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HEARING TO EXAMINE NEW AND INNOVATIVE 

WAYS TO IMPROVE NUTRITION AND 

WELLNESS PROGRAMS

HEARING

BEFORE THE

SUBCOMMITTEE ON DEPARTMENT OPERATIONS, 

OVERSIGHT, NUTRITION, AND FORESTRY

OF THE

COMMITTEE ON AGRICULTURE 

HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS

FIRST SESSION

AUGUST 5, 2009, LINCOLN, NE

Serial No. 111–28

(

Printed for the use of the Committee on Agriculture 

agriculture.house.gov 

COMMITTEE ON AGRICULTURE 

COLLIN C. PETERSON, Minnesota, Chairman 

TIM HOLDEN, Pennsylvania, 

Vice Chairman 

MIKE MCINTYRE, North Carolina 

LEONARD L. BOSWELL, Iowa 

JOE BACA, California 

DENNIS A. CARDOZA, California 

DAVID SCOTT, Georgia 

JIM MARSHALL, Georgia 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HENRY CUELLAR, Texas 

JIM COSTA, California 

BRAD ELLSWORTH, Indiana 

TIMOTHY J. WALZ, Minnesota 

STEVE KAGEN, Wisconsin 

KURT SCHRADER, Oregon 

DEBORAH L. HALVORSON, Illinois 

KATHLEEN A. DAHLKEMPER, 

Pennsylvania 

ERIC J.J. MASSA, New York 

BOBBY BRIGHT, Alabama 

BETSY MARKEY, Colorado 

FRANK KRATOVIL, JR., Maryland 

MARK H. SCHAUER, Michigan 

LARRY KISSELL, North Carolina 

JOHN A. BOCCIERI, Ohio 

SCOTT MURPHY, New York 

EARL POMEROY, North Dakota 

TRAVIS W. CHILDERS, Mississippi 

WALT MINNICK, Idaho 

FRANK D. LUCAS, Oklahoma,

Ranking Minority Member 

BOB GOODLATTE, Virginia 

JERRY MORAN, Kansas 

TIMOTHY V. JOHNSON, Illinois 

SAM GRAVES, Missouri 

MIKE ROGERS, Alabama 

STEVE KING, Iowa 

RANDY NEUGEBAUER, Texas 

K. MICHAEL CONAWAY, Texas 

JEFF FORTENBERRY, Nebraska 

JEAN SCHMIDT, Ohio 

ADRIAN SMITH, Nebraska 

ROBERT E. LATTA, Ohio 

DAVID P. ROE, Tennessee 

BLAINE LUETKEMEYER, Missouri 

GLENN THOMPSON, Pennsylvania 

BILL CASSIDY, Louisiana 

CYNTHIA M. LUMMIS, Wyoming 

PROFESSIONAL STAFF

ROBERT L. LAREW, Chief of Staff 

ANDREW W. BAKER, Chief Counsel 

APRIL SLAYTON, Communications Director 

NICOLE SCOTT, Minority Staff Director 

SUBCOMMITTEE ON DEPARTMENT OPERATIONS, OVERSIGHT, NUTRITION, AND

FORESTRY

JOE BACA, California, Chairman 

HENRY CUELLAR, Texas 

STEVE KAGEN, Wisconsin 

KURT SCHRADER, Oregon 

KATHLEEN A. DAHLKEMPER, 

Pennsylvania 

TRAVIS W. CHILDERS, Mississippi 

JEFF FORTENBERRY, Nebraska,

Ranking Minority Member 

STEVE KING, Iowa 

JEAN SCHMIDT, Ohio 

CYNTHIA M. LUMMIS, Wyoming 

LISA SHELTON, Subcommittee Staff Director

(II) 

(III)

C O N T E N T S 

Page 

Baca, Hon. Joe, a Representative in Congress from California, opening statement ...................................................................................................................... 1

Prepared statement .......................................................................................... 3

Fortenberry, Hon. Jeff a Representative in Congress from Nebraska, opening 

statement .............................................................................................................. 4

WITNESSES

Sitorius, M.D., Michael A., Waldbaum Professor of Family Practice, Professor 

and Chair, Department of Family Medicine, University of Nebraska Medical 

Center, Omaha, NE ............................................................................................. 7

Prepared statement .......................................................................................... 10

Yaroch, Ph.D., Amy L., Executive Director, Center for Human Nutrition, 

Omaha, NE ........................................................................................................... 14

Prepared statement .......................................................................................... 16

Russel, Kimberly A., President and CEO, BryanLGH Health System, Lincoln, 

NE ......................................................................................................................... 18

Prepared statement .......................................................................................... 20

Edwards, M.B.A., M.S., R.D., Pamela J., Assistant Director, Dining Services, 

University of Nebraska-Lincoln; President-Elect, Nebraska Dietetic Association, Lincoln, NE .................................................................................................. 21

Prepared statement .......................................................................................... 23

Sensor, Wayne, President and CEO, Alegent Health, Omaha, NE ..................... 36

Prepared statement .......................................................................................... 38

Williamson, M.D., M.S., Blake J., Vice President and Senior Medical Director, 

Blue Cross and Blue Shield of Kansas City, Kansas City, MO ....................... 39

Prepared statement .......................................................................................... 41

Supplemental material ..................................................................................... 77

Lommel, Marsha, President and CEO, Madonna Rehabilitation Hospital, Lincoln, NE ................................................................................................................ 43

Prepared statement .......................................................................................... 44

Supplemental material ..................................................................................... 90

Fosdick, F.A.C.H.E., Glenn A., President and CEO, Nebraska Medical Center, 

Omaha, NE ........................................................................................................... 47

Prepared statement .......................................................................................... 51

Heinen, M.P.P., LuAnn, Vice President, National Business Group on Health; 

Director, Institute on the Costs and Health Effects of Obesity, Washington, 

D.C. ........................................................................................................................ 56

Prepared statement .......................................................................................... 60

SUBMITTED MATERIAL

Janda, Dr. David, submitted material ................................................................... 75

(1)

HEARING TO EXAMINE NEW AND INNOVATIVE 

WAYS TO IMPROVE NUTRITION 

AND WELLNESS PROGRAMS 

WEDNESDAY, AUGUST 5, 2009

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON DEPARTMENT OPERATIONS, 

OVERSIGHT, NUTRITION, AND FORESTRY, 

COMMITTEE ON AGRICULTURE

Lincoln, NE. 

The Subcommittee met, pursuant to call, at 10:00 a.m., at the 

Madonna ProActive Gymnasium, 7111 Stephanie Lane, Lincoln, 

Nebraska, Hon. Joe Baca [Chairman of the Subcommittee] presiding. 

Members present: Representatives Baca and Fortenberry. 

Staff present: Jamie W. Mitchell 

OPENING STATEMENT OF HON. JOE BACA, A 

REPRESENTATIVE IN CONGRESS FROM CALIFORNIA 

The CHAIRMAN. I’d like to call the hearing of the Subcommittee 

on Department Operations, Oversight, Nutrition, and Forestry together to order to examine new and innovative ways to improve nutrition and wellness programs. 

I’ll begin my opening statements. I’ll first introduce myself, and 

then I’ll defer to Jeff Fortenberry, Congressman. 

I’m Congressman Joe Baca, Chairman of the Subcommittee, and 

I’d like to welcome each and every one of you to this hearing on 

improving nutrition and wellness. This is not about the health bill. 

I just wanted to remind everyone in the audience of that. I’m 

pleased to be here with my friend and colleague, Jeff Fortenberry, 

to learn about some of the innovative ways communities and businesses are working to improve the nutrition and health of Americans. 

I’d like to thank Mr. Fortenberry and his staff, who’ve done a tremendous job putting together an impressive list of witnesses with 

experience in ways to promote healthy lifestyles and prevent lifelong disease, and I really want to say to Congressman Fortenberry, 

thank you for bringing Washington, D.C., to Lincoln, Nebraska. We 

believe that this is making history, because I don’t believe we’ve 

had a hearing right here in Lincoln, Nebraska, so I want to thank 

you for being a part in respecting concerns for Nebraska and the 

citizens of this area in saying that it’s time that Washington came 

to Lincoln, Nebraska, instead of Washington—instead of Lincoln, 

Nebraska, going to Washington, so we’re now here. 

2

This is a topic of great interest to me, as a legislator, of course, 

but also as a husband, father, grandfather, and community member. I’m quite active and care a lot about this particular subject as 

an individual that believes that we can increase the quality of life 

through wellness and nutrition and appropriate diet, and, of 

course, I see the gym and the activities that you have here. And 

back in Washington, D.C., I do a lot of bipartisan exercise; and we 

play a lot of basketball. 

We play basketball and we play golf. I think it’s good for a lot 

of us. Any form of activity is good in terms of wellness, and then, 

of course, fresh fruits and vegetables and eating right is important 

to a lot of us. In my district, I come from the San Bernardino area. 

It’s similar to Lincoln in terms of size, but we also have something 

else in common, and that’s in terms of health and welfare of our 

communities. 

I’d like to state some of the statistics that point out how much 

we have in common between Lincoln, Nebraska, and San 

Bernardino. According to the Census Bureau, the rate of diabetes 

in Lincoln County and San Bernardino County are not too far 

apart. We’re basically about the same. Diabetes impacts a lot of us 

when we look at diabetes and obesity and its impact on our nation 

and our country and especially the cost factors that we’ll hear 

about from some of the witnesses here. 

Over the last 4 years, this Subcommittee and the House Agriculture Committee, as a whole, has built a record that links the importance of nutrition and health, and I think we can look at nutrition and health and how it’s tied together. In the 2008 Farm Bill, 

we provided a record level of funding for nutrition and for safety 

net programs like SNAP versus the old food stamps. 

We also included a provision to make sure good nutrition is 

available to all 50 states in the schools. Before the bills passage, 

the SNACK program was only available in 14 states. It’s important 

we have good nutritional programs in our schools because a 

healthy body in school also leads to productivity in terms of learning, the ability to progress, and the attitudes and behavior within 

the classroom as well. 

I wanted to stress that we included in the farm bill healthy eating by funding pilot programs that encourage the consumption of 

more fruits and vegetables, especially in America’s schools. 

Last year in July this Subcommittee heard testimony on the economic costs of poor nutrition in the United States. 

Researchers detailed that hunger costs our country $90 billion 

per year in lost work productivity, the need for special education, 

and other factors. Also testimony from California Advocates demonstrated how a lack of participation in Federal nutrition programs 

means lost revenues to California, and that probably applies right 

here in Nebraska, as well. Whether it’s a senior, disabled or youth, 

we should take advantage of Federal dollars that come back to the 

state, the counties, and the cities. 

That revenue then can be utilized in nutritional programs that 

are available, especially for a lot of our veterans, disabled and 

other individuals like seniors. That’s money we’re all losing because we’re not using it, yet it’s available from the Federal Government. We need to take advantage of these programs to help stimuVerDate 0ct 09 2002 15:21 Jul 16, 2010 Jkt 041481 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 I:\DOCS\111-28\53492.TXT AGR1 PsN: BRIAN
3

late and get over the negative stigma of being on food stamps for 

nutrition, and I’m an example. I was on food stamps. 

But it’s about a healthy body, it’s about nutrition, it’s about 

wellness, and it’s about living longer. It’s important we look at 

these other programs, and I’m sure that Congressman Fortenberry 

and others realize it’s important in the State of Nebraska to help 

individuals that need food during this time of a slow economy. 

In March of this year, the Subcommittee took on the topic of obesity. We had a hearing in Washington, D.C., on obesity and, the 

cost to the nation. Roughly $75 billion is spent on obesity each 

year, so that’s a direct correlation when we look at, obesity what 

it means to us. With indirect costs, it goes as high as $173 billion 

per year. 

You can imagine using that money for other programs, and what 

it could mean to us, as taxpayers, and within our communities. 

That’s why I really appreciate what Congressman Fortenberry is 

doing now in bringing this kind of awareness to Nebraska. 

And I’m encouraged when I look back here to my left and I see 

the gym out here and the people exercising. 

What you’re doing here is very positive. It’s estimated that the 

cost of obesity and being overweight could range from $860 billion 

to $956 billion by the year 2030, so when you look at those figures, 

that’s a high cost. Who’s going to pay? We, the taxpayers, are going 

to pay if we don’t do something in that area. 

The average American today is 23 pounds overweight. This burden is a major factor in the skyrocketing health costs. I indicated 

that research that’s been done in that area tells us what it costs 

on a daily basis. This accounts for about ten percent of all the 

health spending in America and is more than double the amount 

spent on obesity-related issues over a decade ago. Make no mistake: we must find real solutions to the obesity epidemic if we are 

to protect the economic and physical health of the American people, 

and this is what this hearing is about here today, Washington, D.C. 

is making history in Lincoln, Nebraska. 

With that I’m excited to be here with a friend. I know he’s a 

strong advocate. He’s legitimate. I know he practices what he 

preaches. It’s important that we’re practicing the practices we are 

preaching, and Congressman Fortenberry is practicing what he is 

preaching, because he is physically active working out in the gym 

every day. He knows what it means to him and what it means to 

the citizens of Nebraska and Lincoln and the district he represents. 

With that I want to thank you for being here and the witnesses 

who have agreed to be here today, and I look forward to hearing 

your testimony. 

[The prepared statement of Mr. Baca follows:]

PREPARED STATEMENT OF HON. JOE BACA, A REPRESENTATIVE IN CONGRESS FROM

CALIFORNIA

Thank you all for being here today. 

I am pleased to be here in Lincoln with my friend and colleague, Jeff Fortenberry, 

to learn about some of the innovative ways communities and businesses are working 

to improve the nutrition and health of Americans. 

Mr. Fortenberry and his staff have done a tremendous job of putting together an 

impressive list of witnesses with experience in ways to promote healthy lifestyles 

and prevent lifelong disease. 

4

This is a topic of great interest to me as a legislator, of course—but also as a husband, father, grandfather, and community member. 

By way of introduction, I am from San Bernardino County, California, an area 

not too far outside of Los Angeles. 

And, while the District I represent is a much different in geography and demographics than here in Lincoln, we share a common interest in the long term health 

and welfare of our communities and our nation. 

And, some of the statistics I’ve read point out how much we have in common. 

According to data from the Census Bureau, the rate of diabetes in Lincoln County, 

and San Bernardino County are not too far apart. 

Just over seven percent for Lincoln, and just under seven percent for San 

Bernardino. 

Over the past 4 years, this subcommittee, and the House Agriculture Committee 

as a whole, has built a record that links the importance of nutrition and health. 

In the 2008 farm bill, we provided record levels of funding for nutrition for safety 

net programs like SNAP and food banks. 

We also made important changes that promote healthy eating, by funding pilot 

programs that encourage the consumption of more fruits and vegetables, especially 

in America’s schools. 

Last year, in July, this Subcommittee heard testimony on the economic costs of 

poor nutrition in the United States. Researchers detailed that hunger costs our country $90 billion per year in lost 

work productivity, the need for special education, and other factors. 

Also, testimony from California Advocates demonstrated how a lack of participation in Federal nutrition programs means lost revenues to California counties. 

This compounds the costs of hunger and poor nutrition. 

In March of this year, the Subcommittee took on the topic of obesity in the U.S. 

Experts from the Centers for Disease Control and Prevention testified that both 

nutrition education and a lack of access to healthy foods contribute to the obesity 

epidemic. 

Obesity—and with it the subsequent increase in diabetes—continue to be growing 

problems in America. 

More than 2⁄3 of American adults are either overweight or obese. 

The average American today is 23 pounds overweight. 

This burden is a major factor in the skyrocketing health care costs of the past 

2 decades. 

Research released just last week shows us that medical spending averages $1,400 

more a year for an obese person than someone who is normal weight. Overall, obesity related health spending reached $147 billion in 2008! 

This accounts for 10% of all the health spending in America, and is more than 

double the amount spent on obesity related issues only a decade ago. 

Make no mistake—we must find real solutions to the obesity epidemic if we are 

to protect the economic and physical health of the American people! 

I am excited to be here today—to hear about ways to improve health, and at the 

same time save America hundreds of billions of dollars as we move forward. 

It is quite possible that some of the successes here in Nebraska can be used as 

models for improving Federal policies across the country. 

Again, my thanks to you and your staff, Mr. Fortenberry, and to everyone who 

has been so kind and helpful in putting this hearing together. 

Special thanks to the fine witnesses who have agreed to be here today and to 

share their expertise with us. 

I look forward to your testimony. 

And, with that, I will turn things over to Mr. Fortenberry..

THE CHAIRMAN. So at this time I would like to turn it over to 

Congressman Fortenberry. 

OPENING STATEMENT OF HON. JEFF FORTENBERRY, A 

REPRESENTATIVE IN CONGRESS FROM NEBRASKA 

Mr. FORTENBERRY. Thank you. First, let me thank Chairman 

Baca for his willingness to hold this hearing in Lincoln, Nebraska. 

We’re very honored that you would travel to our home, Lincoln, 

here to make history, as you said, and to review the important 

issues of nutrition, health and wellness. Congressman Baca made 

mention that he enjoys sports. He’s being a little bit humble in that 

statement. We recently had a Congressional baseball game, and 

5

you’re looking at the winning pitcher of that game. Now, he revealed to me—and I don’t think he’ll mind me saying this publicly—that he’s 62 years old, and he was clocked at throwing between 62 and 72 miles per hour, so congratulations, Mr. Chairman. 

I’d also like to give a little bit of background on our Chairman. 

He has served in Congress since 1999, and he is a Representative 

of the 43rd District of California which, as he mentioned, is the 

San Bernardino Valley in the southern area of the state. He is 

Chairman of this Subcommittee, which is an agriculture Subcommittee on Department Operations, Oversight, Nutrition, and 

Forestry, and I am the Ranking Member of the Subcommittee. 

Chairman Baca formerly served in the United States Army as a 

paratrooper from 1966 to 1968, and following his military service 

he earned a degree in sociology from the California State University of Los Angeles and then for 15 years worked in community relations with General Telephone and Electric. He has served both in 

the California State Assembly and its state Senate, and he now 

lives in Rialto with his wife of 41 years. They have four children, 

and his son is the new Mayor of Rialto, California, so, again, congratulations. 

I’d also like to thank Marsha Lommel, who is the CEO of Madonna and Madonna ProActive, for allowing us to hold the hearing 

today. I called Marsha, and, of course, this is a wonderful new facility that augments the extraordinary services that Madonna Hospital provides, and we thought it would be somewhat creative, 

given the topic of today’s hearing on nutrition and wellness and 

health, to place us in the center of some very innovative activity 

that is going on in that regard. So, Marsha, thank you very much 

for your generosity in opening this facility. It’s absolutely lovely. 

I also wish to thank the witnesses who are here today. For those 

of you in the audience who can stay with us, we actually have two 

panels, nine persons, testifying who are all experts in the various 

areas of health and wellness, nutrition and health care, so I invite 

you to stay for our entire discussion, but I certainly understand if 

you need to leave. Throughout the country we are engaged in a 

very important debate about the directions of our nation’s 

healthcare system. 

The debate is critical to the well-being of families and small business and to all of us, as American citizens, and I believe our deliberations must be very thoughtful and center on two essential questions: How do we improve healthcare outcomes and reduce costs 

while protecting vulnerable persons? And one important piece of 

the solution is to understand that a major driver of our ever increasing healthcare costs is the rise of chronic diseases. As alluded 

to by the Chairman, we are seeing an epidemic in chronic diseases 

across the country. 

Public health statistics and economic data show that 75 percent 

of all healthcare spending in the country—and that’s about $2.2 

trillion of total amount of healthcare spending—is related in some 

way to treating lifestyle-related chronic conditions. Seven out of 

every ten deaths in the country are caused by chronic conditions. 

The top four killers are heart disease, diabetes, cancer, and strokes, 

and these are largely related to lifestyle. They could be potentially 

6

prevented or certainly better managed and, in some cases, even reversed through healthy lifestyle changes. 

But, sadly, according to recent statistics the average American is 

now 23 pounds overweight. Obesity among young people has tripled since 1980. Obesity is a major risk factor that leads to the 

onset of those described chronic conditions. I believe as a result it 

is imperative that our healthcare system promote incentives for 

healthy nutrition practices and wellness, and we must foster a culture of wellness and reward behaviors that reduce the onset of 

these diseases. 

I believe that billions, if not hundreds of billions, of dollars could 

be saved if we reduced or at least delayed their onset, and as responsible individuals and citizens, I hope that we will personally 

implement wellness and preventive measures that can reduce our 

risk factors for these conditions. And, similarly, I support a paradigm shift in the practice of medicine in our country. We pay doctors to fix or cut or prescribe. I think it’s time we pay doctors to 

prevent as well. 

So these are all reasons that we are gathering at the hearing 

today, and as Ranking Member of this Subcommittee, I’m personally committed to exploring the ways in which good nutrition happens and wellness principles promote policy that support chronic 

disease prevention efforts. I’m eager to hear from our experts who 

are here today from across the state and the Midwest to speak on 

these topics, as well as to hear their suggestions as to what is 

working and what could be potentially duplicated throughout the 

country to promote this culture of wellness and chronic disease prevention. 

Again, Mr. Chairman, it is a privilege to have you join us, a real 

honor for you to be here in the First Congressional District. I want 

to thank you again for holding this hearing, and I look forward to 

the insights that we will learn today together. Thank you. 

The CHAIRMAN. Thank you very much. At this point we’ll begin 

with the first panel that will address obesity and chronic illness 

and nutrition. 

I’ll welcome them, and I’ll start by having our Congressman, 

your Congressman, introduce each one of the panelists. Each one 

of you will have 5 minutes. The light will go on. Don’t panic. Continue to do your presentation even if the light goes on. We’ll allow 

you to go through that process. 

And if you were in D.C., we would hit the gavel and tell you, 

time is up for your statement, and it’s a little bit more flexible here 

in that process. We’ll allow you to go through the presentation you 

have so we can hear from you. So with that Congressman 

Fortenberry, again, will introduce the first panelists, and then 

you’ll begin. 

Mr. FORTENBERRY. Thank you, Mr. Chairman. Our first witness 

is Dr. Michael Sitorius. He is the Chairman of the Department of 

Family Medicine at the University of Nebraska Medical Center in 

Omaha. He is also a professor at the College of Medicine at the 

University of Nebraska Medical Center, and he was appointed to 

the Governor’s Rural Health Advisory Commission, so welcome, 

Doctor. I’ll introduce you all. Then we’ll begin with you, Dr. 

Sitorius. 

7

Our second witness is Amy Lazarus Yaroch. She is a Ph.D., the 

Executive Director of the Center For Human Nutrition in Omaha. 

Ms. Yaroch has led skin cancer research at the National Cancer Institute and National Institutes of Health, so welcome as well. 

Our third witness is Kim Russel, the President and CEO of 

BryanLGH Health System in Lincoln. Ms. Russel has formerly 

served as president and CEO of another institution in Iowa and before that served as Chief Operating Officer of a hospital in Kansas. 

She is a fellow of the American College of Healthcare Executives, 

currently serves on the board of directors for the Lincoln Partnership of Economic Development and the Lincoln Medical Education 

Partnership, so welcome, Ms. Russel. 

Our fourth and final witness for panel one is Pam Edwards, a 

registered dietitian, and she is the President elect of Nebraska Dietetic Association. She is also the Assistant Director of the University Dining Services at the University of Nebraska in Lincoln. 

So, again, thank you all for taking time. We look forward to your 

testimony. Dr. Sitorius. 

STATEMENT OF MICHAEL A. SITORIUS, M.D., WALDBAUM

PROFESSOR OF FAMILY PRACTICE, PROFESSOR AND CHAIR, 

DEPARTMENT OF FAMILY MEDICINE, UNIVERSITY OF

NEBRASKA MEDICAL CENTER, OMAHA, NE 

Dr. SITORIUS. Thank you, Chairman Baca and Representative 

Fortenberry for permitting me this opportunity to testify before 

this Subcommittee about the relevance and importance of promoting proper wellness and nutrition practices. 

My name is Michael A. Sitorius. I’m the Waldbaum Professor of 

Family Practice and Chair of the Department of Family Medicine 

at the University of Nebraska Medical Center. I’m testifying today 

about an issue I feel is critical to the effective delivery of health 

care in America: The coordinated promotion of proper lifestyle and 

nutrition practices in the prevention and treatment of chronic illnesses. During 30 years as both a practicing family physician and 

educator of future physicians, physician assistants, nurse practitioners, and other medical practitioners, I have witnessed firsthand 

a significant increase in the presentation of chronic illness among 

my patients. 

Indeed, my personal experience seems to reflect a national trend. 

Over 125 million people in the United States currently experience 

at least one chronic illness, and over half of those 125 million have 

two or more chronic illnesses. Fifty percent of these chronic illnesses are attributable to five causes: Asthma, diabetes, high blood 

pressure, coronary artery disease, and depression are seen on a 

typical day in my office. Of the remaining 50 percent, a substantial 

portion are related to cancers and osteoporosis that are nutrition 

related. 

Annually, chronic illness is the leading cause of disability and 

death in the United States, exacting enormous tolls on the American population, both in human and economic terms. In a recently 

published health affairs on-line study, July 29, 2009, the CDC reported 973,000 deaths attributable to chronic illnesses up to that 

date. 

8

Chronic illness is not a discrete medical disorder displaying specific symptoms. It is an injury, illness or condition with long duration with no predictable end date that does not require immediate 

hospitalization but is likely to require frequent treatment. Research indicates that poor nutrition and an inactive lifestyle increases one’s likelihood of experiencing one of these chronic illnesses. This suggests that care including implementation of lifestyle modifications and nutrition may be effective in reducing the 

risk of acquiring a chronic illnesses and in treating those that are 

present. 

Obesity has long been associated with poor nutrition and inactive 

lifestyle and is associated with cardiovascular, expiratory, inspiratory. 

According to Health Affairs (July 2009), the cost of health care 

related to obesity rose from $78.5 billion in 1998 to over $147 billion in 2008. Incidentally, 18 percent of the U.S. population in 1998 

was considered obese; 25 percent in 2008. Further, 23 states report 

a rising level of obesity in 2008, and over 30 states report a 30 percent child obesity rate. 

Dr. Risa Lavizzo-Mourey, President and CEO of Robert Woods 

Johnson Foundation, has expressed that a key to any healthcare 

reform is a solution to the epidemic of child obesity. I totally agree 

with that statement, but would add that addressing the rise in 

adult obesity is equally important in creating effective healthcare 

reform. 

The solution to obesity and the solution to caring for chronic illness both require the implementation of more effective methods of 

directing lifestyle, but identifying a need for more efficient care of 

chronic illness belies the complexity underlying these forms of illness and the related care. 

Of the five general factors affecting health status, only 1⁄10 of an 

individual’s health status is accounted for by medical care. Overwhelmingly, a person’s health status is determined by social, genetic and behavioral factors. Indeed, the largest contributor to personal health status is behavioral decisions. Unfortunately, the current healthcare system allows for practitioners to do little more 

than admonish patients to ‘‘stop smoking,’’ ‘‘adjust your diet,’’ or 

‘‘engage in regular exercise.’’ Truthfully, while recognized as important factors of health status, the current healthcare system is not 

designed to effectively promote proper wellness and nutrition practices among patients who are either preventing or suffering from 

chronic illnesses. 

I believe the explanation as to why medical care accounts for 

such a small percentage of the factors influencing health care is directly related to this inability to properly promote healthy lifestyle 

choices and is the result of a healthcare model that is essentially 

reactive in nature. The current priority in medical education and 

care is the assessment and treatment of acute and episodic conditions and not the underlying chronic illness. While providing immediate relief of a patient’s distress, this model does little to address 

the needs of the patient. 

One might say that knowing the description of chronic illness, 

the solution should be simple: Treat the underlying disease. InVerDate 0ct 09 2002 15:21 Jul 16, 2010 Jkt 041481 PO 00000 Frm 00012 Fmt 6633 Sfmt 6601 I:\DOCS\111-28\53492.TXT AGR1 PsN: BRIAN
9

deed, it’s not that simple. There are three reasons why I feel this 

solution is improbable under the current healthcare system. 

The first constraint limiting the effective treatment chronic illness is the limited training and familiarity most healthcare professionals have with monitoring and supporting patients with chronic 

illness. The limited abilities of practitioners to monitor and support 

patients is an extension of the lack of coordinated office systems 

designed to monitor and support clinical decisions. 

Second, even in systems that provide protocols for physicians to 

follow when dealing with chronic illness, the time constraints current systems place on physician-patient interaction simply do not 

allow comprehensive care. Indeed, the system promotes treatment 

of periodic symptom care as opposed to prevention because it can 

be dealt with more quickly. 

Third, current reimbursement systems favor episodic treatment 

over preventive treatments, which may span extensive time. 

These three factors pose significant barriers to the effective treatment of chronic illness; however, in dealing with these factors, I believe we should look towards creating a healthcare system that is 

proactive and team oriented. 

When I use the terms ‘‘proactive’’ and ‘‘team oriented,’’ I have a 

very specific model in mind. That is the Patient Centered Medical 

Home, which consists of six components: A personal physician, physician directed medical care; whole person orientation; coordinated 

and integrated care, a team approach; quality and safety as the 

cornerstones; enhanced access; and payment reform. 

This system favors cumulative care plans versus single interventions, a coordinated comprehensive care in multiple venues over 

time. This system would provide care providers with clearly defined 

protocols, IT support to facilitate real-time communication, evaluation feedback, and educational information between patients, physicians, and the patients’ community. 

With increased guidance and support both within the clinical and 

community settings, physician-directed lifestyle modifications shall 

become the heart of a proactive healthcare system aimed at decreasing the incidence of chronic disease and treating those that 

exist. The natural products of a more efficient and proactive 

healthcare system could include both increases in health and satisfaction and a decrease in overall healthcare cost. 

I hope that my words today emphasize my belief that lifestyle 

modifications such as nutrition and physical activity are the center 

of a more effective healthcare system. I hope to impress upon you 

the systematic approach to coordinating and effectuating communication and treatment between physician, patient and community, 

which creates a successful physician-patient partnership provided 

by the Patient Centered Medical Home, is one way to create an environment in which physicians may influence behavioral, social and 

environmental factors affecting health status. Thank you. 

[The prepared statement of Dr. Sitorius follows:]

10

PREPARED STATEMENT OF MICHAEL A. SITORIUS, M.D., WALDBAUM PROFESSOR OF

FAMILY PRACTICE, PROFESSOR AND CHAIR, DEPARTMENT OF FAMILY MEDICINE, UNIVERSITY OF NEBRASKA MEDICAL CENTER, OMAHA, NE 

Thank you Chairman Baca and Representative Fortenberry for permitting me this 

opportunity to testify before this subcommittee about the relevance and importance 

of promoting proper wellness and nutrition practices from a medical care provider’s 

perspective. 

My name is Dr. Michael A. Sitorius. I am the Waldbaum Professor of Family 

Practice and Chair of the Department of Family Medicine at the University of Nebraska Medical Center. I am testifying today about an issue I feel is critical to the 

effective delivery of healthcare in America: the coordinated promotion of proper lifestyle and nutrition practices in the prevention and treatment of chronic illness by 

medical care providers. During thirty years as both practicing family physician, and 

educator of future family physicians, physician assistants, nurse practitioners, pharmacists, nurses, and registered dietitians, I have witnessed first hand a significant 

increase in the presentation of chronic illness among patients. Indeed, my personal 

experience seems to reflect a national trend. Over 125 million people in the United 

States currently experience at least one chronic illness and over half of this population is afflicted by two or more chronic illnesses. Fifty percent of these chronic illnesses are attributable to five causes: asthma, diabetes, high blood pressure, coronary artery disease, and depression. Of the remaining 50 percent of chronic illnesses 

a substantial percent are attributable to breast, endometrial, colon and prostate 

cancers; and osteoporosis. 

Annually, chronic illness is the leading cause of illness, disability, and death in 

the United States and exacts enormous tolls on the American population both in 

human and economic terms. As of July 9, 2009 the CDC reports 973,000 deaths attributable to chronic illness this year. 

Chronic illness is not a discrete medical disorder displaying specific symptoms. 

The term chronic illness defines an injury, illness, or condition expected to be of long 

duration with no predictable end-date that does not require immediate hospitalization but is likely to require regular periodic care or treatment. Research indicates 

that poor nutrition and an inactive lifestyle increase one’s likelihood of experiencing 

one of these chronic illnesses. This suggests that care including implementation of 

simple lifestyle modifications may be effective in reducing the risk of acquiring a 

chronic illness and in treating those that are present. 

Obesity has long been associated with poor nutrition and an inert lifestyle, and 

is associated with several cardiovascular and respiratory chronic illnesses. However, 

when one examines the incidence of obesity in America one notices a startling trend. 

According to Health Affairs (July 2009) the cost of healthcare related to obesity rose 

from 78.5 billion dollars in 1998 to 147 billion dollars in 2008. Further, at least 23 

states report a rise in adult obesity for 2008, and over thirty states report a 30 percent child obesity rate. 

Dr. Risa Lavizzo-Mourey, M.D. M.B.A., president and CEO of the Robert Woods 

Johnson Foundation has expressed that a key to any healthcare reform is a solution 

to the epidemic of child obesity. I agree with this statement, but would add that 

addressing the rise in adult obesity is equally important in creating effective 

healthcare reform. 

The solution to obesity and the solution to caring for chronic illness both require 

the implementation of more effective methods of directing lifestyle modifications between physician and patient. But identifying a need for more efficient care of chronic illness belies the complexity underlying these forms of illness and the related 

care. 

Of the five general factors affecting health status one may note that medical care 

accounts for only one tenth of an individual’s health status. Overwhelmingly, a person’s health status is determined by social, genetic, and behavioral factors which lie 

outside the scope of traditional care provision. Indeed, the largest contributor to personal health status are factors related to behavioral decisions. Unfortunately the 

current healthcare system allows for practitioners to do little more than admonish 

patients to ‘‘stop smoking’’ ‘‘adjust your diet’’ or ‘‘engage in regular exercise’’. Truthfully, while recognized as important factors of health status, the current healthcare 

system is not designed to effectively promote proper wellness and nutrition practices 

among patients suffering from chronic illness. 

I believe the explanation as to why medical care accounts for such a small percentage of the factors influencing health is directly related to this inability to properly promote healthy lifestyle choices and is the result of a healthcare model that 

is essentially reactive in nature. The current priority in medical education and care 

is the assessment and treatment of acute and episodic conditions and not the underVerDate 0ct 09 2002 15:21 Jul 16, 2010 Jkt 041481 PO 00000 Frm 00014 Fmt 6633 Sfmt 6621 I:\DOCS\111-28\53492.TXT AGR1 PsN: BRIAN
11

lying chronic illness. While providing immediate relief of a patient’s distress this 

model does little to address needs of both the patient and healthcare system in receiving and providing effective economical care. 

Now, one might say, if this description of chronic illness care is accurate the solution to both the financial and treatment burdens created by chronic illness is simple: 

address the underlying illness. Indeed, this is the simple articulation of a solution. 

However, I would like to cite three reasons why this solution is improbable under 

the current healthcare system. 

The first constraint limiting the effective treatment of chronic illness is the limited training and familiarity most health care professionals have with monitoring 

and supporting patients with chronic illnesses. The limited abilities of practitioners 

to monitor and support patients are really an extension of the lack of coordinated 

office systems designed to monitor and support clinical decisions. 

Second, even in systems that provide some protocol for physicians to follow when 

dealing with chronic illness, the time constraints current systems place on physician-patient interaction simply do not allow for the comprehensive care required by 

chronic illness. Instead, the system promotes treatment of acute and periodic symptoms of the illness which are discrete and typically dealt with more quickly. 

Third, current reimbursement systems favor episodic treatment over preventive 

treatments, which may span extensive periods of time. 

These three factors pose significant barriers to the effective treatment of chronic 

illness, and they must be dealt with if we wish to effectively address the health concerns facing this country. However, in dealing with these factors I believe we should 

look towards creating a healthcare system that is more proactive and team oriented. 

When I use the terms proactive and team oriented, I have a very specific model 

in mind. This model is the Patient Centered Medical Home (PCMH). The PCMH 

consists of six main components:

• Physician Directed Medical Care

• Whole Person Orientation

• Coordinated and Integrated care

• Quality and Safety

• Enhanced Access

• Payment Reform

This model favors the systems oriented approach to treating an underlying illness, 

which does not consist of single interventions but of cumulative care plans. This 

type of system would provide care providers with clearly defined care protocols and 

a support staff consisting of members with clearly defined roles designed to facilitate usable and affordable diagnostics at the clinical level. Further, this system 

would integrate an Information Technology (IT) support system that is patient centered, and is designed to facilitate real time communication, evaluation feedback, 

and related educational information between patient, physician, and patient’s community. 

With increased guidance and support both within the clinical and community settings, physician directed lifestyle modification suggestions will become the heart of 

a proactive healthcare system aimed at decreasing the incidence of chronic disease 

among the American population. The natural products of a more efficient and 

proactive healthcare system would include both an increase in patient satisfaction 

and a decrease in overall healthcare cost. 

While I can not provide specifics for creating this system, I can say that a systems 

oriented approach which includes both patient and community as key partners in 

the care and prevention of chronic illness will provide the support necessary to effectuate better care for chronic illness. 

I hope that my words today emphasize my belief that lifestyle modifications such 

as nutrition and physical activity are the center of a more effective healthcare system. Further, I hope to impress upon you that the systematic approach to coordinating and effectuating communication and treatment between physician, patient, 

and community, which creates a successful physician patient partnership provided 

by the PCMH, is the way to create an environment in which physicians may influence behavioral, social, and environmental factors affecting health status.

12

APPENDIX I


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14

STATEMENT OF AMY L. YAROCH, PH.D., EXECUTIVE DIRECTOR, 

CENTER FOR HUMAN NUTRITION, OMAHA, NE 

Dr. YAROCH. Congressman Baca and Congressman Fortenberry, 

thank you for this opportunity to testify. My name is Dr. Amy 

Yaroch, and I’m the Executive Director of the Center For Human 

Nutrition in Omaha, Nebraska. I’m here as a public health nutrition researcher and also as a mother of two young children who I 

would like to protect in the battle against obesity and related 

chronic diseases. I just moved to Nebraska about 4 months ago. Before that I was a Project Officer at the National Cancer Institute, 

part of the National Institutes of Health in Bethesda, Maryland. 

I’m going to talk about both of my experiences as a researcher as 

well as a Project Officer. 

Obesity, which has steadily been on the rise over the past 30 

years, is associated with several debilitating chronic diseases, including diabetes, heart disease, and many of the major cancers. 

Most cases of childhood obesity develop because of an imbalance of 

energy input and output, a phenomenon that is sustained by our 

obesogenic environment. A healthy diet which is characterized by 

an increased intake of fruits and vegetables is linked with a decreased risk of obesity and chronic diseases; but, unfortunately, 

fruit and vegetable intake is still not adequate, and most of the 

population does not consume the recommended five or more 

servings per day. 

National data show that only about one in four adults report eating five or more fruits and vegetables per day, and most people do 

not even know that they should be eating five or more a day for 

good health. 

I’m going to focus on some obesity estimates to help give you an 

idea of the great magnitude of this problem for children and adults 

alike. National data indicate that 2⁄3 of adults are overweight or 

obese and 1⁄3 of children are overweight or obese. African Americans have the highest rates of obesity, followed by Hispanics and 

then whites, and the highest rates are generally found in the South 

and Midwest compared to the West and Northeast. 

We also see high rates among American Indians. 

A recent study reported that among Native American tribes in 

North Dakota, South Dakota, Iowa, and Nebraska, a whopping 47 

percent of children and adolescents were overweight or obese. Overweight and obese children and adolescents are also more likely to 

become obese adults and die at an earlier age than their healthier 

weight peers. In addition, they are more likely to be less healthy, 

less happy, and absent from school more than their lower weight 

peers. 

Unless we act now, today’s children are likely to be the first generation to live sicker lives and die younger than their parents’ generation. I find this statement deeply troubling, especially given that 

I have two young children and how this can play out for them if 

something is not done. Rising obesity rates are attributed to many 

diet and physical activity related factors. 

A couple of diet-related factors that I would like to highlight are: 

Americans eat an average of 300 more calories than they did a 

quarter of a century ago, and these consist of less nutritious foods. 

Unfortunately, nutritious foods such as fruits and vegetables are a 

15

lot more expensive than fatty, sugary, less nutritious foods. In addition, many supermarkets have been vacating poorer more underserved communities, leaving residents who live there with limited 

or no access to healthy and affordable foods. Regrettably, these socalled food deserts have spread across the U.S. 

Financial health costs also merit discussion. 

A paper just released reported that obesity costs the country an 

estimated $147 billion a year, a number that has almost doubled 

since the last time the CDC calculated it in 1998. A main point 

that I want to raise here is that prevention is absolutely key to 

curbing the obesity epidemic and its medical and economic consequences. We are currently in the powerful position to reverse 

and/or prevent obesity and chronic diseases by improving diet and 

increasing physical activity among the U.S. population, both young 

and old, rural and urban, and white and other ethnic minority populations. 

As a Project Officer at the National Cancer Institute from 2002 

until this past March, I had the opportunity to oversee a portfolio 

of diet and obesity prevention studies. What is heartening is that 

I saw a sharp rise in the studies getting funded in the area of obesity prevention while I was at the National Cancer Institute. You 

may have heard obesity referred to as the ‘‘new tobacco,’’ and I 

think that many are beginning to truly acknowledge the extent of 

this national challenge. 

In addition, I saw a shift in the types of studies being funded 

from purely individual level approaches to those incorporating 

more environmental and policy strategies. An example of an individual level approach would be going into a classroom and telling 

children that they should eat more fruits and vegetables. This type 

of approach on its own has met with limited success, but it appears 

that combining this with other more macro level strategies, such as 

taking sugar sweetened beverages out of schools, could prove to be 

very fruitful in the long run. 

I was invited here to talk about the problem, and others will address potential solutions. However, I want to end with urging consideration of a multi-level approach in moving forward. Using a 

systems level three-pronged approach can have great promise in 

addressing obesity and chronic disease prevention. First, we know 

that the individual has been genetically programmed at an early 

age to desire fatty and sugary foods, and so we need to engage the 

individual to help provide them with the knowledge and tools to 

make healthier choices. 

Next, we need to provide a supportive environment where 

healthy eating choices are easily accessible, available, and at a low 

cost. Finally, we need to have local, state, and Federal policies in 

place to ensure that the communities in which people live, work, 

and play are indeed healthy communities. 

Thank you again for giving me the opportunity to testify, and I’d 

be pleased to answer any questions. 

[The prepared statement of Dr. Yaroch follows:]

16

1 World Cancer Research Fund/American Institute for Cancer Research, Food, nutrition, physical activity, and the prevention of cancer: a global perspective. 2007, AICR: Washington, D.C. 2 Hung, H.C., et al., Fruit and vegetable intake and risk of major chronic disease. J. NATL. CANCER INST., 2004. 96(21): p. 1577–84. 3 Key, T.J., et al., Diet, nutrition and the prevention of cancer. PUBLIC HEALTH NUTR., 2004. 

7(1A): p. 187–200. 4 Hu, F.B., Plant-based foods and prevention of cardiovascular disease: an overview. AM. J. 

CLIN. NUTR., 2003. 78(3 Suppl): p. 544S–551S. 5 Van Duyn, M.A. and E. Pivonka, Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: selected literature. J. AM. DIET. ASSOC., 2000. 100(12): p. 

1511–21. 6 Lampe, J.W., Health effects of vegetables and fruit: assessing mechanisms of action in human 

experimental studies. AM. J. CLIN. NUTR., 1999. 70(3 Suppl): p. 475S–490S. 7 Dietz, W., Childhood obesity, in Modern nutrition in health and disease, M.E. Shils, et al.,

Editors. 1999, Williams & Wilkins: Baltimore. p. 1071–80. 8 Sallis, J.F. and K. Glanz, The role of built environments in physical activity, eating, and 

obesity in childhood. FUTURE CHILD, 2006. 16(1): p. 89–108. 9 Glass, T.A. and M. McAtee, Behavioral science at the crossroads in public health: extending 

horizons, envisioning the future. SOC. SCI. MED., 2006. 7: p. 1650–71. 10 Papas, M.A., et al., The built environment and obesity. EPIDEMIOL. REV., 2007. 29: p. 129–

43. 11 Bellisari, A., Evolutionary origins of obesity. OBES. REV., 2008. 9(2): p. 165–80. 12 Maziak, W., K.D. Ward, and M.B. Stockton, Childhood obesity: are we missing the big picture? OBES. REV., 2008. 9(1): p. 35–42. 13 Blanck, H.M., et al., Trends in fruit and vegetable consumption among U.S. men and 

women, 1994–2005. PREV. CHRONIC DIS., 2008. 5(2): p. A35. 14 Stables, G.J., et al., Changes in vegetable and fruit consumption and awareness among US 

adults: results of the 1991 and 1997 5 A Day for Better Health Program surveys. J. AM. DIET. ASSOC., 2002. 102(6): p. 809–17. 15 Van Duyn, M.A., et al., Association of awareness, intrapersonal and interpersonal factors, 

and stage of dietary change with fruit and vegetable consumption: a national survey. AM. J. 

HEALTH PROMOT., 2001. 16(2): p. 69–78. 16 Marcus, A.C., et al., Increasing fruit and vegetable consumption among callers to the CIS: 

results from a randomized trial. PREV. MED., 1998. 27(5 Pt 2): p. S16–28. 17 Havas, S., et al., Factors associated with fruit and vegetable consumption among women 

participating in WIC. J. AM. DIET. ASSOC., 1998. 98(10): p. 1141–8. 18 Krebs-Smith, S.M., et al., Psychosocial factors associated with fruit and vegetable consumption. AM. J. HEALTH PROMOT., 1995. 10(2): p. 98–104. 19 Differences in prevalence of obesity among black, white, and Hispanic adults—United 

States, 2006–2008. MMWR MORB. MORTAL WKLY REP., 2009. 58(27): p. 740–4. 

PREPARED STATEMENT OF AMY L. YAROCH, PH.D., EXECUTIVE DIRECTOR, CENTER

FOR HUMAN NUTRITION, OMAHA, NE 

Congressman Baca and Congressman Fortenberry, thank you for this opportunity 

to testify about the important issue of obesity, chronic diseases, and nutrition. My 

name is Dr. Amy Yaroch and I am the Executive Director of the Center for Human 

Nutrition in Omaha, Nebraska. I am here as a public health nutrition researcher 

and also as a mother of two young children, who I would like to protect in the battle 

against obesity and related chronic diseases. I just moved to Nebraska about 4 

months ago and before that, I was a Project Officer at the National Cancer Institute, 

part of the National Institutes of Health in Bethesda, Maryland. I am going to talk 

both about my experiences as a researcher as well as a Project Officer. 

Obesity, which has steadily been on the rise over the past 30 years is associated 

with several debilitating chronic diseases including diabetes, heart disease and 

many of the major cancers. 1–6 Most cases of childhood obesity develop because of 

an imbalance in energy input and output, a phenomenon that is sustained by our 

‘‘obesogenic’’ environment 7–12. A healthy diet which is characterized by an increased intake of fruits and vegetables is linked with a decreased risk of obesity and 

chronic diseases; but unfortunately fruit and vegetable intake is still not adequate 

and most of the population does not consume the recommended five or more 

servings per day. National data show that only about one in four adults report eating five or more fruits and vegetables per day 13 and, most people do not even know 

that they should be eating five or more a day for good health. 14–18

I am going to focus on some obesity estimates to help give you an idea of the great 

magnitude of this problem for children and adults alike. National data indicate that 

2⁄3 of adults are overweight or obese and 1⁄3 of children are overweight or obese. African Americans have the highest rates of obesity, followed by Hispanics, and then 

whites and the highest rates are generally found in the South and Midwest compared to the West and Northeast 19. We also see high rates among American Indians. A recent study reported that among Native American tribes in North Dakota, 

South Dakota, Iowa, and Nebraska, a whopping 47% of children and adolescents 

17

20 Key facts about childhood obesity. 2009, Robert Wood Johnson Foundation. p. 18. 21 Olshansky, S.J., et al., A potential decline in life expectancy in the United States in the 21st 

century. N. ENGL. J. MED., 2005. 352(11): p. 1138–45. 22 F as in Fat: How obesity policies are failing in America 2009. 2009, Robert Wood Johnson 

Foundation. 23 Larson, N.I., M.T. Story, and M.C. Nelson, Neighborhood environments: disparities in access to healthy foods in the U.S. AM. J. PREV. MED., 2009. 36(1): p. 74–81. 24 Huang, T.T., et al., A systems-oriented multilevel framework for addressing obesity in the 

21st century. PREV. CHRONIC DIS., 2009. 6(3): p. A97. 25 Huang, T.T. and T.A. Glass, Transforming research strategies for understanding and preventing obesity. JAMA, 2008. 300(15): p. 1811–3. 

were overweight or obese 20. Overweight and obese children and adolescents are 

also more likely to become obese adults and die at an earlier age than their peers 

at a healthier weight. In addition, they are more likely to be less healthy, less 

happy, and absent from school more than their lower weight peers [20]. Unless we 

act now, today’s children are likely to be the first generation to live sicker lives and 

die younger than their parents’ generation 21. I find this statement deeply troubling, especially given that I have two young children and how this can play out 

for them if something is not done. Rising obesity rates are attributed to many diet 

and physical activity related factors. A couple of diet-related factors that I would 

like to highlight are: Americans eat an average of 300 more calories a day than they 

did a quarter of a century ago and these consist of less nutritious foods. Unfortunately, nutritious foods such as fruits and vegetables are a lot more expensive than 

fatty, sugary less nutritious foods 22. In addition, many supermarkets have been 

vacating poorer more underserved communities, leaving residents who live there 

with limited or no access to healthy and affordable foods. Regrettably, these socalled food deserts have spread across the U.S.23

Financial health costs also merit discussion. A paper just released reported that 

obesity costs the country an estimated $147 billion a year, a number that has almost doubled since the last time the CDC calculated it in 1998. A main point that 

I want to raise here is that prevention is absolutely key to curbing the obesity epidemic and it’s medical and economic consequences. We are currently in the powerful 

position to reverse and/or prevent obesity and chronic diseases by improving diet 

and increasing physical activity among the U.S. population, both young and old, 

rural and urban, and white and other ethnic minority populations. 

As a project officer at the National Cancer Institute from 2002 until this past 

March, I had the opportunity to oversee a portfolio of diet and obesity prevention 

studies. What is heartening is that I saw a sharp rise in the studies getting funded 

in the area of obesity prevention while I was at the National Cancer Institute. You 

may have heard obesity referred to as the ‘‘new tobacco’’ and I think many are beginning to truly acknowledge the extent of this national challenge. In addition, I 

saw a shift in the types of studies being funded from purely individual-level approaches to those incorporating more environmental and policy strategies. An example of an individual-level approach would be going into a classroom and telling children that they should eat more fruits and vegetables. This type of approach on its 

own has met with limited success but it appears that combining this with other 

more ‘‘macro’’ level strategies such as taking sugar sweetened beverages out of vending machines in schools could prove to be very ‘‘fruitful’’ in the long run. 

I was invited here to talk about the problem and others will address potential solutions. However, I want to end with urging consideration of a multi-level approach 

in moving forward. Using a systems-level three pronged approach can have great 

promise in addressing obesity and chronic disease prevention 24, 25. First, we know 

that the individual has been genetically programmed at an early age to desire fatty 

and sugary foods and so we need to engage the individual to help provide them with 

the knowledge and tools to make healthier choices. Next, we need to provide a supportive environment, where healthy eating choices are easily accessible, available, 

and at a low cost. Finally, we need to have local, state, and Federal policies in place 

to ensure that the communities in which people live, work, and play are indeed 

healthy communities. 

Thank you again for giving me the opportunity to testify. I would be pleased to 

answer any questions you may have.

18

STATEMENT OF KIMBERLY A. RUSSEL, PRESIDENT AND CEO, 

BRYANLGH HEALTH SYSTEM, LINCOLN, NE 

Ms. RUSSEL. It’s a pleasure to be here today to represent 

BryanLGH Health System, a locally owned healthcare system anchored by BryanLGH Medical Center here in Lincoln. Our mission 

statement is to provide excellent care and to promote health with 

a focus on quality, collaboration and compassion. This mission 

statement, with its emphasis on health promotion, showcases the 

importance to us of prevention and wellness. 

What I was asked today to address the financial impact of chronic diseases on the medical system. According to CDC, chronic diseases are the leading cause of death in the U.S. and, therefore, the 

leading cause of admission to U.S. hospitals. Also per the CDC, almost half of all Americans live with at least one chronic condition. 

Chronic diseases account for 70 percent of all deaths in the U.S. 

Medical care costs for people with chronic diseases account for 

more than 75 percent of the nation’s $2 trillion in medical care 

costs. 

Chronic diseases account for about 1⁄3 of the years of potential 

life lost by the year 65 and, after decades of relative stability, increased by 37 percent between 1998 and 2006. Obesity accounts for 

over nine percent of all medical spending—$147 billion in 2008—

and annual per capita increase in Medicare spending due to obesity 

is 36 percent and is 47 percent for Medicaid. So from the perspective of an acute care health system, the number one chronic condition that impacts all of the chronic diseases is obesity. 

We now commonly hear the phrase ‘‘obesity epidemic’’ to describe 

this phenomenon, and I totally agree that obesity is an epidemic 

in America today. 

We would not be able to find a hospital or a physician’s practice 

that has not been impacted by an increasingly obese patient population. At BryanLGH we have made many adaptations to better 

serve people of larger sizes. Manufacturers have adapted medical 

equipment such as operating room tables, patient lifts, MRI scanners, et cetera, to accommodate this patient population. 

Over the years BryanLGH, like other hospitals, has purchased 

this new equipment of this nature to safely provide care to these 

patients. Every hospital, including BryanLGH, is battling an increasing number of back injuries among our staff as a result of lifting larger patients. Obesity can also complicate a patient’s discharge from the hospital. Some long-term care facilities limit the 

number of obese patients they will accept due to the additional 

staff and lifting needs. 

In other cases, it is obesity, not the underlying medical condition, 

that prevents a patient from being discharged from the hospital to 

their own home. Patients who are obese carry much higher risks 

of medical complications. Whatever the underlying disease, obesity 

makes nearly everything worse for the patient and truly impacts 

or reduces that patient’s quality of life. 

Today I want to share with you some new research that we are 

studying in collaboration with other Lincoln partners to help establish new health and living culture in our community. 

In June the Community Health Endowment at BryanLGH cosponsored a site visit to Lincoln by Dan Buettner, who is a reVerDate 0ct 09 2002 15:21 Jul 16, 2010 Jkt 041481 PO 00000 Frm 00022 Fmt 6633 Sfmt 6601 I:\DOCS\111-28\53492.TXT AGR1 PsN: BRIAN
19

searcher and author of a book called The Blue Zones. The book presents Dan’s research of four areas of the world where people are 

living longer and healthier (into their 90s and beyond). The four 

areas Dan studied are in Italy, Japan, Costa Rica, and Loma 

Linda, California. Dan is coining the phrase ‘‘blue zone’’ to describe 

areas of the globe that are longevity hot spots. The blue zone or 

longevity hot spots are striking, because in these areas of the 

world, there are greatly reduced rates of chronic disease compared 

to rates in the U.S., 50 to 70 percent less. 

We had standing only room only in the BryanLGH Medical Center Conference Center with over 400 people in attendance to hear 

the results of Dan’s work. 

I found his message particularly interesting in the context of the 

national discussion that is ongoing about national healthcare reform. The common themes that Dan discovered when researching 

longevity trends in these disparate areas of the world are actually 

quite simple, practical and, frankly, don’t rely upon legislation. Although some of the advice are things we’ve heard our whole lives, 

such as walking, sustaining regular low intense activity throughout 

the day and adding activity into our daily routines, et cetera, others 

are perhaps newer concepts to many Americans. Dan’s basic 

premise is diets and exercise programs in the U.S. have, for the 

most part, been a failure. They fail to impact our culture, and 

what’s really needed is a cultural change in our country. 

For example, one thing he discovered, that in Okinawa it’s built 

into the culture to stop eating when one’s stomach is 80 percent 

full, and there’s even a little saying to remind you of that that is 

said before each meal, almost like a prayer. Another study showed 

that people who place their food on the plate in the kitchen and 

put the food away before taking the plates to the table to eat consumed 14 percent less food than those who placed the serving dish 

on the table and ate family style. 

Another very simple tip that Dan found in his studies were the 

longevity or ‘‘blue zone’’ people used smaller dinner plates and 

glasses than most of us tend to use. Other advice relates to social 

activity and family time, adding time to our faith, surrounding 

yourself with people who share the same wellness values, kind of 

like a support group concept. 

Well, Dan is now working in Albert Lea, Minnesota. He is trying 

to create a new blue zone. 

The other blue zones in the world were naturally occurring, have 

been occurring over generations of time. His experiment now is to 

see if he can take a typical American community and actually create a new blue zone. The entire Albert Lea community is working 

together to implement the principles of the blue zones. This involves making the communities walk-able, working with local restaurants on nutritional options, adding life trails absolutely everywhere. In fact, interestingly, many of Dan’s blue zone principles 

were incorporated into the CDC’s recently announced community 

strategies to prevent obesity in the U.S. that was just brought out 

by the CDC a year or so. 

Dan returned to Lincoln earlier this week for further discussion 

with partners including BryanLGH, the Community Health Endowment, the City of Lincoln, Lincoln Public Schools, and others to 

20

see what more we can learn about making Lincoln the next blue 

zone. I invite Congressman Fortenberry and other interested individuals to keep abreast of these developments as we all learn more. 

In summary, we have an epidemic of obesity and other chronic 

diseases in our country. What’s needed is a change in the American 

culture. Certainly, Federal health policy and insurance reform can 

greatly contribute to this effort. So can enlightened employers who 

give employees incentives to lead healthier lifestyles, but our basic 

practices as a country must change. I’m hoping that here at home 

we can learn some simple lessons from researchers like Dan 

Buettner and his colleagues that will make a difference here in Nebraska. Thank you. 

[The prepared statement of Ms. Russel follows:]

PREPARED STATEMENT OF KIMBERLY A. RUSSEL, PRESIDENT AND CEO, BRYANLGH 

HEALTH SYSTEM, LINCOLN, NE 

It’s a pleasure to be here today to represent BryanLGH Health System, a locally 

owned health care system anchored by BryanLGH Medical Center here in Lincoln. 

The Mission Statement of BryanLGH Medical Center is to provide excellent care 

and promote health with a focus on quality, collaboration and compassion. This Mission Statement, with its emphasis on health promotion, showcases the importance 

of prevention and wellness. 

Today, I will share with you some new research that we are studying in collaboration with other Lincoln partners. 

In June, the Community Health Endowment and BryanLGH Health System cosponsored a site visit to Lincoln by Dan Buettner, a researcher and author of a book 

called ‘‘The Blue Zones.’’ The book presents Dan’s research of four areas of the world 

where people are living longer and healthier (into their 90’s and beyond). The four 

areas Dan studied are in Italy, Japan, Costa Rica, and Loma Linda, California. Dan 

and his team of researchers have recently begun another study in Albert Lea, Minnesota. 

We had standing room only in the BryanLGH Medical Center Conference Center 

with over 400 people in attendance to hear the results of Dan’s work. 

I found his message particularly interesting in the context of the national discussion that is ongoing about health care reform. The common themes that Dan discovered when researching longevity trends in these disparate areas of the world are 

actually quite simple, practical and do not rely upon legislation. Although some of 

the advice are things we have heard our whole lives such as walking, sustaining 

regular low intense activity throughout the day and adding activity into our daily 

routines, others are perhaps newer concepts to many Americans. 

For example, Dan discovered that in Okinawa it is built into the culture to stop 

eating when one’s stomach is 80% full. Another study showed that people who place 

their food on the plate in the kitchen, then put the food away before taking the plate 

to the table to eat, consume 14% less food those who place the serving dishes on 

the table. Another simple tip that Dan found in his studies were that the longevity 

or ‘‘blue zone’’ people used smaller dinner plates and glasses.Other advice relates 

to adding social activity and family time to one’s schedule every day and to surround yourself with people who share the same wellness values (kind of a support 

group concept). 

Dan is now working in Albert Lea, Minnesota, where he is trying to create a new 

‘‘blue zone’’. The entire Albert Lea community is working together to implement the 

principles of the ‘‘blue zones’’ found around the world. 

Dan returned to Lincoln earlier this week for further discussion with Lincoln 

partners including BryanLGH, Community Health Endowment, City of Lincoln, Lincoln Public Schools and others to see what more we can learn about making Lincoln 

the next blue zone. I invite Congressman Fortenberry and other interested individuals to keep abreast of these developments as we all learn more. 

In summary, we have an epidemic of obesity and diabetes and other related complications in this country. What is needed is a change in the American culture. Certainly, Federal health policy and insurance reform can greatly contribute to this effort. So can enlightened employers who give employees incentives to lead healthier 

lifestyles. But, our basic practices as a country must change. I am hoping that here 

21

at home we can learn some simple lessons from researchers like Dan Buettner and 

his colleagues that will make a difference here in Nebraska.

STATEMENT OF PAMELA J. EDWARDS, M.B.A., M.S., R.D.,

ASSISTANT DIRECTOR, DINING SERVICES, UNIVERSITY OF 

NEBRASKA-LINCOLN; PRESIDENT-ELECT, NEBRASKA

DIETETIC ASSOCIATION, LINCOLN, NE 

Ms. EDWARDS. Good morning and thank you, Chairman Baca and 

Congressman Fortenberry. My name is Pam Edwards. I’m a Registered Dietician and the Assistant Director of the University Dining Services at the University of Nebraska in Lincoln. 

I’m also currently the President-elect of the Nebraska Dietetic 

Association and speak on behalf of 600 registered dietitians who 

are Nebraska’s food and nutrition experts. I thank you for the opportunity to address the role nutrition, diet, and Registered Dietitians play in the prevention of obesity and chronic diseases and the 

expanding role of local foods in wellness. 

To start, nutrition and diet have a significant impact on the leading causes of death in the United States which are also considered 

chronic diseases and include heart disease, cancer, stroke, diabetes, 

pulmonary disease, and others. 

Chronic diseases are the most common and costly of all health 

problems, yet the good news is they are the most preventable. Nutrition is a key component of this prevention. An example is prediabetes, a condition in which the blood sugar level is higher than 

normal but not high enough to be classified as type 2 diabetes. Research has shown that nutrition therapy by Registered Dietitians 

is more effective than medication in slowing and/or preventing type 

2 diabetes. Another example is heart disease. For every dollar 

spent on medical nutrition therapy provided by a Registered Dietician, $3 are saved. 

These chronic conditions are exacerbated by being overweight 

and obesity. In fact, in Nebraska there has been a steady increase 

in adult obesity at a rate of 16 percent in 1995, to 27 percent in 

2008. These are problems that defy an easy cure. Overall, the dilemma today is that our population is overfed and undernourished. 

This paradox is the most significant nutrition problem facing the 

nation. It has been reported that after the age of 8, the percentage 

of children consuming the daily recommended intake of key nutrients drops significantly, but obesity continues to rise. 

Prevention is the answer. Nutrition is a key component of prevention because diet can help prevent and/or delay the onset of 

both chronic diseases and obesity. We know that it is far more cost 

effective to prevent obesity and chronic diseases rather than to 

have to treat them. This prevention must be made in childhood 

when poor eating practices begin and are carried forward to adulthood. 

These poor eating practices include the following: Too many calories, too much saturated fat and trans fat, too much sodium, too 

many refined grains and sugars, and at the same time too few 

fruits and vegetables, too few whole grains, and too few legumes. 

The Centers for Disease Control reported that 60 percent of United 

States children and adolescents eat more than the recommended 

daily amounts of saturated fats, and only one in four adults and 

22

one in five children eat the recommended amounts of fruits and 

vegetables. 

The overall strategy for prevention should center on plant-based 

foods (fruits, vegetables, whole grains, nuts, seeds, and legumes) 

enhanced by lean meats, fish, poultry and eggs, healthy fats and 

oils, low-fat and fat-free dairy, and occasionally refined grains, 

sweets, and salt. 

Today we are also experiencing a surge of interest in good quality, safe and local food, and Registered Dietitians are playing a 

leading role in reconnecting individuals of all ages to the food they 

eat. The education—this education is being accomplished through 

local foods, a growing and important area of the overall wellness 

of our population. 

I want to now focus on my experience with our University local 

foods residence hall dining and catering program, known as The 

Good, Fresh, Local, or GFL, University of Nebraska-Lincoln Sustainable Food Project that began in September of 2005, with the 

goals to promote the value of local, meaning Nebraska, food; educate students about sustainable agriculture; and provide a new distribution channel for farmers and producers. 

The popularity of our GFL program with students has grown 

each year. Types of local foods served include free-range beef, poultry and eggs, fresh fruits and vegetables, whole grains, walnuts, 

pecans, cheese, and many other items. With GFL there has been 

an expanded and marked interest in eating fresh fruits and vegetables. Students are actually eating things like Swiss chard, beets, 

purple carrots, and cabbage, and when we ask them why, they tell 

us simply, ‘‘They just taste good,’’ and when foods and—fruits and 

vegetables taste good, more are eaten, therefore having a beneficial 

impact on health and wellness. 

Local foods can move university students in a direction of 

wellness and away from obesity and the development of chronic 

diseases. Students also learn how the local foods market can improve and help sustain the wellness of our communities environmentally, economically and socially. There are other successful Nebraska nutrition prevention and wellness programs, and more information about these is in my written testimony. 

Nutrition is the common denominator for preventing, decreasing 

and treating chronic diseases and obesity. Registered Dietitians are 

the food nutrition experts, and using their expertise will have a 

positive impact on preventing and reducing the incidence of obesity 

and chronic diseases of the United States. They are uniquely 

trained to address these issues and are playing a leading role in 

reconnecting individuals of all ages to food and health. The best 

strategy for health must be prevention. The most effective time for 

this to begin is childhood, and local food connections provide an exciting way to expose children of all ages to healthful foods that lead 

to wellness for life. Thank you. 

[The prepared statement of Ms. Edwards follows:]

23

PREPARED STATEMENT OF PAMELA J. EDWARDS, M.B.A., M.S., R.D., ASSISTANT DI- RECTOR, DINING SERVICES, UNIVERSITY OF NEBRASKA-LINCOLN; PRESIDENT-ELECT, NEBRASKA DIETETIC ASSOCIATION, LINCOLN, NE 

Good morning and thank you Chairman Baca and Congressman Fortenberry. My 

name is Pam Edwards. I am a Registered Dietitian and am the Assistant Director 

of University Dining Services at The University of Nebraska-Lincoln. I am also currently the President-elect of the Nebraska Dietetic Association and speak on behalf 

of 600 dietitians who are Nebraska’s food and nutrition experts. I thank you for the 

opportunity to address the role nutrition, diet, and Registered Dietitians play in the 

prevention of obesity and chronic diseases and the expanding role of local foods in 

wellness. 

Nutrition and diet have a significant impact on the leading causes of death in the 

United States (U.S.) and many of these are also considered chronic diseases.

• Heart disease.

• Cancer.

• Stroke.

• Diabetes.

• Pulmonary disease.

• Liver disease.

• Kidney disease.

• Pneumonia and influenza.

• Prenatal complications.

• Septicemia.

Chronic diseases are the most common and costly of all health problems. Half of 

all Americans suffer from chronic diseases and alarmingly seven of ten die from 

them. The good news is that we can prevent some of these diseases and delay the 

onset of others. Diet is a key component of this prevention. For example, pre-diabetes is a condition in which the blood sugar level is higher than normal, but not high 

enough to be classified as type 2 diabetes. Research has shown that nutrition therapy by Registered Dietitians is more effective than medication in slowing and/or 

preventing type 2 diabetes. Another example is heart disease. For every $1 spent 

on medical nutrition therapy provided by a Registered Dietitian, $3 are saved. 

The alarming rate of overweight and obesity throughout all ages has exacerbated 

all of the chronic conditions. Two out of every three adult Americans are reported 

to be overweight or obese while one out of every three children is overweight or at 

risk for being overweight. There has been a steady increase in the percent of Nebraskans who are obese (BMI 30 and above) from 16.3 percent in 1995 to 27.2 percent in 2008. 

The dilemma today is our population is overfed and undernourished. 

This paradox is the most significant nutrition problem facing the nation.

Data shows that after the age of 8 the percent of children consuming the daily recommended intake of key nutrients drops significantly.(see attached chart) But at the 

same time obesity in children continues to increase. These are problems that defy 

an easy cure. 

Prevention is the answer. Nutrition is a key component of prevention because diet prevents and/or delays the onset of both chronic diseases and obesity. We know that it is better to prevent obesity and chronic diseases, rather than 

to have to treat them. 

Thus focusing on our children’s nutrition and health is critical. Poor eating practices begin in childhood. These poor eating practices include consuming too 

many calories, too much saturated fat and trans fat, too much sodium, and too 

many refined grains and sugars. At the same time we are eating too few fruits, 

vegetables, whole grains, and legumes. The Center for Disease Control reported that 

60 percent of U.S. children and adolescents eat more than the recommended daily 

amounts of saturated fats. Only one out of four U.S. and Nebraska adults and one 

out of five U.S. children are eating the recommended amounts of fruits and vegetables. 

The overall strategy for prevention should center on plant- based foods 

(fruits, vegetables, whole grains, nuts, seeds, and legumes) enhanced by lean meats, 

fish, poultry and eggs, healthy fats and oils, low-fat and fat-free dairy and occasionally refined grains, sweets, and salt. Including a variety of these foods as part of 

healthful eating practices is recommended so that complex carbohydrates, healthy 

fats, protein, vitamins, minerals, phytonutrients and fiber are obtained through the 

food eaten. 

24

The American Dietetic Association’s (ADA) research shows that American parents 

are reluctant to help their children because they don’t know how to help and they 

are disengaged from their children’s eating habits. Registered Dietitians (RDs) are 

uniquely trained to help parents; however, few people are referred to RDs because 

their services are rarely covered by insurance. Registered Dietitians are the food 

and nutrition experts and are uniquely trained to focus on nutrition and prevention. 

Using RD’s expertise in counseling individuals of all ages about healthful nutrition 

practices will have a positive impact on reducing the incidence of obesity and chronic diseases in the U.S. 

While there is understandably great concern about obesity and chronic disease, 

there is at the same time a surge of interest in good quality, safe, and local food 

occurring throughout the United States and Registered Dietitians are playing a 

leading role in reconnecting individuals of all ages to the food they eat. This includes teaching not only about the nutritional impact different foods have on health 

but also where and how food is grown and raised and how to prepare and experience 

the exciting taste of a variety of food. For we all know if food doesn’t taste good 

it is not eaten and no nutritional benefits are received. 

I will now focus on unique and practical approaches to prevention by Nebraska 

RDs. The first is my experience with a local foods university dining program. Fresh 

locally-grown foods have a positive impact on wellness due to students eating more healthfully. Why? Because it tastes good and replaces higher calorie foods.

Our program is known as The Good. Fresh. Local. (GFL)—The University 

of Nebraska-Lincoln Sustainable Food Project. This local foods residence hall 

dining and catering program began in September 2005 with the goals to:

• Promote the value of local (Nebraska) food.

• Educate students about sustainable agriculture and the positive impact it can 

have on the environment, local economy, and communities.

• Provide a new distribution opportunity for local farmers and producers in the 

world of university dining service.

At the time GFL began there were approximately 200 college and universities 

throughout the United States with local foods programs on their campuses. This 

number continues to grow along with college students’ consumption of and interest 

in local foods. 

Examples of local foods served in the GFL program include a variety of fresh 

fruits and vegetables, pasture-raised ground beef and poultry, free-range eggs, organic oat flakes, natural pork, walnuts and pecans, homemade whole grain bread 

products, cheese, jams, honey and dressings. Today the program includes approximately 75 Nebraska farmers/producers and manufacturers which is 

up from 25 when the program began.

The popularity of the GFL program has grown each year with students proclaiming ‘‘It’s GFL time.’’ Students have connected with local foods as evidenced by an average of 35 percent increased attendance when GFL meals 

are served. There has also been a marked expanded interest in eating fresh 

fruits and vegetables. Students have willingly tried and enjoyed vegetables such 

as Swiss chard and beets along with purple carrots, broccoli and cabbage. When 

students are asked why they are willing to try the various local fruits and 

vegetables—the simple response is ‘‘They just taste good.’’ And when fruit 

and vegetables taste good—more are eaten, therefore having a beneficial 

impact on health and wellness.

The overall goal is for the university students to incorporate these healthful nutrition practices so that when they graduate they will be moving in a direction of 

wellness and away from obesity and development of chronic diseases. Another major 

benefit of the GFL program is that students gain an appreciation for Nebraska agriculture in rural communities and begin to understand how the local foods market 

can improve and help sustain the wellness of our communities—economically, environmentally, and socially. 

Nebraska RDs are involved in nutrition settings where program goals are aimed 

at prevention by increasing the consumption of fruits and vegetables and other 

types of foods that result in healthful meal practices. The following highlight programs that increase the consumption of fresh fruits and vegetables including those 

with local food connections.

• The USDA’s Fresh Fruit and Vegetable Program (FFVP) is administered 

by Bev Benes, RD, PhD, Director of the Nebraska Department of Education—

Nutrition Services. The FFVP serves fresh fruits and vegetables to elementary 

school students as healthy snack options that are alternatives to snacks high 

25

in fat, sugar and salt. Participating schools must have at least 50 percent of 

students eligible for free and reduced-priced meals and the snacks are provided 

in addition to other school meal programs. A goal of the FFVP is to help 

combat childhood obesity by teaching children the importance of developing healthy eating habits. In addition, schools are required to provide nutrition education to accompany the snacks. Ideally, children will experience the 

great taste of a variety of fresh fruits and vegetables and will begin to include 

those as part of their eating practices for the rest of their lives. An exciting dimension of the FFVP is that schools can support local agricultural producers 

by buying fresh produce at farmers’ markets, orchards, and growers in the 

school’s community. By serving locally grown produce, schools can support their 

communities and also educate students about the local agriculture in their communities and state. In 2008/2009 Nebraska had 28 participating schools and 

there will be 59 schools participating in 2009/2010.

• A study to determine the impact of local fruits and vegetables on a school lunch 

program was conducted at the Central City Middle School in Central City, Nebraska. Because USDA now allows schools to purchase local produce, Joyce 

Rice, School Food Service Manager, wanted to determine if students would eat 

more fruits and vegetables if offered a variety of fresh local fruits and vegetables. The program goal was to increase fruit and vegetable intake for healthier 

students. The study was conducted during first semester 2008–2009 and involved 500 students from kindergarten through eighth grade. Local fresh fruits 

and vegetables were purchased from local growers in the St. Libory area. The 

impact of the program resulted in fresh fruit and vegetable intake that 

increased by 199 percent by serving local fruits and vegetables. Because 

of Nebraska’s weather, the program was limited by the seasonality of local fresh 

fruits and vegetables

• The garden-to-school connection has been planted at Beattie Elementary School 

in Lincoln, Nebraska by Karen Creswell, M.S., R.D. and Master Gardener. Elementary school children are taught about food through planting, tending, and 

harvesting produce from their school garden. This experience is enhanced by 

learning how to ‘compose’ a meal made of the following:

» The cook, the food and the eaters.

» A balance of food groups 1-2-3-4-5.

» Inspiration from the season.

» Flavor.

» Variety and contrast.

The overall goal of the program is to work with children on becoming 

‘skilled eaters’ so they know how to handle themselves around new and 

strange food. This type of positive experience in a safe environment under the 

direction of a Registered Dietitian leads children toward to the development of 

a positive relationship with food ‘from seed to plate’. When children can expand 

their food preferences they do better with eating for good health and good 

weight regulation.

• In July, 2008, the Nutrition and Activity for Health Program within the Nebraska Department of Health and Human Services was selected as one of 23 

states to receive support from the Center for Disease Control (CDC) for chronic 

disease and obesity prevention. Work in these areas is centered on promoting 

healthy eating and physical activity and creating or enhancing environments 

and systems that support healthy eating and greater physical activity. One of 

the focus areas of the funding is to make it easier for Nebraska residents of all ages to eat more fruits and vegetables. This is facilitated 

through CDC’s Fruits and Veggies—More Matters initiative which encourages the consumption of fruits and vegetables by explaining the 

impact fruits and vegetables have on promoting good health and reducing the risk of chronic diseases—stroke, cardiovascular disease, and 

certain cancers. Within the Nebraska Department of Health and Human 

Services, Holly Dingman, M.S., R.D. serves as Coordinator for the Nutrition and 

Activity for Health program and the Coordinator for CDC’s Fruit and Veggies—

More Matters initiative. Holly has successfully collaborated with two different 

state agencies to promote more fruit and vegetable consumption in the following 

ways:

» Supporting the Nebraska Department of Education with the Fresh Fruit and 

Vegetable Program (FFVP) for elementary school students.

26

» Working with the Nebraska Department of Agriculture to start a weekly 

produce market outside the state office building designed so that state employees and individuals working in downtown Lincoln can purchase locally 

grown produce. This project demonstrates how two state agencies share a desire to improve the health of Nebraska residents and the economy of Nebraska agriculture. 

Conclusion 

Nutrition is the common denominator for preventing, decreasing, and treating 

chronic diseases which are the most common and costly of all health problems. The 

alarming rate of overweight and obesity has exacerbated all the chronic conditions. 

Registered Dietitians are uniquely trained to address these nutrition issues. And 

they are playing a leading role in reconnecting individuals of all ages to food and 

health. 

The best strategy for health must be prevention. Nutrition is key to prevention 

because diet prevents and/or delays the onset of both chronic diseases and obesity. 

The most effective time for this to begin is in childhood. Local food connections provide an exciting way to expose children to healthful foods that lead to wellness for 

life. 

Note: 

American Dietetic Association’s research has documented that most Americans 

have no idea of their own nutritional status, weight or eating patterns. Even when 

a diet-linked condition as serious as pre-diabetes is identified, a patient is likely to 

encounter very real barriers to professional nutrition care and services. In other 

words, few people are referred to Registered Dietitians to begin with as their services are rarely covered by insurance. To explain: Medicare is the template for most 

insurance plans. Medicare currently covers screening for pre-diabetes. A patient can 

be tested as frequently as every 6 months to check his or her status. However, there 

is no referral—no covered care by Medicare or most private insurance—until prediabetes deteriorates to full blown diabetes. Only when the diagnosis has reached 

a dire situation will Medicare meet patients’ needs through covered diabetes services. If the patient is very lucky his or her physician may send them to a Registered 

Dietitian for Medical Nutrition Therapy or an accredited Diabetes Self Management 

Training program. 

A children’s nutrition and activity program is being piloted that uses the expertise 

of Registered Dietitians. Thanks to the work of the Alliance for a Healthier Generation, a pilot program has been developed to help overweight children see their physicians and Registered Dietitians to learn better nutrition and activity habits. Several 

health insurance organizations are part of this ground-breaking effort which will 

reach nearly one million children during the first year. The long-term goal of the 

initiative is that within the first 3 years, 26 percent of all overweight children (approximately 6.2 million) will have access to the benefit. 

27

ATTACHMENT

The CHAIRMAN. Thank you very much. I want to thank all of the 

witnesses for their expertise. 

You’ve been extremely patient, and now we’ll begin with a series 

of questions from myself and, of course, Congressman Fortenberry 

as well. But before I do, I just want to make a statement. As you 

look at obesity and longevity and the cost factors: I was watching 

ESPN, and I was watching a broadcast where the Texas Rangers 

were playing someone, and a community lady—she happened to be 

a hundred years of age—and they asked her who’s her favorite 

player, and she said, ‘‘Well, my favorite player is young third baseman from there.’’

And then as the game went on, of course, someone came over the 

loudspeaker and said the lady was celebrating her birthday, and 

then they asked her, ‘‘Well, what are you going to do after the 

game?’’ And she said, ‘‘I am going to ask for my own exit.’’ I mean, 

it’s amazing. So that happens when we’re talking about nutrition 

and proper health, and as I looked at the woman, she was not overweight, and that has a lot to do with it. When you look at longevity 

in terms of living a lot longer and exercising, as we see here to the 

left, we’ll live a lot longer if we diet right and have the appropriate 

nutrition and then also reduce our costs to each one of our states, 

counties and cities that are bearing the costs to provide a service 

to someone who is chronically ill. Not only will it prevent obesity 

and being overweight, but diabetes was mentioned earlier in terms 

of adding to these costs and its impact it has on our family members. 

Personally, I’ve lost my father, who was diabetic, overweight. He 

originally lost toes and then half a leg and a full leg. Two of my 

brothers ended up dying, my sister, nieces and nephews, and then 

my brother-in-law, who was a great athlete, played ball, but didn’t 


111028007
28

take care of himself, and ended up having dialysis, needed a kidney 

transplant because his health wasn’t there, and he ended up dying. 

The effects it has on us and the effects it has on others are very 

important. 

That’s why I really appreciate the leadership and vision that 

Ranking Member Fortenberry has, and I appreciate that vision and 

leadership in bringing awareness and addressing the issue and 

tying it into wellness, nutrition, and the cost to our society. We can 

coordinate how it is all interrelated, how it would benefit our society and our nation, and the impact it’s having on children. Obesity 

at a younger age is related to learning abilities when we don’t provide fresh fruits and vegetables. 

That’s why one of the things we have to do—and I mentioned 

that by changing the culture we have to change attitudes and behaviors and make adjustments, and that’s a hard thing for all of 

us. Some of us have habits because of traditions from one family 

to another. We ended up eating because our parents put it on the 

table. I remember eating a lot of flour tortillas and, once in a while, 

noodles. 

Mr. Fortenberry, remember our first meeting that we had on obesity. A Member from Ohio had asked a question of all of us, how 

many of you still weigh the same as you did in high school. With 

a show of hands, there was only one person that weighed the same 

amount as they weighed when they graduated from high school. 

Mr. FORTENBERRY. It wasn’t me. 

The CHAIRMAN. I have a little bit more. But with that I’d like to 

begin the questions for all of the panelists right now, and anyone 

of you, you can chime in and give a response. You’re all experts in 

the fields of nutrition, obesity and chronic illness. In your expert 

opinion—and I state, in your expert opinion, what is the one most 

important thing that we can do as a nation to help fight the obesity 

epidemic, the one thing? Anybody begin. 

Ms. RUSSEL. I really believe it’s a cultural change in our society. 

It’s building activity into our daily lives. It’s not building our lives 

around a screen. It’s have a lot of family involvement, et cetera. To 

me, it’s a total cultural change compared to the way that we live. 

The CHAIRMAN. Can you sort of define ‘‘cultural change’’? Because I know we’ve got a recording of this, and there are a lot of 

definitions for cultural change. Elaborate a little bit on that. 

Ms. RUSSEL. It’s figuring out how we can build low intensity sustained exercise into our daily lives. I’m not suggesting that we all 

give up on cars, but that we plan time in our daily activities and 

schedules for more walking, for example. An example is, like I was 

mentioning in my comments, what is going on in Albert Lea, Minnesota. One of the things that they’ve done there to help children 

get more exercise in their daily lives is the school buses in the public schools are now stopping a quarter mile away from the front 

door of the school, so the children are walking a quarter mile from 

the bus into the school and then reversing it at the end of the day. 

You know, simple things like that. 

Dr. YAROCH. I just attended a meeting about 2 weeks ago, and 

it was called The Weight of the Nation Meeting, and it was held 

in Washington, D.C., and was very interesting. Policymakers were 

researching and getting together to talk about this issue, and one 

29

of the things I mentioned in my testimony is I really do think that 

it’s going to take a very comprehensive approach in order to address the situation, so from my standpoint, I’m a researcher. 

There are different models that are proposed, like a social and 

ecological model, so I mentioned it briefly in my testimony, but one 

of the things, you know, that’s really important is to think of all 

these different factors we have. Individual level factors, as you 

mentioned, we do have level factors like knowledge, attitudes, so 

we need to do things about changing those, whether it be among 

kids or adults. 

Environmental level changes that I mentioned vending machines 

in schools, and then really having those policy level changes in 

order to support all of this, so I wouldn’t say that it’s just one 

thing. I mean, I’m just racking my brain thinking, All right, is 

there one? But I really do think that we need a comprehensive approach that really incorporates all of these factors. 

Ms. EDWARDS. I guess I would say that this is very practical, but 

it’s exemplified by what’s at the table, and that is that people need 

to reconnect with food, just basic food and how great it is. It sounds 

very simple, but we just have to make the move of getting to know 

what fruits and vegetables are, what are whole grains, as a first 

step toward reducing obesity and the rate of chronic diseases. 

Dr. SITORIUS. I’m going to add one thing. You said one thing, and 

I can’t think of that one thing, but I think education and building 

teams, because I think it’s education for the providers of health 

care, and it’s having them team together. We have a lot of examples of individual projects, and I think it’s education of the citizens, 

but it’s going to happen through that kind of education. 

The CHAIRMAN. Thank you. That’s a very important point, because as we look at the comprehensive approach, change in attitudes and behaviors and adjustments and side effects; you can’t 

make change unless you’re educating the entire country. That’s a 

good point. Thank you very much. I have several questions, but I 

know that my time has run out, and as I look at the little red light, 

it indicates to me there’s no time to ask another question, but I’m 

going to ask one more question of all of you, and then I’ll hand it 

over to our Ranking Member, for his questions. Then, we’ll come 

back, and we’ll have some additional questions we may ask. How 

can we best raise the awareness of obesity and its cost in relation 

to chronic illnesses in America? 

Dr. SITORIUS. Well, one is by holding hearings that are outside 

of the purview of Washington, D.C. I think it’s very important to 

be out where the people are and having these kinds of discussions 

where you have people present who can listen. 

Dr. YAROCH. I think our sociological campaigns are very important so, for instance, I know I’ve just said that I moved to Nebraska a few months ago, but there is 54321 Go! Campaign that’s 

going on right now with the Omaha kids. We begin to raise awareness by providing information, whether it be kids, adults alike, on 

how they actually go about improving dietary and physical activity 

efforts. 

Ms. RUSSEL. I would say I think the media has done a good job 

of covering the point of the costs of obesity. I think our problem is 

individuals simply don’t know what to do about the problem. 

30

They’re helpless, so to speak, or feel helpless to attack their own 

overweight problem. 

Ms. EDWARDS. I think we talk about everything starting with 

children, and I would think that the education in the school systems with the children, as well as their parents, would be a very 

good way of starting. When you give to the children and their parents, you’re starting momentum for later in life. 

The CHAIRMAN. Thank you very much. 

Dr. YAROCH. Can I just add one more point? I do want to point 

out that I think education is key and very important, but we also 

know that giving people the knowledge doesn’t necessarily change 

their behaviors, so education, to me, in addition to all these other 

things like social marketing, and other things that we can do and 

actually giving people the tools to make the changes. 

The CHAIRMAN. Thank you. I think all of you have brought up 

some very interesting points and ways to address it, and the media 

can also help us in creating this kind of awareness. Now that we 

have a hearing, as I stated before, we have foresight. We can look 

at the costs to our society in reference to obesity. We have $75 billion in direct costs and $139 billion in indirect costs just now. Then 

we look at what’s projected if we don’t do anything in terms of the 

year 2030. 

I mean, we’re not talking about millions. We’re talking about billions when we look at $160 billion if—it’s billions if we don’t address the issue, and the media can play a very important part in 

helping us get that kind of awareness and knowledge along with 

nonprofit organizations. With that I’d like to turn it over to Ranking Member Fortenberry to ask some questions. 

Mr. FORTENBERRY. Thank you, Mr. Chairman. 

Dr. Sitorius, I want to pick up a comment you made, and then 

I’m going to refer to you after I point out some of the particular 

findings that I’d like to highlight from all of your testimony. If you 

all would be willing to respond as well to the questions I generate 

to Dr. Sitorius. You said our healthcare system is not properly designed for wellness, it is reactive, and then you laid out a couple 

of critical factors regarding specifically the medical culture to the 

patient centered approach. 

I think that’s an important point, and all of you, if you’d like to 

respond back too as we unpack that a little bit further, that’s a key 

point in your testimony, but the key finding is I think that all of 

you touched on one way or another, again, the cost of the significant difficulty of obesity in our country being $7 to $8 billion or so 

10 years ago. It now has doubled. You have pointed out that we 

consume 300 more calories today than 25 years ago, obesity being 

particularly acute as well with Native American populations, and 

there are two very large reservations in the First Congressional 

District, by the way. 

Dr. Russel, you pointed out the blue zones, and, again, Japan, 

Costa Rica, Italy, and Loma Linda. You also suggested that if I just 

serve myself in the kitchen, I could lose these extra, or something 

like that. Interesting key points, Ms. Edwards, you pointed out that 

even in Nebraska the issue of obesity rises from 1995 at 60 percent 

up from 27. I think we have a pretty good idea of the trend line 

here. 

31

I think we also have a pretty good idea in general of what we 

have to do, but in terms of systematic changes, going back to what 

you said, Dr. Sitorius, our healthcare system is not properly designed for wellness, this interplay between nutrition and lifestyle 

practices, meaning the healthcare system being reactive in nature, 

creating a gap of what we all want to achieve, all—what we all are 

watching happen in the wrong direction. Can you further unpack 

this idea of looking to a more patient-centered approach? 

Dr. SITORIUS. Well, it’s not new. Pediatrics has been doing this 

since about 1967 or the early 1960s, but it is going to require a 

change in the incentives for patients and incentives for the providers of health systems to really jump into this. 

I think I stated it as clearly as I can think about it, and that is 

we currently reward people for doing something to somebody after 

they’ve already had a problem, and we need to really look at a system that recognizes and rewards both the patients, lawyers, and 

the health professionals to work—working at prevention. Not just 

preventing it, the chronic illness initially, but dealing with it secondarily and interpolate prevention. 

Mr. FORTENBERRY. I agree with your key point there. I think our 

next panel will actually have some experience in some of those incentives so, again, that will be unpacked later. You talk about the 

limited ability to monitor and support patients, time constraints, as 

well as just episodic treatment that all link itself to the rethinking 

of a team type of approach to patient care. Did I get your——

Dr. SITORIUS. Yes. You’re right, and I think there’s a great deal 

of expertise to manage a lot of medical problems that’s done in silence or individually, and I think we have to find a way to put the 

systems together better and to allow them to communicate. IT is 

going to be—information technology is going to be very important 

in that to allow that communication, but I also think we have to 

enjoin the patient and community to be part of the solution to 

these chronic illnesses, because they are equally important, as I 

heard some of my colleagues talk about, as the support system 

changes. 

Mr. FORTENBERRY. The rest of the panel, would you like to respond to the issue that I just laid out? 

Dr. YAROCH. Yes. Actually, there have been studies to show that 

doctors are the most trusted source for people to get their information from. However, physicians don’t even typically get training in 

nutrition. So, for instance, where I got my doctorate was Emory, 

and the people who were getting their MDs were only required to 

take one short course in nutrition, so I feel that there’s a breakdown in the system there. 

And just the whole idea that this is an interrelated system, so 

connecting doctors with patients, patients with other important 

things, and just one of the things I didn’t have a chance to say that 

I brought up a little bit in my testimony is that really there are 

some of us who don’t have access and availability to healthy foods. 

So the idea of some populations, low income, African American, 

American Indian, Hispanics who live in food deserts who don’t even 

have the choices. They don’t have it there to be able to make it. 

Mr. FORTENBERRY. This is actually a phenomenon in some urban 

areas as well, as the Chairman and I learned about on the last 

32

hearing on obesity. It’s not just education, but it’s access, and that 

was a key finding. 

Ms. RUSSEL. I really agree with Dr. Sitorius’s point that our system is not set up well to focus on prevention, and absolutely I 

agree as well that the physician has such an ability to make an impact with the patient when they—in that exam room when they 

look at them eye to eye and tell them they need to stop smoking, 

or they have an obesity problem, or whatever the chronic condition 

might be. 

The problem with our system, of course, as you well know, because you made this comment, Representative Fortenberry, in your 

opening remarks, is that our physicians are paid, frankly, on piecework, and they have—with the physician shortage in our country, 

there are tremendous volumes of patients to be seen every day, and 

our extremely busy physicians simply have very limited time to 

have these very deep, meaningful conversations which can be very 

impactful with patients, so I think that’s an example of how our 

system is not put together well. 

The support needs to happen with prevention and wellness. 

Ms. EDWARDS. It’s now been said that a team approach is the 

best way to do anything, whether it’s in the hospital setting, 

whether it’s in the organization, whether it’s in the school, wherever it might be. I think that you find the people who are best suited to provide the care in those types of organizations and, as far 

as nutrition goes, speaking for Registered Dietitians, in those kinds 

of settings, I would like to see that Registered Dietitians are the 

people who are trained in nutrition and are the ones who are spoken to and asked for their advice in working with these types of 

different situations for obesity and reducing obesity and chronic 

diseases among the population. 

The CHAIRMAN. Thank you. We begin with a series of questions 

that all start up with Ms. Russel. Ms. Russel, thank you for your 

testimony. As a Californian, my Congressional district borders the 

area of Loma Linda University, and you mentioned that as one of 

the cities researched, as referred to in your testimony. I believe 

you’re right. We need to change the culture of America when it 

comes to food. 

As a Hispanic, I was raised to view food in a particular way, but 

I had to learn I couldn’t always eat tamales and menudo, so I had 

to change that. Do you believe there’s any particular guidelines we 

must follow as we work to change the culture around food? 

Ms. RUSSEL. Again, the research that I was quoting, one of the 

commonalities among all of the four areas of the world was that 

the diets of people were plant based with a heavy dose of beans 

and nuts and just a small amount of wheat, so take whatever you 

want from that. That was the common dietary theme among those 

four areas in the world with a striking high in longevity trends and 

a striking low in chronic stress. 

The CHAIRMAN. Thank you. I know that I’ve had to change. Even 

this morning I had fruits, and I wanted to have the omelet. I was 

thinking, oh, gosh, these potatoes, these are real good, but I had 

the fruit. 

Ms. RUSSEL. Good for you. 

33

The CHAIRMAN. In your testimony you pointed out one of the biggest struggles we have in Congress is how to pay for good programs. The Fresh Fruit and Vegetable Program is certainly a step 

in the right direction, but it’s costly. Have you investigated how 

much more, if anything, it costs for schools to purchase locally produced items than those that are more readily available? 

Ms. EDWARDS. As far as the cost, I’m not representing public 

schools. I can speak for our particular situation, that local foods do 

sometimes cost more, but the benefit far outweighs the cost, and 

in planning properly to give those types of foods in the system is 

certainly something that can be accomplished very successfully, 

and I’d like to add one more thing about Loma Linda. Loma Linda 

is has a very, very high—not total—vegetarian population; and, 

therefore, their diets are plant based, and for years the research 

has shown that in that area they have a lesser degree of chronic 

diseases, obesity. 

They’re more active, they don’t smoke, so I think that whole population is a very, very good one to study when you look at prevention. 

The CHAIRMAN. Dr. Sitorius, you know, I was struck by your 

statement in the testimony that the current healthcare system is 

not designed to effectively promote proper wellness and nutritional 

practices. Can you elaborate on your suggested use of the Patient 

Centered Medical Home model? 

Dr. SITORIUS. As I said, I think they have been tried. They do 

have some validity with the pediatric groups for the last 40 years, 

and I think there is—as we’re looking at changing some of the direction of our healthcare system, I think this would play a tremendous impetus, because you get primary exposure, you get teamwork 

approach. I don’t think any of these chronic illnesses can be managed by one physician or one health system piece by piece. 

I think it really takes a connected system and better communication between the providers in the system. It’s a teamwork approach. 

The CHAIRMAN. Do you think this location is the next in line to 

use in terms of exercise and what’s available in terms of changing 

actions and behaviors? 

Dr. SITORIUS. I think this is an excellent location, and again, 

speaking as an educator at the science center, we have to take the 

young people we get into the health science system, teach them 

interdisciplinarily and also teach them about how to practice in 

this environment that might be out there in the future instead of 

sustaining what has been the past. I think that’s going to be one 

of the responsibilities we’re going to have as academic health 

science centers. 

Mr. FORTENBERRY. Well, Doctor, I’d like to follow up on that last 

point. Are you suggesting there is a significant under-emphasis in 

medical school training on this interdisciplinary approach? 

Dr. SITORIUS. Yes, I would say that’s true. 

Mr. FORTENBERRY. So how do we fix that? 

Dr. SITORIUS. Well, I think as the healthcare system evolves and 

if we can build in the popular incentives for patients and their providers when it comes to prevention and wellness, I think you’re 

going to find a lot more interest and a lot more energy to move toVerDate 0ct 09 2002 15:21 Jul 16, 2010 Jkt 041481 PO 00000 Frm 00037 Fmt 6633 Sfmt 6601 I:\DOCS\111-28\53492.TXT AGR1 PsN: BRIAN
34

wards this interdisciplinary approach and teamwork approach to 

providing medical care. 

Mr. FORTENBERRY. Let me switch now back to Ms. Edwards regarding the—what’s the full name of the title of the cafeteria at the 

University, local fresh and——

Ms. EDWARDS. Good, Fresh, Local. 

Mr. FORTENBERRY. Good, Fresh and Local. 

That’s right. Talk about the demand. Is it significant? Is it profitable? You’re a nonprofit setting, but is there a demand? 

Ms. EDWARDS. I think the demand has been tremendous. It’s 

grown each year, and as far as profitability, one thing that we, personally, think is that students now are becoming more familiar 

with local foods, and potential students coming to the University 

are aware of local foods. They’re asking, Do you have those kind 

of programs? So that all helps the University as far as bringing in 

potential of more students to come, so it’s been extremely popular, 

and students are asking for it, and habits are changing, which is 

the most important thing. 

Mr. FORTENBERRY. What percentage of the student population do 

you surmise partakes in the purchase of these foods? 

Ms. EDWARDS. Well, within our housing department, which is 

where it’s offered, it’s about a fifth of the 25 percent, up to 50 percent on special occasions, that partake in this. 

Mr. FORTENBERRY. Excellent. Dr. Yaroch, given your background 

in cancer research, talk about the linkage between nutrition and 

cancer prevention. 

Dr. YAROCH. Just the diet, physical activity, both of those behaviors are related to obesity, which then ultimately is related to cancer, various cancers, as well as heart disease, diabetes, all these 

other things, so there is a linkage. I mean, there’s a very clear linkage in the literature showing that people with poor diets who are 

less physically active and more overweight have a higher tendency 

to get various cancers. 

Mr. FORTENBERRY. So you can do everything right, of course, and 

still get cancer, but the probability of that is, would you say, significantly increased with weight, the risk? 

Dr. YAROCH. Oh, yes, absolutely. 

Mr. FORTENBERRY. Mr. Chairman, that’s all the questions that I 

have. 

The CHAIRMAN. Thank you very much. Again, we thank everyone 

for their efforts and knowledge in sharing that information. We’ve 

a lot of work ahead of us in changing health, attitudes and behaviors and also as we look at the cost difference of proper nutrition, 

the more we ask that when a child learns behavior in school that 

provides fresh fruits and vegetables in practice, the more you can 

change your attitude and behavior and probably the test results 

too. 

You ought to change how—we talk about no child left behind, but 

it seems like we’re leaving them behind in fresh fruits and vegetables. So, today we’ll look at ideals, making sure that every child 

has some form of fresh fruits and vegetables. Again, we change culture and attitudes, and we can’t change what the advertisers are 

going to do on TV because the media, the first thing they do is they 

35

have a fast food commercial after something you watch on The Disney Channel. 

They’re rushing right on you, we’ve all got the same bad habits, 

but I’ve got to change my habits as well. With that I’d like to thank 

you and call our next panelists. Thank you very much. 

We’d like to now begin the second panel, and the second panel 

will address wellness and prevention practices. I will begin by welcoming each one of you to the table, and we’ll proceed at this time. 

I’ll ask Representative Fortenberry to introduce each of the panelists. As I stated before, if you weren’t here, you have approximately 

5 minutes to give your statement. We’ll allow latitude. Don’t panic 

if the red light comes on, but remember that the first person will 

set the example for the others, I want to remind you. 

I’ll make that statement first. So with that we will begin, and 

hopefully the other two panelists are somewhere in here. So if I 

could have Representative Fortenberry introduce the first panelist 

and have the first panelist begin with a 5 minute presentation. 

Mr. FORTENBERRY. Thank you, Mr. Chairman, and today I’d like 

to welcome Mr. Wayne Sensor as our first expert witness. He is the 

President and CEO of Alegent Health, a company of nearly 10,000 

employees of Omaha. Mr. Sensor brings 25 years of experience in 

leading major healthcare systems and previously served as a President and CEO of another large healthcare system in Louisiana. He 

was named to be on the Executive Committee of the greater 

Omaha Chamber of Commerce and was also selected as its Chair 

of the Public Policy Council. He serves on the National Governors 

Association State Alliance on e-Health and the HealthLeaders Advisory Board. Thank you, Mr. Sensor, for being here. I’ll introduce 

all of you, and then we’ll turn to you for your testimony. 

Our second expert witness is Dr. Blake Williamson, the Vice 

President and Senior Medical Director of Blue Cross Blue Shield in 

Kansas City. 

Dr. Williamson formerly served as Senior Vice President of 

Asante Health System in Oregon and brings over 10 years of experience in managing integrated health systems, managed care organizations, and physician practices. Welcome, Doctor. 

Our third witness is Marsha Lommel. She is President and CEO 

of Madonna Rehabilitation Hospital in Lincoln, formerly a speech 

pathologist. She has served as CEO since 1989. Marsha has served 

on numerous health and service-related boards at committee and 

state and local levels, including American College of Healthcare 

Executives, Wells Fargo Lincoln Advisory Board, VHA of the Midlands, Lincoln Chamber of Commerce, Community Health Endowment Board, Friendship Home, Leadership Lincoln, Governor’s 

Urban Advisory Task Force, American Heart Association, and the 

American Burn Association. Thank you again, Ms. Lommel. 

Our fourth witness is Dr. Glenn Fosdick, President and CEO of 

Nebraska Medical Center, a 687 bed acute care teaching hospital 

that includes over 300 outpatient clinics in four states. 

Mr. Fosdick formerly served as Senior Associate Dean for the 

University of Nebraska College of Medicine in Omaha and before 

that as President and CEO of another health center in Michigan. 

Welcome, Mr. Fosdick. 

36

And our final witness is LuAnn Heinen, the Vice President of the 

National Business Group on Health and Director of the Institute 

on the Costs and Health Effects of Obesity located in Washington, 

D.C. She formerly served as Vice President of the Center for 

Healthcare Evaluation at the UnitedHealth Group in Minneapolis 

and as a Divisional Vice President at Chronimed, Incorporated. She 

also provided consulting services on Federal health plans at The 

Lewin Group, a financial healthcare consulting firm, so we’d like 

to welcome you all. 

The CHAIRMAN. Thank you. At this time we’ll begin with the first 

panelist. 

STATEMENT OF WAYNE SENSOR, PRESIDENT AND CEO, 

ALEGENT HEALTH, OMAHA, NE 

Mr. SENSOR. Thank you very much, Congressman Fortenberry 

and Congressman Baca. It’s a pleasure to be here to participate in 

democracy at its best, at the grass roots level. I am Wayne Sensor. 

I’m the CEO of Alegent Health. In our brief moment together 

today, I want to talk a little bit about some of the specific experiences we’ve had as an organization in stimulating prevention and 

wellness, both within our own workforce and more broadly in the 

communities we serve. 

I would posture Alegent in a relatively unique position as we talk 

about health and wellness in that we are both a major employer 

with over 9,000 employees, the largest permanent employer in the 

State of Nebraska, but also the largest regional provider, which 

gives us some latitude to experiment and innovate ways that might 

be a bit unique. By way of background, Alegent Health is a faith 

based, not-for-profit healthcare system, and we would like to effectually position ourselves as what I would call a ‘‘post-reform’’ 

health system. 

That means that we’ve done things like substantially push 

health information technology across our delivery system. We’ve 

worked hard to improve quality and safety while reducing the cost 

of the care we provide and to provide a seamless transition of patients—for our patients across our entire delivery system. We’ve 

done that, in part, by the development and deployment of evidencebased care protocols across all of our delivery sites, and, in part, 

because of that work we were recently recognized by the Network 

for Regional Healthcare Improvement, which is a national coalition 

of Regional Health Improvement Collaboratives, as the number one 

health system in the United States for our CMS Core Measure of 

Performance as well as our HCAHPS patient satisfaction level. 

As we think about ways in which we can support and promote 

wellness and prevention, certainly one of the underlying principles 

must be to help people become more accountable for their health 

and their health care on an individual basis. From our vernacular 

that means we need to develop incentives to cause Americans to do 

the right things that are otherwise in their best interest anyway, 

and we need to provide them with good information so that Americans can make better choices about how they can be good consumers of health and health care. 

As an organization our journey began over 3 years ago really beginning with the petri dish of our own employees and broadening 

37

out to our community at large. It began with the development of 

a robust benefit plan for our own employees, our 9,000 employees 

and their dependents, that would cause people to focus on prevention and wellness. Two constructs in our benefit plan particularly 

speak to prevention and wellness. 

The first is if it’s preventive care, it is free, no deductible, no copay for a wide array of things, everything from child immunizations to annual physicals, mammographies colonoscopies, and everything else you would suggest for a particular age cohort. My 

workforce today seeks 21⁄2 times more preventive care than the nation at large. What a great investment. 

The second construct built into our own healthcare program is to 

incentivize people to make health changes, reimburse people to lose 

weight, to get active, to lose weight or to manage their healthcare 

conditions. Just a case in point, 500 of our employees have quit 

smoking. We’ve lost 17,000 pounds as a workforce in the last 24 

months. The results have been relatively phenomenal. 

First, from the cost perspective, I will tell you our workforce is 

now engaged on a daily basis in making choices about their health 

care, making choices about how we can be more engaged in their 

health, and you’ll ask me this, so I’ll say it out loud now. Our motive wasn’t lowered costs, but, indeed, we’ve seen increases in our 

healthcare premiums of roughly half what the national average is 

over the last 3 years, and just in passing now I want to acknowledge that HRAs and HSAs are the vehicles we’ve chosen to use to 

be able to give people more accountability and control of their own 

healthcare dollars. 

There are also things that we, as a provider organization, must 

do to engage people more readily as consumers of health care. We 

believe in transparency. We believe Americans have a right to 

know how good we are and what are the costs. In September of 

2005, we began transparently sharing our quality stories for our facilities. In January of 2007, we rolled out a very unique cost estimation tool which gives people the other half of the valid equation. 

In summary, Alegent Health has been working hard to literally 

participate in our own version of healthcare reform within the purview of our own control. It started with the commitment to dramatically improve quantity, reduce costs, and adopt health information technology; but, quite simply, that’s not enough. If we really, really want to reform this healthcare system in America, we 

need to drive individual and personal responsibility for health. 

We speak of consumption of health care in the United States of 

America like it’s a mystery. Too many of us smoke. We’re a nation 

of junk food and video games. We super-size everything, and we 

love all-you-can-eat buffets. If we’re going to really reform the system from a public policy standpoint, we must find ways to engage 

consumers in their health and their health care. We must 

incentivize Americans to live healthier lives, to practice true prevention and true wellness, and we hope our experiences on a very 

granular level will provide some insight. Thank you very much. 

[The prepared statement of Mr. Sensor follows:]

38

PREPARED STATEMENT OF WAYNE SENSOR, PRESIDENT AND CEO, ALEGENT HEALTH, 

OMAHA, NE 

Good morning, Congressman Fortenberry and Members of the Committee, thank 

you for the opportunity to be here with you today. My Name is Wayne Sensor, I 

am the President and Chief Executive Officer of Alegent Health; today I want to 

give a brief overview of Alegent Health’s experiences with prevention and wellness. 

We are both the largest private employer in the state and a substantial provider 

of healthcare, which gives us a unique perspective on these issues. In both roles, 

we have made it our goal to partner with people to proactively manage their health, 

as well as make better choices about the care they need. 

Alegent Health is a faith-based, not-for-profit health care system that serves eastern Nebraska and western Iowa. Our 9,000 employees and 1,300 physicians are 

proud of the care we provide in our ten hospitals and more than 100 sites of service. 

As a provider, we believe we are a model of a post-reform healthcare system. We 

employ substantial health information technology to improve the quality and safety 

of the care we provide and to ensure a seamless transition for patients across the 

many services in our healthcare system. 

Through the dedication and commitment of our physicians—a combination of employed and independent—we have implemented evidence-based care order sets 

across more than 60 major diagnoses. 

Our CMS Core Measure and HCAHPS Scores are consistently among the highest 

in the nation. In June 2008, the Network for Regional Healthcare Improvement 

identified Alegent as having the best combined healthcare quality scores in the nation. 

And yet, in our estimation, those efforts are only a small part of what it will take 

to achieve true healthcare reform. We adamantly believe that people must take 

more accountability for their health, and to do so they must have incentives and 

good information. 

We began our journey to greater consumer involvement in health care 3 years 

ago, when we made a commitment to more fully engage our workforce in their 

health. 

Incentives for Preventive Care/Lifestyle Change/Chronic Disease management

There are two important constructs in Alegent’s employee health benefit plans. 

First, preventative care is free. From services like annual physicals, and 

mammographies to childhood immunizations and colonoscopies—if it is preventative, it is free. As a result, our workforce is consuming more than 2.5 times the preventive care than the nation at large. 

That’s an investment that we’re willing to make, even without longitudinal studies that quantify the financial benefit to our organization. 

And second, through an innovative ‘‘Healthy Rewards’’ program, we pay people a 

cash award to make positive changes in their lifestyles or to manage a chronic illness. We also offer a variety of assistance programs free of charge—weight loss 

counseling, smoking cessation programs and chronic disease management with the 

assistance of a free health coach. 

Our objective was first and foremost to improve the health of our workforce, and 

we believed by doing so, our costs would decline. And while we are still building 

data on the effect our efforts have had on productivity, absenteeism and organizational health care costs, I can report that a majority of employees take an annual 

health risk appraisal and to date, we’ve lost 17,000 pounds as a workforce, and more 

than 500 of our employees have quit smoking. 

Our approach has allowed us to substantially slow the growth of our healthcare 

spending. Over the first 2 years, our cost increases were limited to an average of 

5.1 percent, despite industry trends in the 8–10 percent range. 

And, as we approach a new benefit plan year, we are carefully constructing an 

Advanced Medical Home pilot for our chronically ill employees and several other 

large employers in our community. Through a dedicated team of physicians, nurses, 

counselors and care managers, we believe we will have an even more profound impact on the health and quality of life of people living with chronic disease. 

Key to our results was the use of HSA and HRA accounts, which give employees 

better control of their health care dollars and allow us to directly reward people for 

changing unhealthy behaviors. 

Tools to Facilitate Cost and Quality Transparency

But giving our employees more control required us, as providers, to make dramatic changes. 

39

First and foremost, we created tools to provide meaningful and relevant cost and 

quality information. What other good or service do people purchase in this country 

without knowing how good it is and how much it costs? 

Nearly 3 years ago, we began sharing our quality metrics with both our employees 

and the public—the good and the bad—and since then, we’ve seen our quality scores 

soar. On our Web site we currently reports 40 quality measures—the CMS 20,10 

surgical measures and ten stroke measures. 

Unlike most providers we did not stop there. 

By working with a third insurance database, My Cost is able to verify insurance 

policies and deductibles in order to provide party patients an extremely accurate, 

personally relevant cost estimate on more than 500 medical test and procedures. As 

the CEO of a health care organization, I understand the arguments against providing transparency on cost and quality and I reject them. Alegent Health is proof 

that you can share cost and quality information and not only be competitive, but 

excel in your marketplace. 

Summary

In summary, Alegent Health began our own ‘‘healthcare reform’’ efforts several 

years ago, when we made an organizational commitment to dramatically improve 

quality, lower cost, and adopt health information technology. And yet, that will simply not be enough. 

Our challenge as a country—as physicians and nurses, members of congress and 

employers, individuals and families, is to find a way to help people become more 

individually responsible for their health. 

We speak of the tremendous consumption of healthcare as if it is some sort of 

mystery. It’s no mystery really, too many of us still smoke, we’ve become a nation 

of junk food and video games, of ‘‘super-size’’ and ‘‘all you can eat’’ buffets. These 

unhealthy behaviors cause expensive chronic diseases like heart disease, diabetes, 

and obesity. Somehow, we must find a way through public policy to engage consumers in their healthcare and incentivize all Americans to live better, healthier 

lives. Only then will we be successful in changing health care. 

Thank you.

The CHAIRMAN. Thank you. Dr. Williamson. 

STATEMENT OF BLAKE J. WILLIAMSON, M.D., M.S., VICE

PRESIDENT AND SENIOR MEDICAL DIRECTOR, BLUE CROSS 

AND BLUE SHIELD OF KANSAS CITY, KANSAS CITY, MO 

Dr. WILLIAMSON. Well, good morning. 

Congressman Fortenberry, Congressman Baca, thank you very 

much for this opportunity to tell you a bit about some breakthrough wellness programs that we have started at Blue Cross and 

Blue Shield of Kansas City for the employees that work for us or 

work with us in the Kansas City area and their employees across 

the country. 

The results of our program to date are very encouraging and 

show positive health outcomes for those who are participating. 

These results are the direct effect of our common significant investment in our members, and it is a clear example of the innovative 

contributions that only the private sector can make. 

Further validation of our programs comes from the National 

Committee for Quality Assurance. That’s NCQA, a highly respected 

organization that evaluates, accredits and certifies a wide range of 

healthcare organizations, and we recently were honored to be the 

first organization in the country to receive accreditation for our 

programs under NCQA’s Wellness & Health Promotion program. 

This is a great honor for us and is leading to greater innovations 

on our side. 

Health and wellness initiatives certainly are not new, and many 

companies and organizations have been in this business for a long 

time. Results of these initiatives have been uncertain at best. 

40

For members enrolled in our wellness programs, however, the results are real, and our most innovative program, a program called 

A Healthier You, has been in place for 4 years. We’ve been able to 

track 15 employers large employer groups who have been in that 

program for those 4 years, and here are just a few examples of 

some of the successes that we’ve seen in this program. 

First, aggregate wellness course from our Health Risk Appraisal 

tool have steadily increased, showing that health risks are going 

down in this population. Blood pressure readings in members who 

are participating in the program have decreased. 

Total cholesterol levels have decreased. Emergency room visits 

for those employer groups who are in this A Healthier You program 

have decreased slightly, while our other employee groups that are 

in our insurance company have increased. 

The costs associated with those ER visits have gone down as 

well, and non-participating companies have shown an increase in 

those costs, and the other thing is that we have also seen routine 

medical exams increase in number, which we think is a good sign. 

It is a sign that people are taking some accountability for prevention and taking better care of themselves. 

After an in-depth analysis of the cost outcomes of this program, 

we feel confident that it does have a return on investment of approximately three to one. For every $1 that gets spent on this, an 

employer can return and see $3 in savings in their healthcare 

costs. 

Our health and wellness programs target the needs of all our 

members, regardless of where they are in the continuum of health. 

It’s our objective to keep healthy members healthy and move those 

who have some risks or have some chronic health conditions back 

down that continuum toward the healthier end of the scale. It’s a 

sad fact that about five percent of our members—and this is the 

truth nationally—account for around 50 percent of all healthcare 

costs that get spent. The vast majority of these costs are related 

to unhealthy behaviors and lifestyle decisions that people make 

every day. 

As a company, we lead the market in service and wellness initiatives. We use health plan tools to gather data and warehouse that 

in a data warehouse and then personalize communications that go 

out to members with educational resources, interventions for people 

who have a few health risks, and individualized approaches for 

those who have more chronic and catastrophic illnesses. 

For members who are healthy and may have just a few health 

risks, our A Healthier You worksite program provides personalized 

counseling, on-line tools, support behavior—support behavior 

changes that members may wish to make. Members take health 

risk appraisals and then determine where they fall on the continuum, engage in appropriate programs that target their needs, 

and then our employees receive aggregate information about their 

population’s health and recommendations for their company in the 

future. 

Members who live with chronic conditions need extra care to help 

them prevent those conditions from progressing into the wrong direction and having higher health costs, so we’ve developed special 

programs for members with chronic diseases, and those members 

41

work with nursing professionals on a one-on-one basis to help them 

get control of their healthcare conditions. 

And then, for those that are on the most critical side, including 

those that have life-threatening illnesses or those who have transplants or other injuries, we have case management nurses who are 

involved with them. The interventions they make are variable depending on the member’s particular needs and are developed collaboratively between the nurse and that member to meet the goals 

that they share, and that fosters a one-on-one relationship allowing 

the nurse to become an advocate for that member. 

So, in conclusion, Blue Cross and Blue Shield of Kansas City believes that the future of healthcare cost containment lies in disease 

prevention and the practice of evidence based medicine and increasing the accountability that a member or a person has for their 

own lifestyle choices and their behaviors. 

Nationwide, around 70 percent of all healthcare costs are the direct result of those lifestyle choices that we make every day. 

We believe we have in place—we have placed the right programs 

in place to empower our members to make better healthcare decisions so that they can live longer and happier lives, and I’ve provided more detail in the packet that I’ve submitted, and I look forward to answering any questions that you might have. Thank you 

for your time. 

[The prepared statement of Dr. Williamson follows:]

PREPARED STATEMENT OF BLAKE J. WILLIAMSON, M.D., M.S., VICE PRESIDENT AND

SENIOR MEDICAL DIRECTOR, BLUE CROSS AND BLUE SHIELD OF KANSAS CITY,

KANSAS CITY, MO 

Introduction 

Good morning/afternoon! Thank you for this opportunity to tell you about the 

breakthrough wellness programs that Blue Cross and Blue Shield of Kansas City 

has developed for our clients in Kansas City and their employees around the country. Results of these programs to date are very encouraging and show positive 

health outcomes for those participating. These positive results are the direct result 

of our company’s significant investment in our members—a clear example of the 

kinds of innovative contributions that only the private sector can provide. 

Further validation of our programs comes from the National Committee for Quality Assurance (NCQA), a highly respected organization that evaluates, accredits and 

certifies a wide range of healthcare organizations. We were recently honored to be 

the first organization in the country to receive accreditation for our programs under 

NCQA’s Wellness & Health Promotion program. This is a great honor for us, and 

is leading to even greater innovations on our side. 

Real Results 

Health and wellness initiatives are certainly not new, and many companies and 

organizations have been in this business for a long time. Results of initiatives have 

been uncertain to this point. 

For members enrolled in our wellness programs, however, the results are real. 

Our most innovative program, A Healthier YouTM, has been in place for 4 years, 

and we’ve been able to track 15 large employer groups that have been in the program for all 4 years. Here are just a few examples of the success we are seeing in 

this program:

• Aggregate wellness scores from the Health Risk Appraisal have steadily increased several points over the 4 years, indicating health risk levels are going 

down.

• Blood pressure levels have decreased.

• Total cholesterol levels have decreased.

42

• Emergency room visits by A Healthier You participating companies have decreased slightly, while ER visits by non participating companies have increased 

by 17%.

• The costs associated with these ER visits have also gone up significantly for 

those not participating in the program.

• Overall medical costs have trended up at a slower rate for those participating 

in the program (10% increase); non participating companies have seen overall 

medical costs increase more than 17%.

• We have also seen routine medical exams increase in number, which we believe 

is a good sign; it shows prevention is on the rise and people are taking care 

of themselves better.

After an in-depth analysis of the cost outcomes of this program, we feel confident 

that it has a return on investment of approximately three to one—for every $1 spent 

on the program, the employer will receive $3 in return in lower employer healthcare 

costs. 

Continuum of Health 

Our health and wellness programs target the needs of all our members, regardless 

of where there are on the continuum of health. Our objective is to keep healthy 

members healthy, and move those members who have some health risks or chronic 

health conditions back down the continuum toward the healthy end of the scale. It’s 

a sad fact, five percent of members account for nearly one half of all claims costs, 

and a vast majority of these costs are the result of unhealthy behaviors and lifestyles. 

As a company, we lead the market in service and wellness initiatives. We use 

health plan tools and data, gathered in our extensive Electronic Data Warehouse, 

to determine where members are on the continuum and personalize our communication with them. We provide education and resources for members who are healthy, 

interventions for those who may have a few health risks, and individualized care 

for those members with chronic conditions or catastrophic illnesses. 

Overview of Programs 

For those members who are healthy or may have just a few health risks, our A 

Healthier You worksite program provides personalized counseling and online tools 

to support healthy behavior and any changes the member may wish to make. Members take health risk appraisals to determine where they fall on the continuum and 

engage in the appropriate programs that target their needs. Employers receive aggregate results with insights into their employee population’s health and recommendations for future engagement. 

Members living with chronic health conditions need extra attention to prevent 

their conditions from progressing in the wrong direction on the health continuum, 

leading to higher costs. We have developed special programs for members with diabetes, asthma, chronic heart failure, chronic obstructive pulmonary disease, coronary artery disease, depression, rheumatoid arthritis, hepatitis C, and multiple sclerosis. Our Disease Managers, who are also nursing professionals, reach out to these 

members and help them get control over their conditions. 

Finally, for our members with the most critical needs, including life threatening 

illness or injury and transplant cases, our Cases Management nursing professionals 

are there to assist them with their highly specialized needs. Interventions are variable based on the member’s needs and are developed collaboratively between the 

nurse and member, fostering a one-on-one relationship and allowing the nurse to 

serve as an advocate for the member. 

Conclusion 

Blue Cross and Blue Shield of Kansas City believes the future of healthcare cost 

containment lies in disease prevention, the practice of evidence based medicine, and 

increased member accountability for lifestyle behaviors and the care of their health. 

Nationwide, nearly 70% of all healthcare costs are the direct result of the lifestyle 

choices we make. We believe we have in place the right programs to empower our 

members to make better healthcare decisions and live longer, happier lives. I’ve provided more detailed information on the topics I covered today in the packet that you 

have. I look forward to answering your questions. Thank you for your time today.

43

STATEMENT OF MARSHA LOMMEL, PRESIDENT AND CEO, 

MADONNA REHABILITATION HOSPITAL, LINCOLN, NE 

Ms. LOMMEL. Chairman Baca, welcome to Lincoln, Nebraska, 

and to ProActive, and Representative Fortenberry, thank you for 

allowing us to participate in this really, really broad and important 

issue. My name is Marsha Lommel, and I am President and CEO 

of Madonna Rehabilitation Hospital. Madonna is the only freestanding rehabilitation hospital in Nebraska who specialize in rehabilitation for children and adults with traumatic brain injury, 

spinal cord injury, stroke, pulmonary disease, and pediatrics. 

ProActive, our medical fitness center, the host for today’s hearing, was completed in January of 2006. It is based on the rehabilitation model of holistic care; that is, it does not focus on a body 

part or a disease like traditional western medicine. Rehabilitation 

is the original holistic medical model. It focuses on a person’s ability to fulfill their life roles through wellness in all dimensions: 

Emotional, physical, vocational, social, spiritual, and intellectual. 

In fact, those are the dimensions of wellness incorporated into 

the ProActive wellness assessment, a tool developed by our research institute. Along with a health risk assessment, the 

ProActive Wellness Assessment allows members to focus not just 

on exercise or diet alone, but on the issues that are preventing 

them from making positive changes in their lives. Rehabilitation 

meets each person at their individual level of functioning. One 

ProActive member’s goal was to do anything for 5 minutes. She 

started by walking in the cross-current water track with the current. 

In an early study we found that almost half of our 3,800 members were non-traditional members of a fitness club; 45 percent 

were over 50 years of age, and 40 percent of those had significant 

health impairments or disabilities; 66 percent were overweight. We 

all know that many of the attempts to improve the health of society 

at large is not—have not been successful. Often wellness programs 

attract the healthiest people, and those with chronic conditions and 

obesity are too embarrassed or intimidated, or have already experienced too much failure to participate. 

We’ve found that the most important first step for these people 

is to feel comfortable in this situation. The goal for the design of 

ProActive in program and in architecture was that everyone from 

the non-fit to the athlete would feel comfortable here. Programs 

like MedFit for those with medical issues and chronic conditions include the expertise of nurses and physical therapists. Classes like 

Adaptive Training are for those with physical impairments. 

Our research institute adapted 12 pieces of commercial fitness 

equipment so that it can be used for those with physical limitations 

due to stroke, arthritis, Multiple Sclerosis, and a host of other medical conditions. At ProActive we have seen thousands of people regain health through that holistic rehabilitation approach. A 42 year 

old woman avoided gastric bypass surgery, losing 115 pounds. A 67 

year old woman who had three strokes and was diabetic is now off 

most medications and is an avid participant in the senior tap dancing classes at ProActive. 

Madonna’s occupational health service Fit for Work provides occupational health and work injury services to Madonna employees, 

44

as well as 43 other companies. Fit for Work uses the holistic 

ProActive rehabilitation model to develop wellness initiatives to 

augment the occupational health services. Wellness programming 

includes all of the standard health screenings, wellness presentations, weight loss programs, stress management, fitness classes, 

as well as medically based programs. 

The approach is truly health care and prevention. Fit for Work’s 

wellness program has been offered to Madonna’s 1,400 employees 

with much success. We are self-insured for health care, so our results are particularly pleasing. The total cost to Madonna for 

health care per employee has increased eight percent in the past 

5 years for an average of 1.76 percent per year. Thus far 773 employees have participated, and 433 have completed at least one 

wellness Lifestyle Challenge program. 

Outcomes are tracked by each initiative in the program. One example is the ‘‘Holiday Jumpstart’’ initiative for weight maintenance, which led to 71 percent of participants meeting or exceeding 

their goals, with 55 percent even losing weight over the holiday 

season, and that’s kind of tough. We also found that we were able 

to attract employees with the highest health risks to participate. 

Sixty-nine percent of our employees participating in the Lifestyle 

Challenge had a body mass index of overweight or obese; 78 percent of the overweight or obese employees lost weight, 23 of whom 

decreased their weight so significantly that they lowered their body 

mass index risk category. 

We are finding similar results at the companies we serve that 

are served by Fit for Work. Each company has its own profile and 

an individualized program to meet its unique needs and budget. 

For example, in one company almost 90 percent of the employees 

were smokers. In another company sedentary work is a contributing factor to health risks. These are measurable examples of the 

outcomes for one approach to improving health and wellness. 

As our nation moves forward with the prospect of providing 

health care for all, it should be kept in mind that life saving is not 

the only responsibility we have in health care. If we do not put the 

health back in health care, the economic burden will continue to be 

devastating. We need more medical fitness wellness centers like 

ProActive and BryanLGH’s LifePoint. We need to include coverage 

for medical wellness programs in insurance plans and in Medicare 

and Medicaid. 

We need to fund research at the grass roots level to identify innovative programs and best practices to achieve long-term results. I 

urge the Committee to include rehabilitation and wellness in the 

healthcare reform bills that are weaving through Congress. You 

may save some lives as well as ease the financial burden. 

[The prepared statement of Ms. Lommel follows:]

PREPARED STATEMENT OF MARSHA LOMMEL, PRESIDENT AND CEO, MADONNA

REHABILITATION HOSPITAL, LINCOLN, NE 

My name is Marsha Lommel and I am President and CEO of Madonna Rehabilitation Hospital in Lincoln, Nebraska. Madonna is the only freestanding rehabilitation hospital in Nebraska and the only facility in the country with a Long Term 

Care Hospital and an Acute Rehabilitation Hospital under one roof. Madonna also 

has a nursing home, an assisted living facility, a large outpatient program, an occupational health program and a medical fitness center, ProActive, your host for toVerDate 0ct 09 2002 15:21 Jul 16, 2010 Jkt 041481 PO 00000 Frm 00048 Fmt 6633 Sfmt 6621 I:\DOCS\111-28\53492.TXT AGR1 PsN: BRIAN
45

day’s hearing. Madonna specializes in rehabilitation for adults and children with 

traumatic brain injury, spinal cord injury, stroke, pulmonary disease and pediatrics. 

In fact, Madonna has one of only seven accredited pediatric brain injury programs 

in the nation and is one of only four to offer an accredited pediatric spinal cord injury program. 

What does rehabilitation have to do with wellness? We believe the rehabilitation 

model lends itself to wellness because rehabilitation is holistic, that is, it does not 

focus on a body part or a disease like the traditional western model of medicine. 

Rehabilitation focuses on a person’s ability to fulfill their life roles through health 

in all dimensions—emotionally, physically, vocationally, socially, spiritually and intellectually. In fact, those are the dimensions of wellness incorporated in the 

ProActive Wellness Assessment, a tool developed by our research institute. Along 

with a Health Risk Assessment, the ProActive Wellness Assessment allows members to move beyond diet and exercise alone, beyond health risk, to address issues 

that are preventing them from making positive changes in their lives. One of the 

most significant of these identified by national studies as well as our own experience, is stress management. 

Second, rehabilitation emphasizes that each dimension of a person affects all 

other dimensions. We know, for example, that a simple walking program increases 

satisfaction in social and emotional, as well as physical, dimensions. And last, rehabilitation accommodates each person at their level of functioning. One ProActive 

member’s goal was to do anything for 5 minutes. She started by walking in the cross 

current water track with the current to ease her mobility, and later progressed to 

full participation in water and land exercise. 

We all know that many of the things that have been tried to improve the health 

of society at large have not been successful. These include scaring people, one size 

fits all programs and a sole focus on medication or disease management. People are 

not their diseases. Often wellness programs attract the healthiest people, and those 

with chronic conditions and obesity are too embarrassed or too intimidated, or have 

already experienced too much failure, to participate. We have found that the most 

important first step for these people is to feel comfortable in the situation, and see 

that they are on the journey with people like them. That is why the non-fit and the 

moderately fit population do not feel comfortable in a traditional fitness facility with 

the younger or more athletic clientele. 

ProActive has almost 3800 members and a little more than half of them are considered non traditional members of a fitness club. In an early study of our membership, 66% were overweight, 70% had inadequate fitness level, 74% were at an elevated risk for cancer, 45% were over 50 years of age and 40% of those had significant health impairments or disabilities, 36% had a moderate to high risk of coronary 

artery disease. These are the health problems of America. But when we look at the 

underlying attitudes and beliefs of this population, it is apparent that there are significant obstacles in the ability to change. 33% did not feel confident in their ability 

to succeed in a fitness plan, 17% reported excessive stress and poor coping skills. 

At ProActive, we have seen thousands of people regain health through a holistic 

approach. A 42 year old woman avoided gastric bypass surgery, loosing 114 pounds 

and reducing her triglycerides by 100 points. She states she didn’t feel ‘‘one bit intimidated at ProActive’’ and when she described her outcome, she said ’’Emotionally, 

I’m so much happier.’’ The women in her aquatic classes have become such good 

friends, they recently rewarded themselves with a group trip to Kansas City. That 

is the power of the holistic approach and a concentration on all of the dimensions 

of wellness. 

A 67 year old woman who has had three strokes, was diabetic and had high blood 

pressure and high cholesterol, is now off most medications and is an avid participant in the senior tap dancing classes at ProActive. She said ‘‘I needed a place 

where I felt comfortable. It’s better than any medicine.’’

Successful programming, we have found, is based on the holistic model of rehabilitation. It means including an element of fun, an element of competition and a focus 

on grouping people with similar characteristics and problems. It means dance classes with participants at any skill level. It means paired and group competitions with 

prizes (even small ones will do), healthy cooking classes, women’s and men’s groups, 

classes for seniors, programs like MedFit for those with medical issues and chronic 

conditions, and special classes like Adaptive Training for those with physical impairments. Our research institute conducted a 2 year research project to adapt commercial fitness equipment so it can be used by those with physical limitations such 

as those who are partially paralyzed due to strokes, have arthritis or have neuromuscular problems such as MS. 

As you look around you at ProActive, you will see that it was designed to address 

the psychological and spiritual aspects of wellness, as well as the physical. The goal 

46

was to make ProActive entirely different from a typical fitness center so that people 

who would never set foot in a traditional fitness center, as well as the body building 

athlete, would feel comfortable here. And they all do. It is a place of energy as well 

as contemplation. It is accessible to, and welcoming to, those in wheelchairs and 

with walkers, the elderly and medically fragile. The cross current water track and 

the simple-to-use circuit were all designed for non-fit and moderately fit members. 

The staff of three nurses, two dietitians, five physical therapists, exercise trainers, 

lifestyle coaches, dance instructors and group instructors address the needs of each 

member individually, starting with health risk and wellness assessments and individual counseling. ProActive provides medically supervised programs for people with 

cardiac conditions, arthritis, fibromyalgia, and diabetes. Our success in developing 

this model has resulted in positive, life enhancing outcomes that have exceeded our 

expectations. 

Madonna’s occupational health program, Fit For Work, provides occupational 

health and work injury services to 43 businesses in and around Lincoln. Working 

in partnership with businesses and their employees, the expensive costs of worker’s 

compensation, time loss and decreased productivity can all be greatly diminished. 

Fit for Work staff provided over 1,300 health screens and delivered over 7,300 flu 

shots to these businesses as well as for the State of Nebraska workers. 

Fit for Work incorporated the holistic philosophy of ProActive and developed a 

wellness initiative to augment its occupational health services. Fit for Work is currently providing wellness services to over 25 companies employing approximately 

5,500 employees. Services include Health Screenings for early detection of health 

risks, Wellness presentations, Weight Loss programs, Tobacco Cessation programs, 

Nutrition and Wellness Coaching, Walking programs, Stress Management, Fitness 

classes and medically based programming. The approach is truly health care and 

prevention verses sick care. 

Madonna Rehabilitation Hospital also uses the Fit for Work wellness program for 

our 1400 employees. Because we are self insured, our cost for employee healthcare 

can be tracked fairly accurately. In the past 5 years, the total cost to Madonna for 

healthcare, per employee, has increased 8% or an average of 1.76% per year. 

Thus far, 773 employees have participated and 433 have completed at least one 

Fit for Work wellness program, one of which is the Lifestyle Challenge. This program offers free screenings, regular weigh-ins, health tips and prizes. Outcomes of 

wellness programs, like rehabilitation, must be tracked over many years to evaluate 

their true contribution to health. Because of the cost involved in applying research 

methodology, it is prohibitive for businesses to obtain reliable and valid outcomes 

or conduct blind studies. 

However, Fit for Work does track outcomes for each initiative and program and 

I can give you a sample of those results. In the ‘‘Get In the Game Season Training’’ 

program 97% of the participants stated that they learned healthier behaviors at the 

live events and 70% took action steps to incorporate new choices into their lifestyle. 

The ‘‘Holiday Jumpstart’’ initiative for weight maintenance led to 71% of participants meeting or exceeding their goals, with 55% even losing weight over the holiday season between November and January. The impact of these events at Madonna 

has been echoed at the other businesses that implemented the Fit For Work 

wellness plan. 

We also found that we were able to attract employees with the highest health risk 

to participate. which is often cited as a problem for wellness programs. For example, 

69% of our employees participating in the Lifestyle Challenge met the body mass 

index categorization of overweight or obese; 78% of the overweight or obese employees lost weight, 23 of whom decreased their weight so significantly that they lowered their body mass index risk category. 

Another example of the success of Lifestyle Challenge is the subjective evaluation 

results gathered at the end of each competition. Examples of employee’s perceptions 

of their health changes through the program include 55% who said they felt happier 

with themselves, 52% reported having more energy and 24% reported a decrease in 

stress levels. 

With 1,400 employees working shifts around the clock and at locations scattered 

throughout Lincoln, Fit For Work wellness programming has continued to be creative in finding ways to reach busy workers in the challenging field of health care. 

Program design allows for all shifts to participate and often the education comes to 

them. Rolling carts from unit to unit with healthy snacks and educational presentations on nutrition or stress management or exercise, our wellness staff are able 

to give personal attention to employees who may never attend one of the more formal sessions. The focus is on real life challenges such as the miles it takes to walk 

off a stadium hot dog or the best and worst choices for breakfast cereal. 

47

Another successful example is the walking program, in which participants are 

given pedometers and departments compete for most steps, or most improvement or 

even most participation. Groups of employees are now seen walking the 23 acre 

campus on breaks and over lunchtime. 

We saw a ten-fold increase in our wellness programming engagement when fun 

and surprise events were incorporated. Successful wellness programs feel private 

and personal to participants, yet also foster the camaraderie of developing a 

healthier workplace culture. It has to meet the needs of the most sedentary staff 

member and the weekend athlete. It has to help each person feel like their day-today choices shape their health. 

Wellness is about personal touch and connection. With confusion generated by 

sound bite media messages, employees need to be able to access information and 

participate in programs that are relevant to them and fit into their lives. 

We are finding similar results at the companies served by Fit for Work. Of the 

2,400 employees who took the health risk assessment, 74% had a higher risk of cancer, 70% had poor fitness levels, 66% were above the recommended weight, 64% 

need to improve nutrition and 35% had moderate to high risk of coronary artery disease. Each company has its own profile and an individualized program to meet its 

unique needs and budget. For example, in one company, almost 90% of employees 

were smokers. In other companies, sedentary work is a contributing factor to health 

risk. 

The Lifestyle Challenge is one example of a team focused, weight and physical 

activity challenge; 900 members of five different businesses who were part of the 

programming lost over 2,400 pounds and logged over 36,400 hours of physical activity above and beyond their typical workday activity. 

These are measureable examples of the outcomes for one approach to improving 

health and wellness. As our nation moves forward with the prospect of providing 

health care for all, it should keep in mind that life saving is not the only responsibility we have in healthcare. If we do not include rehabilitation and wellness, the 

economic burden will continue to be devastating. We need more medical wellness 

centers like ProActive and BryanLGH’s LifePoint, we need to include coverage for 

medical wellness programs in insurance plans and in Medicare and Medicaid. We 

need to fund research at the grass roots level to identify best practices in wellness 

and establish long term results. 

I urge the Committee to include rehabilitation and wellness in the healthcare reform bills that are weaving through congress. You may save some lives, as well as 

ease the healthcare financial burden.

STATEMENT OF GLENN A. FOSDICK, F.A.C.H.E., PRESIDENT 

AND CEO, NEBRASKA MEDICAL CENTER, OMAHA, NE 

Mr. FOSDICK. Congressmen, good morning. My name is Glenn 

Fosdick, and I am President and Chief Executive Officer of The Nebraska Medical Center. It is my intention to share with the Committee what healthcare providers are doing in prevention and 

wellness practices to better control healthcare costs. With this in 

mind I would like to note the experiences of The Nebraska Medical 

Center and highlight specific examples where costs have been significantly reduced and our employees have improved their overall 

health. 

The Nebraska Medical Center is a 689 bed academic medical center providing the most sophisticated tertiary and quaternary care 

in the region. The largest hospital in the state, we employ over 

5,700 FTEs within a budget over $750 million. 

With the escalating challenges declining reimbursement and increasing costs, we experience the same fiscal concerns that all 

healthcare providers do. 

Accordingly, our budgetary process is very sensitive to the costs 

associated with the provision of healthcare benefits for our employees. 

As a good employer, it is our goal to provide the most possible—

the best possible services and ensure the overall good health and 

48

well-being of our employees and their families. Because of the complexities of care that we provide, our employees have a very thorough understanding of the healthcare delivery system and expect 

high quality care. Like all employers, we have experienced the 

challenge of the inflationary increases associated with healthcare 

benefits; however, it has been our commitment to identify opportunities to better control these costs without compromising the service provided to our employees. 

Our efforts in this area focus on the basic philosophy of improved 

health and a proactive process to identify and address medical 

issues early (the cause). This, we believe, is dramatically more efficient and cost effective than treating the inevitable medical problem (the result) when it becomes a significant and expensive clinical issue. 

Included in our approach is a dedicated program for employee 

wellness. This collaborative approach, which began in 1991, incorporates a variety of methods of connection and communication with 

the employee to educate and influence them and their dependents 

on effective and realistic approaches to prioritize the individual’s 

personal well-being. These include specific initiatives in weight 

management, fitness, cholesterol monitoring, and health prevention, including providing an on-site fitness center for employees. It 

has received numerous awards in the last several years. 

A second thing I’d like to discuss is our employee screening process, SimplyWell, initially developed here in Omaha, which we believe has had substantial impact on our success. 

In 1998, the SimplyWell program was developed under the leadership Dr. James T. Canedy, an orthopaedic surgeon from The Nebraska Medical Center who recognized that the long-term improvement in healthcare quality depended on the implementation of an 

effective screening and risk reduction program. 

The unique capability of this organization is that it provides a 

turnkey operation with components in place, ready to implement 

for all types of businesses and size and scope. It incorporates an 

on-line health risk management assessment which helps identify 

priorities unique to each individual. In addition, it combines the 

traditional blood pressure, height, weight, and flexibility screening 

mechanisms with a lab blood draw analysis, which allows for greater problem recognition and detail. 

SimplyWell has developed an on-line personal health record for 

each participant. It utilizes health lifestyle coaching, which includes a minimum of one telephone call annually per participant or 

more often, as needed, as well as a 24 hour nurse call line for follow-up questions information. Of particular interest is the capability of the personal health record, which provides on-line access 

to laboratory test results and identifies areas of concern above and 

below appropriate ranges, as well as providing over 1,300 individual, 5 minute or less educational modules on specific health 

areas that may be of interest or concern to the individual. While 

this individual record is not available to the employer, SimplyWell 

examines collaborative data throughout the organization to identify 

trends or particular areas of concern. 

The Nebraska Medical Center has utilized a conservative and 

positive approach to encouraging enrollment, including a $50 check 

49

for employee participation. This will be enhanced this coming year 

with a required $500 contribution for non-participating employees. 

The program currently serves over 33,000 members nationally, 

including over 200 employers in banking, manufacturing, medicine, 

retail, agriculture, and higher education in all 50 states and 20 

countries. It has demonstrated an audited and consistent return on 

investment of one to one in year one and as much as three to one 

by the third year. 

The individual value of this program is reflected to us annually 

as we identify specific problems associated with our employees in 

a pre-emptive time frame. These include, for example, the identification of employees who are in a pre-diabetic status and who, 

without proper lifestyle management, will face the clinical liabilities of diabetes. This area is in itself significant, given that medical expenditures incurred by diabetics in the United States are estimated at $116 billion per year. The American Diabetes Association has estimated that people diagnosed with diabetes on average 

have medical expenditures approximately 2.3 times higher than 

those without diabetes. 

In addition, each year we identify other significant risks. These 

include obesity, pre-leukemic status, heart disease, and a variety of 

other problems of note. 

The comparative value of these efforts has been substantial for 

The Nebraska Medical Center. In examining the average participant cost associated with employer-sponsored health plans for 2004 

through 2008, there has been a national increase of 27.7 percent. 

By comparison, The Nebraska Medical Center cost has increased 

only 4.2 percent during this 5 year period. Specifically, in 2004, our 

average participant costs were 97 percent of the national average. 

In 2008, they were 79 percent of the national average. The impact 

on our budgeting process is significant. Our ability to control our 

costs neutralized the inflationary impact of health care. 

The challenges of controlling healthcare costs by both employers 

and government are formidable. Our culture has defined the standard for the critically ill as immune to financial limits. We must not 

compromise our commitment to utilize all of our skills and abilities 

to address their needs. This is economically possible if we recognize 

and take advantage of opportunities in other areas, including 

wellness and preventive screening on an annualized basis. The results speak for themselves. 

Finally, this effort is one of four specific areas of opportunities 

I would submit can positively influence the control of healthcare 

costs. One is wellness and screening. Second is participant contribution. As long as these services are free, they are hard to control. End-of-life control, recognizing that the last 60 days of life are 

the most expensive in your healthcare history. There are substantial opportunities with increased palliative care intervention to reduce inappropriate and valueless costs; and, finally, malpractice/defensive medicine. With the expense associated with defensive medicine estimated as much as ten percent of healthcare costs, we cannot ignore this. 

It is my belief that these four areas provide the greatest and 

most reliable realistic opportunities for enhancing control of 

healthcare costs. These may not be the easiest, but it can be the 

50

most successful. Thank you for allowing me to share these 

thoughts. 

[The prepared statement of Mr. Fosdick follows:]

51

PREPARED STATEMENT OF GLENN A. FOSDICK, F.A.C.H.E., PRESIDENT AND CEO, 

NEBRASKA MEDICAL CENTER, OMAHA, NE


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STATEMENT OF LUANN HEINEN, M.P.P., VICE PRESIDENT,

NATIONAL BUSINESS GROUP ON HEALTH; DIRECTOR,

INSTITUTE ON THE COSTS AND HEALTH EFFECTS OF

OBESITY, WASHINGTON, D.C. 

Ms. HEINEN. Good morning, Chairman Baca and Ranking Member Fortenberry. I’m LuAnn Heinen, Vice President of the National 

Business Group on Health. We’re a member organization. We represent about 300 mostly very large employers that provide coverage 

to more than 55 million U.S. workers, retirees, and their families. 

I’ve been asked to speak about worksite wellness programs and 

what we know today about whether they work. 

The World Health Organization estimates that exercise and better diets, along with smoking cessation, can prevent at least, at 

least, 80 percent of all cases of heart disease and stroke and type 

2 diabetes and up to 40 percent of cancers. Now, it’s clear that to 

prevent anything approaching 80 percent of today’s burden of heart 

disease or 40 percent of cancers will take massive change across 

many sectors and is much bigger than the workplace, but just at 

the worksite evidence is growing that health promotion (also called 

wellness) programs can positively influence employee health risks 

and achieve a positive return on investment. 

I’m going to speak to just three examples of important research. 

First—and I’ll summarize it briefly—an authoritative review of 50 

studies of worksite interventions by the CDC Community Guide 

Task Force found small but cumulative significant health benefits, 

so they concluded that worksite health promotion programs reduced tobacco use, reduced dietary fat consumption, reduced high 

blood pressure and cholesterol, as well as days off of work and increased productivity. 

The second study was a review of 25 return on investment studies of workplace health promotion programs, and they found an average cost reduction annually of two to four percent of total medical 

claims costs, so that’s across these 25 studies, and that translated 

into a return on investment of a dollar to $3 for every dollar spent 

on health promotion programs. Now, this means that looking only 

at direct medical costs (not factoring in productivity, absenteeism, 

or other indirect costs), these worksite health promotion programs 

showed a small but definite positive ROI. 

And then, third, one of our member companies, The Dow Chemical Company, has published a return on investment projection 

model to analyze the break-even point for employee wellness, and 

they showed small improvements in health risks for Dow employees would yield significant savings in health costs for the company. 

So the break-even point, according to Goetzel, at which savings exactly equaled investment dollars occurred when each of the health 

risks they measured was reduced by just .17 percent annually. 

So across a large population you didn’t need to see a major reduction in order to get a benefit, a pretty big dollar benefit, so increasingly our membership, large employers, see themselves as 

population health managers, and this works especially well in companies with relatively low turnover so that small risk reductions 

over a large workforce over several years can dramatically bend the 

trend. 

57

Now, notwithstanding the research results cited above, a majority of large companies actually do not wait for or fund or participate in the types of research that definitively answer the question, 

‘‘Does this program have a positive return on investment?’’

And that’s because human resource departments and medical departments and safety and occupational health departments tend 

not to have a budget for research, nor are they willing to spend the 

needed time or information technology resources to evaluate their 

programs, and their measures of success are going to be different 

from those of academic researchers. 

And so it happens even effective programs may be eliminated 

when there’s a downturn in the company’s revenues or market capitalization, so this clearly limits the volume and type of research 

that can be conducted on corporate wellness programs, and it also 

slows the development of an evidence base that’s going to be compelling to academicians and policymakers. Now, employers, however, do not require the same level of evidence for their own decision-making purposes, so it’s worth noting that the latest survey 

data from our own membership—and we had a response rate on 

this of 75 respondents—16 percent of them said that wellness initiatives to improve employee health are the single most effective 

tool they feel they have to control health costs, and a third of them 

said wellness is one of the top three most effective steps they can 

take. 

The other two would be employee cost-sharing and the use of 

consumer-directed health plans, so many employers work with 

their health plans, their insurance companies, and other partners 

to be sure that overweight and obesity are included in health education and communications that come out from the plans that are 

furthering health benefit plan design. They’re offering coaching and 

health improvement programs, and they also have disease management and disability/return-to-work initiatives. 

Our members often work to ensure that the culture and the environment at work promote healthy weight and healthy life-styles by 

encouraging physical exercise, offering healthy food, and establishing social norms around healthy behaviors, so we have a program called the Best Employers for Healthy Lifestyles, and just 

this past June we had our fifth-year anniversary of this program. 

We recognized 63 large employers representing the full spectrum 

of companies across the country of the U.S. economy for their exceptional commitment to healthy workplaces and helping employees and families make better choices. 

So the 2009 class of award winners is the largest ever, with companies demonstrating an unprecedented breadth and depth of programs to support employee health and wellness, so winners were 

honored in one of three categories: Platinum, for very well established programs with measurable success and documented outcomes; or the gold level for creating cultural environmental 

changes—cultural and environmental changes to support employees and helping them commit to long-term behavior change; and 

then, finally, silver, which is for employers who have more recently 

launched programs and services to support healthier lifestyle. 

So we did find that there is strong evidence to the increased 

value employers today are placing on workplace health and 

58

wellness. The number of advocates, the number of winners, it’s 

gone up every year, and in 2009, we gave nearly three times the 

number of awards as we did 5 years ago, and I won’t go through 

and read all the award winners, you’ll be happy to know, but just 

to give you a feel for them, they are companies like Dell, Hannaford Supermarkets, IBM, Occidental Petroleum, JPMorgan Chase, 

Mayo Clinic, Wal-Mart, Xcel Energy, lots of different kinds of companies. 

And one of our platinum winners for the last 5 years, Union Pacific Corporation, is based right here in Nebraska. Their health 

promotion program, HealthTrack, is a comprehensive program to 

improve the health of employees. It addresses a variety of risk factors, including inactivity, weight, nutrition, smoking, cholesterol, 

blood pressure, and depression. They include a risk reduction program, tobacco cessation program. They have exercise facilities 

throughout the country and have applied for research grants to further develop their program. 

Also located in Nebraska is the Wellness Council of the Midlands, which is one of the first employer-led wellness councils in 

the country. It may be the first. It was established in 1982. And 

then the national organization, Welcoa, also in Nebraska, provides 

information and recognition to thousands of smaller businesses nationally, and that’s very important, because smaller business today 

has not embraced wellness the way that large business has. 

And so the national—actually, our survey, not their survey, of 

450 large employers that we did with Watson Wyatt said that large 

employers recognize and identify employees’ poor health habits as 

their number one challenge to try to maintain affordable health 

benefit coverage, and so a majority of large employers offer health 

risk appraisals, weight management programs, lots of great programs. 

Based on survey data, if you see the growth of the suppliers and 

the vendors in this field who supply corporate wellness programs 

and also what we hear from employers, we actually believe that 

among the group we deal with, a tipping point has probably been 

reached and that large employers now have or believe they should 

have wellness programs in place. But, in great contrast to that, 

only 6.9 percent of small employers with fewer than 750 employees—and this was a big national representative sample between 

1999 and 2004 and published in 2008. 

It’s called the National Worksite Health Promotion Survey, and 

they found a decline in offerings by small employers and only 6.9 

percent offering them at this point, so because small businesses 

employ about 50 percent of the workforce in the private sector, this 

survey is an important and very sobering perspective on the typical 

American worksite. 

One of the really important things for us, moving forward, is role 

models, and although an estimated hundred or more very large employers have substantial programs affecting millions of employees 

and some small mid-sized employers are following suit, many others have been slow to react. Now, certain employers have the visibility to be role models and to influence the climate for change, and 

in particular healthcare organizations, and I’d like to acknowledge 

59

the role of the companies on this panel we’ve heard from today and 

how much they’re doing. 

Health organizations and public employers should absolutely 

model best practices in support of employee health, so all 

healthcare companies and delivery organizations should adopt 

wellness programs and policies similar to those we’ve heard about 

on the panel today, and hospitals in particular are houses of healing open to the community and should serve as examples by offering healthful dining, healthy vending, and tobacco-free campuses. 

Public employers, including state offices, Federal buildings, county facilities, and school districts also should demonstrate their commitment as well. State employees’ wellness programs are becoming 

more common, and at least a dozen states have some type of 

wellness program available to employees. The National Conference 

of State Legislatures reports that King County in Seattle projects 

their health costs will fall by as much as $40 million between 2007 

and 2009, due to wellness initiatives. 

Now, once employers, either public or private, offer wellness and 

health promotion programs, it’s up to employees to participate and 

take advantage of these offerings, and disappointing levels of program participation are the Achilles heel of many corporate wellness 

programs. Even when programs are launched with employee input 

and leadership support and do the right things, they’re well communicated, they’re subsidized or priced for affordability and they’re 

offered at convenient times and locations, low participation can be 

a barrier to success. 

So ‘‘build it and they will come’’ is not a strategy for success. Instead, companies are adopting in increasing numbers incentive programs—we’ve heard a little bit about that today—to increase participation and to award program completion, so you might offer an 

incentive to get someone to take a health assessment and then perhaps another incentive to reward program completion, such as a 

coaching program. 

Premium incentives for nonsmokers are on the rise in the wake 

of new evidence showing financial incentives have an impact on 

smoking cessation that was conducted at General Electric among 

General Electric Corporation employees, and also incentives for 

weight loss can be effective in a corporate setting. On the other 

hand, before we fall to one single solution, we also know from survey data that almost half of employees say that financial incentives 

will not encourage them to participate in healthy lifestyle programs, so all of this reinforces our understanding that purely voluntary wellness and health participation programs will fall short 

of ideal participation levels. 

Now, one state has taken an interesting approach. Faced with a 

serious budget shortfall and not being constrained by the Health 

Insurance Portability and Accountability Act non-discrimination 

regulations in the same way as private self-insured employers are, 

the State of North Caroline employee health plan has determined 

that it will not allow tobacco users (beginning next year) to join the 

more favorable 80/20 health plan, and it expects to preclude those 

with a high Body Mass Index from joining the same favorable 

health plan beginning in 2011. Instead, those beneficiaries who do 

60

not meet the standard for the 80/20 plan will be enrolled in the alternative 70/30 plan. 

So, in closing, the Federal Government should do all that it can 

to help employers set up employee wellness programs and encourage employees (and, where possible, dependents) to participate, so 

we’d suggest that Congress help by removing tax barriers, particularly for employees, to allow more widespread adoption of wellness 

programs by employers and greater participation by employees and 

by expanding the IRS definition of ‘‘qualified medical expenses’’ to 

include expenses primarily to maintain health and wellness, and 

that’s including but not limited to expenses for exercise, fitness, 

weight management, and nutritional counseling; and then, third, 

extending the current tax deduction for the fees, dues or membership expenses paid by employers for their employees at on-site athletic facilities to the fees, dues to membership expenses at off-site 

facilities and supporting health reform provisions to expand permissible wellness incentives—right now they’re only 20 percent 

permitted under HIPAA non-discrimination—and providing tax 

credits to employers for wellness programs which would include nutrition and weight management programs; and then, finally, only 

targeting Federal subsidies to foods that are essential for a healthy 

diet and removing any obstacles that exist to increased fruit and 

vegetable production. 

So thank you for the opportunity to share the perspective of large 

employers on the preventable health problems of employees that 

lead to chronic diseases and excess costs which are borne by employees and employers alike. We believe it’s essential to combat the 

tsunami of obesity that threatens to overwhelm us, and we think 

that in terms of lifetime and generational impact that actually obesity has ramifications greater than those associated with the current economic crisis, and we welcome dialogue on this. 

[The prepared statement of Ms. Heinen follows:]

PREPARED STATEMENT OF LUANN HEINEN, M.P.P., VICE PRESIDENT, NATIONAL

BUSINESS GROUP ON HEALTH; DIRECTOR, INSTITUTE ON THE COSTS AND HEALTH

EFFECTS OF OBESITY, WASHINGTON, D.C. 

Good morning Chairman Baca, Ranking Member Fortenberry and members of the 

U.S. House Committee on Agriculture. I am LuAnn Heinen, Vice President of the 

National Business Group on Health (Business Group), a member organization representing approximately 300 mostly large employers that provide coverage to more 

than 55 million U.S. workers, retirees and their families. The National Business 

Group on Health is the nation’s only nonprofit organization devoted exclusively to 

finding innovative and forward-thinking solutions to large employers’ most important health care and related benefits issues. 

America’s Obesity Epidemic Continues Unabated 

Today’s hearing is focused on defining efforts in health care, industry and communities that are effective in addressing the problems of poor nutrition, obesity, and 

related chronic disease. These are problems affecting every state, including Nebraska. Adult obesity rates continue to rise in 23 states, and have not decreased 

in any state; Nebraska ranks 20th among states in adult obesity prevalence (Trust 

for America’s Health, 2009). Rates of obesity among children (2–19) have more than 

tripled since 1980 and may have leveled off; CDC research reports no statistically 

significant change between 2003–2004 and 2005–2006 (Ogden et al., 2008). 

Last week, Health Affairs reported that medical spending on conditions associated 

with obesity has doubled in the past decade and could reach $147 billion a year as 

of 2008. Obesity now accounts for almost 10% of all medical spending, up from 6.5% 

in 1998. Spending associated with obesity is almost entirely tied to costs generated 

from treating the diseases that obesity promotes, such as diabetes. For example, exVerDate 0ct 09 2002 15:21 Jul 16, 2010 Jkt 041481 PO 00000 Frm 00064 Fmt 6633 Sfmt 6621 I:\DOCS\111-28\53492.TXT AGR1 PsN: BRIAN
61

cess weight is the single greatest predictor of developing diabetes, a disease that 

costs $191 billion a year. The study also found that ‘‘if lawmakers are serious about 

cutting health care spending.they should be focusing on ways to reduce obesity and 

its related risk factors since it is increasingly imposing a heavy burden on both private and public payers’’ (Finkelstein et al., 2009). 

Just last week, the incoming CDC Director, Dr. Thomas Frieden, shared some 

startling statistics at ‘‘Weight of the Nation,’’ a CDC-sponsored conference attended 

by approximately 1,000 Federal, state and local policymakers and public health officials:

• The average American is 23 pounds overweight.

• As a nation, we have 4.6B pounds of excess weight; if this were converted to 

useable energy, we could power the city of Washington D.C. for more than a 

year and a half. 

• The cost of extra food that is needed to maintain the nation’s excess body 

weight is greater than $50B per year.

As Obesity Rates Have Climbed, So Have Rates of Associated Health Conditions

• Overweight and obesity associated prevalence of 11 chronic conditions grew 

180% in the 8 years from 1997–2005 (Thorpe et al., 2009).The number of working-age adults who report being diagnosed with at least one of seven major 

chronic conditions (heart disease, hypertension, stroke, diabetes, emphysema, 

asthma, and cancer) has grown 25% since 1997 to nearly 58 million in 2006 

(Hoffman and Schwartz, 2008).

• CDC reports that more than 133 million Americans—45% of the total population—have at least one chronic disease. Chronic diseases kill more than 1.7 

million Americans yearly, and account for a third of years of potential life lost 

before age 65 (CDC, 2005).

Obesity Has Played a Major Role in Rising Health Care Costs

• Average per capita health spending increased by 40% from 1997 to 2005, but 

the average for the 15 costliest conditions—all associated in some way with obesity—jumped 55% (Thorpe et al., 2009).

• Overall, obesity accounts for 27% of the increase in inflation-adjusted health expenditures among working age adults. Inflation adjusted medical spending for 

working age adults increased by nearly 70% from 1997 to 2005, growing from 

$316 million to $526 million (Thorpe et al., 2009).

• If the prevalence of obesity were the same today as in 1987, health care spending in the U.S. would be 10% lower per person, or about $200 billion less each 

year (Thorpe et al., 2009).

Do Worksite Wellness and Prevention Programs Work? A Summary of Evidence on Health and Financial Impacts 

The World Health Organization (WHO) estimates that exercise and better diets 

along with smoking cessation could prevent at least 80% of all cases of heart disease, stroke, and type 2 diabetes and up to 40% of cancers (WHO, 2005). It’s clear 

that to prevent anything approaching 80% of today’s burden of heart disease or 40% 

of cancers will take massive change across many sectors and is much bigger than 

the workplace. 

Just at the worksite, however, evidence is growing that health promotion (also 

called wellness) programs can positively influence employee health risks and 

achieve a positive return on investment (ROI).

• An authoritative review of 50 studies of worksite interventions by the CDC 

Community Guide Task Force concluded that these worksite health promotion 

programs reduced tobacco use, dietary fat consumption, high blood pressure and 

total cholesterol levels and days if work lost while also increasing productivity 

(Goetzel and Ozminkowski, 2008).

• A review of 25 ROI studies of workplace health promotion and disease management programs found an average annual cost reduction of 2–4% of total medical 

claims costs which translated into an ROI of 1:1.5 to 1:3.0 for health promotion 

programs. In other words, looking only at direct medical costs (not factoring in 

productivity, absenteeism or other indirect costs), these worksite health promotion programs showed a small but definite positive ROI (Serxner et al.,

2006).

62

• An ROI projection model used by The Dow Chemical Company to analyze the 

break-even point for its investments in employee wellness showed that even 

small improvements in health risks for Dow employees would yield large savings in health costs for the company. ‘‘The break-even point, at which savings 

exactly equals investment dollars, occurs when each health risk is reduced by 

0.17% annually.’’ (Goetzel et al., 2005). Increasingly, employers see themselves 

as population health managers—especially in companies with relatively low employee turnover—and small risk reductions over a large workforce carried out 

over several years can dramatically reduce health expenditures.

Notwithstanding the research results cited above, a majority of large companies 

do not wait for, fund, or participate in the types of research that can definitively 

answer the question, ‘‘does this program have a positive ROI?’’ Human resource departments tend not to have a budget for research, nor are they willing to spend the 

needed time or IT support to evaluate programs. Their measures of success are usually very different from those of academic researchers, and even effective programs 

may be eliminated when there is a downturn in the firm’s revenues or market capitalization. This clearly limits the volume and type of research that can be conducted and slows the development of an evidence base that is compelling to academicians and policymakers. Employers themselves do not require the same level of 

evidence for decision-making purposes (Heinen and Darling, 2009). 

It is worth noting that the latest survey data from our own members (n=75 respondents) show that 16% of respondents said wellness initiatives to improve employee health are the single most effective tool they have to control health costs, 

while 30% said wellness is one of the top three most effective steps they can take 

(the other two are employee cost-sharing and the use of consumer-directed health 

plans) (National Business Group on Health, 2009). 

Employers are Leading the Way to Reduce Obesity and Promote Healthy 

Lifestyles 

Many employers work with their health plans and other partners to be sure that 

overweight and obesity are included in health education and communications, plan 

design, coaching and health improvement programs, as well as disease management 

and disability/return to work. In addition, members of the National Business Group 

on Health often work to ensure the culture and environment at work promote 

healthy weight by encouraging physical exercise, offering healthy food, and establishing social norms around healthful behaviors. 

In June, the National Business Group on Health recognized 63 large employers—

representing the full spectrum of the U.S. economy—as 2009 Best Employers for 

Healthy Lifestyles award winners for their exceptional commitment to a healthy 

workplace and for helping their employees and families make better choices about 

their own health and well-being. The 2009 class of award winners is the largest 

ever, with companies demonstrating an unprecedented breadth and depth of programs to support employee health and wellness. More than ever, employers are 

making investments that should pay substantial dividends over the long term. Winners of the 5th Annual Best Employers for Healthy Lifestyles awards were honored 

in one of three categories: Platinum, for established ‘‘Healthy Weight, Healthy Lifestyles’’ programs with measurable success and documented outcomes; Gold, for creating cultural and environmental changes that support employees who are committed to long-term behavior changes; and Silver, for employers who have launched 

programs or services to promote living a healthier lifestyle. 

As a testament to the increased value employers place on workplace health and 

wellness programs, the number of award-winning employers in 2009 (a total of 63) 

grew by 21% compared to 2008 when 52 employers were recognized. The 2009 tally 

is nearly triple the first-year number of employers, 22, who were recognized by the 

National Business Group on Health in 2005.

2009 Best Employers for Healthy Lifestyles Winners Include: 

Platinum

Aetna® Baptist Health South Florida Campbell Soup Company 

CIGNA Dell Inc. FPL Group 

Hannaford Supermarkets IBM Medtronic 

Occidental Petroleum Corporation PepsiCo Inc. Pitney Bowes Inc. 

Quest Diagnostics Texas Instruments Incorporated Union Pacific 

University of Pittsburgh Medical 

Center, UPMC Health Plan 

Volvo Group Companies including 

Mack Trucks, Inc.

63

2009 Best Employers for Healthy Lifestyles Winners Include:—Continued

Gold

American Specialty Health Incorporated AstraZeneca Blue Cross and Blue Shield of Alabama 

Boehringer Ingelheim Pharmaceuticals, Inc. Chrysler Group LLC Cummins Inc. 

CVS Caremark General Dynamics Electric Boat General Mills 

Healthways Humana Intel Corporation 

JPMorgan Chase Mayo Clinic Paychex, Inc. 

Pfizer Inc. Raytheon Company Saint-Gobain Corporation 

Sprint The Boeing Company Unum 

Verizon Visant Corporation Wal-Mart Stores Inc. 

WellPoint, Inc.

Silver

Accenture American Express ARAMARK 

Cardinal Health, Inc. H.J. Heinz Company Lowe’s Companies, Inc. 

Meijer Michelin North America PRO Sports Club 

Qwest Communications Rockwell Collins sanofi-aventis U.S. 

Target Texas Health Resources The Children’s Hospital of Philadelphia 

The Home Depot Unilever Watson Wyatt Worldwide 

Wm. Wrigley Jr. Company Xcel Energy 

Wellness Leadership Here In Nebraska 

One of our Platinum award winners for the last 5 years, Union Pacific Corporation, is based right here in Nebraska. Union Pacific’s health promotion program, 

HealthTrack, is a comprehensive program that seeks to improve the health of Union 

Pacific’s employees. The program addresses the following health risk factors; inactivity, weight, nutrition, smoking, cholesterol, blood pressure, asthma, diabetes, fatigue, stress and depression. HealthTrack includes a health risk identification tool, 

lifestyle management program (risk reduction program), a tobacco cessation program, health education programs, system health facilities (exercise facilities through 

the country) and research grants. 

In addition, Omaha’s Wellness Council of the Midlands, established in 1982, is 

one of the first employer-led wellness councils in the country. Its national organization, Welcoa, also in Nebraska, provides information and recognition to thousands 

of smaller businesses nationally. 

Small Business Has Not Embraced Wellness 

A survey of 450 large employers identified ‘‘employees’ poor health habits’’ as the 

number one challenge named by employers as they try to maintain affordable health 

benefit coverage (National Business Group on Health and Watson Wyatt, 2009). A 

majority of large employers responding to this survey offer health risk appraisals 

(83%) and weight management programs to reduce obesity among employees (74%). 

Based on survey data, observed growth in vendors and suppliers of corporate 

wellness programs, and employers’ testimony, a tipping point may have been 

reached that leading large employers now have, or believe they should have, 

wellness programs in place. 

In striking contrast, relatively few small employers have adopted comprehensive 

health promotion (or weight management) programs. The most recent National 

Worksite Health Promotion Survey results actually suggest a decline in offerings by 

employers with fewer than 750 employees between 1999 and 2004 (Linnan et al.,

2008). The survey reports that only 6.9% of this nationally representative sample 

of employers offers wellness programs. Reported barriers included a lack of employee interest, lack of resources, and lack of management support. Because small 

businesses (fewer than 500 employees) employ 50% of the private sector workforce, 

this survey provides an important, albeit sobering, perspective on the typical American worksite. 

Role Models Needed 

Although an estimated 100 or more very large employers have substantial 

wellness programs affecting a few million employees, and some small and mid-sized 

employers are following suit, many others have been slow to react. Certain employers have the visibility to be role models and to influence the climate for change. In 

particular, health care organizations and public employers should model best practices in support of employees’ health. All health care companies and delivery organizations should adopt wellness programs and policies, similar to those we’ve heard 

about today here in Nebraska. Hospitals, especially, are houses of healing open to 

64

the community and should serve as examples by offering healthful dining, vending 

and tobacco-free campuses. 

Public employers, including state offices, Federal buildings, county facilities and 

school districts all should demonstrate their commitment to healthy employees and 

a health-promoting work environment. State employees’ wellness programs are becoming more common; at least a dozen states have some type of wellness program 

available to employees. The National Conference of State Legislatures reports that 

King County (Seattle) is projecting their health costs will fall by as much as $40M 

between 2007 and 2009 due to wellness initiatives. 

The Participation Challenge and Role of Incentives 

Once employers, public or private, offer wellness and health promotion programs, 

it is up to employees to participate and take advantage of these offerings. Disappointing levels of program participation are the Achilles heel of many corporate 

wellness programs. Even when programs are launched with employee input and 

leadership support, are well communicated, are subsidized or priced for affordability, and are offered at convenient times and locations, low participation can be 

a barrier to success. 

‘‘Build it and they will come’’ is not a strategy for success. Instead, companies are 

adopting incentive programs to attract participation (e.g., in voluntary health assessments) and, increasingly, to reward program completion (e.g., health coaching). 

Premium incentives for nonsmokers are on the rise in the wake of new evidence 

showing financial incentives have an impact on smoking cessation and weight loss 

in a corporate setting. However, we also know from survey data that almost half 

of employees say that financial incentives will not encourage them to participate in 

healthy lifestyle programs. 

This reinforces our understanding that voluntary wellness and health participation programs will always fall short of ideal participation levels. 

Faced with a serious budget shortfall and not constrained by the Health Insurance Portability and Accountability Act (HIPAA) non-discrimination regulations in 

the same way as private self-insured employers, the State of North Carolina employee health plan (655,000 covered lives) has determined it will not allow tobacco 

users (beginning in 2010) to join the more favorable 80/20 health plan, and it expects to preclude those with a high Body Mass Index from joining the 80/20 plan 

beginning in 2011. Instead, beneficiaries who do not meet the standard for the 80/

20 plan will be enrolled in the alternative 70/30 plan. 

Federal Leadership Can Help 

The Federal Government should do all that it can to help employers set up employee wellness programs and encourage employees (and, where possible, dependents) participation. Congress can help by:

• Removing tax barriers, particularly for employees, to allow more widespread 

adoption of wellness programs by employers and greater participation by employees to lead to a healthier America;

• Expanding the IRS definition of ‘‘qualified medical expenses’’ under Section 

213(d) to include ‘‘expenses primarily to maintain health and wellness, including but not limited to expenses for exercise, fitness, weight management and 

nutritional counseling;’’

• Extending the current tax deduction for the fees, dues, or membership expenses 

paid by employers for their employees at on-site athletic facilities to the fees, 

dues, or membership expenses at off-site athletic facilities;

• Supporting health reform provisions to expand permissible wellness incentives 

under HIPAA to 30% of premiums and providing tax credits to employers for 

wellness programs (including nutrition and weight management programs); and

• Only targeting Federal subsidies to foods essential for a healthy diet and removing any obstacles to increased fruit and vegetable production.

Thank you for the opportunity to share the perspective of large employers on the 

preventable health problems of employees that lead to chronic diseases and excess 

costs borne by employers and employees alike. We believe it is essential to combat 

the tsunami of obesity that threatens to overwhelm us. In terms of lifetime and 

generational impact, obesity has ramifications greater than those associated with 

the current economic crisis. The National Business Group on Health welcomes further dialogue with the Subcommittee on this or related matters. 

References 

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www.cdc.gov/NCCdphp/overview.htm#2

65

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Spending Attributable to Obesity: Payer- and Service-Specific Estimates, HEALTH AF- FAIRS (online), July 27, 2009. 

Goetzel, R.Z., Ozminkowski, R.J., Baase, C.M. and Bilotti, G.M., Estimating the 

Return on Investment from Changes in Employee Health Risks on The Dow Chemical 

Company’s Health Costs, JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDI- CINE 47 (6): 759–768, 2005. 

Goetzel, R.Z. and Osminkowski, R.J., The Health and Cost Benefits of Work Site 

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3, 2009. 

Heinen, L. and Darling, H., Addressing Obesity in the Workplace: The Role of Employers, THE MILBANK QUARTERLY, March 2009. 

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Chronic Conditions: Ten Years of Change, HEALTH AFFAIRS (online), July 22, 2008. 

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2008. 

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Ogden, C.L., Carroll, M.D., and Flegal, K.M., High Body Mass Index for Age 

among U.S. Children and Adolescents 2003–2006, JOURNAL OF THE AMERICAN MED- ICAL ASSOCIATION 299 (20): 2442–2443, 2008. 

Serxner, S., Baker, K. and Gold, D., Guidelines for Analysis of Economic Return 

from Health Management Programs, American Journal of Health Promotion, July/

August 2006. 

Thorpe, K.E., Ogden, L. and Galactionova, K., Weighty Matters: How Obesity 

Drives Poor Health and Health Spending in the U.S., National Business Group on 

Health, 2009. 

Trust for America’s Health, F as in Fat: How Obesity Policies are Failing in America 2009, July 2009. 

World Health Organization, Preventing Chronic Diseases—A Vital Investment: 

WHO Global Report, 2005.

The CHAIRMAN. Thank you very much for your expertise and 

your knowledge and sharing the information with us about the 

wellness and prevention and practices that can be implemented, 

both in the private sector and also in the public sector. I know that 

a lot of us are very much concerned, and we realize during a time 

of crisis in the economy, for example, right now that these are part 

of the first programs that go, both in the private and public sector. 

Yet, they’re the ones that will actually save an employer on health 

costs to that employer for that individual due to their productivity, 

absenteeism, illnesses that occur. 

Wellness programs are important. That’s why I think that both 

public, and private sector it is important we have these programs. 

The problem is that once we have the programs, how do we get the 

employees to participate in these kind of programs? And like Ms. 

Heinen said at the very end, when we talk about different kinds 

of incentives to make sure that we have the employees become involved in the programs. 

Not only will it greatly reduce employers’ costs in private health 

care, but the individuals can get these tax deductions and tax credits for the small businesses involved. That’s important, but let me 

start with my first question, and I’d like to ask Mr. Sensor, thank 

you for your testimony today. You mention that you provide preventative care without charge, and I state without charge, but that 

you do not quantify savings. 

How difficult would it be to assess the cost-benefit? That’s question number one. And number two, that would be a very helpful 

66

piece of information for anyone interested in copying your program 

model in Nebraska. 

Mr. SENSOR. Thank you, Chairman Baca. I appreciate the nature 

of the question. It is quantifiable. We know exactly what we spend 

on a yearly basis, and we do certainly have some glimpse of the impact that has on the consumption of healthcare services. The challenge that all of us face is the lack of longitudinal studies over a 

period of years, which we normally use in these sorts of areas, we’d 

like to prove definitively the impact. 

In addition to that, of course, we all suffer from some level of 

turnover, and so you’re making an investment today in employees 

that, frankly, may or may not be there in the long haul with you. 

That said, we certainly do have quantitative information we would 

love to share with the Committee that gives you some pretty good 

glimpse of the return on investment of prevention specifically, and, 

yes, it is great. 

The CHAIRMAN. Dr. Williamson, again, thank you for your testimony. Congratulations on the recent honor your organization received from the NCQA. Can you explain in layman’s terms what 

the continuum of health you mentioned in your testimony means? 

Dr. WILLIAMSON. Sure. You know, the continuum of health really 

is not about the fact that we have a large portion of our population 

which is healthy or doesn’t have any significant health risks. We 

have some who have some lifestyle-related issues and risks. There 

are some who have already developed chronic diseases, and there 

are those who are undergoing some kind of acute event, they were 

in the hospital for one reason or another; and then on the far end 

are people who have something catastrophic—they’ve been in a 

major car accident, had head injuries, or they need a transplant, 

those kinds of things. 

So there—people range from one end of that continuum to the 

other and, a lot of times, move from one side to the other, so the 

important thing is to keep those who are healthy from—in that 

area of the continuum and then to take those who have some kind 

of risk or chronic condition and trying to help them improve their 

overall health status and live a better life and spend less money. 

The CHAIRMAN. Ms. Lommel, thank you for giving your testimony. I appreciate your organization’s commitment to finding the 

personal touch in your report and connection that helps employees 

become better motivated about wellness. Can you explain why the 

holistic model of rehabilitation is viewed as the most effective 

method of creating a healthier lifestyle? 

Ms. LOMMEL. I’m not sure it’s the most effective. It has been effective for us. I like Kim Russel’s comments about culture. I’m sort 

of a culture fanatic, and I think that when you ask the question 

for what is the definition of that, I would say the definition of culture is the—some of the attitudes, beliefs and behaviors of a group 

of people, and the key there is a group of people. Every group of 

people has its own culture from a large university hospital setting 

to a smaller rehabilitation hospital to a school, down to a workplace. 

All of those cultures are different, and I think that wellness programs have to fit the culture of the group of people that are—that 

it is addressing. The reason that rehabilitation is a very successful 

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model for wellness programs is that it is holistic. It does appeal to 

all of the dimensions of wellness that a person needs to address. 

The kinds of people who are not changing, the ones that are not 

participating in the company’s wellness programs, are not doing so 

because they’re afraid, and what they see out there is a goal of 

health and wellness that is unattainable to them because they already are overweight or diabetic or whatever. 

Rehabilitation meets people where they’re at, and that could be 

a quadriplegic with a high spinal cord injury getting back to a very 

productive life, so it’s an easy transition for us to see a person who 

is sedentary, overweight, diabetic, and has had three strokes to 

start with walking with the current on the water track, so it is an 

issue of culture, and it’s also an issue of meeting people individually where they’re at. 

The CHAIRMAN. Thank you. One of the things that you had mentioned is it’s very embarrassing to many individuals sometimes. 

With rehab it’s more a sense of comfort, and so that becomes very 

important. And then, of course, the idea that the person is afraid 

or if we can’t afford it, or what the outcome will be. These are all 

important. But, what steps can the government take to incentivize 

employers to advocate a health and wellness program that goes the 

extra mile to make consumers feel comfortable and personally invested? 

Ms. LOMMEL. Again, I would go back to a group setting. You 

know, we all like sports. We all like competition; right? We all have 

competitions. Why do we like those things? You know, in a rehabilitation model everything has to be fun. I mean, we have a lot 

of fun in our various programs. We have dietitians, people on the 

night shift who roll carts of avocados. 

We have competitions between departments. We have competitions at ProActive. We have a big dance program at ProActive, ballroom dancing for older people. 

You know, it has to fit the situation, so when I think of a school, 

for example, what do kids like? You know, fit the wellness program 

to the situation that you’re in. I think your question was what can 

the government do. None of this at ProActive is paid for by the government. I mean, there is no help for medical fitness centers or 

for—very few employers help subsidize fitness centers like this, 

even though we have many employees who change their entire 

lives here. 

The CHAIRMAN. Does anybody else want to tackle that? Mr. Sensor. 

Mr. SENSOR. I certainly agree with that notion, but I would add 

maybe the elephant in the room, and that is the payment reform. 

I think about the 1,200 physicians that practice medicine under the 

umbrella of Alegent Health and what their day looks like on a 

daily basis and what their day could look like on a daily basis, and 

they, because of being driven by reimbursement as a reality, see 

patients largely in 15 minute blocks. 

They don’t really have time to engage with that patient as to 

their health and health challenges, to encourage prevention, to help 

them evaluate assessments that have been performed, et cetera. So 

while I agree with all of you on the panel, there are things that 

we, as employers, and things that we, as providers, can do to drive 

68

prevention and wellness, and ultimately, as a country, we need to 

pay for it if we want it to happen even more broadly. 

The CHAIRMAN. Thank you. 

Mr. FOSDICK. I think it goes back to accountability, and I really 

believe that the government has to hold employers more accountable, and the bottom line is the fact that I think we have to hold 

everybody accountable. I think some of the points brought out 

today are very specific, that a very specific amount of healthcare 

costs are held by a very small percentage, and some of those are, 

unfortunately, unstoppable. 

Some of things are things that could be corrected, and I think 

that we have to start holding a higher level of accountability to employers as well as the individual. I think that there are ways that 

could be done, and we have found that if we don’t look at it seriously and keep people informed and hold people accountable that 

things don’t change. 

Ms. HEINEN. I just spoke a little about the Safeway example. 

There’s been so much written about how Safeway is trying to do 

just that and hold its employees accountable for four things. It’s 

not using tobacco, healthy weight, cholesterol, and blood pressure; 

and, of course, it’s a voluntary program with the maximum incentive they do give employees who, if they meet the standard on 

those four health risks, they are paying 20 percent less for their 

health care so—if they can’t keep it or fix it, and that’s something 

that many companies are more and more interested in. 

It’s a way of holding employees accountable. However, right now 

the incentives are limited and under HIPAA non-discrimination, 

and it’s a voluntary program. 

The CHAIRMAN. I know my time has run out. I’ll turn it over to 

our Ranking Member Fortenberry. I know that we won’t have time 

to come back around. I have to catch a flight back. 

Mr. FORTENBERRY. That’s the Chairman’s way of telling me politely to hurry up, so I’ll try, 

Mr. Chairman, thank you. Let me, as I did for the previous 

panel, highlight some of the findings that I think jumped out from 

what you had to say today, and I’ll come back and go through some 

specific questions. 

First of all, Mr. Sensor, you pointed out that you have half the 

premium of increases in your organization because of your 

wellness—or direct correlation to your wellness program compared 

to the national average. 

Dr. Williamson, you pointed out that five percent of patients account for 50 percent of healthcare expenditures. Ms. Lommel, I 

don’t want to mis-state this, but your healthcare increases are less 

than 1.5 percent per year, 1.76 less than two percent a year. Extraordinary level compared to the national average. 

Mr. Fosdick, again, the Nebraska Medical Center, 27 percent in 

the last 5 years, nationally four percent, again attributable, directly correlatable, to what you’ve addressed in wellness programs 

that you’ve done for your employees. 

Ms. Heinen, this is particularly important to me. You’re representing studies for 55 million Americans were represented for 

working for large companies. Diet and exercise, smoking cessation 

can result in 80 percent lower risk in the onset of heart disease 

69

and 40 percent lower risk in the onset of various type of cancers. 

You then also point out that, again, across a very large pool, which 

is confirmed by what we’re finding here in smaller organizations in 

Nebraska and the region, there is a two to four percent cost reduction annually because of wellness and cost savings. 

Marsha, let’s go back to the example you gave of the 67 year old 

person who was now free from numerous medications that she was 

on previously. Why don’t you—I think it’s important to talk about 

that journey a little bit and the incentives that were in place there. 

Clearly, that’s a natural will by that woman to take a turn and try 

something different, but were there other structures in place that 

affirmed those actions by the individual? 

Ms. LOMMEL. Well, that was just one example of a ProActive 

member who was retired who came to ProActive after having had 

several strokes and multiple health problems. 

Mr. FORTENBERRY. She joined ProActive as a citizen of Lincoln 

to try to get better? 

Ms. LOMMEL. Yes. 

Mr. FORTENBERRY. She’s not a former employee. Just a member? 

Ms. LOMMEL. No. Right, right, right. Well, we have 3,800 members. About, like I said, half of them come because they really need 

help in getting well. Some of them come as physicians’ prescriptions written on a pad, ‘‘Go to ProActive and get well.’’ They write 

that on a pad. 

Mr. FORTENBERRY. But insurance is not paying for that? 

Ms. LOMMEL. No, no. Insurance is not paying for that. It’s all private pay. Yes, they join as a member. She would start with a 

health risk assessment, and the ProActive wellness assessment 

that I talked about was just the adjunct to a health risk analysis. 

It is an individual session with a lifestyle coach to develop a program for her. If I don’t know if she had arthritis, but a lot of the 

early stage people who have significant risks start with aquatic 

therapy, and our aqua track is the best thing going. 

It’s a cross-current water track that we use for arthritis therapy, 

for MS, for a whole bunch of different diseases. We would get very 

involved with a social group. In this case, she wanted to dance, and 

we have all kinds of dancing programs or classes for members because it’s fun, so she got very involved in tap dancing, started 

changing her eating habits, her lifestyle. It all balloons, you know, 

snowballs. You know, when you get into that wellness mentality, 

it snowballs and starts affecting everything. 

Mr. FORTENBERRY. So I think the larger question is for you, in 

the industry, as well as us, as lawmakers, is to how do you affirm 

undergird that will, an act to take on a mind-set or paradigm, as 

well as through the proper incentives, both at the employer level—

and Ms. Heinen referred to this non-discrimination clause issue 

that you raised—but also at the individual level? So, essentially, 

could you address it a little more precisely, the types of incentives, 

specific examples? 

You had talked about preventative care where you were able to 

actually pay to get well, and then we’ll come back to your non-discrimination clause. 

Mr. SENSOR. Thank you, Mr. Fortenberry. Absolutely, and both 

of those are complimentary of one another. Like you’ve heard from 

70

several panelists already today, our employees and their dependents are encouraged to annually participate in health appraisals 

and an on-line tool. They’re given $100 simply to do it. It identifies 

electronically and immediately what the risk factors are. Sometimes those are small risk factors. 

I recently did mine, and I have seen my doctor. My cholesterol 

was slightly elevated, and it gave me some suggestions as to how 

to lower my cholesterol. Sometimes there are significant issues, for 

example, smoking or perhaps alcohol use, in which case the individual can voluntarily choose to participate in a program, or they’ll 

get a call from a personal health coach, all free. That individual 

will encourage them to enroll in a program and become their new 

best friend in their achieving the goals of that program. 

If they complete that program, they’ll then be remunerated on top of the $100, depending on what risk factor they addressed, 

$200, $300, or $400 additional. You can see the construct. The 

same thing. I’m going to pay you $500 a day to get you to quit 

smoking will oftentimes cause people to walk across the line. They 

already knew they should quit. Now they’ve been incentivized to 

quit, and I won’t take our precious time today, but the stories are 

really incredible of people approaching me from the grocery stores 

and gas stations and the halls of our hospitals talking about how 

their employer has finally helped them to address their risk factors, how they’ve gotten off their blood pressure medicine, how 

much better they feel, how much more energy and how less sick 

they are. But, it’s really the concert of the preventative programs 

and the wellness and lifestyle programs working together to change 

their health. 

Thank you. 

Mr. FORTENBERRY. Thank you. Ms. Heinen, again, you pointed 

out that some of the interplays of legal restrictions here actually 

may be interfering with such types of incentives. Now, it’s put 

under the label of non-discrimination, but I wonder if that’s an unfortunate word, because you’re not talking necessarily about discriminating, but not being allowed to incentivize, and that’s another way to put it at a higher level. 

So let’s talk about the interplay of Federal laws that might unintentionally, while trying to project the individual patient rights, 

interfere with innovative opportunities that we may have here to 

partner with patients for their own wellness. 

Ms. HEINEN. Well, exactly, and as the other panelists have testified that, you know, financial incentives can make a difference, and 

not all will make a difference. They don’t work for everyone, but 

they can be very important, and in just getting these programs on 

the radar screen, incentives in the workplace to participate, a 20 

percent limit, you know, is a little bit of a barrier. 

We understand and acknowledge that certainly there are risks 

that aren’t preventable by the individual, and we need appropriate 

protection, but employers do feel that given the magnitude of the 

savings, in the Safeway example, they say they have held their 

trend constant for the years that they’ve been doing this program, 

4 years now. 

That’s a big impact financially on the company and does also 

benefit the employees who also, let’s not forget, pay for health care. 

71

Mr. FORTENBERRY. Do you think this rule like 20 percent is artificially low? 

Ms. HEINEN. I would say that, yes. 

Mr. FORTENBERRY. Dr. Williamson, Mr. Fosdick, would you care 

to elaborate again on anything that you’ve done that is—you’ve 

both provided us some examples of the protectiveness of your own 

wellness programs, but how that could be expanded in an interplay 

with a Federal law. 

Dr. WILLIAMSON. We’ve had a chance to work with over 100 employers on this particular program and tried many incentives on 

the particular culture in their company they want to—that fits 

what they want to do, so the one that seems to create the most participation for us is actually the personal contribution to premium 

differential, so even at $10 a month difference in what that family 

is contributing or that person is contributing on their insurance 

premium will make a difference in how they participate. 

You know, the way we have structured this is that it’s generally 

a phased approach, so when an employer initially gets involved, 

they might just want to incentivize participation in the health care 

and completing the health risk assessment and maybe talking to 

a lifestyle coach about particular issues. But, over time I think it 

needs to progress if this is going to continue, if their improvement 

continues, so if they have a risk, they have a chronic disease or 

they have some other risk, then the next step ought to be that they 

address that. I think the final step probably is something along the 

lines of what we’ve heard from Ms. Heinen, which is more of a 

standard base. 

You know, if you had—if you smoke, you need to quit. If you’re 

overweight, you need to get your BMI down below a certain level, 

or if your cholesterol is high, it should come down, and that’s where 

you get into this 20 percent concern. You know, there’s a point 

where you build up these incentives, and at 20 percent you’re running against this issue here, and you’re kind of stuck. 

Mr. FORTENBERRY. All right. Thank you. 

Mr. FOSDICK. And I think it goes back to education. The bottom 

line is the fact that there are still many, many corporations in this 

country who’ve resisted every year and have their HR person or 

managements implying that our healthcare costs will go up four or 

six or eight percent and inflate the sheet that much, and they kind 

of resist it every time. 

They’d rather take it, and the bottom line is I think there can 

be some way that maybe—you know, maybe leadership in Congress 

can send information to CEOs saying, Here’s some examples, here 

are best practices, and I would be very uncomfortable if I was an 

HR person who went in every year and say, Good news, our costs 

are going up, and I don’t have a clue on how to fix it. 

I think that may be very uncomfortable for me, so I think sharing the best practices, but I wouldn’t do it—I would make sure they 

go directly to the CEOs, because obviously HR people aren’t willing 

to take the initiatives do the things they’ve got to do. 

Mr. FORTENBERRY. We’re somewhat confined. 

Well, thank you all for your insights. Clearly, this is very helpful. 

Now, of course, we haven’t had time to impact the issue of limited 

participation by smaller employers where a majority of Americans 

72

are working and the cost factors there for the small employer in 

terms of incentive wellness, but clearly large employers, large 

health systems that are doing this are showing these three to one 

returns on investments, so hopefully there’s a trickle down effect 

there and an educational effect to show that this is a true cost saving measure. 

Of course, we’re not talking about people who are having to buy 

their own individual policy or who are priced out of the market because of unaffordability issues there, but if we can lower our overall healthcare costs, that should lower premiums in the general 

market and improve outcomes. I think what you’re saying is pretty 

helpful to me, important in that regard, so thank you very much. 

The Chairman is about to conclude. 

Before he does, I hope you all will bear with me, but because we 

are anticipating a potential national championship year this year, 

I thought I’d give our Chairman a Nebraska football jersey and 

thank him for his generosity in coming to us. 

The CHAIRMAN. Thank you very much. I’m going mention something from the earlier panel about participating earlier in education because the research needs to be done, especially if we look 

at the subject matter that we’ve addressed today. I really do appreciate our Ranking Member for bringing this to our attention on a 

national basis, and for having a hearing here in Lincoln, Nebraska. 

One of the things that needs to be done from an education perspective is for employers who run a small business. 

Large employers hand out materials on health benefits that are 

there, but you really don’t have an actual orientation of what it actually means, and maybe we should have some form of an orientation on a voluntary basis. That would save tons of dollars and people would begin to understand the real value not only to their life, 

but also the impact it has on the cost factors of health. I appreciate 

you making your statements. 

We need to do more on a voluntary basis in local and private and 

public systems, having a way for people to really begin to understand, to change their attitudes and behaviors, and what it means 

to them in their life. It’s very difficult for us to participate in the 

lives of our kids and others and grandchildren as we mature in 

age, and we want to assist with our grand kids, and that’s why it’s 

important we have this kind of orientation. 

We don’t have a teacher orientation; we don’t have anything that 

covers health. 

What is it that we need to cover in that area? We need to do a 

little bit more on a voluntary basis. With that I’d just like to again 

thank all of the panelists for being here. Before I make my final 

closing statement, I would turn it over to our Ranking Member 

Fortenberry to make his closing remarks, and then I will make my 

closing remarks and then officially do what I have to do to adjourn 

this official meeting. 

Mr. FORTENBERRY. Well, again, thank you, Mr. Chairman, for the 

generosity you have shown in taking time away from your constituents in California to be with us here. We appreciate your sincere 

leadership on these important essential questions affecting our nation and are honored to have you. I’d like to conclude by picking 

up on one comment that Marsha Lommel gave as well. We talked 

73

quite a bit in our earlier panel about the relationship between nutrition and wellness and health and how it’s showing the experience that you all have had in making wellness programs, how it 

actually does reduce costs and improve healthcare outcomes, and 

we all feel better. 

But you made a very good point, Marsha, in sensitizing this to 

the fact that wellness programs, in and of themselves, can attract 

healthy people, and there are certain barriers to those who are facing more challenges that make it difficult for them to participate. 

I think that was very insightful as well, because clearly this is a 

direction that we must embrace as a nation. Better nutrition, better lifestyle, better incentives, understanding of the legal interplay 

for those incentives, but also having an impact by creating a facility with a real caring heart and a progressive, holistic approach to 

the various dynamics of health care, so with that said, again, thank 

you for hosting us today. I thank all of the witnesses who graciously joined us, and again, thank you, Mr. Chairman, for leading 

us today. 

The CHAIRMAN. Thank you very much, and again I want to thank 

each of the panelists for your knowledge and your expertise and 

your participation. We hope that the best policies meet the challenges of our economy and our nation, especially as it pertains to 

health; not only the importance of preventive measures, but the 

cost to society and its taxpayers. I think we began to address the 

impact it has on us as we address national issues of health, and 

nutrition. Nutrition becomes very important for a lot of us, the appropriate nutrition not only for our children, but for adults, in 

making changes. 

With that I want to again thank Congressman Fortenberry for 

having the leadership in bringing this panel together and taking on 

this topic. It was his choice to raise this topic, and he said, ‘‘I want 

to have it in Lincoln, Nebraska, not back in Washington, D.C. I 

want to bring it to our area and address this on a national level.’’ 

And I’m glad we were able to work out a schedule with him out 

here. 

Again, I look forward to hearing from you in the future, and 

you’re all welcome to come to my district anytime to beautiful San 

Bernardino. Fog is there. It’s really pretty, but the smog is there 

in that area. With that I’d like to state that under the rules of the 

Committee our record of today’s hearing will remain open for 30 

calendar days to receive additional materials, supplemental witness 

responses from the witnesses, and any questions posed by Members. 

The hearing on the Subcommittee on Department Operations, 

Oversight, Nutrition, and Forestry is now adjourned. 

[Whereupon, at 12:48 p.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 

74

75

SUBMITTED MATERIAL BY DR. DAVID H. JANDA

A Prevention & Consumer Driven Approach 

Achieving Health Care Emancipation & Freedom 

By David H. Janda, M.D. 

On September 22, 1862 President Abraham Lincoln issued The Emancipation 

Proclamation:

‘‘That on the 1st day of January, in the year of our Lord 1863, all persons held 

as slaves within any state or designated part of a state, the people whereof 

shall then be in rebellion against the United States, shall be then, thenceforward, and forever free; and the executive government of the United States, 

including the military and naval authority thereof, will recognize and maintain 

the freedom of such persons and will do no act or acts to repress such persons, 

or any of them, in any efforts they may make for their actual freedom . . . And 

upon this act, sincerely believed to be an act of justice, warranted by the Constitution upon military necessity, I invoke the considerate judgment of mankind 

and the gracious favor of Almighty God.’’

With these words President Lincoln ended slavery, which was a flagrant violation 

of the institutions of America—‘‘a government of, by and for all the people.’’

The institution of slavery denied freedom to fellow Americans. In 2009, freedom 

is being denied to every man, woman and child—freedom of health care. Some in 

the HMO industry, many in the insurance industry, and many Federal ‘‘Big Government’’ bureaucrats are denying Americans their freedom of health care. The Obama 

Health Care Plan is the instruction manual and play book for this approach. The 

‘‘Masters’’ of Health Care are trying to deny individuals their freedom to choose 

what doctor you can see, what medicine you can take, what hospital you can go to, 

and how your spend your health care dollars. They even take it a step further in 

the Obama Health Care Plan—IF—yes, IF you can be treated. These ‘‘Masters’’ of 

Health Care are driving us to unnecessary pain, suffering, and, in some cases, 

death. The health care system needs drastic reform, in this country and around the 

world. Most importantly, this reform must be based on the bedrock of providing 

each person, each family and business their healthcare freedom. 

As I wrote in my book, The Awakening of a Surgeon, I believe health care reform 

has become ‘‘A Domestic Vietnam.’’ One of the tragic lessons from the Vietnam War 

was that if the policy makers and decision makers do NOT listen to the grunts on 

the front line we will lose the war. If we lose the battle to implement ethical and 

humane health care reform, this time we can NOT get in our helicopters and planes 

and fly away. Every American citizen, family and business will become a casualty. 

The message from the front line is: Stop empowering Big Government bureaucrats, 

the HMO industry and the insurance industry. The key to reform is to EMPOWER 

each American citizen, family and business. We should fight to give people, families 

and businesses control over their health care finances and the right to chose who 

they see, where they go for treatment and what treatment they can receive. Above 

all, focus on PREVENTION. Prevention is the key to the most efficient, humane and 

ethical health care cost containment policy. 

The issues of health care reform and the proposed ‘‘solutions’’ are very frustrating 

for those of us on the frontline of health care delivery. Health care reforms often 

are presented as a politically Right/Left/Liberal/Conservative issues. On the contrary, this is an issue that transcends political parties and affects every man, 

woman, child, business and community in our country. I do not see health care on 

a political Left/Right Axis; I see it on an Up/Down Axis. Up represents individual 

freedom, freedoms of health care for every person. Down represents oppression of 

people and businesses and their health care freedom. I believe Americans’ health 

care freedoms are currently being oppressed by a number of different entities. Many 

individuals at the Federal Government level and their proposed reform/plans are 

hindering health care freedom. Certain corporate entities in the HMO and the Insurance Industry also are limiting freedom. They are dictating what type and how 

much health care is to be delivered. They have decimated the doctor/patient relationship and I believe they are putting people and businesses in harms way. When 

I became a physician I took an oath to ‘‘Do No Harm.’’ This current structure inflicts 

harm. 

There is one solution that unlocks the shackles that HMO’s, some insurance companies and Big Government Bureaucrats have placed on every person, family and 

business. That solution is Health Savings Accounts. Competition reduces costs in 

health care, just as in other ‘‘industries.’’ Personal Health Savings Accounts (HSAs) 

already demonstrate an ability to change the system for the better. Putting people 

back in charge of their own health care gives them incentives like nothing else can. 

76

People make healthier choices about how they live when they ‘‘have a dog in this 

fight.’’

Personal HSAs are coupled with higher deductible, Catastrophic Insurance coverage, so no one falls through the net by an unexpected major need. Such coverage 

is much less expensive. An employer can put the cost savings into the HSA, before 

taxes. Both immediate and long-term savings ensue. HSAs earn investment income, 

and can be used for all medical expenses, covering the deductible, as well as medications and incidentals. Unspent, it grows yearly. An HSA is fully portable, if you 

change jobs, as many now do. It is also inheritable by a spouse. For those now on 

Medicaid, patients would be provided an HSA at a fraction of the current cost paid 

by state and Federal governments. 

A recent analysis of Health Savings Accounts by The United States Department 

Treasury revealed 33% of small businesses now with HSA’s previously did NOT 

offer coverage. In addition, 31% of those signing up were previously uninsured. 

Forty-two percent of HSA purchasers had family incomes below $50,000. The benefits of the HSAs are many, reducing health care costs by an average of 35% and 

extending coverage in the process. 

Health Savings Accounts, coupled with prevention-related interventions are the 

keys to reducing health care costs for every person, family and business. Prevention 

of health care need is the most efficient and ethical means of cutting health care 

costs. It is a far more effective and compassionate way of reducing costs than manipulating health care ‘‘need’’ by reducing access and availability of care through rationing as promoted by the Obama Health Care Plan, the Federal Government, and 

the HMO and insurance industries. By way of example, according to the Federal 

Government, one of our studies at The Institute For Preventative Sports Medicine 

revealed how to prevent 1.7 Million people from being injured every year and how 

to save $2 Billion in health care costs per year. Of note is that we spent $1,000 on 

that series of studies. When it comes to Prevention, this financial benefit is not the 

exception, it is the rule. Health Savings Accounts are the vehicle to drive health 

care costs down, and Prevention is the key that ignites the engine to the HSA vehicle. 

The goal is to make health care available and affordable. When I became a physician, I took an oath to ‘‘Do No Harm.’’ I decided to add to that oath to ‘‘Prevent 

Harm.’’ Through Prevention initiatives and Health Savings Accounts, we have an 

opportunity to bring health care freedom to every person, family and business. If 

we do not act now, we will never be free of the ‘‘Masters’’—the HMO and Insurance 

Industries, and Big Government bureaucrats. 

Victor Hugo stated, ‘‘There is nothing more powerful than an idea whose time has 

come.’’ The time has come for Health Savings Account driven by Prevention and 

Wellness initiatives.

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SUPPLEMENTAL MATERIAL SUBMITTED BY BLAKE J. WILLIAMSON, M.D., M.S., VICE

PRESIDENT AND SENIOR MEDICAL DIRECTOR, BLUE CROSS AND BLUE SHIELD OF

KANSAS CITY


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SUPPLEMENTAL MATERIAL SUBMITTED BY MARSHA LOMMEL, PRESIDENT AND CEO, 

MADONNA REHABILITATION HOSPITAL


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Æ


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