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INNOVATIONS IN ADDRESSING CHILDHOOD 

OBESITY 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

DECEMBER 16, 2009 

Serial No. 111–90 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 


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COMMITTEE ON ENERGY AND COMMERCE 

HENRY A. WAXMAN, California, Chairman 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

EDWARD J. MARKEY, Massachusetts 

RICK BOUCHER, Virginia 

FRANK PALLONE, JR., New Jersey 

BART GORDON, Tennessee 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

BART STUPAK, Michigan 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

Vice Chairman 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANE HARMAN, California 

TOM ALLEN, Maine 

JANICE D. SCHAKOWSKY, Illinois 

CHARLES A. GONZALEZ, Texas 

JAY INSLEE, Washington 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

CHARLIE MELANCON, Louisiana 

JOHN BARROW, Georgia 

BARON P. HILL, Indiana 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

JERRY MCNERNEY, California 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

JOE BARTON, Texas 

Ranking Member 

RALPH M. HALL, Texas 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

NATHAN DEAL, Georgia 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOHN B. SHADEGG, Arizona 

ROY BLUNT, Missouri 

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

(II) 


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SUBCOMMITTEE ON HEALTH

FRANK PALLONE, JR., New Jersey, Chairman 

JOHN D. DINGELL, Michigan 

BART GORDON, Tennessee 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

JANICE D. SCHAKOWSKY, Illinois 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

JANE HARMAN, California 

CHARLES A. GONZALEZ, Texas 

JOHN BARROW, Georgia 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

NATHAN DEAL, Georgia, 

Ranking Member 

RALPH M. HALL, Texas 

JOHN B. SHADEGG, Arizona 

STEVE BUYER, Indiana 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 


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C O N T E N T S 

Page 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 1 

Hon. Kathy Castor, a Representative in Congress from the State of Florida, 

prepared statement .............................................................................................. 3 

Hon. Joseph R. Pitts, a Representative in Congress from the Commonwealth 

of Pennsylvania, prepared statement ................................................................. 33 

Hon. Tim Murphy, a Representative in Congress from the Commonwealth 

of Pennsylvania, prepared statement ................................................................. 39 

Hon. Bruce L. Braley, a Representative in Congress from the State of Iowa, 

prepared statement .............................................................................................. 118 

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

California, prepared statement ........................................................................... 126 

Hon. Anna G. Eshoo, a Representative in Congress from the State of California, prepared statement .................................................................................. 129 

Hon. Bart Gordon, a Representative in Congress from the State of Tennessee, 

prepared statement .............................................................................................. 131 

Hon. Joe Barton, a Representative in Congress from the State of Texas, 

prepared statement .............................................................................................. 133 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, prepared statement .................................................................................. 136 

WITNESSES

William H. Dietz, M.D., Ph.D., Director, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and 

Health Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services .......................................................... 5 

Prepared statement .......................................................................................... 7 

Terry T-K Huang, Ph.D., M.P.H., Director, Obesity Research Strategic Core, 

Eunice Kennedy Shriver National Institute of Child Health and Human 

Development, National Institutes of Health, U.S. Department of Health 

and Human Services ............................................................................................ 23 

Prepared statement .......................................................................................... 25 

Ron Jaworski, Jaws Youth Fund, National Football League Play 60 ................. 54 

Prepared statement .......................................................................................... 58 

Sandra Hassink, M.D., Chair, Obesity Leadership Workgroup, American 

Academy of Pediatrics .......................................................................................... 64 

Prepared statement .......................................................................................... 66 

Answers to submitted questions ...................................................................... 140 

Jeremy Nowak, Ph.D., President and CEO, Reinvestment Fund ........................ 81 

Prepared statement .......................................................................................... 84 

Mary Sophos, Senior Vice President, Government Affairs, Grocery Manufacturers Association ................................................................................................ 91 

Prepared statement .......................................................................................... 93 

Risa Lavizzo-Mourey, M.D., and President and CEO, Robert Woods Johnson 

Foundation ............................................................................................................ 99 

Prepared statement .......................................................................................... 101 

Answers to submitted questions ...................................................................... 143 


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INNOVATIONS IN ADDRESSING CHILDHOOD 

OBESITY 

WEDNESDAY, DECEMBER 16, 2009 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH, COMMITTEE ON ENERGY AND COMMERCE, Washington, DC. 

The subcommittee met, pursuant to call, at 9:42 a.m., in Room 

2123, Rayburn House Office Building, Hon. Frank Pallone, Jr., 

[chairman of the subcommittee] presiding. 

Present: Representatives Pallone, Capps, Schakowsky, Barrow, 

Christensen, Castor, Sarbanes, Murphy of Connecticut, Space, 

Braley, Shimkus, Pitts, Murphy of Pennsylvania, Burgess, and 

Gingrey. 

Staff Present: Kaen Lightfoot, Communications Director, Senior 

Policy Analyst; Bruce Wolpe, Senior Advisor; Naomi Seiler, Counsel; Camille Sealy, Fellow; Lindsay Vidal, Press Assistant; Allison 

Corr, Special Assistant; Elizabeth Letter, Special Assistant; Matthew Eisenberg, Staff Assistant; Anne Morris, Professional Staff 

Member; Ryan Long, Minority Chief Counsel; Aarti Shah, Minority 

Counsel; and Chad Grant, Minority Legislative Analyst. 

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. The subcommittee hearing will be called to order. 

And today’s hearing is on ‘‘Innovations in Addressing Childhood 

Obesity.’’ I will recognize myself for an opening statement initially. 

The top innovations in addressing childhood obesity is one of 

many interests of this committee and also Members of the House. 

I have to say we are having this hearing today because many Members, including some that are not on the committee, approached me 

on the floor and asked me to address this issue in various ways. 

Childhood obesity is a huge public health problem in this country 

that puts millions of American children at risk. Data from the Centers for Disease Control and Prevention, the CDC, indicates that 

over the last 3 decades, the rates of childhood obesity have been 

skyrocketing. In every age category, we have seen at least a doubling, and, in some age groups, a tripling in the numbers of children who are classified as obese. In addition, there are millions 

more who are just at the cusp and are in danger of becoming obese 

as well. 

The rates are the worst among minority populations. According 

to the CDC, Hispanic boys and African American girls have the 


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highest rates of obesity, with 22.1 percent of Hispanic boys and 

27.7 percent of African American girls classified as obese. And 

though the rates are starting to level off, there are still too many 

children in this country who are dangerously overweight. 

Childhood obesity can lead to health problems that 30 years ago 

were rarely seen in children. A report conducted by the Trust for 

America’s Health in 2009 highlighted that more and more children 

are being diagnosed with Type 2 diabetes, hypertension, sleep 

apnea, joint problems and depression, just to name a few. 

And I should say for many years now, I have been the Vice Chair 

of the Native American Caucus. And when we go around to the 

various reservations, I have just noticed in the 21 years that I have 

been in Congress, that the rate, if you will, for Type 2 diabetes and 

the number of people that have it, when we go around to the reservations it just gets younger and younger every year. It is really 

almost of an epidemic nature in my opinion amongst the Native 

American populations. And these children are likely to continue to 

have health problems as they age into adulthood. 

Some experts have even predicted that if the trends in childhood 

obesity continue, we will for the first time see a generation that 

lives sicker and dies earlier than their parents. Regardless, we 

know that if left unaddressed, this epidemic alone has the potential 

to cripple our health care system. 

The price of obesity in this country is unsustainable. Adult obe- sity is estimated to cost our Nation $147 billion a year and childhood obesity adds another 14 billion to that price tag. Studies have 

shown that up to 80 percent of obese children will become obese 

adults. As we watch the number of these obese children skyrocket, 

the cost to our Nation will not only increase, but an obese and 

unhealthy Nation may very well bring about an unproductive Nation. 

In my State, New Jersey, 31 percent of our children are clinically 

overweight. That is nearly 7 percent higher than the rate of adult 

obesity. And I am worried that at a time of economic recession and 

high unemployment rates, many of these children will be less likely 

to have access to healthier, more expensive foods. 

Meanwhile, safety net health programs are continuously overextended as the numbers of uninsured and underinsured continue 

to grow, posing further risks to children who may not be receiving 

the medical care that they need. 

There are many factors that contribute to our rising rates of obesity. Personal habits definitely play some part. But many studies 

have been able to link obesity to unsafe neighborhoods, less exercise opportunities, and lack of access to healthy foods. Our health 

care system also plays some part, with millions of children living 

without preventive health services such as nutrition counseling and 

screening for obesity-related diseases. 

These are all things that we as a Nation can work together to 

address so that we can eventually reverse the trends of childhood 

obesity. And basically we are holding the hearing today because we 

are trying to find out from our witnesses about innovative work 

they are doing to address childhood obesity, to hear about how we 

at the Federal level can play a part in curbing this trend and to 

learn more about what makes obesity intervention successful. And 


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I am also eager to hear a bit about where we need to focus our efforts over the next 10 years. 

I am not suggesting to any of you that this is something that we 

are going to be able to solve overnight. I know it is something that 

needs long-term attention in many cases. I was thinking today 

about when I was growing up in the neighborhood—I don’t live in 

the neighborhood anymore, but my father is still there and our congressional office is in the same neighborhood where I grew up. Almost all the recreational opportunities that existed when I was a 

kid have disappeared. The local playground is not there anymore. 

The YMCA is not there anymore. We live in a small town of about 

30,000 people. It is not an urban area per se. But if you are going 

to bring back those things, it is not something you can do overnight, unfortunately. 

And I just think that we haven’t paid enough attention to a lot 

of these underlying problems, whether it is recreation, whether it 

is food, whether it is supermarkets. And these are not things that 

you can necessarily deal with immediately, but they have to be addressed. 

So thank you. Thank you for being here. We will introduce the 

panel after the rest of the opening statements. 

And we have the gentleman from Georgia, Mr. Barrow. 

Mr. BARROW. Thank you, Mr. Chair. I waive on opening. 

Mr. PALLONE. You will waive. And next is the gentlewoman from 

Florida, Ms. Castor. 

OPENING STATEMENT OF HON. KATHY CASTOR, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA 

Ms. CASTOR. Thank you, Mr. Chairman, very much for calling 

this important hearing. The good news is that over the past few 

years the Congress has made wellness and healthy living and children’s health a national priority. 

At the beginning of this year, the beginning of our agenda, the 

Congress passed and sent the children’s health care legislation to 

the President for his signature. That expanded health services and 

medical care to millions of children all across America. And last 

month, the House version of the health care reform bill dedicated 

a huge part of the health reform effort to preventive care, wellness, 

and public health initiatives, really the most landmark investment 

in public health ever in the history of our country. 

And in going back to the last Congress in 2008, the farm bill required the USDA to purchase more fruits and vegetables for nutrition assistance programs and created a new program to provide 

fresh fruits and vegetables to elementary schools. 

So all of that is very positive. But all of this is in recognition of 

the fact that obesity rates for both adults and children in the 

United States have increased exponentially. We now have a clear 

understanding that this is an issue we need to address head on. 

There is a growing movement to live healthier lives and ensure 

that our children grow up with the same understanding. 

But I look at the statistics, Chairman Pallone, like in my State, 

the children in Florida, 33 percent of children in Florida are overweight or obese. That is above the national average. And there is 

no excuse for this. This is the sunshine State where you can play 


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outside all year round. So like many States, Florida is trying to do 

some creative things. In my community in Tampa, the University 

of South Florida has developed the USF Healthy Weight Clinic, an 

exciting new multidisciplinary clinic for children, teenagers, adults 

who are overweight. It is family focused. It is a clinic that brings 

together pediatricians, internists and specialists who don’t just do 

primary care but concentrate on weight management. In our public 

schools in 2007, the State of Florida passed a law requiring elementary students complete 150 minutes of physical education. 

They have modified that, unfortunately. At the start of the school 

year, though, Florida required that all middle-school students have 

at least one class of PE daily for a full semester. 

So while all of these initiatives and programs are excellent steps 

in fighting the obesity epidemic, we cannot stop there. It is critical 

that we need to do more, and I will be very interested in your expert advice today. 

But let me just say government cannot do this alone. Parents 

across this country have to take personal responsibility. And they 

have got to go to the grocery store and buy the healthy fruits and 

vegetables. They have got to fight for those supermarkets and markets in their neighborhoods. They have got to turn off the TV and 

tell their kids to go outside and play or do something constructive 

with their time. 

As co-chair of the Children’s Congressional Health Care Caucus, 

childhood obesity has been one of our priorities. So I thank you, 

Chairman Pallone, again, for calling this hearing and I look forward to hearing from the witnesses. I hope that we can use this 

today as a step towards a broader national strategy to end this epidemic. I yield back. 

Mr. PALLONE. Thank you. 

Does the gentleman from Ohio wish to make an opening statement? 

Mr. SPACE. I will waive. 

Mr. PALLONE. You will waive? OK. I think that concludes our 

opening statements. 

We will go to our witnesses. And on our first panel, we have with 

us on my left, Dr. William Dietz, who is Director of the Division 

of Nutrition, Physical Activity, and Obesity for the Centers for Disease Control and Prevention. And then next to him is Dr. Terry 

Huang, who is Director of the Obesity Research Strategic Core for 

the Eunice Kennedy Shriver National Institute of Child Health and 

Human Development at the National Institutes of Health. 

And we welcome both of you. Thank you for being here today. We 

have 5-minute opening statements that become part of the record. 

And then we will move to questions by the members of the panel. 


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STATEMENTS OF WILLIAM H. DIETZ, M.D., Ph.D., DIRECTOR, DIVISION OF NUTRITION, PHYSICAL ACTIVITY, AND OBESITY, 

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION 

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

HUMAN SERVICES; AND TERRY T-K HUANG, Ph.D., M.P.H., DIRECTOR, OBESITY RESEARCH STRATEGIC CORE, EUNICE 

KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD 

HEALTH AND HUMAN DEVELOPMENT, NATIONAL INSTITUTES OF HEALTH, U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Mr. PALLONE. We will start with Dr. Dietz. Thank you for being 

here today. 

STATEMENT OF WILLIAM H. DIETZ 

Dr. DIETZ. Thank you, Chairman Pallone and members of the 

subcommittee, for the opportunity to provide you statements on the 

record for today’s hearing. 

Mr. PALLONE. You might have to bring your mike closer. 

Dr. DIETZ. Thank you for the opportunity to provide this statement for the record on today’s hearing on innovative practices to 

prevent childhood obesity. 

Mr. Chairman, you were correct about the prevalence data; 16 

percent of 2- to 19-year-olds in the United States are obese, and an 

almost equal number are overweight. So about a third of our children and adolescents are obese or overweight. 

You also pointed, correctly, to the increased prevalence among 

certain subgroups of the population. So, for example, in 2006, 27 

percent of 6- to 11-year-old male Mexican Americans were obese, 

and 27 percent of 12- to 19-year-old African American females were 

obese. And although as you correctly pointed out, we are at a plateau, an apparent plateau, that is not grounds for complacency. We 

need to invest in turning the corner on this epidemic. And we believe that just as the environment was the major contributor to this 

epidemic, the environment is where those solutions lie. 

Childhood obesity is associated with a variety of precursors for 

adult disease; namely, elevated lipid levels which predispose to 

hardening of the arteries; increased tolerance to glucose, which predisposes or is a precursor to Type 2 diabetes and elevated blood 

pressure; 70 percent of obese children and adolescents have at least 

one of those risk factors and 40 percent have two or more. 

In addition, the persistence of childhood obesity into adulthood is 

associated with an increased risk of severe obesity in adulthood. 

About 50 percent of adults, half of all adults with severe obesity, 

namely 100 pounds or more of excess weight, had onset of this disease in childhood. So that even though childhood obesity contributes a minority of adult disease, it may have a disproportionate effect on the severity of obesity and its attendant costs and complications. 

Ten percent of the national health care budget is now spent on 

obesity and its complications, and that is a significant barrier to 

controlling the costs of our medical system. We believe that a 

multicomponent, multisectoral approach is essential that focuses on 

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There are at least seven areas of interest. Excessive weight gain 

during pregnancy, Type 2 diabetes or gestational diabetes during 

pregnancy, and tobacco use during pregnancy all predispose to 

early childhood obesity. We also believe that control is going to require an increased intake of fruits and vegetables, a reduced intake 

of high-energy density foods such as fast foods, reduced intake of 

sugar sweetened beverages, reduced time spent viewing television, 

increased rates of breast feeding and increased rates of physical activity. Those are the target behaviors. Those are not the strategies 

that are necessary to implement those. 

So that, for example, with respect to increasing rates of breast 

feeding, we need to implement policies and environmental supports 

in maternity care settings, implement the same policies and environmental supports in the work site, and develop State and national breast feeding coalitions to improve support for breast feeding. 

Now, I would like to turn to three examples, one in day care or 

child care, one in schools and one in communities as examples of 

innovative strategies. One of the most innovative strategies is the 

New York City Group Day Care Initiative which calls for the provision of no sugar-sweetened beverages for children in group day 

care; limits to 6 ounces of 100 percent juice per day; 1 percent of 

low-fat milk for children over the age of 2; water available at all 

meals; increased rates of physical activity, 60 minutes, which is the 

requirement for children; and limits on television time. 

Now, the combination of these multiple targets and these multiple strategies in a day-care setting is likely to have a significant 

impact on the prevalence of obesity, not to mention the health of 

these children. A notable example of a school-based initiative has 

occurred in Mississippi where 65 school districts have replaced 

deep fat fryers with oven steamers, thereby reducing the calorie 

and fat content of the foods served to children. In addition, Mississippi has made major improvements in decreasing the availability of sugar-sweetened beverages and other high-calorie foods. 

They are now a leader in terms of school initiatives in the country. 

And then finally, with respect to community initiatives, the 

American Recovery and Reinvestment Act has allowed us to begin 

to invest in community and State-Level changes that address these 

strategies. And at the time of the weight of the nation, we released 

an MMWR, a morbidity and mortality weekly report entitled ‘‘Recommended Community Strategies and Measurements to Prevent 

Obesity in the United States. And these strategies focus on the increased availability of healthy food, decreased access to less healthful foods, increased access to recreation facilities, and increased 

physical education programs in schools. There are a total of 24 of 

those strategies which we would be happy to share with you. 

In closing, children are our most precious resource and obesity is 

a major threat to their health and to the costs of health care in the 

United States. We are seeing progress, but the opportunity now exists through the American Recovery and Reinvestment Act and 

other innovative programs to begin to reverse this epidemic. Thank 

you for this opportunity. 

Mr. PALLONE. Thank you, Dr. Dietz. 

[The prepared statement of Dr. Dietz follows:] 


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Mr. PALLONE. Dr. Huang. 

STATEMENT OF TERRY T-K HUANG 

Mr. HUANG. Mr. Chairman and members of the committee, thank 

you very much for the invitation to testify today. I am pleased to 

be here today to share with you some of our recent research and 

some of our plans for addressing this multifaceted problem as we 

move forward. 

The NIH recognizes that to really make a difference on childhood 

obesity, research should address the broader system in which children learn, play, live, and obtain health care. Such a systems-oriented framework will need to link biological factors of obesity with 

social, environmental and policy factors that influence children’s 

diet and physical activity. Over the last few years, research has 

demonstrated the important impact of the physical, social, and economic environments on the obesity epidemic. For example, neighborhoods with lower socioeconomic status have less access to safe 

settings for physical activity which is associated with decreased 

physical activity levels and higher prevalence of obesity. Other 

community characteristics, such as the lack of public transportation or land use and zoning issues, can also contribute to decreased opportunities for physical activity. 

In addition, there is research showing that the availability of and 

access to healthy foods are important. Areas that are food hazards 

or areas with a high density of fast food, relative to other restaurant choices, are associated with a higher prevalence of overweight and obesity. 

Research has also shown that economic factors such as food marketing and pricing are critical as they can influence the purchase 

and consumption of nutrient-poor but energy-dense foods. 

To accelerate research progress and translate research findings 

into effective solutions, the NICHD, in partnership with a number 

of other NIH Institutes and offices, the CDC, and the Robert Woods 

Johnson Foundation, came together to form the National Collaborative on Childhood Obesity Research earlier this year. NCCOR is 

designed to coordinate and synergize the funding efforts from member organizations to avoid duplication of efforts and to pool resources for large, ambitious projects that bring us closer to effective 

and sustainable solutions. 

For example, NCCOR recently launched the Envision Project, 

which aims to help us understand the complexity of the childhood 

obesity problem, and virtually tests environmental and policy interventions through sophisticated computational systems models. 

NCCOR also will soon be beginning beginning funding in a nationwide study to determine the effectiveness of existing companybased strategies and programs, using a common evaluation approach. Some of those communities might be the era of funded communities that Dr. Dietz talked about, for example. 

In addition, a consortium of prevention and treatment trials that 

simultaneously target multiple settings in which children learn, 

play, live and/or seek health care will be funded this year. 

Other recent research programs of note include initiatives on encouraging community-based partnerships of obesity researchers 

with local or State-Level policymakers, and research on school and 


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community policies that impact obesity-related behaviors and outcomes. 

Funding received by NIH under the American Recovery and Reinvestment Act has also created opportunities for innovative research. One NICHD example is a unique weight maintenance 

study with strong focus on children’s social environment that aims 

to help children who have achieved weight loss to maintain their 

reduced weight. 

To conclude, it is important to note that the childhood obesity 

problem is linked not only to children’s and parents’ behavior, but 

also, more importantly, to social and economic development and a 

number of policy areas outside of the traditional public health 

sphere. Thus, we need to deal with obesity as a systems issue, not 

just a health issue. We need to invest resources into research that 

is systems-oriented, multilevel, and cross-disciplinary, and include 

partners from all sectors of our society to generate effective and 

sustainable solutions. 

The solution to the childhood obesity problem will require a coordinated, collaborative, and multisectoral strategy that includes 

strong actions from the government, industry, community and family. Together we need to create an environment that not only favors 

trade and economic productivity, but it also takes into account the 

long-term health of the population. Until both healthy eating and 

physical activity become naturally embedded in everyday life, there 

is little chance that the childhood obesity toll in the U.S. and 

around the world will diminish. 

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

Mr. PALLONE. Thank you, Dr. Huang. 

[The prepared statement of Mr. Huang follows:] 


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Mr. PALLONE. And now we will have questions for the panel. And 

I will start out by recognizing myself. What I am going to say I 

guess is kind of a cliche, but I love to use stories or personal stories 

to sort of make a point when I can. 

What you said, Dr. Huang, and I totally agree, is we need strong 

action. But the question is, a lot of these things are so personal in 

nature, not necessarily viewed by the American public as something that the Federal Government gets involved in. So I guess my 

question always is to what extent can the Congress legislate or provide funding that is meaningful. 

Let me just give you my story. I always think about my grandparents because they were Italian American immigrants and they 

came from Italy. And my grandfather lived to be I think 96 or 98. 

Was always thin. And he would literally have a garden in the backyard, raise the things that he would eat, not completely, but a lot 

of the stuff. My grandmother would can the goods, put the tomatoes and peppers and everything in the jars. So much of what they 

ate was just grown by them in their backyard, and then they 

would—even in the winter they would have it, because they would 

can it or whatever and preserve it. And they never went out. I remember my grandmother like had an aversion to ever going out to 

a restaurant. I can never remember her going to a restaurant ever, 

or doing takeout. I don’t even know if it existed to them. But it just 

didn’t occur. OK? 

Today it is just the opposite. When I go home, we are always 

looking to go for takeout. I have teenage kids. They are always 

looking to go to McDonald’s. It is just the whole nature of the lifestyle has changed. 

And I was mentioning Native Americans that—one of the highest 

incidents of diabetes is with the Pima people. And I have been out 

to the Pima reservation, to the Tohono O’Odham in Sells, Arizona, 

which is another Pima people. And that is where I would see— 

every year that I would go, there would be lower and lower—the 

kids would get diabetes at a younger age. And what they would tell 

me was that historically they were a desert people. They would 

gather in the desert everything they ate. It is was a very different 

diet. Now they are eating all processed foods. 

Now, the question really is, we can’t go back. You are not going 

to take people back to the old days. Are there things we can do 

now, though, that recreate that? Like, for example, with the 

Tohono O’Odham, it was suggested that they start like a vitamin 

supplement program. And then there was a nonprofit called TOCA, 

T–O–C–A, that started trying to get people to grow some of the traditional foods through a local cooperative. We can’t go back to what 

life was like 30, 40 years ago when people were healthier in terms 

of what they ate. But on the on the other hand, what is the role 

of the Federal Government? Because so many of these things are 

personal, they are not necessarily—it is lifestyle. I know it was a 

broad question. 

Mr. HUANG. Well, thank you for your question and comment, Mr. 

Chairman. I think your point is well taken. I think research has 

clearly shown that along with social and economic changes, as you 

have mentioned, many aspects of our lifestyle have changed and 


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many aspects of our environment have changed to result in the lifestyle that we have today. 

So I think what the collection of research is suggesting what we 

need to do is to really somehow think about making the environment conducive for people to have healthy eating and physical activity habits. So I think in a way, you can think it of as giving people the full gamut of choices so that people can truly exercise personal responsibility. If families don’t have access to healthy foods 

in their neighborhood, because there is no supermarket or there is 

a lack of variety of food outlets, then they don’t really have the option to even exercise the full range of personal choice. 

Mr. PALLONE. That goes back to the other thing I mentioned. 

When I was growing up in the neighborhood where my father still 

lives, and where our congressional office is, there was a school that 

had a playground. The school closed. No playground anymore. The 

Y closed because they didn’t have enough money. 

And that is what is happening. In a lot of the urban areas or 

poor areas—and this isn’t really a poor area, I am not suggesting 

that, but it is not a high-income area. A lot of the nonprofits and 

the educational institutions that had these recreational opportunities have sort of dried up for lack of funds. They are more likely 

to build a Y in a suburban area than they are in an urban area. 

At least I have never done a survey, but it seems that way. 

Mr. HUANG. I think there are a lot of promising actions that are 

taking place on the ground right now, and I think our second panel 

will illustrate some of those very promising approaches. Reintroducing food to areas where—that are considered food deserts, for 

instance. We are going to hear from someone in Pennsylvania later 

today on that issue. 

Right in D.C., you see a resurgence of neighborhoods, increased 

mixed land use, so people are walking more, they are getting more 

physical activity. These are all, I think, really promising ideas that 

are in keeping with advancing progress, but at the same time, 

building back physical activity opportunities and healthy food opportunities back into our daily lives. And I think these are promising opportunities. 

We definitely need to do more research. We need to monitor and 

evaluate what effects these changes will have on people’s behavior 

and health outcomes. But I think that there are promising solutions that are already taking place and there is a lot of that, I 

think, all sectors of society can do from the government all the way 

down to the individual family and children. 

Mr. PALLONE. All right, thank you. The gentleman from Pennsylvania, Mr. Pitts. 

Mr. PITTS. Thank you, Mr. Chairman. 

Mr. PALLONE. You still have—I have been in your district. You 

still have a lot of farms and healthy foods there. 

Mr. PITTS. Farmers markets and a lot of canning. The Amish and 

Mennonites do a lot of that. With unanimous consent, I would like 

to submit my opening statement for the record. 

Mr. PALLONE. Without objection, so ordered. 

[The prepared statement of Mr. Pitts follows:] 


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Mr. PITTS. Thank you, Dr. Dietz. In your testimony, you mentioned that the obesity trend is leveling for boys and girls ages 2 

to 19. What factors do you think are contributing to that leveling? 

Dr. DIETZ. I wish we knew with some specificity. 

Mr. PALLONE. Maybe it is a good time for me to mention we are 

going to have four votes. But I am going to try to get a couple more 

questioners in before we break. 

Dr. DIETZ. Sure. I wish we knew with some specificity what was 

accounting for the plateau. By way of analogy, what we saw with 

tobacco was a steady acceleration of per-capita tobacco use, until 

awareness began about the adverse effects of tobacco, at which 

point cigarette smoking began to plateau. 

The attention given to obesity in the press recently and at all 

levels of government, I think, may have increased awareness of the 

adverse health impacts of obesity and changed behaviors in some 

ways that we don’t yet understand clearly. 

The other major development has been in schools. Our Division 

of Adolescent and School Health has shown very substantial 

changes in the reduction of the availability of unhealthful foods in 

schools which may have also been an important contributing factor. 

But it is important to emphasize all we have is a plateau. We don’t 

yet have in place the kind of environmental and policy initiatives 

that drove tobacco in the other direction. And those are the areas 

that we think we need to invest in with respect to obesity. 

Mr. PITTS. In your testimony, you mentioned that communities 

are putting prevention to work program. Can you elaborate further 

on this program? Has the program begun? 

Dr. DIETZ. Sure. These are the American Recovery and Reinvestment Act funds that came to CDC for community and State initiatives. We have received a very large number of applications from 

both States and communities to address either obesity through nutrition and physical activity strategies, or tobacco, or both. I wish 

I could provide you with details about how those applications are 

distributed. But we see those as the most promising investment in 

understanding what works at the community level And that this— 

in my testimony, I included an outline of the target behaviors and 

some of the strategies that we think are necessary to accomplish 

those changes. And those initiatives or those suggestions have been 

shared with the communities applying for these funds, and we expect those States and communities to implement these strategies. 

That will give us an opportunity to understand the intensity of the 

interventions necessary to control obesity and the combination perhaps of those interventions. 

Mr. PITTS. Thank you. 

Dr. Huang, in your testimony you mentioned the Envision 

Project, funded at $15 million. And the project aims to, quote, understand the complexity of the childhood obesity problem and virtually test environmental and policy interventions through computational systems models. Can you elaborate a little bit on that? 

Mr. HUANG. Sure. So this is a very nice example of cross-disciplinary—transdisciplinary research where those of us on the public 

health side have begun to learn a lot about methods used, for example, in engineering, in computer science, where computational 

techniques to integrate very, very large and complex sets of data 


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simultaneously can be applied to very complex public health problems such as obesity. And as we mentioned here today, obesity results from a wide range of ideological factors, and research to date 

hasn’t really been able to integrate all of that information simultaneously in analysis or design of interventions. 

So the idea of the Envision Project is to capitalize on our current 

computing power, to try to piece together the different aspects of 

the obesity puzzle; but, at the same time, to help us play with different intervention techniques that are perhaps expensive and difficult to implement because they are at a more macro-level, such 

as environmental modifications and policy changes—and to help us 

anticipate what are some of the intended and unintended consequences of those interventions in a virtual environment. And that 

information should provide great insight into what might be effective or not, and in what context, before we go out there and implement some of these large-scale interventions. 

So similar work has been done for example, in infectious disease 

areas. The U.S. Government already uses a lot of these systems 

models for the control of the flu epidemic, for example. And I believe that a lot of that work has been extremely insightful. And we 

anticipate a similar success with the Envision Project. 

Mr. PITTS. Thank you. My time has expired. 

Mr. PALLONE. Thank you. We have 9 minutes left. So I want to 

get at least one more speaker in. And Mr. Murphy is next. 

Mr. MURPHY of Connecticut. Thank you very much, Mr. Chairman. And thank you for this hearing. I think it is an incredibly important subject, having been chair of our State of Connecticut’s 

Public Health Committee in the State legislature. We tried to deal 

with this issue on a number of levels, and I am glad to see some 

attention being focused here. 

Let me just open up one subject, knowing that we are short on 

time, and I will ask you both to comment on it. My district in 

northwestern Connecticut reflects the diversity of living patterns 

throughout this country. I have got quintessentially rural areas, I 

have got suburban areas, and then I have got some urban centers. 

And it strikes me that we need different tools and we face different 

challenges in each one of those settings. 

So I just want to ask you particularly about that urban setting 

and about the particular challenges presented to families and kids 

in urban centers where, even if you make a decision as a family 

to eat more nutritionally, you have a harder time finding that kind 

of food that creates the kind of nutritional lifestyle that we are putting forth with these new policies. 

And, second, with regard to exercise, kids are in schools that 

don’t have fields. They have to travel a distance to find any type 

of open space to run around and play football and baseball on. And 

I wonder what you see as the particular challenges and maybe the 

particular policy responses that we need to attack some of the specific challenges that inner-city and urban kids are facing today? 

Dr. DIETZ. In my testimony, I indicated the publication of an 

MMWR, Morbidity and Mortality Weekly Report, that we published 

in July which began to outline strategies for the implementation of 

better foods, increased physical activity in communities. One of the 

major problems which you have pointed to is access, and we think 


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that programs like the Fresh Food Financing Initiative in Pennsylvania, which builds supermarkets in underserved areas, are a 

model that we ought to point to and try to implement more broadly. 

Access is also a factor affecting recreation facilities and parks for 

physical activity of children and adults. How one accomplishes that 

is less certain. And that is—again, I think the funds that we have 

through ARRA give us an opportunity to understand those challenges and the impact of making changes in those arenas. 

Mr. MURPHY of Connecticut. So the problem is stop and shop at 

Whole Foods. They are not going to go into those areas because 

they just don’t see a market for it. So you can either work over a 

period of decades to create the demand and hope that private sector capital follows demand to put those type of full-service grocery 

facilities in those neighborhoods. Or maybe you are suggesting, as 

Pennsylvania has done, you actually put some government money 

behind the financing of those inner-city fresh food facilities or fullservice grocery facilities? 

Dr. DIETZ. Right. I am not an expert on the Fresh Food Financing Initiative. I think it is a mix of private and public funds. But, 

yes, that can be done on a variety of scales. It can be done by putting a supermarket into an underserved area. And in New York 

City, Dr. Frieden had a Bodega Initiative, which provided loans or 

access to facilities for keeping fresh fruits and vegetables cold, implementing a low-fat or no-fat milk campaign in those stores. So 

there is—but what we don’t understand yet is what the impact of 

those types of initiatives are on food quality and food intake. 

Mr. MURPHY of Connecticut. Dr. Huang. 

Mr. HUANG. I would just concur. And I think the Congressman 

points out some of the crux of what we are talking about in terms 

of really making the environmental changes that would be conducive to having people engage in healthier eating practices or physical activity. Without those options people can’t have the full range 

of choices. 

I think that some of our recent research with NIH, CDC, and the 

Robert Woods Johnson Foundation and other funding organizations 

is hoping to evaluate the effectiveness of various community-level 

strategies. 

I mentioned earlier in my testimony that we are about to launch 

a nationwide evaluation with a nationally represented example of 

communities using different approaches. And hopefully in a few 

years we will have some good data to point towards what might be 

effective and what might be sustainable. 

And I think the sustainability aspect is a really key thing. And 

some of the things that we may need to do in terms of solution are 

putting in place the seed for long-term change. We are not going 

to solve the childhood obesity problem overnight. And I think we 

need to have our eyes set on a long-term trajectory in putting in 

place measures that will get us to where we want to be down the 

road, not just for the current generation, but the for the next generation. 

Mr. PALLONE. Thank you. Now, we have four votes. It will take 

us maybe a little more than half an hour, but we will try to get 


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right back. And we still have some more questions of you before we 

go to the next panel. So the committee stands in recess. 

[Recess.] 

Mr. PALLONE. The subcommittee hearing will reconvene. 

We go to the Republican side, Mr. Murphy of Pennsylvania. 

Mr. MURPHY of Pennsylvania. Thank you, Mr. Chairman. 

Mr. Chairman, I ask that my testimony be submitted for the 

record on this. 

Mr. PALLONE. Without objection, so ordered. 

[The prepared statement of Mr. Murphy follows:] 


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Mr. MURPHY of Pennsylvania. I thank our panelists here. I have 

a couple of questions on your testimony. Thank you for that. 

One has to do with, Dr. Dietz, in your testimony, you talk about 

perinatal problems, infant mortality rates, et cetera, with this. Is 

this something that, given that, and also the comments you make 

later on or you made in other parts of your testimony about the increased cost of health care with obesity, are you aware of any studies done or studies that are planned on such issues as, for example, 

looking at our infant mortality rates and factoring in the issue of 

obesity as something we should be paying attention to? 

Dr. DIETZ. No, we have not done that. The issue I am most 

aware of is less about infant mortality than infant morbidity, that 

we know that excessive weight gain during pregnancy, tobacco use 

during pregnancy and diabetes during pregnancy predispose to big 

babies, so there is likely an increased frequency of complications 

during delivery. There is early onset of obesity in children exposed 

in utero to those factors. 

Mr. MURPHY of Pennsylvania. Given that, the other question I 

have for both you and Dr. Huang has to do with some insurance 

plans, some health insurance plans, actually offer differences in 

premiums and copay if people keep their weight within certain 

ranges and see their physicians, et cetera. 

Are either of you aware if there are any studies that talk about 

when those incentives are offered, changes in premiums or copays, 

based upon a person’s weight within a certain range, if it makes 

a difference in their health and their morbidity rates, and, of 

course, ultimately also in their health costs? 

Dr. DIETZ. I have some nagging thoughts that, yes, there are 

such data, but I can’t call them to mind. 

Mr. MURPHY of Pennsylvania. Is that something you could get for 

us? 

Dr. DIETZ. Yes. 

Mr. MURPHY of Pennsylvania. Dr. Huang, do you have any 

knowledge of studies in these areas? 

Mr. HUANG. To my knowledge, NIH hasn’t funded any studies 

with regard to that specifically, but perhaps our colleagues at 

AHRQ might have more data. 

Mr. MURPHY of Pennsylvania. You can imagine how valuable 

that would be to this committee to know that information. So I appreciate that. 

The other area I wanted to ask about, there is so much of the 

testimony that we have heard also talks about nutrition. Of course, 

we hope people eat healthy. We talk about such things as activity 

and we hope they take advantage of activities, but we haven’t 

talked about a requirement for activity. 

I am fascinated by some work that has been done in the 

Naperville school district. I don’t know if you are aware of that. 

But they actually require an hour of activity every day. I think Illinois is the only State that requires a physical ed class. The rest 

of the States have dropped that. Many times States say we don’t 

have the time to do this because we have to spend more time with 

math and reading, et cetera, to get the academic scores up. 

I find it interesting, they said that 97 percent of freshmen are 

at a healthy weight compared to the other things we see about 


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young children. Students wear heart monitors during their gym 

class to make sure they stay at target heart rates. They are allowed a wide range of activities. It isn’t just dodge ball with the 

big kids where they can stand at their side. Also they perform in 

the top 10 in the world on standardized math and science tests, a 

fascinating link there. 

I wonder if you two could comment on other studies we might 

learn from. Or jumping to the next level, should we require students to take gym class, or at least educate our school systems 

around the country of the value of that? 

Dr. Dietz. 

Dr. DIETZ. Well, there are two very important benefits of physical 

activity and obesity prevention and control. One of the benefits is 

that physical activity reduces the risk of co-morbidity. So that if 

you are overweight and have elevated blood pressure and are inactive and become active, your blood pressure will positive. Similarly 

for lipids, similarly for glucose tolerance. So when one begins to 

talk about health at any weight, which is an important concept because not everybody can lose weight, physical activity is one of 

those important strategies. 

The second benefit is one you alluded to. We published a study 

2 years ago showing that physical activity improved test performance in younger children. And anecdotally, at least, teachers say 

that physical activity also improves behavior. So the irony is at a 

time when schools are vesting themselves of physical education 

programs because of the no child left behind program, they may be 

throwing out one of the most important programs to improve test 

scores. 

The third comment is that in Pinellas County in Florida, they 

have developed an integrated program that focuses on physical activity, both in child care and in elementary schools. Whether it is 

going to have the same results as those in Naperville remains uncertain, because Naperville has just an extraordinary program, as 

you correctly point out. 

Mr. MURPHY of Pennsylvania. Dr. Huang, any comments on that? 

Mr. HUANG. I concur with Dr. Dietz’s comment. There is definitely research linking physical fitness with better academic outcomes, so I am in concurrence with that. 

Mr. MURPHY of Pennsylvania. I hope that is another area you 

can get to the chairman so he can distribute it to the committee. 

It is very valuable to us to do that, because it is not one of those 

things that costs a lot, to keep kids active, and the outcome in 

grades is huge. And I hope more schools pay attention to this. I 

hope the word gets out. 

Dr. DIETZ. Just to be certain, you are asking about the study—— 

Mr. MURPHY of Pennsylvania. If you are aware of some other 

studies that talk about basically overweight, underactive underachievers, versus getting kids involved again. 

Thank you very much. I yield back, Mr. Chairman. 

Mr. PALLONE. Thank you. Next is the gentlewoman from Florida, 

Ms. Castor. 

Ms. CASTOR. Thank you, Mr. Chairman. 

Dr. Huang, as both you and Dr. Dietz have testified, childhood 

obesity is an epidemic affecting all children regardless of race or 


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where they come from or their socioeconomic status. However, we 

can’t ignore the fact that childhood obesity disproportionately impacts racial and ethnic minorities. 

I wonder, given that TV viewing paired with advertising is a 

major contributor to childhood obesity—I mean, there is still a 

breakfast cereal that is cookies, right? I am curious if research has 

revealed that disparity in marketing of unhealthy foods to racial 

and ethnic minority children. 

Mr. HUANG. Yes, there is. I believe that there was just a press 

conference this past Monday by Children Now releasing a couple 

of studies showing that there is disproportionate exposure among 

minority children to advertising for foods that may be nutrient poor 

but energy dense. The Institute of Medicine has also released a report in recent years indicating how exposure to advertising leads 

to or influences consumption of different kinds of foods. 

So I think the research is pretty strong, indicating at least a link 

between food consumption, dietary behavior and exposure to advertising. So I understand that right now there is an interagency 

group looking at these issues, and I believe that results from some 

of those dialogues should be forthcoming, and we look forward to 

looking at FTC statements on nutrition standards for advertising 

and collaborate with them in appropriate ways. 

Maybe Dr. Dietz has other comments with regard to CDC’s involvement in that. 

Dr. DIETZ. Terry is absolutely correct that there are disparities, 

both in terms of the amount of television viewed, which tends to 

reflect the differential prevalence rates in children as well as differences in the type of advertising that is directed towards minorities. 

Yesterday, we released a report, the FTC released a report that 

CDC, FDA and USDA were a part of, which began to set advertising standards for foods advertised to children in the media. 

Those were the product of a lot of hard work by this working group 

to base these standards in a very transparent way on prior recommendations, as well as what was optimal for the health of children. And we have asked industry to respond to those standards 

and let us know how those standards would affect their current 

products and those products advertised on children’s television. 

Ms. CASTOR. Are there any insidious ways other than the research on prevalence of TV viewing and things like that, but have 

you come across those insidious marketing practices that are targeted specifically to minority children, or is it really across-theboard and then the prevalence impacts the obesity rates? 

Dr. DIETZ. I don’t know the answer to that question. 

Ms. CASTOR. I will yield back, Mr. Chairman. 

Mr. PALLONE. Thank you. 

The gentleman from Georgia, Mr. Gingrey. 

Dr. GINGREY. Mr. Chairman, thank you. 

Dr. Dietz, Dr. Huang, thank you for being with us today and testifying. I want to ask kind of almost a rhetorical question. We are 

going to be hearing from a second panel, and I guess there are five 

or so individuals on that panel. I have read most of the testimony 

and I am looking forward to actually hearing from the American 

Academy of Pediatrics. 


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In that testimony, there was a recommendation for a real comprehensive approach toward solving this problem. In fact, they say, 

the pediatrician is going to testify that to solve this problem, you 

need a medical home, you need the medical disciplinary care of pediatricians, subspecialists, surgeons, nurses, dieticians, mental 

health professions, exercise specialists, school staff and social workers. 

I am not disagreeing necessarily with that, and I do think that 

this is a significant problem that we need to try to address in the 

most cost efficient way. But when you get too comprehensive, of 

course, every one of these people have to be paid and they are 

going to be expecting to be paid. But, you know, we have a limited 

amount of money. We have been talking about that for the last almost year as we debated this comprehensive health insurance reform plan and how to spend the dollars effectively. 

I don’t know that there is a silver bullet, but if there is an arrow 

or two in the quiver that is sharper than the rest of the pack, I 

think we should use it. 

So my question is this: How important do you think the role of 

parental behavior is in regard to the problem of childhood obesity? 

Could you give it a percentage? I know we are talking about genetics and environment and lack of ability for the children to exercise 

and too much television, et cetera, et cetera, et cetera. But, of 

course, they are eating at the same table, for the most part, with 

the parents, and there is a lot of learned behavior here. 

Comment on that, both of you, if you will. 

Dr. DIETZ. That is a hard question to assign a percentage, because there aren’t, as you point out, genetic determinants or genetic susceptibility. But those genetic elements that increase susceptibility are acted upon by an environment. Certainly the first 

environment and one of the most important that young children 

live in is the home, and there is no question that parents can play 

a significant role and do play a significant role in the types of foods 

their kids eat, the access or utilization of physical activity facilities, 

and screen time, all of which are significant risk factors. 

But in many cases, although we would like parents to make the 

right choices, they don’t have the right choices to make, and that 

opens up a broader environmental issue. For example, you can’t 

very well expect an inner-city parent who lives in an unsafe neighborhood to allow their children to go out and play. You can’t very 

well expect somebody to increase their fruit and vegetable intake 

if they don’t have access to supermarkets or farmers markets that 

provide those. 

Frankly, I don’t think we have a good way of accessing parents 

in a way that fosters behavior change. 

Dr. GINGREY. Dr. Dietz, I understand that. I don’t mean to cut 

you off. I want to hear from Dr. Huang. I had one follow-up real 

quickly, if I have time. Dr. Huang. 

Mr. HUANG. There is no question that parents play an important 

role. But as Dr. Dietz pointed out, parenting and parents’ behavior 

do not occur in isolation. So, providing the environment that would 

be conducive to having parents engage in the behaviors that we 

want them to engage in I think would be really critical. 


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We have spent years in doing research trying to tell parents to 

get their kids to eat better and get their kids to exercise. Even if 

we might be effective in changing some of those behaviors in the 

short-term, we are not able to sustain those behaviors over the long 

term, and I think the precise reason is because behaviors occur in 

context. 

Dr. GINGREY. I want to thank you. In the few seconds I have left, 

I would like to make this comment, Mr. Chairman. 

When we marked up H.R. 3200 then, which became H.R. 3962, 

our health care reform bill, there was an amendment made to suggest that employers should be able to incentivize their employees 

for healthy behavior, stop smoking, lose weight, exercise, and in return a premium reduction, kind of a reward to get people to buy 

into that. Of course, the payback for the employer was better attendance, better workers, better skills, less accidents in the workplace, and apparently HIPAA limits the amount of reduction in 

premium to 20 percent. 

Now, in the bill, I think we did raise it to 30 percent, maybe 50 

percent even on the Senate side. But the Secretary of Health and 

Human Services would have to approve those type programs. I 

know you don’t have time to respond, but I think this is a good 

thing that we ought to continue to stress and push. Because if 

these parents get healthy at work, they are going to come home 

and pass that on to their children. 

Mr. Chairman, thank you for your indulgence, and I yield back. 

Mr. PALLONE. Thank you. 

The gentleman from Maryland, Mr. Sarbanes. 

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

This is a very important hearing. This is one of the most important hearings I think we have had in this committee all year. You 

have heard the discussion. So much of it is focused on our young 

people and developing in them the right kind of lifestyle habits so 

that they can improve their health over the course of their lives. 

I wanted to just mention a couple of pieces of legislation that I 

have been involved with that I think are very much on the mark 

with some of the testimony we have heard today. 

The first is something called the No Child Left Inside Act. It is 

a little bit of a play on words. We have No Child Left Behind. But 

it is the idea of trying to promote more opportunities for environmental education and the integration of outdoor learning experiences and education into the overall instructional program across 

the country. It would encourage States to establish environmental 

literacy plans, which is sort of their vision to how to make sure 

when children graduate from high school, they have had some 

baseline exposure to the environment and have incorporated these 

experiences in. 

It is based on research, and we have heard some of this already 

today, but research that indicates that these days, the average 

young person is spending 4 to 5 hours a day inside on video games, 

television and the Internet, and about 4 minutes a day in what we 

would say is outdoor, unstructured recreation. 

We have gone from a generation where your mother had to keep 

calling you in for dinner, to where parents, albeit dependent on the 

tinge environment or neighborhood they are in, are trying to push 


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their kids more outside because they seem to be spending all their 

time on screen time. And we have got to get back to a balance. 

So that is one legislative vehicle, to try to bring more attention 

to this need for a balance. 

The other is something called the Foundation For a Fit Nation. 

There is a council, the President’s Council on Physical Fitness, that 

was established under President Eisenhower and then President 

Kennedy expanded its charge, that focuses on physical fitness and 

tries to keep that kind of high profile. But it is currently unable 

to raise private funds to support its mission. So this bill would actually create an opportunity for that, to support its activities. I think it gets about $1.2 million a year now directly in appropriation, but could certainly do much more if it had support from 

the private sector. 

So all these things are designed to bring more attention to the 

issue that you are describing. 

I had two questions: One relates to each of those. We have heard 

about how this problem of obesity, and I want to focus particularly 

in on childhood obesity, can be affected by a combination of diet/ 

nutrition, genetics to some degree, the environment, and then the 

amount of exercise. 

As you think about those components, and maybe others, do you 

have a kind of, in your own mind, do you prioritize one over the 

other? Do you find them so inextricably linked to one another that 

it is unuseful to do that, or do you say we can make huge strides 

at very little cost arguably if we just improve the kind of exercise 

component? 

So if you could speak to that. Then I have one other quick question. 

Dr. DIETZ. I think both are equally important for different reasons. I think that dietary intake is critical in the prevention and 

even more important in the treatment of childhood obesity, reductions in dietary intake. But physical activity has an important role 

in reducing the morbidities associated with obesity, like elevated 

cholesterol or lipid levels, blood pressure and glucose tolerance. So 

I don’t think you can separate those. I think they are both essential 

and have different effects on obesity and its outcomes. 

Mr. HUANG. I would just add, I think it is important to note that 

the environment enables or constrains behavior, such as diet, such 

as physical activity. We have done research for so many years now 

that are targeted solely at the individual level with very little 

promising and sustainable results. So I think if we are truly going 

to make a dent on this problem with the population level, we really 

need to begin addressing the environment more aggressively. 

Mr. SARBANES. I have got 8 seconds. I will just close with a comment. Representative Gingrey talked about the importance of parental leadership in this effort. I think there is real opportunity for 

partnership between parents and schools to begin to emphasize 

this. 

I remember a young man. I was on a field trip with some youngsters to illustrate the importance of this No Child Left Inside effort, 

and he talked about how because of some of the activities at school 

that they had begun we they would get out into nature and do 

these walks and so forth. He had convinced his parents on the 


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weekends to go every Saturday morning to do a two to three hour 

walk with the family. The parents are often guided in their priorities for leisure time by what their children want, if not always. So 

I think you can get this partnership working in a very productive 

fashion. 

I yield back my time. 

Mr. PALLONE. Thank you. 

The gentleman from Illinois, Mr. Shimkus. 

Mr. SHIMKUS. Thank you, Mr. Chairman. I apologize for not 

being here for opening statements. But I appreciate this panel and 

I appreciate the second panel that will be in. 

My first question would be, what role does genetics play in this 

whole debate? 

Dr. DIETZ. It is a significant role and it influences susceptibility, 

but I don’t think that we can point to genetics as the factor which 

accounts for the—— 

Mr. SHIMKUS. The primary factor, but it could be contributing 

based upon the family. 

Dr. DIETZ. Yes. 

Mr. SHIMKUS. Dr. Huang? 

Mr. HUANG. I agree. The human genome hasn’t changed over the 

last 50 years, yet the obesity rate has skyrocketed. 

Mr. SHIMKUS. Those folks who are predisposed based upon their 

genetic makeup probably have to put even more of a focus on the 

basic issue. My frustration is I am kind of like Dr. Gingrey. I am 

a family individual. I think parental involvement—you know what 

these kids need? They need a good health instructor, they need 

good food in the schools, and they need a good gym teacher. That 

is what they need. 

We can have all the dang Federal programs we want. But the 

micromanagement, that is why I appreciate what the NFL is doing. 

We have to educate these people. If is it is calories in, calories out. 

You don’t gain weight if you burn more calories than you consume. 

Is that correct? 

Dr. DIETZ. Yes. 

Mr. SHIMKUS. Dr. Huang? 

Mr. HUANG. That is true. 

Mr. SHIMKUS. So it is an issue of educating people. I am a big 

man. I am a number one, extra value meal, Big Mac drive-through 

guy. I have my Hershey bar and my diet coke. This is for my mental health. But I will also go down to the gym and work out as long 

as I can, get to it for maybe an hour to 90 minutes. And I will burn 

those calories. 

So I am concerned that as we pile upon big government to try 

to micromanage the roles of the family and the roles of primary 

education in this country, we ought to be incentivizing them to do 

the right thing and encouraging them. 

It is not rocket science. It is calories in, calories out. You burn 

more calories, you don’t gain weight. If you are genetically predisposed, you have to work harder. If you are genetically predisposed to high cholesterol, you have to then focus more on diet. 

But don’t make this any harder. Please don’t have the Federal 

Government rules and regulations. Let’s just empower the local 


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communities to get into their local public school systems and say, 

please diet, exercise, healthy foods. 

I appreciate your time, and I yield back. 

Mr. PALLONE. Thank you. The gentleman from Iowa, Mr. Braley. 

Your State is the only one that has a physical ed requirement, apparently. 

Mr. SHIMKUS. We have a statewide requirement, Chairman. 

Mr. BRALEY. I want to talk about that, because as I have been 

talking about health care for 3 years, I remind everybody that 

health care is not a disease treatment response; that if we gut 

funding for our physical education programs in our schools and if 

we try to impose a 1950s era physical education curriculum on today’s youth, we are going to be drastically failing our responsibility 

to them. 

Do you both agree with that? 

Mr. HUANG. Yes. 

Dr. DIETZ. Yes. 

Mr. BRALEY. Because when I was growing up in the sixties, we 

ate Sugar Smacks, which had 56 percent sugar in them; Sugar 

Frosted Flakes, Sugar Pops, Supper Sugar Crisps, and I remember 

looking around my classroom and there may be one or two kids in 

a class of 30 during the baby-boom era who were considered obese. 

And I think if you looked at caloric intake back then, we probably 

had a higher caloric intake per capita than students today do. But 

we also were getting more healthy food in some base on a daily 

basis and we spent all day outdoors. 

Yet the harsh reality is as parent who had kids growing up in 

the nineties, most parents are faced with very different choices 

than our parents did, where you had a mother in many cases living 

at home and monitoring the behavior of children, and children who 

were faced with much fewer threats out in the world that allowed 

them to spend all day outdoors the way we did as kids. 

So my question is, how do we get society to focus on the challenges of providing lifestyle physical education in our schools on a 

daily basis, that gives them not just dodge ball skills, but things 

that teach them aerobic activities they can carry throughout their 

lives, and how do provide the type of informed nutrition labeling 

at the point where they are consuming food in the schools, which 

is our best place to reach them outside the home, to give us a realistic chance of bending this curve of upward juvenile obesity downward? 

Dr. Huang? 

Mr. HUANG. Well, I agree with your points completely, and I 

think, actually, the points consistent of the Congressman from Illinois with our message today. Providing good gym teachers or providing good food in schools, those are part of the changes in the environment that we are talking about today to make it possible or 

easier for parents and kids to engage in the right behaviors. 

With regard to your point specifically, we do have I think emerging trends, for example in urban planning, creating more opportunities within urban environments for physical activity, whether it 

is physical activity engaged going back and forth between public 

transportation and schools or work, or new building designs, like 

in New York City, for instance, putting in—looking at design of 


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staircases, looking at different building codes, having playgrounds 

nearby new housing developments, et cetera. We are going to care 

more about activities with regard to reintroducing healthy food access to some of the neighborhoods around the country. 

So I think there are promising strategies that are consistent with 

our modern life. But it is really important to know that we can’t 

just keep telling children and parents that you have to eat better, 

you have to exercise. We have to create a larger context to make 

those behaviors possible. 

Mr. BRALEY. Dr. Dietz, before I get to you, I want to frame this 

a little differently. One of the things we know is kids do behave differently today. Many of them are focused on access to computer 

games, the Internet, and they are stimulated differently than we 

were when we could go outside and hang out with our friends all 

day long without having to be indoors. 

So what I am interested in is how you take technology like Wii 

Fit activity, or some of the other computer games that require 

physical activity, and how you use those to motivate kids to get 

more engaged, realizing you have got a much more difficult challenge with today’s generation of young children to get them to exercise than we did in the past. 

Dr. DIETZ. Yes. One example of where that has been done is in 

West Virginia where they introduced Dance Dance Revolution in 

their schools. I think that that is an important example and opportunity. And I think we need a lot more experience. As adults, we 

tend to prescribe to children what we think is appropriate. 

Mr. BRALEY. Like dodge ball. 

Dr. DIETZ. Right. But I think kids have a better idea of that, and 

we need to invest much more strongly in understanding what they 

would like to do and how to meld the electronic media and environment with the physical activity environment. 

Mr. BRALEY. But the key is to get them moving. 

Dr. DIETZ. Absolutely. 

Mr. BRALEY. Thank you. 

Mr. PALLONE. The gentleman from Illinois, Mrs. Schakowsky. 

Ms. SCHAKOWSKY. Thank you. I apologize for not being here for 

your testimony in the opening statements. 

A couple of points I wanted to make. Earlier this year, along 

with Dr. Burgess, we introduced H.R. 2354 called the Health Promotion First Act. I hope you will take a look at it. The goal of the 

bill is to identify ways to help people develop and maintain healthy 

lifestyles, promoting the kinds of living and working environments 

to encourage people to eat right, to be physically active, to adopt 

behaviors that improve their health. 

Our bill, I think, takes innovative approaches of requiring collaboration across agencies to identify what the best practices and 

effective strategies for health promotion would be. So I hope you 

will take a look at it. 

The other thing I wanted to tell you is last week I met with a 

woman, her name is Rochelle Davis, and she is executive director 

of the Healthy Schools Campaign in Chicago. She has developed, 

along with the public schools, a collaboration on school lunches. 

The Chicago public schools want to be early adopters of the Institute of Medicine recommendation changes in school meals that reVerDate Mar 15 2010 23:19 Oct 19, 2012 Jkt 074861 PO 00000 Frm 00058 Fmt 6633 Sfmt 6633 E:\HR\OC\A861.XXX A861

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quire more, like way more, vegetables and fruits and whole grains. 

But, unfortunately, current USDA standards prevent that. 

So I think one of the goals we have to have is look at the policies 

that exist right now and identify some of the barriers that we have 

to actually adopting some of the strategies that we actually no will 

work. 

We want to encourage States and localities to be innovative. I 

just went to my grandchildren’s school and looked at the school 

lunch program. They actually happen to have a kitchen, so they 

can do more innovative things. But fewer and fewer schools now 

have their own kitchen, so we are looking more at the central delivery places, what kind of work that they are doing. 

Parents, I think, actually are getting more involved than I remember in what the school lunch programs look like, at least in 

my district, and I am very, very encouraged by that. And I think 

once they figure out some programs that are cost-effective, because 

always cost is an issue, that we can promote those. 

But I wondered if you could talk a little bit about the barriers 

that we have existing right now in our Federal regulations that 

might prevent these kinds of things from being adopted? 

Dr. DIETZ. Certainly the existing policies that govern school 

meals are a concern, and I think that there is a lot of interest in 

the child nutrition reauthorization bill. And in conversations that 

we have had with the USDA, there is great interest on their part 

in moving forward. 

Another important program, which is not in schools but has an 

equal impact in child care settings, is the child and adult care food 

program, the recommendations of which are under review by the 

Institute of Medicine. I think a report is forthcoming in 2010, and 

the hope is I think on USDA’s part that that will help change the 

face of child nutrition in schools. 

Ms. SCHAKOWSKY. Do you want to add anything, Dr. Huang? 

Mr. HUANG. Well, incidentally, I just met with Dr. Thorn, the 

Deputy Under Secretary of nutrition from USDA yesterday, or 2 

days ago, and I know they are paying close attention to the new 

IOM recommendations. So I agree with you. 

Ms. SCHAKOWSKY. You know, I did the food stamp challenge, I 

don’t know if it is last year now or 2 years ago—2 years ago. This 

was before the food stamp program got more funding. It was $1 a 

meal essentially, $3 a day. By the time I got to the produce section, 

fruits and vegetables, there was essentially no money left. I think 

I got one tomato for the week and a couple of bananas or something. 

So, again, I think that we want, especially since the new information on how many people rely on food stamps in this country— 

what do we call it now? 

Dr. DIETZ. SNAP program, Supplemental Nutrition Assistance 

Program. 

Ms. SCHAKOWSKY. SNAP program, which is better than ‘‘food 

stamps,’’ which don’t exist anymore, thankfully. But we have to 

provide the avenues for people. It is nice to say that families are 

supposed to do this and they should have healthy food. If you can’t 

afford to buy those healthy foods, it is not going to happen. Any 

comments on that? 


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Mr. HUANG. Right. I concur. I think my colleagues from USDA told me they are trying to work with $1.25 per meal. That is kind 

of their budget with the school meals. So your point is very well 

taken. I think it is very consistent with our message today. 

Ms. SCHAKOWSKY. I yield back. Thank you. 

Mr. PALLONE. Thank you. I think that completes our questions 

for this panel. There is just so much more to delve into. We are 

spending our time today, what little time we have, in trying to 

delve into some of these concerns. But I know there is a lot more 

we have to do. But I do appreciate your input. We may have some 

additional questions that the Clerk will send you within the next 

10 days or so as follow up. 

Thank you very much. 

I would ask the second panel to come forward. 

Let me introduce our second panel. Starting on my left is Ron Jaworski, who is with the Jaws Youth Fund and the National Football League Play 60. These are both organizations that you either 

started or have been involved with. Thank you for being here 

today. We appreciate it. 

Dr. Sandra Hassink, who is chair of the Obesity Leadership 

Workgroup for the American Academy of Pediatrics. 

Jeremy Nowak, Ph.D., President and CEO of the Reinvestment 

Fund. 

Mary Sophos, who is Senior Vice President of Government Affairs for the Grocery Manufacturers Association. 

And Dr. Risa Lavizzo-Mourey, who is a doctor and President and 

CEO of the Robert Woods Johnson Foundation. 

STATEMENTS OF RON JAWORSKI, JAWS YOUTH FUND, NATIONAL FOOTBALL LEAGUE PLAY 60; SANDRA HASSINK, 

M.D., CHAIR, OBESITY LEADERSHIP WORKGROUP, AMERICAN ACADEMY OF PEDIATRICS; JEREMY NOWAK, PH.D., 

PRESIDENT AND CEO, REINVESTMENT FUND; MARY 

SOPHOS, SENIOR VICE PRESIDENT, GOVERNMENT AFFAIRS, 

GROCERY MANUFACTURERS ASSOCIATION; RISA LAVIZZOMOUREY, M.D., AND PRESIDENT AND CEO, ROBERT WOODS 

JOHNSON FOUNDATION 

Mr. PALLONE. I appreciate all of you being here. I know you have 

innovative ideas about how to deal with some of these childhood 

obesity problems. Each of you have been renowned, if you will, in 

your own sphere in dealing with that. 

As I mentioned to the first panel, you each should give a 5 

minute opening statement and then we will have some questions. 

We will start with Mr. Jaworski. 

STATEMENT OF RON JAWORSKI 

Mr. JAWORSKI. Chairman Pallone and members of the Subcommittee on Health, it is great to be with you here this morning. 

Good morning, everyone. I am having so much fun here this morning, I may hang around and cover a football game on Monday 

night. Why not? It has been a great stay thus far. 

I really want to thank you for the opportunity to testify on an 

issue of great, great importance to me, to my Foundation and to 


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the National Football League, the epidemic on childhood obesity. I 

am proud to testify before you today in two capacities. 

First, I represent the United Way Jaws Youth Fund, a partnership my family created more than 10 years ago with the United 

Way of Camden County, New Jersey. Through the United Way 

Jaws Youth Fund, I am proud to have delivered close to $3 million 

to more than 70 nonprofit organizations providing service to children ranging from ages 7 to 18. 

In addition, I am also testifying on behalf of the National Football League and its signature community relations initiative, the 

Play 60 campaign. Launched in 2007, the Play 60 campaign is a 

national youth health and fitness campaign focused on increasing 

the health and wellness of young fans and combating childhood 

obesity by encouraging youth to be active for at least 60 minutes 

a day. 

Mr. Chairman, the facts surrounding childhood obesity in this 

country are startling. They are startling. Nearly one in three children and teens in the U.S. are obese or overweight. That is one in 

three. More than 23 million youth, that is 23 million, are obese or 

overweight. Startling numbers. In the last two decades, the rate of 

overweight children has doubled. 

We know that youth who are overweight or obese are more likely 

to have health risk factors associated with cardiovascular disease, 

such as high blood pressure, high cholesterol and type 2 diabetes. 

In contrast, the benefits of good health translate to the classroom, 

where studies show that fit students are less likely to have disciplinary problems. Healthy students also perform better on standardized tests. 

It is possible that these facts, while shocking, should not come 

as such a surprise when we consider that more than 60 percent of 

children ages 9 to 13 do not participate in any organized physical 

activity during non-school hours. The number of idle children is increasingly significant when schools around the country find it challenging to offer physical education classes. Sadly, very sadly, 50 

percent of the schools do not provide physical education in grades 

1 through 5. Even more startling, 75 percent do not provide physical education for grades 6 through 8. 

This is not a new issue for me, unfortunately. Mr. Chairman, you 

may remember back in 1989, the New Jersey public schools were 

considering eliminating physical education classes. I was very 

proud to lend my voice, along with at that time physical fitness 

guru Pat Croce, who became the Philadelphia 76’s president and 

part owner, along with Ed Solomon, a legislator in New Jersey, and 

we defeated that proposal. We were successful, and physical education remained a requirement in New Jersey public schools. It is 

amazing, here we are 21 years later still talking about the same 

things. 

I am pleased to also announce that I will be joining the United 

Way’s National Board in 2010. Last year, the United Way system 

established a 10-year health goal to increase by one-third the number of youth and adults who are healthy and avoiding risky behavior. In order to achieve its 10-year health goal, the United Way has 

made combating childhood obesity a priority which requires the resources and commitment of all of us working together. 


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One of the best examples of the type of health and wellness activity that the Jaws Youth Fund supports is Steve’s Club in Camden, New Jersey. In addition to being the most dangerous city in 

the country, Camden’s childhood obesity rate is a staggering 60 

percent. The United Way’s Jaws Youth Fund is proud to help fund 

Steve’s Club, an organization that provides fitness training to Camden kids, giving them a place to get their bodies healthy and stay 

off the streets. 

This young man that is joining me here today, Jose Henriquez 

is a former gang member turned fitness guru. It is a great story, 

a great story to be told. Jose has been working out of Steve’s Club 

for years. He recently turned 19 and received his official personal 

trainer certification. He trains kids in the club. He visits kids in 

Camden schools. The Jaws Youth Fund even bought a van for him 

so he could drive around and sell fitness to the kids in Camden, 

and, trust me, they need it. A real good friend of his through the 

great leadership and inspiration of Jose lost 50 pounds. There is a 

real example of the good work being done in our community. 

I can give you a number of anecdotes and great stories. I don’t 

know if it would be boring. Maybe there will be another time I can 

give you more of those. 

But on a broader scale, I would like to discuss the NFL’s Play 

60 initiative, a fantastic program, and describe for you some of the 

terrific work they and all of the member NFL clubs do in our community. 

Play 60 is a multi-disciplinary campaign that addresses the issue 

of childhood obesity through the national outreach and online programs as well as grassroots initiatives implemented via the NFL’s 

in school and after school and team-based programs, and the players and leadership of the NFL does a magnificent job. 

NFL Play 60 was designed to build on the league’s and teams’ 

longstanding commitment to health and the fitness. The NFL decided to focus on the issue of childhood obesity because it recognized not only the public health crisis facing our Nation, but also 

the NFL’s unique place in our culture and its ability to influence 

attitudes and behaviors, especially among young people. 

Since the inception of Play 60 in 2007, the NFL has committed 

more than $200 million to youth and health fitness through media 

time, PSAs, programming and grants. They put their money where 

their mouth is. This year alone, more than 700 events have been 

hosted by all 32 national football teams who implement Play 60 in 

their local markets. 

NFL Play 60 is supported year-round by many of the NFL’s most 

prominent players, including Drew Brees, Eli Manning, DeMarcus 

Ware, Jason Witten and Troy Polamalu, who donate their time to 

help the program. 

NFL Play 60 promotes the importance of getting 60 minutes of 

physical activity per day. That is it, 60 minutes. Just give us 60 

minutes. Kids are encouraged to find their own ways to get active, 

whether it is taking advantage of the local playgrounds which have 

been rebuilt, playing four-square in the school yard, or just walking 

around with some friends having some fun. Play 60 represents organized sports, including youth football, as a very good way to get 

active, but certainly not the only way. 


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Another story. Through the league’s Play 60 Super Bowl Contest, 

12-year-old Jared Doutt from Erie, Pennsylvania, took his family to 

Arizona for the Super Bowl 2 years ago. He enjoyed the experience 

and delivered the football for the kickoff. 

When he went home, he went back and started working outside 

on a regular basis. His sister also plays soccer and he coaches the 

soccer team after school. Great real life stories. 

The Super Bowl contest is only one way the NFL is involved. 

With South Florida hosting the Super Bowl this year, the NFL is 

asking all of its star players, because the Pro Bowl will be there— 

I will get a plug, I will be covering the Pro Bowl, I will get a plug 

in for that—we will be covering the Pro Bowl, and we will be out 

in the community. I will be out in the community with the pro bowl 

players, the elite players of the National Football League, surrounding Miami and all of the communities in the area, promoting 

how important it is. I look forward to participating in that blitz and 

being part of such exciting projects. This is just an illustration of 

the great work being done by the NFL in this area. 

Obviously, I have attached some testimony in here, descriptions 

of some of the other programs that are involved with the National 

Football League. But, Mr. Chairman, I do want to commend you 

and this subcommittee for holding this hearing and focusing congressional attention on this very vital public issue. I certainly do 

look forward to being with you again, and whatever I can do to 

move this forward, I will be there. 

Thank you. 

Mr. PALLONE. Thank you. Thank you, Mr. Jaworski. I appreciate 

it. 

[The prepared statement of Mr. Jaworski follows:] 


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Mr. PALLONE. Dr. Hassink. 

STATEMENT OF SANDRA HASSINK, M.D. 

Dr. HASSINK. Well, good morning, and thank you. I appreciate 

this opportunity to testify today on childhood obesity, and I am 

proud to represent the American Academy of Pediatrics. Allow me 

to share with you a story. 

Janie is a 9-year-old patient of mine in our obesity clinic. When 

she first came to us, her BMI was 35, that means her weight was 

about 150 pounds, and she was not doing well in school. As we 

talked, I learned a number of things about this little girl’s life and 

health habits. 

Janie told me she did not eat breakfast. She had lunch at school, 

but bought extra snacks. After school, she would have cookies at 

her grandma’s House and was drinking six cans of soda and several glasses of juice a day. 

Janie did her homework at her grandmother’s house, but she 

didn’t go outside often because her neighborhood wasn’t safe. She 

was having 5 to 6 hours of screen time each day and she went to 

bed around 11 o’clock while watching TV in her room. 

She has physical ed in school only one day a week, and she had 

to use her asthma inhaler often, so exerting herself was uncomfortable for her. She was being teased and bullied by some of her 

peers, which made her unhappy and caused her school work to suffer. 

How do we help a child like Janie? First and foremost, we must 

recognize there is no single factor responsible for obesity in a case 

like this. Obesity, in the end, is the result of a complex interplay 

of different issues. Any solution must therefore be equally complex 

and multifaceted. 

Davidson and Birch describe the socioeconomic model obesity 

which illustrates the many factors that impact weight. The concentric circles of this model show the issues related to the individual, 

family, community and larger social structure that either promote 

or inhibit good nutrition, physical activity and overall health. Any 

meaningful attempt to stem the rising tide of obesity must address 

many of these issues simultaneously over a prolonged period of 

time in order to produce sustainable change. 

The health care community is currently engaged in a race to 

learn what types of intervention we can employ in medical practice 

to reduce pediatric overweight and obesity. A number of common 

elements among successful interventions have begun to emerge. 

The medical home. Every child must have access to a medical 

home that will provide continuity of care and coordinate the services received from various sources. Without a medical home, the 

child and family receive fragmented and inconsistent advice and 

services. In the case of obesity, where progress must be tracked 

methodically and longitudinally, a medical home is critical to the 

success of any health care intervention. 

Levels of care. The Expert Committee on Obesity in 2007 recommended that patients have access to four levels or stages of care 

explained in my written testimony. These stages of care allow 

health care practitioners to tailor their approaches to the child and 

family based upon their current health status, readiness to change 


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and other special needs. Public and private health insurers must 

provide appropriate payment based upon the complexity of the 

child’s case and the level of service required. 

Family center care. Successful interventions cannot focus upon 

the child to the exclusion of the rest of the family. Children have 

limited control over the foods they eat or are served, the amount 

of physical activity in which they engage, and other key factors 

that determine their health. The engagement of the entire family 

and behavior change is critical to the success of a practice based 

intervention. 

While practice based interventions are a vital tool, we must also 

recognize that health is profoundly affected by the community in 

which a child lives. Without equal attention to community-based 

policy interventions, practice-based approaches have a much-reduced likelihood of success. 

Child nutrition programs. Federal child nutrition programs 

should require all participating schools, child care providers and 

other institutions to follow the dietary guidelines in serving meals 

and snacks to children. The Secretary of Agriculture should have 

authority to regulate competitive foods. The AAP strongly supports 

the recent updates to the WIC food packages and breast feeding 

promotion, which is an important component of establishing good 

nutrition and appropriate feeding habits at the beginning of life. 

The reinstatement of compulsory daily quality physical education 

classes is vital to children’s health and can also impact their ability 

to learn in the classroom. Screen time for children should be limited to less than 2 hours a day. 

Our physical environment, the built environment, determines to 

a large extent how children travel, move and play. Modern communities have been created for cars, not children. The AAP has issued 

recommendations for the design of communities to provide healthy 

active living. 

Sugar sweetened beverages are a significant source of empty calories in many children’s diets. The AAP recommends eliminating 

sweetened drinks in schools and strictly limiting soft drinks and 

fruit juice in children’s diets. The AAP also supports taxation of 

sugar sweetened beverages as an method of both reducing consumption and raising revenue for other children’s health priorities. 

Finally, the AAP supports a ban on junk food advertising during 

programming that is viewed by young children and calls upon Congress and the FCC to prohibit interactive advertising to the children. 

Children and families deserve all the help we can give them in 

combating this epidemic. I thank you, Mr. Chairman, for this invitation, and look forward to your questions. 

Mr. PALLONE. Thank you, Dr. Hassink. 

[The prepared statement of Dr. Hassink follows:] 


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Mr. PALLONE. Dr. Nowak. 

STATEMENT OF JEREMY NOWAK 

Mr. NOWAK. Thank you, Mr. Chairman. Distinguished members 

of the Subcommittee on Health, thank you for inviting me to testify. My name is Jeremy Nowak. I am the president of the Reinvestment Fund. We are a community development financial institution with a principle location in Philadelphia, although offices are 

in Baltimore and Washington, D.C. We manage about $600 million 

in assets and are active throughout cities and towns in the midAtlantic. 

I would like to bring an economic development perspective to the 

issue of childhood obesity. Comprehensive approach to reducing 

childhood obesity and diet-related diseases in our view has to take 

into account the issue of access to high quality, fresh food. While 

having a choice between healthy foods and unhealthy foods will not 

in and of itself solve the problem, a lack of healthy food choice will 

certainly keep us from a solution. 

We have provided about $1 billion of loans and investments into 

some of America’s poorest communities. During the past 5 years, 

we have managed the Pennsylvania Fresh Food Financing Initiative, which was referenced in the first panel. We have done this in 

collaboration with The Food Trust, a nonprofit policy and advocacy 

group, and the State of Pennsylvania. Both have been really important partners. 

We are, as far as we know, the most successful economic development effort in the Nation, dedicated to ensuring that all communities have access to competitively-priced fresh food. In that sense, 

we are more than an economic development initiative. We are also 

a health and community building program. It creates local jobs, revitalizes neighborhoods, and demonstrates the widespread demand 

for quality food among working and low income families. 

In my testimony, I want to talk a little bit about why the Pennsylvania Fresh Food Financing Initiative works and why we think 

that a national fresh food financing initiative ought to be part of 

any comprehensive attempt to reduce childhood obesity. 

The most important point I want to leave you with, if I leave you 

with nothing else, is that this problem is absolutely solvable from 

the perspective of access. This is a solvable problem from the perspective of access. 

So now let me talk about the Pennsylvania Fresh Food Financing 

Initiative. We are a collaboration of public, private and civic centers. It is created through the initial organizing of The Food Trust, 

who brought together public officials, health care practitioners, consumer advocates and retail operators. It was very important to 

have the retail industry and the private sector in at ground zero 

to design this program. 

Together, we shined a light on the problem through a data-driven analysis and then a programmatic strategy. The result was a 

partnership with the State of Pennsylvania, and I will talk a little 

bit about the use of the money later, who put up $30 million, and 

the Reinvestment Fund matched it on a three-to-one basis with $90 

million of private money. 


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Since 2004, the year we launched, we have approved the financing of 81 projects, from full service 70,000 square foot supermarkets to 900 square foot shops; from traditional entrepreneurs 

to co-ops and public markets, like the one I noted when the Congressman from Lancaster was here in the first session, and we did 

a public market in the city of Lancaster, which was a terrific market. 

Since then, that has resulted in 1.5 million square feet of new 

development, about 4,800 full and part-time jobs and fresh-food access to more than 400,000 people that did not have it before. The 

financing efforts have created new stores in abandoned lots, refreshed stores that have previously been closed, and led to significant expansions with enhanced inventory selections. They are in 

the inner city, but they are also in rural Pennsylvania, and they 

are in small town Pennsylvania, places like Lancaster, Gettysburg, 

York, throughout the State. 

There are six things that I detailed, and I won’t go through them 

at great length. But there are six things that I detailed that are 

key to our success. One, we use some of the money for subsidies, 

small subsidy grants to help entrepreneurs incur some of the barrier entry costs that are there and also to help move private debt 

into the projects where credit enhancements were needed. 

Number two, we did this through very flexible financing. We 

made sure that access to capital would be there for customers in 

a variety of different—through a variety of different financial products based on the need of the customers. We used multiple strategies; this was not just about big super markets. It was about enhancing the inventory of small corner stores. It was about helping 

the small bodega expand their inventory and open up a second 

store. But it was also about the large retail operations. 

We targeted our money using a very sophisticated spatial database. We did it with market expertise. We know how to underwrite 

through the underwriting the business and real estate underwriting, and we have had a high quality of transparency throughout. 

This project has been replicated. It has been cited as an innovative model by the U.S. Centers for Disease Control and Prevention; 

the National Conference of State Legislatures; Harvard’s Kennedy 

School of Government; and the National Governors Association. It 

can build on the demonstrated success of the program. 

There are a variety of States right now, Louisiana, Illinois, New 

Jersey—New York is going to announce it today at 11:00; Governor 

Paterson is going to announce the beginning of such a program— 

that are in various stages of development. We are working in fact 

in New Jersey, and we hope to announce new stores in Newark, 

Atlantic City and Paterson some time quite soon. 

In partnership with the Food Trust and Policy Link, a national 

group that specializes in the replication of proven initiatives, we 

have been in discussion with Members of Congress and with the 

Obama administration regarding the design and capitalization of a 

national initiative. The idea of a national program is not meant to 

replicate local initiatives but to accelerate their development. 

Anything that happens has got to facilitate private money and be 

matched by local government. Nor is it meant to crowd out private 


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investment, but once again to facilitate its entry. It was easier, 

frankly, to come up with $90 million of private money 5 years ago 

than it is today, and in fact, the way we would use grant money 

or public money to facilitate private money would be a bit different 

right now than it was 5 years ago. 

We have developed—and I know my time is short, So I will just 

say a few other things. We have developed this spatial statistical 

model that uses retail food data, distance-to-store analytic with 

grocers with annual sales of $2 million or more, and a real estate 

cluster model that we think conservatively estimates the market 

viability for additional fresh food retailers. Based on this analysis, 

we think that there are 23 million Americans living in communities 

without access to high quality fresh food, even though there is commercial viability for store location. 

This is the critical issue. If we are going to solve the access problem, you can only solve it at the intersection of social need and 

market viability, retail viability. And this is possible. If there was 

a billion dollar program, in our view, from the Federal Government 

that was maxed at a minimum of a dollar per dollar, we could improve health access to 15 million people, help create or improve 

2,100 stores, rehabilitate 50 million square feet of retail space and 

create and retain 29,000 full-time jobs and 119,000 part-time jobs 

based on the metrics we extrapolate from the State of Pennsylvania. 

I will leave you with one other thought. There is clearly a bridge 

here between economic development and health impacts. People on 

this panel and the people on the panel before know more about the 

health issue as it relates to childhood obesity. We know there is no 

simple answer to this. But it is clear to us that access is a piece 

of the solution puzzle. We also know it is about education, but we 

know that we will need an educational commitment that is as significant as the kind of commitment we had when we first started 

to target anti-smoking ads to young people. 

We know it is about more sustainable agriculture processes, but 

surely the necessity for fresh food access has to be part of the toolbox of solutions. Let’s not forget the place-based factors at work 

here. They are real. They are the ones that we live with all the 

time in the work that we do. It is not just an urban issue. It is also 

a rural, small town issue, and there are opportunities to solve it 

and sign posts that say there is a way to get it done. 

Thank you again for inviting my testimony. I wish you the best 

as you grapple with the critical issue of childhood obesity, its link 

to disease, and the best intervention strategies for us going forward. Thank you very much. 

[The prepared statement of Mr. Nowak follows:] 


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Mr. PALLONE. Thank you, Dr. Nowak. 

Ms. Sophos. 

STATEMENT OF MARY SOPHOS 

Ms. SOPHOS. Thank you, Mr. Chairman and members of the subcommittee. 

My name is Mary Sophos, and I am senior vice president and 

chief government affairs officer for the Grocery Manufacturers Association. I greatly appreciate having the opportunity to be here 

today. It is critically important that we identify and support strategies that work to reduce childhood obesity. 

This year, Mr. Chairman, we worked together to pass sweeping 

food safety legislation, and our industry is committed to work with 

you again on this issue. 

Since 2002, the food and beverage industry has taken significant 

steps to create and encourage healthier choices. In recent years, we 

have changed our packaging to promote portion control, and we 

have reformulated more than 10,000 products to reduce or remove 

saturated fat, trans fats, calorie, sugar and sodium. 

Changes in advertising practices have resulted in a significant 

shift in the product mix of advertising viewed by children and by 

adults as companies continue to respond to consumers’ desire for 

healthy products and a healthy lifestyle. 

We think that the key to helping individuals achieve and maintain a healthy weight lies with developing the habits and skills to 

incorporate energy balance into our daily lives, something Dr. 

Huang referred to as well. This means balancing calories consumed 

as part of a healthful diet with calories expended through physical 

activity. We think this should be the focus of our collective efforts. 

We are beginning to see what works and the importance of this energy balance message. 

Three years ago, GMA and its member companies helped create 

the Healthy Schools Partnership, a partnership of the American Dietetic Association Foundation, PE4life and the American Council 

for Fitness and Nutrition. The HSP integrates a nutrition curriculum into the PE4life physical education classroom, training registered dieticians to be nutrition coaches, to coach and motivate 

students alongside the PE4life teachers. And I would say, the 

PE4life is the organization that documented the statistics that 

Congressman Murphy was talking about on the improvements in 

academic performance and discipline. 

The initial evaluations of the nutrition component of this program undertaken by UC Berkeley have been extremely positive. Although they started out roughly the same, after coaching, students 

in the intervention schools had scores significantly higher than 

those of students in control schools, particularly in understanding 

how to maintain a healthy body weight and recognizing the value 

of eating more fruits and vegetables. After RD nutrition coaching, 

twice as many students from intervention schools, 31 percent, compared to the control group, 17 percent, were eating vegetables in 

school. And as we know, consumption of fruit and vegetables is one 

of the key indicators of a healthy weight in children. 

It is programs like Healthy Schools Partnership that are making 

a difference in children’s lives. I would note that the original 


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schools, which are in Kansas City, Missouri, are in the urban core, 

and 75 percent of the student population is eligible for free or reduced price lunch. 

This year and next, we will be expanding the Healthy Schools 

Partnership into additional schools in the Kansas City metropolitan area; into Des Moines, Iowa; and a tribal community in Iowa; 

a school in Chicago; and four schools in Washington, D.C. This expansion is being made possible by an $8.5 million grant from the 

Healthy Weight Commitment Foundation, which was launched in 

October of this year. It is a coalition of 40 retailer, nongovernmental organizations, and food and beverage manufacturers who 

have launched a $20 million national multiyear effort designed to 

reduce obesity, particularly childhood obesity, by 2015. 

The HWC will promote helping ways to help people achieve a 

healthy weight through energy balance in the places where people 

spend most of their time, schools, workplace and the marketplace. 

And because it is very important that solutions be evidence-based, 

all the initiatives under the Healthy Weight Commitment Foundation include the use of objective outside expert evaluators, notably 

the Robert Wood Johnson Foundation will be serving as outside expert evaluator on the marketplace and particularly with respect to 

calories in and calories out. And we very much appreciate their engagement. And the National Business Group on Health will evaluate the workplace initiatives. 

Finally, early next year, the Healthy Weight Commitment Foundation will launch a public education campaign aimed at children 

ages 6 to 11, their parents, and caregivers to help raise awareness 

about the importance of balancing a healthy diet with physical activity. 

Mr. Chairman, our industry will do more to meet this complex 

challenge, and we look forward to updating you on the activities of 

the Healthy Weight Commitment Foundation and the Healthy 

School Partnership in the coming months. 

And Congressman Braley, when you were out of the room, I 

noted that this unique partnership in the schools we are bringing 

to Des Moines, Iowa, and a tribal community in Iowa this year and 

over the next several years. 

In particular, we urge Congress to increase investments in physical education, nutrition education, and to encourage changes in 

the built environment and to support workplace wellness programs 

that recognize and reward improvements in health among employees. We think these are shown to be among the most promising 

strategies and where additional investment, so that we can bring 

these pilot programs to scale, is desperately needed and would actually produce significant results. Thank you very much. 

[The prepared statement of Ms. Sophos follows:] 


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Mr. PALLONE. Thank you. 

Dr. Lavizzo-Mourey. 

STATEMENT OF RISA LAVIZZO-MOUREY, M.D., M.B.A. 

Dr. LAVIZZO-MOUREY. Thank you, Chairman Pallone. 

Mr. Chairman, thank you and other members of the committee 

for this opportunity to testify about innovative solutions and strategies to address the epidemic of childhood obesity. 

The Robert Wood Johnson Foundation has committed to invest 

over $500 million in reversing the epidemic of childhood obesity by 

2015. We focus our approaches on research that suggests how to 

use nutrition and physical activity, which are both required in 

order to reverse this epidemic. 

There are five key areas that we think are important for change: 

First, providing only healthy foods and beverages for students at 

school; improving the availability of affordable and healthy foods in 

all communities; increasing physical activity before, during, and 

after school; improving access to safe places where children can 

play; and regulating marketing to children. 

In my written testimony, I gave a number of examples of projects 

across the country that we are funding in this area. However, at 

this time, I want to tell you a story about a young man, Kenyon 

McGriff, whose picture is shown here. Kenyon is an African-American teenager who has a family history of diabetes and heart disease. And when he was 15 years old, a few years ago, his physician 

told him that, at 270 pounds, he was at risk for diabetes and a 

whole host of other chronic illnesses. 

Kenyon took his physician’s warning seriously. He got help. He 

joined a running club. He changed his diet. But even armed with 

the best intentions and all the good information that he had, 

Kenyon still struggled to get healthy, because his neighborhood, 

west Philadelphia, was home to dozens of fast food restaurants, 

take-out joints and convenience stores that did not sell healthy 

foods. As he used to say, it takes income to be healthy. And his 

school didn’t offer healthy choices. Lunch for him, as he said, was 

burnt pizza and often soggy hoagies. 

Now, Kenyon did his very best to eat healthfully on the budget 

that he had, and he stayed committed to his running club, often 

running through the traffic-clogged streets of west Philadelphia. He 

and his teammates set and met a goal to complete the Philadelphia 

marathon. 

Now, Kenyon is an aspiration and an inspiration for all of us. 

But there are a lot of kids in neighborhoods across the country who 

get discouraged when they don’t have the help and the means to 

overcome the environmental barriers that make it so hard for them 

to live well, to eat well, and to be healthy. We know that where 

we live, learn, work, and play has a tremendous impact on how 

healthy we can be. Our environments, that means the places where 

we eat our food, the choices that we have in school and in restaurants, the threats that we may face because of crime and traffic, 

and the lack of social support, those social factors can create real 

barriers to health. And with those barriers, it is no wonder that so 

many kids are overweight and obese. 


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In communities across the country, it is far too much easier to 

make unhealthy choices rather than healthy choices. And we must 

change that. What if the corner grocery store in Kenyon’s community agreed to stock healthier foods so that kids had more healthy 

options and nutritious snacks as they walked home from school? 

And what if they limited marketing and advertising of unhealthy 

foods? Well, that is happening in Baldwin Park, California, under 

a program that we are funding. 

And what if community coalitions worked to improve safe access 

to improving routes to schools that connected the schools also connected neighborhoods and parks and also provided job training and 

employment opportunities for young people who could be healthy 

park ambassadors? Well, that is happening in Chicago. 

And what if faith-based communities worked in partnership to 

provide direct transportation routes between neighborhoods that 

have supermarkets and those that don’t? Well, that is actually happening in Nashville, Tennessee. 

We know that in communities across the country, there are ways 

to make it easier for children and families to make those healthy 

choices. It is critical that a diverse set of partners working together 

effect community change. It is the responsibility of families, of 

schools, of health providers, of industry, of government, of really 

the entire community. 

By solving this epidemic, we are going to have to rely on the 

leadership and the coordination at the Federal level but also across 

departments and agencies at the State and local level as well. 

Transportation, housing, education, agriculture policies along with 

health policies will have an impact on the kind of health that our 

kids will have by giving them access to healthy, nutritious foods 

and safe streets and environments. 

Together, we must ensure that every community is healthy in 

order to reverse this epidemic and ensure that all of our children 

can be healthy and grow up to be healthy adults. 

I thank you again for this opportunity to testify today. And I look 

forward to your questions. 

[The prepared statement of Dr. Lavizzo-Mourey follows:] 


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Mr. PALLONE. Thank you. 

And let me thank you all. 

We will take questions now from the members. And I will start 

with myself. As I mentioned, the real purpose of this hearing was 

to try to get your innovative ideas and see if we could use them 

somehow in a broader way, either through government, private sector or whatever. And of course, I, being that we are in Congress, 

I always stress what the government can do, if it can do anything. 

I cannot help but focus on the two individuals who mentioned 

New Jersey here today, because both Mr. Jaworski and Dr. Nowak 

brought up New Jersey several times. And so my questions to the 

two of you are related to this whole issue. 

In other words, like, Mr. Jaworski, you particularly talked 

about—well, you mentioned keeping a phys-ed requirement in New 

Jersey. That is a government function, in that case, the State. 

You mentioned an innovative program in Camden. I was—I have 

been actually—go to Camden quite a lot, even though it is like an 

hour and a half away from my district because as—there is a ministers association there called PICO. P–I–C–O. I forget what it 

stands for. I remember particularly when we were doing the 

SCHIP, which is an expanded children’s initiative which we passed 

and the President signed earlier this year, before we got into the 

larger health care reform, and they were very supportive, and they 

asked me to come down and show what a difference it would make 

if we had the SCHIP program expanded. It is called Family Care 

in New Jersey. And I was really struck by a number of things just 

in my couple of days visiting Camden; a lot of the drugs being sold 

openly on the streets. 

So tell me a little more. You mentioned Steve’s Club, that was— 

it is like a gym that you fund? Is there any way that that can be 

expanded or we could do something like that beyond what you do? 

I take it, it is all privately funded by you from what I understand. 

Mr. JAWORSKI. Yes, Chairman. 

Steve’s Club is privately funded. At a golf tournament that I run 

every year to raise money for the Jaws Youth Fund, we earmark 

one of those community organizations that will receive the funds. 

And my family and I visited a number of the organizations 

throughout Camden and south Jersey and kind of determine the 

needs in our community. And we were very, very impressed, in fact 

blown away, by the effort of the young boys and girls at Steve’s 

Club. These are inner city kids that are really trying on their own 

to make a difference, and we felt we needed to do something to 

help them. 

So we were able to get money to them. We got a local business 

to chip in, so we could buy this van. So, actually, Jose could drive 

around and bring his kids over to the club. It was—excuse me a 

second—it was pretty impressive to see. When you give people a 

chance, they will make things happen. And it was happening. 

And there were other things that happen—I don’t mean to single 

out Camden. But in the City of Camden, there is not a grocery 

store really in the city. It is on the outskirts. And they did a study, 

went into some of these local corner grocery stores. There were no 

groceries. There were no fresh fruits. There were no fresh vegetables. Those are things we are hearing about here. So really the 


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mission here is just to enlighten people on what is really going on 

out there. I just felt that part of the organization I have, my Jaws 

Youth Fund, could do a weekend help, and Jose is a real living example, and there are probably hundreds of others. But there are 

needs in our community. 

Mr. PALLONE. Well, Dr. Nowak, not only following up on what he 

said, you mentioned your Pennsylvania initiative now. You are 

doing this in a number of cities in New Jersey. You mentioned 

quite a few. And you said it was a public-private partnership. 

Again, same essential question is, how do we replicate this? Is 

there a Federal role or something we can do to expand this? And 

tell us a little bit more about it. 

Mr. NOWAK. I believe there is. Could I just say one word about 

Camden? 

Mr. PALLONE. Sure. 

Mr. NOWAK. We actually work with the PICO affiliate very closely in Camden, Camden Churches Organized for People, and done 

hundreds and hundreds of housing units that we finance with 

them. 

Ron is right; there is not a full service grocery store with fresh 

fruit and vegetables in the City of Camden. We are a city of 90,000 

people. We are actually working on a site right now, one of the extraordinary things that has happened recently in Camden, with the 

expansion of Cooper Hospital, Rutgers University is starting to get 

some development in the central part of the city. 

Many of the supermarkets that we have financed in the inner 

city are right on the edge, interestingly, between middle class and 

low-income neighborhoods. So the entrepreneurs are able to build 

markets that are able to draw from both. And there is a tremendous lesson there. And we think there is great opportunity right 

now in the City of Camden. 

We are working with the Economic Development Administration 

in New Jersey. They have put up some debt and we have also for 

the grocery stores. I think the role of the public, the role of public 

money is always and only to pay for costs that the private sector 

can’t pay for because of a market failure or because of some legacy 

cost that simply can’t be incurred. If you look at a place like Camden, there are land costs related, for example, to environmental 

reclamation that simply no one can—— 

Mr. PALLONE. Also, I remember with PICO, I know I am—there 

was also the problem with—what do you call it? Where these— 

where the land or the houses had these tax liens that made it very 

difficult for them to be transferred or reused, too. That was another 

issue. 

Mr. NOWAK. Right. So the public role is to help get private 

money in or to pay for certain costs that can’t be incurred by the 

private sector, but only to do it in situations where you believe 

there is market viability for a high-quality retail operator. I think 

now is a great time, frankly, because many of our urban operators, 

as an example, have found that cities and small towns are places 

where they have now more competitive advantage—these are the 

independent operators—than they do in places where, frankly, they 

can’t compete with 130,000-square-feet super stores. 


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So the west Philadelphia site where hopefully Kenyon is now 

buying his groceries at 52nd and Parkside that we recently financed. There an operator with 12 grocery stores, a guy named Jeff 

Brown, can compete. He is now grossing in west Philadelphia close 

to a million dollars a week in that store and serving low-income 

people, doing it successfully, making money in a low-margin business, 1 to 2 percent margin business. But he got some public health 

to do that through some new market tax credits and also through 

a grant that helped with land reclamation for an environmentally 

toxic site. 

Mr. PALLONE. My time is up, but I want to follow-up with both 

of you on some of these initiatives, particularly in my State, but 

obviously, it can apply anywhere. I appreciate it. 

Thank you. 

The gentleman from Georgia, Mr. Gingrey. 

Dr. GINGREY. Mr. Chairman, thank you. 

I was going to ask my first question to Mr. Jaworski. Since my 

401-k is down about 40 percent, I was going to ask him for a tip 

on the upcoming Super Bowl. I guess we don’t know the teams yet, 

and that question might be a little inappropriate. 

I will hold back on that one. 

Mr. Jaworski, first of all, I commend you for the work you are 

doing with the Jaws Youth Fund that you had so much to do with 

organizing and, of course, the NFL 60 program as well. 

Let me ask you, in regard to school PE programs, my good friend 

from Iowa, Mr. Braley, would discuss that and ask some questions 

of the first panel. And I am from Georgia, and I was on a school 

board, started my political career actually on a local school board. 

And there was—and every time something got cut, and there was 

always this struggling to have enough dollars, it would be physical 

education. And I think Bruce is right. I mean, when they had it, 

it would be dodge ball. It wouldn’t be something that was aerobic 

exercise where the kids, clearly—you are a professional athlete, 

and I would just like to hear your opinion in regard to the importance or lack of it, if you feel that way, of getting physical education back in our school systems. 

Mr. JAWORSKI. Mr. Gingrey, obviously, it is very important. As 

a student at Youngstown State University, I was a health and 

phys-ed major. So I learned through my curriculum the value of 

health and physical education and maintaining a quality lifestyle 

from eating properly to maintaining the body properly. 

And obviously, as a professional athlete, it was paramount that 

I maintain my body in the most opportunistic way that I could. 

And I was very fortunate to have personal trainers, strength coaches, proper nutrition, nutritionists, all those things that go along 

with being a professional football player for 17 years. 

But What I learned at Youngstown State was the importance of 

physical education, to have a sound mind, to have a sound body, 

to eat foods nutritionally. And as I grew a little older and a little 

bit wiser and I saw that some of these programs in grade schools 

and high schools and middle schools were being eliminated, it was 

unconscionable to me, knowing personally the value of physical 

education. It is invaluable. 


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What the NFL is doing is not trying to solve the physical education problem, just saying hey, 60 minutes. I am not saying, take 

4 hours a day, but find a way to get off the couch and give me that 

60 minutes. And we hear about couch potato, computers and all 

that. The NFL with EA Sports now has EA Fit. So you can actually 

watch your computer, like some people do with Wii, and play golf 

and bowl and play tennis and do all those things. So I think there 

is now the opportunity, even through the new wave kids where 

they can not sit on the couch but get some sort of physical activity, 

and we are only talking for 60 minutes. 

Dr. GINGREY. Absolutely. Thank you. 

Dr. Hassink, I referenced the American Academy of Pediatrics 

and your upcoming testimony when I was talking to the first panel. 

And you heard my question to them. And I know in your testimony, it was great testimony and very, very comprehensive, you do 

seem to put a strong emphasis on the use of, by definition, taxpayer dollars to promote a social norm of good health. A very comprehensive approach. But as I said earlier, these folks have to be 

paid. 

Do you think—do you think that parents can provide that social 

norm of physical activity and give children the support day in and 

day out to make these healthy choices? 

Dr. HASSINK. Well, I often tell my parents in clinic, it is a little 

right now like guerilla warfare for the families. They are trying to 

make choices in an unhealthy environment at times. So the first 

step is to help them with knowledge and skills to make the healthy 

choices and then get them in a situation when they go back home 

to have healthy choices to make. 

So I think parents need all the support we can give them in 

terms of understanding what needs to be done and then further 

support, access to make the right choice. I honestly say, I have 

been doing this for 22 years, you don’t meet parents who don’t 

want what is best for their children. Our parents want healthy 

children. They are struggling to know how to get them. 

They are frustrated with what is available to them. Some of 

them are frustrated with school meals. Some of them are frustrated 

with the fact that it is a competitive sports environment in many 

schools, not a participatory environment. So the child who is a little slower to develop their skills maybe a little heavier, they get 

opted out of sports pretty quickly in the school environment. Then, 

if you don’t have PE, they can’t—where do they learn team work? 

Where do they learn skills? Where to they learn sports? And that 

tails off very quickly. So I think I see the parents, they want to try. 

They will learn. They do need help. But when you send them out 

and they are not supported, it becomes very difficult for them. And 

it is sad because they want healthy children. 

Dr. GINGREY. Thank you. 

Mr. Chairman, I see my time has expired. Will we have a second 

round, I hope? 

Mr. PALLONE. The only limitation on it would be I think we 

might be having votes soon. But let’s see. If not, we can, and assuming that the panel can say, and there is only three of us. But 

let’s—— 


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Dr. GINGREY. Mr. Chairman, before I yield back, I want to ask 

unanimous consent to submit my opening statement for the record. 

I didn’t get an opportunity to do that. And thank you, Mr. Chairman. 

At this point, I yield back then. 

Mr. PALLONE. Without objection, so ordered. 

Mr. Braley. 

Mr. BRALEY. Thank you, Mr. Chairman. And I also would request 

unanimous consent to submit my opening statement for the record. 

[The prepared statement of Mr. Braley follows:] 


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Mr. PALLONE. So ordered. 

Mr. BRALEY. Dr. Hassink, I am going to follow up on your comment, which several of the other witnesses have talked about, and 

that is parents frustrated with food choices in school. And I think 

that is one of the reasons why I introduced the Healthy Choices 

For Kids Act earlier this year to promote the idea of labeling the 

foods being served in school cafeterias with nutritional information, 

which would authorize a pilot program in 100 schools to label the 

foods being served with nutritional and caloric information at the 

point of decision. 

And I would highlight there is a recent study that has actually 

shown that students were more likely to make healthier food selections when the nutritional information was available next to the 

food item being served, and that was a 2005 issue of the Journal 

of Child and Nutrition Management, which found that students’ 

choices for more healthy entrees increased after reading nutritional 

content labeled next to the food item. 

And my hope is that the Healthy Food Choices For Kids Act will 

be included with the Child Nutrition Program’s reauthorization. 

And I have been working with the Education, Labor Committee 

and Chairman Miller to include this legislation in that program. 

I also wanted to comment, Dr. Lavizzo-Mourey, more on your 

comment about safe routes and the importance for kids who increasingly face difficult environments getting to school. And the 

Transportation Committee, which I have previously served on, has 

jurisdiction over the Safe Routes to Schools Program, which is Federal dollars being used to enhance the security of routes to schools 

for kids. 

When I was in Denver last summer for the Democratic Convention, I went to an elementary school in Denver that is combining 

a lot of the aspects of what we have been talking about here today, 

where kids who rode their bikes to school would be given a bike 

helmet with a bar code on it, and they would ride past this computer terminal which made a clanging noise to reenforce auditorily 

with the kids they had ridden their bike to school. And that would 

automatically then record it in the school computer. And the more 

days they rode or walked to school, they would get points. And at 

the end of the school year, they got some kind of a prize, maybe 

an iPod or something depending on the level of participation. 

Now, here was the biggest complaint that they got, because parents got more engaged in riding their bikes to schools with kids 

that when it started to snow in Boulder, they were getting complaints from parents who were being forced to ride in the snow 

with their kids who were obsessed with scoring points and getting 

physical activity. So I think that is a good problem that we have 

in this country, and we need to have more of those problems. 

But one of the things that I have also heard today, and that is 

that recreational time for kids has increasingly gotten structured. 

And Mr. Jaworski, I want to ask you this question because it is 

a paradox that has been created by some of the activities of the 

NFL. I was a kid who grew up with Punt, Pass and Kick. I also 

coached youth sports using jerseys donated by the NFL, which was 

a great thing to attract interest in the program. 


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But part of the problem we have with youth activities is that a 

lot of kids and a lot of parents seem to have bought into the concept that, unless you are in a structured, team sports activity, 

there is no value to participation. So can you tell us some of the 

things that your foundation and the NFL is doing to take a broader 

message to kids about the need to engage in unstructured play, 

aerobic activities that have nothing to do with team participation, 

and get us to the point where we have a balanced comprehensive 

approach to team and team building and exercise with youth 

today? 

Mr. JAWORSKI. Yes, sir, Mr. Braley. 

And, in fact, I think because we hear Play 60 really sponsored 

by the National Football League, we probably—the conception is 

some organized kind of sport. But it is real simple. Just 60 minutes 

of activity. It could be a walk in the park. It could be a ride on your 

bicycle. It doesn’t have to be an organized team activity. So I think 

that that should be clear. That is not what they are saying, you 

need to be a team. Although there are some leadership skills and 

social skills that you acquire by being involved with a team, that 

is not the driving force behind the program. It is 60 minutes of activity, and be creative as you want to find a way to get your exercise in. 

And I might just add, with the Jaws Youth Fund, we have had 

5k runs, fitness fests, over 1,000 people in Stone Harbor, New Jersey, at a 5k run; doing basketball, cheerleading, Navy SEALs on 

the beach, senior citizen activities, different things like that. Just 

ways to keep active. 

Dr. LAVIZZO-MOUREY. Congressman, let me just highlight a program that brings forward an opportunity that we haven’t talked 

about today, and that is recess. Many schools no longer have recess. And yet that has been identified as the single biggest opportunity for children to have activity during the day. 

We fund a program called PlayWorks that brings kids, young 

people into the playground, helps to teach young children, who may 

not have learned those games that we all learned as children, that 

not only teaches them how to mediate their differences, but how to 

have good, unstructured play that we have been talking about. 

That is the kind of program that starts locally and yet can be taken 

to scale through the kind of initiatives that you have been talking 

about. 

Ms. SOPHOS. Yes, Congressman. 

I wanted to mention that the PE4life program, which is the physical education component of the Healthy School Partnership, is 

built on exactly those principles, that every child should have the 

ability to enjoy and engage in physical activity. And they structured it so that children who aren’t good at competitive sports, they 

compete against themselves. They are learning how to improve 

their own fitness and then taking that and learning skills that they 

can then take outside the school and into the family to continue. 

And we think that that is a key aspect of what we are going to 

have to do to reach the broader audience of children. 

Mr. BRALEY. Yes. 

Dr. HASSINK. Congressman, there is—— 


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Mr. PALLONE. I am going to ask you guys to wrap it up because 

we have one more speaker, member, Ms. Schakowsky, and then we 

have to vote, and we will be done. So, quickly. 

Dr. HASSINK. There is a whole other category of activities that 

children need. There is dance class, karate. There are a lot of community activities they can engage in that aren’t team sports that 

get them with their peer group. Children love other children, and 

the way to get children to be active is to get them to be active with 

other children. So I don’t want to forget about all of the other activities that can be available. 

Mr. BRALEY. Thank you. 

Mr. PALLONE. Thank you. 

So we will have Ms. Schakowsky, and then we will be done. I 

just wanted everyone to know. Because we are going to have votes, 

and we really can’t come back, and I know you guys can’t either. 

Ms. SCHAKOWSKY. Mr. Nowak, I understand that you are head 

of a CDFI. And although the last few days, I have really been 

working with Treasury to make sure that those get the kinds of 

funds they need, how are you doing as a CDFI? 

Mr. NOWAK. How are we doing in general, given the economic situation? We are doing well. We have been affected like everybody 

else, real estate values and the volatility—— 

Ms. SCHAKOWSKY. I am concerned that some of the new TARP 

funds be used for CDFIs, who are really the institutions that are 

investing in communities, creating jobs and lending money. 

Mr. NOWAK. I am with you. 

Ms. SCHAKOWSKY. OK. Good. We could use your help if you want 

to call the Secretary of Treasury. 

Chicago was mentioned a couple of times, Mr. Jaworski. Were 

you the one that mentioned Chicago? I am very interested and I 

know you did—talking about what your funding—well, could I hear 

what is going on in Chicago? 

Mr. Jaworski, did you mention—— 

Mr. JAWORSKI. I did not. 

Dr. LAVIZZO-MOUREY. There are a number of programs—we are 

funding a number of programs in Illinois and Chicago, in particular, that are bringing community-based organizations together, 

stakeholders at cross sectors to try to create innovative solutions 

that build on the assets of the community. So, for example, there 

is—one of the things that they are looking at is, how do you get 

safe routes from—— 

Ms. SCHAKOWSKY. That is all—— 

Dr. LAVIZZO-MOUREY. Exactly. 

Ms. SCHAKOWSKY. That is in my area. 

I just want to say one thing about this. I think the issue—I think 

you mentioned bringing these things up to scale. There is all these 

innovative projects, all over the country. Best practices that have 

been developed, but then we need to have the resources to make 

sure that—go ahead. 

Dr. LAVIZZO-MOUREY. I think there are three key things there. 

One is to make sure there are opportunities for communities that 

are innovators to learn from one another, so that there are clearinghouses that will how them to share best practices and information, and then to have innovative funding opportunities at the 


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State and Federal level that can take these to scale. And some of 

the ones that have already been mentioned, like the Fresh Food Financing, started as a local innovation that now brings together 

public-private financing and is looking to have Federal financing to 

take that truly to scale. That kind of model, lower—— 

Ms. SCHAKOWSKY. Is Robert Wood Johnson a clearinghouse for 

that? 

Dr. LAVIZZO-MOUREY. We have a project to actually provide a 

clearinghouse for our grantees, but that is only one part of it. 

Clearly, there are many other organizations that are working, and 

a clearinghouse that includes not only the work we are doing but 

beyond that would be very useful in taking this to scale. 

Ms. SCHAKOWSKY. You were going—— 

Ms. SOPHOS. I was just going to mention that the Healthy 

Weight Commitment Foundation, which is a private initiative, as 

part of their commitment of bringing funding for an expansion of 

the Healthy Schools Partnership to a school in Chicago, including 

PE4life, which was referenced earlier as a school program in 

Naperville, Illinois. And then the nutrition coaches will be sponsored through the ADAF, the American Dietetic Association Foundation. 

Ms. SCHAKOWSKY. Is GMA sponsoring some of those ads that are 

saying, don’t tax soft drinks and those kinds of things on television? 

Ms. SOPHOS. We have supported the American Beverage Association effort in that regard. We haven’t provided financial support. 

Ms. SCHAKOWSKY. I think it is sort of give and take, give and 

take here; that if we are serious about promoting healthy foods, we 

have to be serious about it. I saw that General Mills is lowering 

the amount of sugar in its products. I hope that they find that commercially viable. And I hope that school districts like Chicago will 

encourage that by purchasing the lower cost—the lower sugar cereals. But I understand commercial viability. And, Mr.—my eyes are 

so bad—my CDFI friend. 

Mr. NOWAK. Nowak. 

Ms. SCHAKOWSKY. Said that we want to make sure that these 

things also make money. But it is disappointing to me that you are 

supporting that effort because I think we need to be discouraging 

these high sugar drinks. 

Ms. SOPHOS. I think there has been a tremendous amount of innovation and improvements in the nutrition profiles of products. 

That has been a focus of our industry. And I think that you will 

see that continue. 

The American Beverage Association has a unique partnership 

with the Alliance For a Healthier Generation to remove soft drinks 

from—full-strength soft drinks from schools. So I think the industry is doing a great deal to help ensure that healthy products attain a bigger place in consumers’ pantries and their daily lives. 

I think we may agree on the use—disagree on tax policy and 

whether that works, which we don’t think it is an effective strategy. But our industry is committed to provide healthy—healthful 

products and continuously improve the nutrition profile of our 

products. 

Ms. SCHAKOWSKY. Good. Thank you for that. 


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Mr. Nowak. 

Mr. NOWAK. I would just note that Chicago, as you probably 

know—and I would be happy to provide the data—has well documented areas that do not have high quality fresh food access. 

Ms. SCHAKOWSKY. We have food deserts, absolutely. 

Mr. NOWAK. Number two, at the State level in Illinois, there has 

been some interest in replicating the Pennsylvania initiative, I believe a $10 million appropriation was put forward. I do not think 

there has been a request for proposals issued for that to try to create it. But there has been some movement at the State level in Illinois. I could get more information. 

Ms. SCHAKOWSKY. I would love that. 

Mr. NOWAK. We talked to the Treasury of the State several times 

about it and how to structure it, and there are several organizations, including the Illinois Facility Fund, that I know have some 

input. 

Mr. PALLONE. Which I know well. Great. Let us talk more. 

Thank you so much. 

We have votes, so we are going to have to end. And I know some 

of you have to get going, too. 

We can do written questions, though. You may get some written 

questions from us within the next 10 days. And we appreciate your 

getting back to us. And we are going to take these ideas and look 

at possible legislative initiatives. So thank you. 

And without objection, the hearing of the subcommittee is adjourned. 

[Whereupon, at 12:51 p.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 


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