. I am Hunt Shipman,

executive vice president of government affairs and communications

for the National Food Processors Association located here in Washington. NFPA is the voice of the $500 billion food processing industry,

and our three scientific centers, our scientists, and professional

staff represent food industry interests on government and regulatory affairs and provide research, technical services, education,

communications, and crisis management support for our U.S. and

international members.

Obesity is a multi-faceted issue and requires a multi-disciplined

approach. I would like to briefly discuss efforts now underway that

we believe can be successful in helping to combat obesity.

The food industry has a long history of providing consumers with

safe, affordable, and nutritious foods that meet their expectations

for taste, value, and convenience. Innovation and reformulation are

key tenets for our industry. Food companies have responded to consumer demand by creating a variety of reduced, low and non-fat

food products, reduced and low-calorie foods, and foods modified for

specific dietary and medical needs. Such foods help ensure that all

consumers can find products they need to create their own healthful diet.

An important fact to remember is that the greatest source of nutrition information for most consumers is the Nutrition Facts panel

found on the foods they purchase every day. The Nutrition Facts

panel was developed and designed to help make consumers aware

of the various nutritional components in food, and it also can be an

excellent weight management tool.

NFPA is now preparing a consumer-friendly brochure on following food labels for healthy weight management, featuring easy-tounderstand information on food labels and how labels can help

them attain or maintain a healthy weight by making wise food

choices. This consumer information will be on NFPA’s Web site,

where it can be downloaded by consumers and health experts, or

anyone who communicates to consumers about how to better understand food labels.

Because of the importance of physical activity in combating obesity, the food industry sponsors a number of programs designed to

encourage children’s physical activity and nutrition education, such

as the University of North Carolina’s Get Kids in Action program

and Triple Play, the Boys and Girls Club of America’s new health

and wellness initiative, to promote healthy lifestyles.

As Ms. Kretser noted, the food industry has also endorsed legislation designed to provide more Government support for school

physical activity programs, such as the Impact bill. We believe that

Federal support for in-school physical activity programs is important to the success of such efforts. And the food industry has actively participated in numerous conferences and other public events

to discuss various approaches to combating obesity.

As I noted at the beginning of our remarks, obesity is a multifaceted issue, and no one approach or activity will solve this situation. Clearly, labeling alone will not bring about the behavioral

69

changes needed to reduce obesity in this country. We need to ensure that the information we provide to consumers is linked to both

motivational and actionable education messages so that consumers

will use nutrition information to create healthful diets. Such messages need to be thoroughly researched and consumer-tested.

In 2004, both USDA and HHS have been active participants in

the process of reviewing the Dietary Guidelines for Americans, as

well as the Food Guide Pyramid. Revised versions of both the Dietary Guidelines and the Pyramid are scheduled to be released in

early 2005. Throughout the review process for the Dietary Guidelines and Pyramid, NFPA has strongly advocated that these nutrition education tools must be easily understood and must trigger the

behavioral change by the public. Attention to positive dietary guidance messages, coupled with consumer research to evaluate their

effectiveness in motivating behavioral change is essential. federally

funded biomedical and behavioral research related to health promotion and disease prevention is also needed.

Food companies succeed by meeting consumer demand, and

clearly the consumer demand for both a wide variety of food products to meet varying dietary needs and the demand for more information on how to attain or maintain a healthy wealth is strong.

Labeling flexibility will help to create incentives for products designed to meet consumers’ needs and demands. Government’s role

should be to ensure that labeling and claims that can help consumers to better understand the role that various foods can play in

healthful diets is both truthful and non-misleading.

In closing, stakeholders, including the food industry, Government, and the medical and public health communities will have to

work together. Without cooperative efforts, we will make no

progress in this issue. Dedicated collaboration, energy, and resources will make a difference in the classroom, on the playground,

in the home, and throughout our Nation.

Thank you for the opportunity to appear before the committee.

[The prepared statement of Mr. Shipman follows:]

70

71

72

73

74

Mr. BURTON. Thank you, Mr. Shipman.

Mr. Downey.

Mr. DOWNEY. Thank you, Mr. Chairman, and I want to thank

you for convening this hearing. I hope it is the first of several on

this topic, because it is very complicated and complex.

I also would like to take this opportunity to applaud the work of

Secretary of Health and Human Services, Tommy Thompson, over

his tenure. He has taken on obesity as a major issue. He has led

the components of HHS to develop comprehensive and sound plans

for attacking this problem. We also hail his decision in July for

Medicare to recognize that obesity is a disease and to open the door

to developing appropriate treatment strategies for treating it.

In the opinion of the American Obesity Association, obesity is the

most fatal, chronic, prevalent disease of the 21st century. No other

human condition combines obesity’s prevalence and prejudice, sickness and stigma, death and discrimination. We believe that the full

weight of the Federal Government’s capacities be brought to bear

on the problems of obesity in the same way we have tackled other

challenging health problems like cancer, heart disease, smoking,

teen pregnancy, HIV-AIDS, and bioterrorism. All such efforts have

involved a commitment of leadership, time, and resources across a

spectrum of activities, including education, research, prevention,

treatment, consumer protection, and discrimination.

I would like to briefly touch on each of these areas and what the

Federal Government may be doing.

On the educational front, although we have had a spate of information and features on obesity, it is still largely misunderstood in

many corners, and this is true in the policy area as well. One of

the things that we have overlooked, as you saw earlier the slides

from the CDC, is that while the population has doubled over 30

years who had a BMI of 30, the population with a BMI of 40, morbidly obese, has tripled during that period of time, and the population with a BMI of 50 has increased some 400 percent.

The problems of obesity—mortality, morbidity, sickness, health

care costs, health care utilization—scale up, so those increasing

levels of severe morbid obesity, where people are 100 pounds or

more overweight, is really where a large part of the problem is. We

have tended to think of this as a statistically small part of the population. It is not. If all of the persons in the United States with

morbid obesity live together, it would basically be the 12th largest

State in the country, roughly the size of Illinois. It would encompass, as my crude estimates take it, 29 congressional districts. The

population with morbid obesity, just morbid obesity alone, is over

two and a half times the size of our entire Alzheimer’s population.

This population receives nothing in the way of research or many

of the programs and policies that have been discussed to attack

their problems at that level.

We have important educational messages that we think need to

be brought out. Obesity is not a behavior; obesity is excess adipose

tissue. It is a disease because it meets every rationale definition of

disease. It is a chronic, fatal, relapsing disease that is at least as

complicated to treat as heart disease or cancer. It is a problem that

is largely going to be solved by more research. And while diet and

exercise are intrinsic to discussions of obesity prevention and treatVerDate 11-MAY-2000 09:50 Feb 03, 2005 Jkt 000000 PO 00000 Frm 00078 Fmt 6633 Sfmt 6633 D:\DOCS\98212.TXT HGOVREF1 PsN: HGOVREF1
75

ment, much more is needed as the long-term effects of these interventions are poor.

Obesity is a global problem arising from a combination of genetic,

environmental, and behavioral factors. We don’t know how to effectively prevent and treat obesity over the long term, with the exception of bariatric surgery for persons with morbid obesity. If we do

not drastically and quickly expand the research base of obesity,

new treatments and new prevention strategies are likely to fail,

and it will sink the entire U.S. health care system, which simply

cannot absorb millions of new cases of diabetes, heart disease,

stroke, and the other conditions you have mentioned. Simplistic assertions that obesity is easily prevented or easily remedied do a

disservice to persons with obesity and inhibit the discovery of effective solutions.

We believe that one of the areas that is most important to address is this area of research. I have provided the committee with

three graphs I will briefly describe. One depicts the growth in the

NIH budget since 1998, roughly doubling from $13.6 billion to

$28.8. And yet you will see although there has been a dollar increase in the obesity budget it has basically been a straight line as

the funding has increased so dramatically.

Second, the obesity budget at NIH is far behind that of the conditions caused by obesity, such as diabetes, cardiovascular disease

and, in comparison to some areas like HIV-AIDS and smoking, receive a very small portion of the funding.

And, finally, we have a graph here depicting the prevalence of

various conditions and comparing that to NIH levels of funding. It

is hard for us to imagine how we are going to get out of the problem with this insufficient attention to our research base to give us

the information to get there.

So for that reason, as well as some others, we are calling on Congress to look at establishing a National Institute of Obesity research at NIH which would focus and concentrate attention on the

various problems such as basic research, epidemiology, genetics,

neuroscience, prevention, therapeutic development, economics,

health policy, etc.

Mr. Chairman, I have more to say, but I see my time is out. I

would be glad to address some areas if you would like me to.

[The prepared statement of Mr. Downey follows:]

76

77

78

79

80

81

82

83

84

85

Mr. BURTON. Thank you, Mr. Downey.

Dr. Spratt.

Dr. SPRATT. Thank you. Chairman Burton, I would like to begin

by thanking you for the opportunity to testify here today. I am director of reproductive endocrinology and endocrine research at

Maine Medical Center. In my clinical practice I deal every day with

both adolescents and adults with obesity-related problems. I am

here today as Chair of the Government Relations Committee for

Endocrine Society.

The Endocrine Society is the world’s largest and most active professional organization of endocrinologists, representing over 12,000

members worldwide. We are dedicated to quality research, patient

care, and education.

I will be primarily addressing issues of research in obesity today.

In the other presentations you have heard the magnitude of the

obesity problem in the United States. Our Society has provided to

your committee our Obesity Handbook that provides additional details. This Handbook is part of a major effort of the Endocrine Society that has been undertaken over the past 2 years to increase scientific and public awareness of the obesity crisis.

As you have noted and other panel members, the Federal Government has also set in motions efforts to begin to tackle the obesity problem. In addition to those measures noted before, NIH Director Dr. Zerhouni has created the NIH Obesity Research Task

Force. Its strategic plan for obesity research, which was released

in February of this year, calls for the NIH to undertake research

exploring, preventing, and treating obesity through lifestyle modification, pharmacological, and surgical approaches, and research

that further examines the link between obesity and its associated

health conditions, such as metabolic syndrome.

Several important questions confront us. What is the cause of

obesity? Is it genetic, cultural, environmental? Well, the truth is

there may be no one cause of obesity, but, rather, a combination

of many, with different combinations in different individuals. Why

are more than 65 percent of Americans overweight or obese?

And even more alarming, why has childhood obesity tripled since

1970? Why are racial and ethnic minorities disproportionately affected by obesity and related ailments such as diabetes and cardiovascular disease? While we should not single out one cause or one

issue for obesity, I have been asked today to update the committee

on current research being conducted by those in the field of endocrinology.

What role can our Society play in helping you address these

problems? Well, as you know, endocrinologists work with hormones

and metabolism. Hormones are substances that are secreted by

glands that regulate body functions. For instance, the thyroid gland

secrets thyroid hormone, which regulates general body metabolism.

Well, researchers have recently discovered that adipose, fat tissue,

actively secretes hormones that influence many body functions, and

that the adipose is in turn regulated by hormones from other

glands.

As metabolic specialists, endocrinologists are actively engaged in

the study, management, and treatment of obesity and related diseases. In both the clinical and basic research setting, we evaluate

86

the hormones that regulate appetite, metabolism, and energy balance. Endocrine researchers are attempting to determine the root

causes of obesity and to find the most effective measure to prevent,

as well as combat, this condition.

One recent endeavor resulted in the discovery of the hormone

leptin by Jeff Friedman at the Rockefeller Institute, and this

opened a whole new dimension in the field of obesity. Leptin is a

hormone produced by fat cells that travels in the blood stream to

the brain to influence appetite. It also influences body temperature,

reproductive function, and the speed at which calories are burned.

This important discovery established the principle that fat cells

can communicate with the brain and influence metabolic processes.

Since this discovery, there have been many more discoveries demonstrating that other organs, like the pancreas and the GI tract,

can produce substances that control appetite and metabolism.

It is also worth noting that breakthroughs in obesity research

have resulted from what we call ‘‘broad-based’’ research. This is research that is conducted without a particular clinical goal established at the onset of the research. For example, scientists at Mass

General Hospital have recently evaluated thousands of genes from

the C. elegans worm. Among other discoveries, they found hundreds of promising genes that may help determine how fat is stored

and used in a variety of animals, including us.

This new information can be used to find similar genes in humans and then assess their significance for the control of obesity.

The decision to characterize this worm genome was not made with

obesity in mind, but more for the general belief that deciphering

this genome would have some payoff down the road. So we must

continue to support broad-based research in science, as some of the

most important breakthroughs have been serendipitous.

This basic information lays the foundation for clinical research.

For instance, currently there are only two FDA approved drugs for

long-term treatment of obesity, and neither is fully effective. Clinicians routinely prescribe medications to treat the complications of

obesity that have been listed here, but we only have these two

pharmaceutical options to treat obesity before it results in comorbidities. Better knowledge of the physiology and

pathophysiology of obesity can lead to development of more effective drugs, as well as more effective nutritional, surgical, and other

approaches. We, as doctors, and the American public as patients,

need better medications based on the knowledge we will gain from

basic and clinical research.

We believe, finally, that obesity research should be continued on

three levels. First, basic research should continue to better understand the body’s complex mechanisms of storing and utilizing energy. Second, transitional research should be moving these basic

discoveries into trials of clinical treatments. Our evolving knowledge will provide numerous opportunities for better diagnostic,

pharmaceutical, surgical, nutritional, and behavioral approaches.

Third, as these approaches are implemented, outcome or impact

research should be designed and put in place to assess efficacy, as

mentioned in part of the Impact bill. Finally, we should pay particular attention, as has been noted here, to the disproportionate

87

occurrence of obesity and its related health problems in our childhood and minority populations.

So I want to thank you for inviting me to testify here today, and

thank your committee for furthering the public discourse on this

growing problem of obesity.

[The prepared statement of Dr. Spratt follows:]

88

89

90

91

Mr. BURTON. Thank you, Dr. Spratt.

Dr. Wadden.

Mr. WADDEN. Mr. Chairman, Ms. Watson, thank you for the opportunity to testify on behalf of NAASO, the North American Association for the Study of Obesity. NAASO’s members include more

than 1,800 scientists, practitioners, and educators who are dedicated to improving the prevention and treatment of obesity in the

lives of those affected by this condition.

I am Tom Wadden, the vice president of NAASO and professor

of psychology at the University of Pennsylvania in Philadelphia.

We have heard today that the United States is experiencing an

epidemic of obesity. What can we do to control this public health

crisis that threatens the lives and well-being of so many of our citizens? NAASO offers three recommendations today: first, increase

the availability of treatment for people who are already obese; second, substantially strengthen efforts to prevent the development of

obesity, particularly in children; and, third, double NIH funding for

obesity research from its current level of $400 million. Let me

briefly discuss each of these.

In 2002, a landmark study supported by the NIH showed that a

15-pound weight loss reduced the odds of developing Type 2 diabetes by more than half in overweight persons who were at risk of

developing this illness. To meet their treatment goals, study participants received frequent individual counseling from dieticians

and other health professionals.

Remarkably, such treatment, though clearly effective, is not covered by most insurance plans today. Ironically, insurance companies pay to treat the complications of obesity, including high blood

pressure, Type 2 diabetes, and heart disease, but they do not cover

obesity itself. These serious medical problems could be prevented,

or at least alleviated, if patients could obtain help in managing

their weight.

NAASO believes that the treatment of obesity should be reimbursed when provided by appropriately trained health professionals. NAASO met this morning with officials from the Centers

for Medicare and Medicaid Services. We strongly urge Congress to

direct CMS, in collaboration with private insurers, to develop

guidelines for covering weight management services, including diet

and exercise counseling, medications, and surgical interventions.

We also urge Congress to assist universities, as well as State Departments of Health, in training more health professionals to provide weight management services.

While we must treat obesity to prevent the development of

health complications, our greater need is to prevent the development of obesity itself. As we have heard, America’s children are of

paramount concern. Fifteen percent of our youth are now overweight. An additional 15 percent are at risk of overweight; they are

just a few pounds away. And we have heard about the explosion

of Type 2 diabetes in pediatric clinics.

NAASO urges Congress to provide greater support for obesity

prevention programs. The Centers for Disease Control and Prevention, as we heard from Dr. Thompson, are playing a crucial role

through their Division of Nutrition and Physical Activity, which administers the State-based Nutrition and Physical Activity Program.

92

But only 28 States are currently supported by CDC, and of these

only 5 are funded at an adequate level, the basic implementation

level. Those States receive $750 million to $1.5 billion per year.

The United States needs this program in all 50 States funded at

adequate levels. NAASO urges Congress to strengthen support for

this and other CDC initiatives, including its Division of Adolescent

School Health and its VERB campaign that Dr. Thompson spoke

of.

The solution to our Nation’s obesity epidemic seems so simple:

people need to eat less and exercise more. And yet the solution

could not be more complex, because so many factors influence our

daily eating and activity habits, as you have already told us, Congressman Burton. Children today see 10,000 food-related commercials on TV each year. Most are for sweet or fatty foods. How do

these ads influence children’s eating behavior and body weight at

the age of 4 or 14 or later at 40? Think what your brother’s weight

would be today if he had seen 10,000 food ads per year.

How do TV and video games affect children’s daily physical activity? We know it decreases it, but by how much? How does the design of a neighborhood, including the need to drive to school and

to shopping centers, affect weight and well-being of children and

their parents?

Answers to such questions are urgently needed in order to develop the most effective prevention programs. We cannot expect

children to make better food and activity choices long-term until we

create environments at home and at school that support better

choices. Willpower is just not the answer for pediatric obesity.

This past August the NIH published its Strategic Plan for Obesity Research, as Dr. Thompson said. This document identifies

short and long-term research goals to improve obesity prevention

and treatment, and to advance understanding of the multiple

causes of this condition. As we heard, this includes groundbreaking

research in genetics and neuroendocrinology that is identifying

basic biological mechanisms for controlling eating, energy expenditure, and body weight. This research will further prevention and

treatment efforts.

NAASO urges Congress to double NIH’s funding for obesity research from its current level of $400 million. Mr. Downey has told

you how little support there is for obesity compared to other disorders. The NIH has a comprehensive program, but it will only succeed if sufficient resources are provided as have been provided in

the fights against cancer, heart disease, and AIDS.

Funds invested in obesity research will yield multiple benefits: as

we reduce the number of Americans who are overweight and obese,

we will dramatically reduce the many complications, including

Type 2 diabetes, heart disease, and several cancers; and as important, we will reduce the personal suffering of the millions of Americans affected by obesity.

Thank you for this opportunity to testify.

[The prepared statement of Mr. Wadden follows:]

93

94

95

96

97

98

99

100

Mr. BURTON. Well, thank you, doctors, ladies and gentlemen. We

really appreciate the testimony. It was very enlightening, because

I have always been of the opinion if you just ate less and exercise

more, you would stay thin. But you have convinced me today that

is not the only solution to the problem, although I think it is a big

one.

You said labels help. I think it was you, Ms. Kretser, who said

that, I believe. And I think they do, but most people, when they

are going to the store to get something for a basketball or football

game, where they kick their feet up and you see these advertisements on TV where some guy is overweight and he is sitting in a

big chair popping all this stuff, they don’t read those things.

Can’t the food industry do something to educate the people

through public service announcements in addition to those kinds of

commercials? It just seems like to me, as the doctor just said, they

see 10,000 food commercials per year, a child, and an awful lot of

those are these junk food ads that lead to obesity. It seems to me,

in addition to trying to find better foods with lower caloric intake

and fat intake and so forth, that the food industry could, in their

advertising or through public service announcements, educate the

public as to what they should be eating. It would also help them

in sales of the products that aren’t so fattening.

Is there any thought about that?

Ms. KRETSER. In response to your question, food advertising has

the potential and it will play an important role in the battle

against obesity. And I can tell you there is a sea change in the type

of advertising that is done in the food and beverage industry. They

are looking at how, within advertising, we can communicate

healthy lifestyles so that if a food such as advertising a cookie, you

show a child coming in from outdoors, being physically active, and

then having the correct amount of a snack. We are very committed

to advertising responsibly and portraying the correct way to use a

food, and how much and the amount of the food. And if it is a

snack food, that it isn’t portrayed as replacing an entire meal. That

is inappropriate.

Mr. BURTON. Well, all I can say is that I have never seen a commercial for a junk food or a fast food that said don’t eat too much

of this, now. They never say that; they always say—and I don’t

want to get into specific products——

Ms. KRETSER. Well, we have in this country a self-regulatory

mechanism that is under the National Advertising Review Unit

that CARU, which is the Children’s Advertising Review Unit that

has a set of principles that all of our companies adhere to in

adveritising to children, and they review commercials for children

under the age of 12, and we have a very high compliance rate if

in fact they have an issue with how a food is——

Mr. BURTON. Well, pardon my English, but it apparently ain’t

working, because you have one in three kids that are being born

today that are going to be a diabetic if we don’t change things, and

kids are getting fatter all the time, and the message——

Ms. KRETSER. Well, I think you have heard today that it is not

just one single issue, such as advertising. There are many multiple

factors that have changed as far as our lifestyle. Within the last

10 years our lifestyle is very, very different.

101

Mr. BURTON. No, I understand that. I understand that. But that

is one part of the solution, and that is to educate. You know, I

watch television like everybody else, and I see beer and alcohol

commercials where they say drink responsibly.

But with fast foods and things like that, I never hear them say

eat responsibly. I am not saying that is the solution, it just seems

to me that the industry, while developing foods that are better for

us that still taste good, that they can also do something to talk

about caloric intake and fat intake. We don’t want to discuss this

ad infinitum, but I just hope that maybe——

Ms. KRETSER. We do communicate. We have a great deal of information on nutrition on company Web sites, and I encourage you to

look at major manufacturers’ Web sites, all of the information that

they have available for consumers.

Mr. BURTON. I would be happy to look at those Web sites, but

that is not what I am talking about. We are talking about 10,000

commercials a child sees in a year, not their Web site. A lot of kids

are very, very good with computers, but they don’t rush to the computer to look at what kind of things they should eat; they see that

coming into the television when they watch a movie or watch some

kind of other thing.

Ms. KRETSER. I understand what you are saying, but I will say

that parents are a tremendous role model, and Government, as far

as schools as well, but parents, you teach how you eat. I have two

children, and they have watched me for years.

Mr. BURTON. I want to ask some other questions. Let me just tell

you we have latchkey kids now. More husbands and wives are

working than ever before. When I was a boy, my mom worked and

my stepfather worked, and my dad went to the slammer because

he was a bad apple. But the fact of the matter is today probably

60, 70 percent of the families, both parents work, and the kids

come home and they spend time watching television, and the parents don’t have the opportunity, as they did in the past, to go into

these things in detail.

I am a free enterprise advocate, as I said, and I don’t like to

mess around with the private sector. Let me just finish. I just

think that the industry would be well served not only to come up

with new products that taste good, that people can consume in a

way that will be safer, but also so that they can help educate the

kids, because the parents, in many cases, aren’t there to do it.

I have a couple of other questions I would like to ask before my

time runs out.

You said, Dr. Wadden, that we ought to double the amount for

research for obesity from $400 million to $800 million a year. I

don’t disagree that is probably a good goal. We have severe budgetary constraints right now. Is there any other way, other than

spending another $400 or doubling the amount of money being

spent on research, to help solve these problems for things other

than just advertising and caloric intake?

Mr. WADDEN. Well, I think that we are going to have more dialog

between the private sector and industry, academia and Government and the public sector, because I do agree we are going to have

to have multiple sources coming together to work on this problem.

I think the NIH plays such an important role in terms of trying

102

to figure out what are the causes, where are the most productive

avenues to intervene.

Your State is ahead on things. In Los Angeles you have decided

to take sugared sodas out of vending machines, which I highly applaud. We would like to be able to say is that a good decision, does

that in fact reduce obesity? So those are the kinds of grassroots

movements that we could provide funding for from NIH to see if

that is a good target. It is a better target to do what you are thinking about, going more after maybe television advertising aimed at

children or at the food industry.

So we do need money for basic research at NIH that can address

these issues, as well as the types of issues you raise, but the partnership has to be with industry, with State government, as well as

the Federal Government doing its part.

Mr. BURTON. Let me just ask Dr. Spratt a question real quick.

You said we need more research for drugs to help combat obesity.

It seems like we have a pill for everything. And you may be correct,

I don’t know. Do we really need more prescription type drugs to

deal with the obesity problem? Would our money be better spent

in education and that sort of thing, rather than, after the fact, giving people pills to control their appetite?

Dr. SPRATT. Well, I personally agree with you, and I think our

community would too, that the knowledge that we are gaining can

lead to many approaches besides just some medicines that will help

control obesity. However, for a subset of patients with morbid obesity, where nothing else is working, that is at great risk, these effective medicines are a great benefit in reducing the problems of diabetes and cardiovascular disease. So it is one part, I believe, of the

solution, certainly not the whole solution.

Mr. BURTON. Ms. Watson, I will yield to you. I am sure my time

has expired.

Ms. WATSON. These are issues that we have been dealing with

for decades, and I am looking at the industries that produce these

foods, fast foods in particular, and in certain areas in my district

you can go into one block and you could find five or six fast foods,

particularly fried chicken. We have new donut shops now, nothing

but oil, dough, carbohydrates. And our kids whose parents are not

in the home, homes most often are dysfunctional, will have breakfast in the morning, a donut and a Pepsi, a donut and a Coke. That

is their breakfast. So what I see is a partnership.

At least we have labeling now, and in a lot of the restaurants

they tell you what is in the food and how it is prepared somewhat.

But they are, I think, attractive nuisances. What can we do to

bring the food production industry, our educational services, our

health services together on this and not appear too heavy-handed

with it?

But we are going to have to do a better job somewhere along this

way of educating people, and I don’t think a pill is the answer, because naturally our body will digest and use the fats it needs and

get rid of the others. But the problem is how do our children in today’s world really know how to use that Pyramid. I remember, and

I am talking about another life when I went to school, that it was

emphasized; now we hardly mention it. So anyone want to speak

to that?

103

Mr. DOWNEY. If I could. I think we have to take drug development as a serious tool here. We are accustomed to using this to

control things like cholesterol, to control hypertension. And if we

did have an array of several, five or six kinds of medications like

we have for diabetes, hypertension and the like, we could get a lot

of these problems under control and not have the higher expenses

that come from leaving it untreated. So I look at this as just another chronic disease. Drug medications are a common way that we

approach these.

And while the environmental activities, areas like you have

touched on, are extremely interesting, we have around the world

really kind of natural experiments going on, countries that are

changing from one kind of lifestyle more to a western lifestyle;

maybe they don’t have television advertising, maybe they don’t

have vending machines. We really don’t know what is happening

there in terms of whether those are influencers, controllers on obesity or not.

Since you raised it, I will mention about the fast food franchises

in particularly low-income minority areas. I don’t have the figures

in front of me, but I came across information a few years ago that

for the Small Business Administration this is a major part of their

whole economic development program in many minority areas. So

the article I read indicated that this is what the SBA was largely

doing with its minority economic development program, was supporting these franchises in these economically depressed communities that provided a lot of jobs and income.

So the issues become a lot tougher to tease out. And while we

talk about food advertising, we also have a situation that Congress,

as is true in virtually every western democracy, heavily subsidizes

the agricultural industry. We produce twice as many calories per

person per day as we need in this country. This creates great demands. We can increase portion sizes without really taking in the

cost of food very much; it puts a premium on advertising and marketing to get market share, etc.

I know Dr. Wadden and I have talked about these a lot, and he

is an expert in these. These are tradeoffs. These things were developed to create obesity, but our whole society is really geared to reducing physical activity. We have engineered physical activity out

of our time. We are trying to increase production so American

workers are now working longer, harder, more productively than

ever before. We are using technology where we didn’t just 5 or 10

years ago. And these are all creating this environment or lifestyle.

It is very hard for an individual to change that; that is the environment that we are all in.

Ms. WATSON. Well, we sit here and we talk about the problem,

and I kind of hear an acceptance of the problem. I am hoping from

you to hear more about how we then resolve these problems for the

future. The free market is going to continue to produce its goods

as long as they are meeting a profit; however, we worry about the

physical health of Americans and what we can do and what policies

we can set, and I do hope that we can hear back from you as to

how you can help us guide policy that would improve the health

of Americans.

Mr. BURTON. Thank you, Ms. Watson.

104

Well, let me just say you have been a very interesting panel. I

really appreciate the illumination of a lot of the issues that I

wasn’t familiar with. One thing that I noticed, Mr. Shipman, I

didn’t ask you a question, but you and the young lady next to you

there, Ms. Kretser—is it Kreetser?

Ms. KRETSER. Kretser.

Mr. BURTON. Kretser. Excuse me, I am sorry.

I think one of you indicated that the Food Processors Association produces about $500 billion a year in product. So it is a very, very

large industry in this country. I don’t know how much of that they

utilize for advertising or for public service announcements, but I

would just like to suggest that maybe in the process of developing

new and better foods that will help solve this problem, that they

might be able to do some advertising which will help in that direction and use just a few of those dollars to educate the public so

that we can maybe enlist their help to solve the problem. Government can’t do it all.

Dr. Wadden asked for $400 million more. We have a huge budget

deficit right now. We have a war we are fighting in Iraq. We have

the war against terrorism. We have to increase our intelligence activities, the CIA and FBI, to protect the American people against

an attack by terrorists. So we don’t have the luxury of being able to put an extra $400 million or $500 million here or $5 billion there, or whatever it happens to be. But the industry that produces these products, and does

in a way contribute to the problem, could be a big help to us by

educating the public through their advertising and through public

services announcements, as well as coming up with new products

that taste good.

I would love to sit down and watch a football game where I could

eat to my heart’s content and not get fat. Right now I can’t do that.

But if you guys come up with something, I will buy that product

day and night.

With that, thank you very much for being here. We really, really

appreciate it.

We stand adjourned. We will have another hearing on this in the

future.

[Whereupon, at 3:55 p.m., the subcommittee was adjourned.]

[The prepared statement of Hon. Elijah E. Cummings and additional information submitted for the hearing record follow:]

105

106

107

108

109

110

111

Æ