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S. HRG. 110–961 

CHILDHOOD OBESITY: THE DECLINING HEALTH 

OF AMERICA’S NEXT GENERATION—NATIONAL 

PROBLEM, SOUTHERN CRISIS 

FIELD HEARING 

BEFORE THE

SUBCOMMITTEE ON CHILDREN AND FAMILIES 

OF THE

COMMITTEE ON HEALTH, EDUCATION, 

LABOR, AND PENSIONS 

UNITED STATES SENATE 

ONE HUNDRED TENTH CONGRESS 

SECOND SESSION 

ON

EXAMINING CHILDHOOD OBESITY, FOCUSING ON THE DECLINING 

HEALTH OF AMERICA’S NEXT GENERATION—NATIONAL PROBLEM, 

SOUTHERN CRISIS 

OCTOBER 23, 2008 (Nashville, TN) 

Printed for the use of the Committee on Health, Education, Labor, and Pensions 

( 

Available via the World Wide Web: http://www.gpoaccess.gov/congress/senate 

COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS 

EDWARD M. KENNEDY, Massachusetts, Chairman 

CHRISTOPHER J. DODD, Connecticut 

TOM HARKIN, Iowa 

BARBARA A. MIKULSKI, Maryland 

JEFF BINGAMAN, New Mexico 

PATTY MURRAY, Washington 

JACK REED, Rhode Island 

HILLARY RODHAM CLINTON, New York 

BARACK OBAMA, Illinois 

BERNARD SANDERS (I), Vermont 

SHERROD BROWN, Ohio 

MICHAEL B. ENZI, Wyoming, 

JUDD GREGG, New Hampshire 

LAMAR ALEXANDER, Tennessee 

RICHARD BURR, North Carolina 

JOHNNY ISAKSON, Georgia 

LISA MURKOWSKI, Alaska 

ORRIN G. HATCH, Utah 

PAT ROBERTS, Kansas 

WAYNE ALLARD, Colorado 

TOM COBURN, M.D., Oklahoma 

J. MICHAEL MYERS, Staff Director and Chief Counsel 

ILYSE SCHUMAN, Minority Staff Director and Chief Counsel 

SUBCOMMITTEE ON CHILDREN AND FAMILIES

CHRISTOPHER J. DODD, Connecticut, Chairman 

JEFF BINGAMAN, New Mexico 

PATTY MURRAY, Washington 

JACK REED, Rhode Island 

HILLARY RODHAM CLINTON, New York 

BARACK OBAMA, Illinois 

BERNARD SANDERS (I), Vermont 

EDWARD M. KENNEDY, Massachusetts (ex 

officio) 

LAMAR ALEXANDER, Tennessee 

JUDD GREGG, New Hampshire 

LISA MURKOWSKI, Alaska 

ORRIN G. HATCH, Utah 

PAT ROBERTS, Kansas 

WAYNE ALLARD, Colorado 

MICHAEL B. ENZI, Wyoming (ex officio) 

DAVID P. CLEARY, Minority Staff Director 

(II) 

C O N T E N T S 

STATEMENTS 

THURSDAY, OCTOBER 23, 2008 

Page 

Alexander, Hon. Lamar, a U.S. Senator from the State of Tennessee, opening 

statement .............................................................................................................. 1 

Riley, Wayne, M.D., M.P.H., MBA, FACP, President, Meharry Medical College, Nashville, TN, statement ............................................................................ 1 

Cooper, Susan R., M.S.N., R.N., Commissioner, Tennessee Department of 

Health, Nashville, TN .......................................................................................... 5 

Prepared statement .......................................................................................... 8 

Barkin, Shari, M.D., MSHS, Director of Pediatric Obesity Research, Diabetes 

Research Training Center Professor of Pediatrics, Monroe Carell, Jr. Children’s Hospital at Vanderbilt, Nashville, TN .................................................... 12 

Prepared statement .......................................................................................... 14 

Tropez-Sims, Susanne, M.D., M.P.H., Associate Dean of Clinical Affiliations 

and Professor of Pediatrics, Meharry Medical College, Nashville, TN ............ 16 

Prepared statement .......................................................................................... 18 

Griffin, David, Participant, Season 4 of NBC’s ‘‘ The Biggest Loser,’’ Cedar 

Hill, TN ................................................................................................................. 20 

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

(III) 

(1) 

CHILDHOOD OBESITY: THE DECLINING 

HEALTH OF AMERICA’S NEXT GENERATION 

—NATIONAL PROBLEM, SOUTHERN CRISIS 

THURSDAY, OCTOBER 23, 2008 

U.S. SENATE, SUBCOMMITTEE ON CHILDREN AND FAMILIES, COMMITTEE ON

HEALTH, EDUCATION, LABOR, AND PENSIONS, Nashville, TN. 

The subcommittee met, pursuant to notice, at 10:10 a.m., at 

Meharry Medical College Library, S.S. Kresge Learning Resource 

Center, 1005 Dr. D.B. Todd Jr. Boulevard, Nashville, TN, Hon. 

Lamar Alexander, presiding. 

Present: Senator Alexander. 

OPENING STATEMENT OF SENATOR ALEXANDER

Senator ALEXANDER. The Subcommittee on Children and Families will come to order. 

We’re delighted to be at Meharry. First, I’d like to recognize Dr. 

Wayne Riley, who is the president of Meharry, who is a friend, and 

who is here. 

Thank you for letting us be here, Dr. Riley. 

STATEMENT OF WAYNE RILEY, M.D., M.P.H., MBA, FACP, 

PRESIDENT, MEHARRY MEDICAL COLLEGE 

Dr. RILEY. I’m very honored—well, good morning, all. Senator, 

we’re honored to have you with us. I just want to thank you for 

being here, but also thank you for your support of Meharry Medical 

College. 

Senator Alexander has been very instrumental in securing funds 

through the earmark process for the renovation of this library, and 

I hope that the next time you come, Senator, we will have transformed this library, with the support that you were able to secure 

for us, plus our own resources. This is one of my major capital 

projects since becoming president on January 1, 2007, which is to 

transform Meharry Medical College Library. I’d like to thank you 

and your staff for the excellent support. 

We’re proud of Meharry. We are delighted that we could play a 

role in discussing a major issue facing Americans, and that is the 

increasing incidence and prevalence of obesity, particularly with 

emphasis on children. 

Senator, we appreciate your leadership in the U.S. Senate, and 

we look forward to working with you for many years. 

Thank you. 

2 

Senator ALEXANDER. Thank you, Dr. Riley. I appreciate your 

leadership. 

One of my favorite stories is that people sometimes ask me, 

‘‘What is more difficult, being Governor of a State, a member of the 

President’s Cabinet, or president of a university?’’ and I always 

say, ‘‘Obviously, you’ve never been president of a university, or you 

wouldn’t ask a question like that’’—— 

[Laughter.] 

Senator ALEXANDER [continuing]. Because it’s a real challenge. 

And you do a great job. We’re tremendously proud of Meharry and 

its history and reputation and service to our community and to our 

country every year. 

Before we start, I want to thank Mary-Sumpter Johnson and 

Sarah Rittling, of my staff, who have worked hard on this hearing 

and done a great job. I want to observe that, while we’re going to 

do a lot of changing, here—this is a great place to have a hearing 

like this—here’s the way we’ll proceed. I’d like to make a brief 

opening statement, and then I’ll go to our four distinguished witnesses and ask them to summarize their testimony in 5 or 6 minutes, and then we’ll have a conversation back and forth on the subject we’re talking about today. 

This is the third hearing by the Senate Subcommittee on Children and Families on this subject. Senator Dodd of Connecticut is 

the chairman of the committee, and I am the ranking Republican 

member, and we’ve worked together on children and family issues 

over the last 6 years. Part of that time, I was chairman, and part 

of the time he was ranking member. It depends upon what the voters have to say in elections. We work in a bipartisan way, and one 

of the issues that we worked on successfully was the so-called 

PREEMIE bill, which we worked on with the March of Dimes, to 

advance research and study and support for the question of premature babies and why they’re born. It struck me, in studying for 

this hearing—and I was talking with some of our witnesses about 

it—in the case of premature babies, in about half the cases, we 

don’t know why they’re born premature. A lot of what we have to 

do is to try to understand that. In the case of childhood obesity and 

why the children are likely to live less longer than their parents 

today, we pretty well know the problem, and we know what’s happening, and we’re going to talk about that today. So, we have to 

figure out, then, what to do about the problem. 

In a way, we should be a little ahead of the curve if we understand the problem. I think I’m right about that, at least; we’ll find 

out in the testimony. A lot of the effort that we have to make is, 

then, What do we do about the problem? What are the tactics that 

we need? 

We’re at a time in our history—and I remember about 2 years 

ago, a physician said to me that this is the first generation of children who are expected to live shorter lives than their parents. It 

made me stop—it was such a dramatic statement that I went back 

to my staff, to Sarah and to Mary-Sumpter and said, ‘‘Go check 

that. I don’t want to go say that in public if that’s an exaggeration 

or inaccurate or something that might not be true.’’ What we’ve 

found is that that’s exactly the case. In the New England Journal 

of Medicine, and the publications of the Institute of Medicine, and 

3 

the Trust for America’s Health, say that, generally speaking, for 

the last 1,000 years, children have lived longer lives than their parents, but children born in the year 2000 are expected to live shorter 

lives. 

It’s a real healthcare crisis. One of the biggest reasons for this 

crisis is what we call ‘‘childhood obesity.’’ The increasing rate of 

diseases that normally have been associated with adults—type-2 

diabetes—are now being found in children. I’m hopeful that—Commissioner Cooper, I think you’re the first witness—maybe you can 

take a minute at the beginning and just explain what type-2 diabetes is and why it’s different. Others may want to talk about that. 

I don’t want to jump right into this subject, just assuming everybody knows what we’re talking about, when, in fact, many people 

don’t. 

It’s especially important in Tennessee, because Tennessee is the 

third most obese State in the year 2007, and one out of every three 

children born are likely to be overweight. Twenty percent of Tennessee’s children, overall, are overweight. 

We’ll hear from our witnesses about the significant increases in 

this condition. One is that, over the last 40 years, obesity rates 

have quadrupled for children from the ages of 6 to 11 years, and 

tripled for adolescent ages 12 to 19 years. It’s prevalent among 

children and youth throughout the entire population. Everybody’s 

children. Hispanic, nonHispanic, black, and Native-American children and adolescents are disproportionately affected when compared to the general population. 

This affects, of course, millions of children, and potentially will 

cost billions of dollars for us to deal with. What we’re doing here 

today, in this third of a series of hearings, is to explore, ‘‘What can 

the Federal Government do to create solutions to this healthcare 

crisis? ’’ Let’s get on the upside of it and see if, over the next 10 

years, we may begin to reduce it as a crisis and save millions of 

lives, help them live longer than their parents, and save billions of 

dollars, which we could use in this country for other purposes. 

One of the things that struck me in the hearing was Commissioner Cooper’s goal—and it may be the goal of others, as well—— 

a good goal would be for high-school students to graduate in the 

year 2018 with a healthy weight. You have a report card for physics, and you have a report card for chemistry. You would know 

what a healthy weight would be, and you could aim for that goal. 

As the late Chet Atkins used to tell us, ‘‘You have to be mighty 

careful, in this life, where you aim, because you’re likely to get 

there.’’ I like that a lot better than talking about obesity, because 

you don’t want to just walk up to someone and say, ‘‘You’re overweight, you’re too fat, you’re obese.’’ That’s not a good way to start 

a conversation. That’s not a good way to challenge people to improve very much. The same with illiteracy; we don’t just walk 

around labeling people with illiteracy. Or, take the issue of the No 

Child Left Behind law; it’s caused us to label schools, although 

they’re not officially labeled in the law this way, as failing schools. 

You pick up the newspaper, and you hear that a school in Nashville is failing. I’d like to change the way we talk about schools in 

No Child Left Behind, to say, ‘‘Here are the schools that have succeeded, and here are the schools that have succeeded even more. 

4 

Then there are some with more work to do.’’ That’s the way we do 

everything else. We give you an A or a B or a C, and then some 

people have a little extra work to do. 

In the case of obesity, I think we need to find a way to talk about 

it to each other on the street and in the school or in the home. I 

can see families and public policymakers and elected officials talking about, ‘‘Let’s have a healthy weight for every child. We know 

the importance of it. Let’s marshal every single thing we can think 

of to do to cause that.’’ 

Our witnesses today are a very distinguished group. One reason 

we’re having this hearing is because Tennesseans are such good examples and—well, all of you are good examples and are experts on 

our subject. I won’t go through the whole history of each witness, 

but let me introduce all four, in brief to start with, and then we’ll 

go right down the line with their comments, and then have a conversation. 

Susan Cooper is commissioner of the Tennessee Department of 

Health here. Tennessee is one of the three States with the biggest 

problem in obesity, and it’s also one of a handful of States that is 

doing the most about it. A lot of that is due to Commissioner Cooper and Governor Bredesen, and I commend them for that. She is 

a special—she made a little history, because she became the first 

nurse to serve as the commissioner of the Tennessee Department 

of Health, and she assumed leadership of Project Diabetes, a program of Governor Bredesen created to address type-2 diabetes. 

She’ll tell us more about their initiatives. She was born and raised 

in west Tennessee. 

Dr. Shari Barkin is director of Pediatric Obesity Research at the 

Diabetes Research Training Center at Monroe Carell Children’s 

Hospital at Vanderbilt University. Dr. Barkin is also a National Institute of Health-funded researcher. She’s made many contributions 

there. She’s focused much of her work on pediatric obesity, children 

who are overweight, looking at prevention and early intervention 

approaches. She’s also a clinician, which means she works every 

day with children and families who are trying to deal with this 

problem. We look forward to her contribution. 

Dr. Susanne Tropez-Sims is associate dean of clinical affiliations 

and professor of pediatrics at Meharry Medical College, where we 

are today. She’s focused her research on faculty development, HIV/ 

AIDS prevention in adolescents, and correlations of infant obesity 

as related to the mother’s obesity. She’s received her M.D. at Chapel Hill, where she continued her internship and residency in pediatrics. She’s a native of New Orleans. 

David Griffin is the celebrity here today. David Griffin was a 

participant on Season 4 of NBC’s ‘‘The Biggest Loser.’’ He’s currently the spokesman for ‘‘Get Fit Tennessee.’’ Originally from 

Cedar Hill, TN, his role as husband and father of four children inspired him to appear on the show. David is about 6 feet tall, and 

he went from weighing 368 pounds to, today, it says here, 228 

pounds. That’s losing a total of 140 pounds and 38 percent of his 

total body weight. All of us are envious, and I’ll look forward to 

hearing more from him—— 

[Laughter.] 

5 

Senator ALEXANDER [continuing]. And congratulate him on his 

excellent example. 

Commissioner Cooper, let’s begin with you and go right down the 

line, then we’ll go forward. 

STATEMENT OF SUSAN R. COOPER, M.S.N., R.N., COMMISSIONER, TENNESSEE DEPARTMENT OF HEALTH, NASHVILLE, 

TN 

Ms. COOPER. Thank you, Senator Alexander. I’m certainly 

thrilled to be with you today to really have a conversation about 

the leading health risk facing the children of Tennessee and our 

Nation, pediatric or childhood obesity. 

As you said, I’m a registered nurse and the commissioner of 

health, and I’m also a mother of three and a grandmother of three. 

Nothing is more important to me than the health of our children. 

As commissioner, my job is to protect, promote, and improve the 

health of all that live in, work in, or visit our great State. It’s really 

important for us to have this conversation about our children. 

We’re facing a public health threat of an unprecedented nature. 

It is absolutely unacceptable to me that of the children born in the 

year 2000, that they would be the first generation in history not 

to live as long as their parents. We’ve heard some of the statistics 

today. Certainly, I think, we’ve talked about the obesity rate, but 

also, when you start thinking about type-2 diabetes, those same 

children born in the year 2000, one in three are anticipated to develop type-2 diabetes, a disease that used to be called ‘‘adult-onset 

diabetes,’’ because we never saw it in children. Then, if you happen 

to be African-American or Hispanic, that number is one in two. 

Think about walking through a cafeteria line in any of our schools 

in Tennessee and looking at the children standing there, and say, 

‘‘One, two, three, you’re it.’’ 

Let me tell you what a life with type-2 diabetes would look like. 

You will become blind. You may lose a leg. You may have end-stage 

renal disease that will require you to receive kidney dialysis or 

have need for a transplant. Oh, by the way, heart attacks and 

strokes are just going to be part of the norm. Unacceptable. Not for 

these children. 

Unfortunately, 8 of the 10 States with the highest obesity rates 

are found in the South. Twenty percent of our 10- to 17-year-olds 

are overweight, the fourth highest rate in the Nation. We believe 

that number is really under-reported. We’ve done screening, 

through our coordinated school health program, and it looks like 42 

percent of our children are either overweight or at risk of being 

overweight. Again, that is unacceptable. 

This epidemic, if left untreated or partially treated, as we do 

sometimes in our clinical work, will result in substantial costs to 

the State and to the Nation, both in health and economic terms. 

Obesity is associated, as we’ve said, with a number of chronic diseases, along with, not just the physical diseases—we see effects to 

the mental health of our children, as well. 

From an economic perspective, overweight and obese adults cost 

the United States between $69 and $117 billion on an annual 

basis. The costs of childhood obesity are growing, as well. Between 

1979 and 1999, that grew from $35 million to $127 million spent 

6 

on hospitalization costs. This State and this country cannot sustain 

the economic or health impacts, and we must take action immediately to halt this epidemic. Please understand that stemming the 

tide of childhood obesity requires that we start to shift our conversation solely from a focus on the care end of healthcare to the 

health end of healthcare. There’s a difference between health and 

healthcare, and we must take a proactive prevention-focused approach to health. 

As a Nation, if we were to make just a modest investment into 

preventive health strategies, if we invested $10 per person in this 

Nation each year in proven community-based programs to increase 

physical activity, improve nutrition, and prevent smoking and 

other tobacco use, we could save this country more than $16 billion 

a year. Of course, that’s about a return of $5.60 for every dollar we 

spend. I would respectfully say that, you know, if you invested just 

1 percent of that $16 billion into health—health, not healthcare— 

we could really change the tide of what we’re looking at today. 

As you said, the Department of Health really does believe that 

we can reach the goal of every child graduating in 2018 of being 

at a healthy weight. No one agency or entity can be responsible, 

in isolation, for finding the remedies that we need to address the 

issue. We’re going to have to have governmental responses, industry responses, media, community, schools, and individuals all to 

commit to prevention efforts and to dissemination of promising 

practices. 

I want to just briefly speak about Tennessee’s approach. I have 

my chief medical officer, who’s going to be the computer-whiz 

extraordinaire over here, in just a moment. 

Tennessee’s approach has really been to look at programs, policies, partnerships, and innovation, and the efforts tend to be paying off. In 2006, the Obesity Initiative from the University of Baltimore gave six States in this Nation a grade of A—and I love talking about good news—for their legislative and public policy work 

around childhood obesity, and Tennessee actually was one of those 

six States. 

Some of our policies are found across a multitude of our agencies 

in—that’s the collaborative focus we’re taking. In health, we have 

the Childhood Wellness and Nutrition Act, where we have developed an Office of Childhood Wellness and Nutrition within the Department of Health, and our goal is really to create a State plan 

for addressing the childhood obesity efforts here. We also have the 

Diabetes Prevention and Health Improvement Act, and we’ve invested $22 million of State-only dollars to fund community-based 

initiatives that will focus on the prevention and/or treatment of 

type-2 diabetes. 

In finance and administration, we are the only State in the Nation that has insurance plans that said, ‘‘You know, preventive 

health is important, so instead of risking you on what you pay, 

based on—do you have heart disease or do you have diabetes—we 

use age, weight, and tobacco usage to determine what your premium cost will be.’’ 

In education, the Coordinated School Health Program is mandated for all school systems. Well, that’s not necessarily unique 

7 

across States, but what is unique, we are the first State in the Nation that has fully funded it for every school system in the State. 

The transportation department—— 

Senator ALEXANDER. Now, you’ve fully funded what? 

Ms. COOPER. Coordinated school health—— 

Senator ALEXANDER. OK. 

Ms. COOPER [continuing]. For each of the school systems. 

Our transportation department has invested almost $5 million in 

the Safe Routes to Schools Programs. 

Economic and community development has a three-star community program to help bring new business in. And one of the indicators is health. 

Also, we’re working with Human Services to work with our licensed childcare facilities to set activity and nutrition standards. 

We’re really excited about this. We have broken down the silos 

that exist in State government, and we have reached out, not just 

to our State partners, but to our community partners, as well. 

With our innovative approaches, I want to talk to you briefly 

about Project Diabetes. 

Next slide. 

In two initiatives in particular, our Get Fit Tennessee Initiative, 

which is an online, interactive fitness community for youth and 

adults that is really a program to help us all start where we are. 

When you think about that messaging, there is something that everybody can do to improve the health of themselves, their families, 

their communities. This is free online too, not only to anybody in 

this State, but anybody in this Nation, where you can set your own 

fitness and nutrition goals, you can track your progress, you can 

create challenges, as you can see, for Child Health Week. 

Next slide. 

Last week, we set a Child Health Week Challenge, for children 

across this State, to look at fitness points. There are dropdown 

boxes of about 100 different activities, built on the Governor’s 

Physical Fitness Challenge, where everybody can get points for 

health and fitness. We really believe that this is a very innovative 

tool that helps everyone find something that they can do. It also 

helps in setting realistic health and fitness goals. 

The second program that I want to briefly show—oh, there’s our 

food journal. I’ll just say, about food journaling, we had this up before the report came out that said, ‘‘If you journal what you eat, 

you will lose up to 50 percent more than if you don’t journal.’’ It’s 

a very effective tool, and it links to the USDA database for calorie 

content. 

Again, Get Fit Tennessee, we’ve spent a lot of time across the 

State. We’ve been to hundreds and hundreds, and almost thousands of community events now, really acknowledging what’s happening at the grassroots effort. Every moment becomes a teachable 

moment. What we’ve found is that fitness can be fun and everybody can do something. 

Those are just pictures of folks from across the State that have 

participated in our opportunities, and what you’ll see is that folks 

are smiling as we’re doing this. I think that’s just the visualization 

of the hope that exists for families today. 

8 

1Ogden, CL, Carroll MD, Flegal KM. High Body Mass Index for Age Among US Children and 

Adolescents, 2003–2006. Journal of the American Medical Association 2008;299(20):2401–2405. 2 Ibid. 

3Trust for America’s Health. F as in Fat 2007: How Obesity Policies are Failing in America. 

www.healthyamericans.org. (accessed June 24, 2008). 

Now, GoTrybe is an online physical fitness program, physical 

education program that we now have in 17 school systems in the 

East and Northeast, in 33 different high schools, and it’s the culmination of a unique public/private partnership funded by Project 

Diabetes. This Web site was designed by health and fitness professionals, we’ll talk a little bit—the Zoo-Do’s are for grades 1 through 

5. Tribe 180 is for grades 6 through 8. And Next Tribe are for our 

high school students, 9 through 12. We’ve got a 1-minute video clip 

explaining what this does. 

[Video presentation.] 

Ms. COOPER. Little—in there. 

Senator ALEXANDER. Better—we want to keep going here so we 

stay within our time. 

Ms. COOPER. Just—every child has an—and I think what’s interesting is, we’re beginning to see the results of our efforts here. 

I want to say that we are committed to this. We appreciate your 

attention in everything you’ve done for all of us, and we’ll turn it 

to Dr. Barkin. 

[The prepared statement of Dr. Cooper follows:] 

PREPARED STATEMENT OF SUSAN R. COOPER, M.S.N., R.N. 

Chairman Dodd, Ranking Member Alexander, and members of the subcommittee, 

thank you for the opportunity to be with you today to testify about the leading 

health threat facing the children of Tennessee and our Nation both today and for 

generations to come—childhood obesity. 

I am Susan Cooper, M.S.N., R.N., Commissioner of the Tennessee Department of 

Health, a registered nurse, mother of three and a grandmother of three. As Commissioner, my job is to protect, promote, and improve the health of all that live in, work 

in, and visit our great State. The health of our children is of utmost importance to 

me and to the future of Tennessee and the Nation. Today, I would like to briefly 

speak to the scope of the problem, the potential contributing factors, and give examples of Tennessee’s response to this national emergency. 

BACKGROUND AND SCOPE OF PROBLEM

We are facing a public health threat to our children of an unprecedented nature. 

It is unacceptable to me that the children born in the year 2000 are the first generation in history not expected to live as long as their parents. You have heard the 

statistics many times, but they are worth repeating. Today, almost 32 percent of 

American children and adolescents—more than 23 million—ages 2–19 are overweight or obese.1 Rates of obesity have more than tripled since 1980, from 6.5 percent to 16.3 percent. One in three children born in the year 2000 is anticipated to 

develop type 2 diabetes,2 a disease that was once called adult onset diabetes because 

it was not seen in children. The likelihood is one in two if you are an African-American or Hispanic child. 

Unfortunately, 8 of the 10 States with the highest obesity rates are found in the 

South. In Tennessee, 20 percent of our 10- to 17-year-olds are overweight, the fourth 

highest rate in the Nation.3 The most recent numbers from BMI screening through 

the Coordinated School Health Program in Tennessee reveal an even deeper problem. Of the 16,513 students 7 through 16 years of age screened in the first year 

of the program, the findings show: 

• 24 percent overweight (above 95th percentile), • 18 percent at risk for overweight (85th–95th percentile), • 42 percent total overweight and at risk, • 56 percent normal weight, and • 2 percent underweight. 

Detailed analysis of Tennessee data reflects the national trends: 

9 

4 U.D. Centers for Disease Control and Prevention. ‘‘Preventing Obesity and Chronic Diseases 

Through Good Nutrition and Physical Activity.’’ U.S. Department of Health and Human Services, http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm. (accessed 

August 2008). 5 Ibid. 

6Trust for America’s Health. Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, July 17, 2008. 

• More boys (26 percent) were overweight than girls (22 percent); 

• A greater proportion of African-American students (29 percent) were overweight 

than Caucasian (24 percent); 

• African-American females had the highest proportion of overweight or at risk 

for overweight (50 percent); 

• Caucasian females had the lowest proportion of overweight or at risk for overweight (40 percent); and 

• The only age group with combined proportion of overweight and at risk for overweight less than 40 percent: Students under age 7. 

The proportions of overweight and at risk for overweight were considerably higher 

than those reported for Tennessee high school students in the 2005 Youth Risk Behavior Surveillance System (YRBSS)—42 percent BMI Screening Program versus 

32.1 percent YRBSS. These findings are limited as the African-American student 

population and urban student populations were underrepresented in the BMI program sample. 

This epidemic, if left untreated or partially treated, will result in substantial costs 

to the State and Nation both in health and economic terms. Obesity is associated 

with a number of chronic conditions and diseases such as type 2 diabetes, increased 

cholesterol and hypertension, heart disease, kidney disease, neurovascular disease, 

and some cancers. Some studies also suggest that overweight and obesity negatively 

affect the mental health of children and their performance in school. From an economic perspective, overweight and obese adults cost the United States between $69 

and $117 billion per year.4 The costs of childhood obesity are growing as well. Obesity-related hospital costs for children ages 6 though 17 more than tripled between 

1979 and 1999, from $35 million to $127 million.5 This country, and our State, cannot sustain this economic or health impact. Action must be taken immediately to 

halt this epidemic. 

Please understand that stemming the tide of childhood obesity requires that we 

start to shift our conversation solely from a focus on healthcare delivery to a 

proactive, prevention-focused approach to health. If we as a Nation made a modest 

investment in the prevention of obesity and its related chronic diseases, rather than 

treating or paying for its subsequent health consequences, we could avert much 

greater costs later. A recent report demonstrated that for an investment of just $10 

a person, every year, in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save the 

country more than $16 billion a year within 5 short years. This is a return of $5.60 

for every dollar.6

With this focus on health promotion in mind, the Tennessee Department of 

Health has set as its vision that every child completing high school in 2018 

will graduate at a healthy weight. 

NATIONAL RESPONSE

No one agency or entity is, or can be, responsible in isolation for finding the remedies we need to address this issue. In the 2006 report, Progress in Preventing 

Childhood Obesity: How do We Measure Up?, the Institute of Medicine issued a call 

to action to all key stakeholders—including government, industry, media, communities, schools and individuals—to commit to leading childhood obesity prevention 

interventions, evaluation and dissemination of promising practices. Government-specific IOM recommendations included establishing a high-level interdepartmental 

task force to set priorities and coordinate Federal, State, local and public-private actions; developing nutrition standards for foods and beverages sold in schools; applying for State-based nutrition and physical activity grants with strong evaluation 

components; expanding and promoting opportunities for physical activity in the community through changes to ordinances, capital improvement programs, and other 

planning practices; and working with communities to support partnerships and networks that expand the availability of and access to healthful foods. In recent years, 

Tennessee has undertaken many of these steps toward developing a coordinated response to childhood obesity prevention. 

10 

7 Cotten, A., Stanton, K.R., Acs, Z.J. and Lovegrove, M. The UB Obesity Report CardΤΜ: An 

Overview 2006. http://www.ubalt.edu/experts/obesity/index.html. October 20, 2008. 

TENNESSEE’S APPROACH

Initiatives to address childhood obesity are grounded in four areas: policies, programs, partnerships and innovation. The efforts appear to be paying off. In 2006, 

the Obesity Initiative, found at the Schaefer Center for Public Policy at the University of Baltimore, gave six States the grade of ‘‘A’’ for their legislative and publicpolicy work in the past year to control childhood obesity.7 Tennessee was among the 

six. Eight types of legislative activities were evaluated to determine the grades: 

• Nutrition standards—controlling the types of foods and beverages offered during school hours. 

• Vending machine usage—prohibiting types of foods and beverages sold in school 

and prohibiting access to vending machines at certain times. 

• Body mass index measured in school. 

• Recess and physical education—State-mandated additional recess and physical 

education time. 

• Obesity programs and education—programs established as part of curriculum. 

• Obesity research—legislative support for other institutions or groups to study 

obesity. 

• Obesity treatment in health insurance—expanding health insurance to cover 

obesity treatment where applicable. 

• Obesity commissions—legislature-established commissions designed to study 

obesity. 

In Tennessee, many State policies have been developed, and collaborative efforts 

among State and local entities have been implemented to address the childhood obesity epidemic. Efforts have focused on developing policies and infrastructure that enable youth and their families to make healthier choices. Specifically, policy development has been focused on the promotion of health across State agencies and designed to influence children and their families where they learn, work and live. 

Health 

In 2006, the Child Wellness and Nutrition Act, created the Office of Child 

Wellness and Nutrition within the Department of Health. This Office interacts with 

other State and local partners to develop and evaluate activities related to child 

health with particular attention to improving childhood nutrition. The Diabetes Prevention and Health Improvement Act of 2006 established a Center within State government for the purpose of developing, implementing and promoting a statewide effort to reduce the incidence of type 2 diabetes. The Center is authorized to issue 

grants to community and faith-based organizations, not-for-profits, local education 

authorities and other health service providers for programs designed to prevent and/ 

or treat type 2 diabetes in children and adults. Furthermore, the Department of 

Health has collaborated on a number of innovative programs designed to increase 

physical activity and nutrition, which I will describe in a moment. 

Finance and Administration 

One of the State’s insurance programs, Cover Tennessee, uses age, weight and tobacco use information to assign risk for their insurance products. TennCare, Tennessee’s Medicaid waiver program, requires its MCOs to have disease management 

models for obesity, and has policies that support Weight Watchers and other healthy 

weight programs for children and their parents. In addition, TennCare issues a 

child and teen newsletter which includes information on healthy food choices and 

exercise. 

Education 

The Coordinated School Health (CSH) program is required for all school systems 

and is fully funded; Tennessee is the first State in the Nation to fully fund its CSH 

program. The CSH program collects BMI and other health information for youth in 

elementary school through high school. The Department of Education, with input 

from the Department of Health, has established nutritional standards for all meals 

and nutritional standards for all competitive foods, including those purchased from 

vending machines. In addition, legislation passed in 2006 requires 90 minutes of 

physical activity per week for all students in grades K–12. 

Transportation 

Tennessee supports a Safe Routes to School program which focuses on the benefits 

of children walking and biking to school. Its primary purpose is to encourage eleVerDate Nov 24 2008 11:31 Dec 18, 2009 Jkt 035165 PO 00000 Frm 00014 Fmt 6633 Sfmt 6621 S:\DOCS\45227.TXT DENISE
11 

mentary and middle school children to safely walk and bike to school, thereby promoting a healthier lifestyle, reducing traffic congestion and minimizing air pollution. 

In 2007, the Department of Transportation provided $4.5 million for these local programs that promote collaboration with schools, the community, and local government to create a healthy lifestyle for children and a safer, cleaner environment for 

everyone. 

Economic and Community Development 

The Department of Economic and Community Development’s Three Star Program 

is an initiative designed to preserve existing employment, create new employment 

opportunities, increase Tennessee family income, improve health and quality of life 

and create a strong leadership base. A detailed plan that promotes access to health 

care is a required component of community development in order for a community 

to achieve Three Star designation. 

Human Services 

The Gold Sneaker initiative was developed to enhance policy related to physical 

activity and nutrition within licensed child care facilities across Tennessee, and represents collaboration among the Department of Health, Department of Human Services and Child Care Resource & Referral system. Enacted policies must include minimum requirements on physical activity (or ‘‘active play’’ ), sedentary activities, 

breastfeeding, meal time and portion sizes. Child care facilities that implement the 

proposed enhanced physical activity and nutrition policies will earn a ‘‘Gold Sneaker’’ award which designates them as a ‘‘Gold Sneaker’’ child care facility. 

INNOVATIVE PROJECTS

Tennessee has utilized many innovative approaches to improving health behaviors 

that rely on partnerships between State and local government and private entities. 

These initiatives acknowledge to critical role that local communities play in the development, implementation and evaluation of effective programs for that community. We recognize that what works to improve child health in Northwest Tennessee, 

for example, may not be the same program that works in South Central Tennessee. 

These innovative programs and initiatives challenge traditional approaches to community-based interventions, and all have an evaluation component. Examples include the following: 

• Project Diabetes is a statewide initiative focusing on innovative education, prevention, and treatment programs for diabetes and obesity. The fundamental 

goals of Project Diabetes are to: 

• Decrease the prevalence of overweight/obesity across the State and, in turn, 

prevent or delay the onset of type 2 diabetes and/or the consequences of this 

devastating disease. 

• Educate the public about current and emerging health issues linked to diabetes and obesity. 

• Promote community, public-private partnerships to identify and solve regional 

health problems related to obesity and diabetes. 

• Advise and recommend policies and programs that support individual and 

community health improvement efforts. 

• Evaluate effectiveness of improvement efforts/programs that address overweight, obesity, pre-diabetes, and diabetes. 

• Disseminate best practices for diabetes prevention and health improvement. 

• Over $10 million in local efforts have been funded through Project Diabetes 

grants. Sixty-three Project Diabetes grants have been awarded; of these, twentynine have a child health focus, with goals to improve physical activity, nutrition and 

health literacy, or to provide culturally and developmentally appropriate activities. 

An example of one such activity is the Step Up to Health program. Step Up to 

Health is a collaboration between State and local government agencies, the Historically Black Colleges and Universities’ Wellness Project, and the National Step Show 

Alliance. This program works with youth at risk for diabetes to improve their physical fitness, health knowledge and awareness, self-efficacy and self-esteem through 

the performance of step shows with integrated health messages. This program will 

reach 300 youth ages 11–15 years; baseline and post-intervention health, nutrition, 

and fitness data will be collected to determine program effectiveness. 

• GoTrybe is an online, interactive fitness community for youth that is the culmination of a unique public-private partnership. Designed by health and fitness professionals, GoTrybe seeks to transform sedentary screen time to active screen time 

for participants to ultimately improve child health. GoTrybe focuses on enhancing 

wellness through increased physical activity, improved motivation, and improved 

12 

nutritional awareness. The tool allows the user to create an individually tailored fitness routine. Built-in data collection tools allow for tracking of individual, school or 

regional-level process measures. 

• Get Fit TN is a statewide program to raise awareness of the risk factors for 

type 2 diabetes and steps that Tennesseans can take to reduce their risk. This free 

online tool combines a personal fitness tracker and nutrition tracker which allow 

the user to set realistic fitness and/or nutrition goals, and provides useful information to facilitate changes in health behaviors. 

CLOSING

In closing, I want to again thank the members of this committee for your past 

and ongoing commitment to improving the health, safety and well-being of our Nation. We know that so much more can be and must be done to protect, promote and 

improve our Nation’s health as we continually anticipate and prepare for a myriad 

of public health threats. We welcome the opportunity to continue to work with you 

in pursuit of that goal. 

Thank you for your attention. I will be pleased to answer any questions you may 

have. 

Senator ALEXANDER. Thank you. Thank you, Commissioner Cooper. That’s exciting testimony. 

Dr. Barkin. 

STATEMENT OF SHARI BARKIN, M.D., MSHS, DIRECTOR OF PEDIATRIC OBESITY RESEARCH, DIABETES RESEARCH TRAINING CENTER PROFESSOR OF PEDIATRICS, MONROE CARELL, 

JR. CHILDREN’S HOSPITAL AT VANDERBILT, NASHVILLE, TN 

Dr. BARKIN. Senator, thank you for the opportunity to discuss 

this growing epidemic, and, really, thank you for your leadership 

and interest in doing something now to make a difference. 

My name is Dr. Shari Barkin. I’m the division chief of general 

pediatrics at Monroe Carell, Jr. Children’s Hospital at Vanderbilt. 

Additionally, I’m an NIH-funded researcher with extensive experience conducting national research trials and the proud recipient of 

State-supported Project Diabetes grant funding, as well, to address 

this problem. 

My focus is in the area of prevention and early intervention for 

pediatric obesity. As you mentioned, I’m a pediatrician and work 

with families who are dealing and struggling with this issue every 

day. 

My testimony will be summarizing recent findings on the causes 

of pediatric obesity. I then will provide some insights from the National Forum on Pediatric Obesity that was held here in conjunction with the FCC last week. And last, I would like to recommend 

some suggestions on the role of the Federal Government to address 

this critical public health problem. 

You heard the statistics. I would just add to that, that childhood 

obesity is linked to adult obesity and, via prevention, science says 

we could have the greatest impact on this problem. For example, 

rapid weight gain in infancy is associated with excessive weight at 

age 4. If you are an overweight toddler, you’re five times as likely 

to be an overweight adolescent. If you’re an overweight adolescent, 

you have a 70-percent likelihood that you’ll be an overweight adult. 

They’re linked. 

So, what’s going on? What are the major causes? What does 

science have to tell us to try to explain the causes of this epidemic? 

I’m breaking this down into three general categories. 

13 

The first category is that we live in a fast-paced society, and the 

problem with this is that we’re out of balance. We consume too 

much, and we exercise too little. Our bodies were not made to do 

this every day; we were designed to move enough and feed our 

needs for movement with an agrarian society. In fact, we know that 

now we are more inactive than we have ever been in recorded history. The average American child spends 45 hours a day [sic] in 

sedentary media-related activities. That’s more time than they 

spend in school, more time than they might even spend sleeping, 

and certainly more time than they’re spending with their parents. 

We also know that we respond to our environment. There has 

been some interesting science on this. In a study published in 2007, 

the easy availability of supermarkets, where consumers have access to healthy foods, was associated with a lower body mass index, 

the index that we use to determine if you’re overweight or obese. 

While the availability of convenience stores, where there are fewer 

healthy choices instead of supermarkets, was associated with a 

higher BMI. We have scientists working right here at Vanderbilt 

looking at geographic informational systems data, showing where 

we have food deserts, for example, in north Nashville. Those are 

areas where we see higher BMIs. This study supports the science 

to explain that. We are responding, our behavior response, to our 

environment. 

The third category that I’d like to bring up is that children’s behavior is greatly influenced by their family and peers. We’re meant 

to be that way. We were meant to be social creatures. We influence 

each other by how we act. 

In a recent study in the New England Journal of Medicine, obesity appears to be socially contagious. If your spouse is obese, you 

have a 37-percent likelihood of being obese yourself. If an adult sibling is obese, you have a 41-percent likelihood of being obese. Importantly, if your friends are obese, you have a 57-percent likelihood of being obese. Very important study that was done in a longitudinal way using the Framingham heart study to look over what 

happens over a 30-year period. This was done with adults, not with 

children. 

I’d like to move us now to some insights that were generated 

from the forum. 

We know that the FCC has had a very dedicated effort bringing 

together a joint task force on media and childhood obesity. We were 

fortunate to host the FCC commissioners here, and, with the leadership of Commissioner Tate, look at some of the recommendations 

that several of our media outlets and food and beverage advertisers 

have considered. 

They noted, for example, in the task force, that during children’s 

programming, advertisers typically have about 80-percent 

unhealthy foods that are advertised during that period, and a suggestion was made to create more of a balance in advertising. If we 

are influenced by what we see, and science shows that that is so, 

that we should promote things that children see that promote a 

healthy lifestyle. 

Second, through self-regulation, media can use common childhood characters to promote healthy lifestyles, and voluntarily, 

media giants like Sesame Street and Disney and Nickelodeon have 

14 

taken on this challenge so that the content reveals positive role 

modeling with this popular culture. 

Third, we discussed at the forum that behavior plays a larger 

role in obesity than genetics. Genetics is an important contributor, 

but behavior contributes largely to whether you’ll become obese. 

We were fortunate to hear about some of our efforts here in Tennessee. Easy access to recreational facilities, for example, allows 

the promotion of healthier active lifestyles. 

Last, we talked about the importance of creating linkages between multiple stakeholders, and these stakeholders include policymakers, scientists, media, food and beverage companies, schools, 

communities, and, of course, parents. 

Here’s an example of some things that have already been tried 

that seem to be promising. The vice president of Disney Channels 

Worldwide, Kelly Pena, presented some initiatives that they put 

into place, just about a year ago, in the Disney theme parks. Disney, I was surprised to learn, is the seventh largest restaurateur 

in the world. People consume a lot of food there. What they did 

with their attention to nutrition and change is that they changed 

how they offered children’s menus. Rather than automatically getting fries and a soda with your children’s meal, you would automatically—the default was set at getting fruits, vegetables, and 

milk. You could always request replacing that with soda and french 

fries, but 80 percent of people didn’t; they ate what they were 

given. 

Based on the recommendations of the Institute of Medicine and 

the National Forum on Pediatric Obesity, I would like to respectfully put forth the following recommendations for governmental 

consideration. Here are some suggestions. 

Government could provide coordinated leadership to truly make 

pediatric obesity prevention a clear national priority, echoing the 

sentiments of Commissioner Cooper, focusing our efforts on prevention. 

Second, government can provide significant funding for research 

on childhood obesity and, importantly, the translation of those effective successful findings into sustainable programs designed to 

impact large populations of children. 

Third, government could address the issue of food advertising imbalance for both children’s and adults’ programming through a 

combination of self-regulation and perhaps legislation 

And last, government could consider incentives that would support built environments that encourage healthy living. 

Once again, I’d like to thank you, Senator Alexander, for your 

leadership, for your focus, for your clear dedication to action. I look 

forward to serving as a resource to your committee in the future. 

Thank you. 

[The prepared statement of Dr. Barkin follows:] 

PREPARED STATEMENT OF SHARI BARKIN, M.D., MSHS 

Chairman Alexander and members of the committee, thank you for the opportunity to discuss the growing epidemic of childhood obesity and its impact on our 

Nation. My name is Dr. Shari Barkin. I am the Division Chief of General Pediatrics 

at the Monroe Carell Jr. Children’s Hospital at Vanderbilt University. In addition, 

I am a NIH-funded researcher with extensive experience conducting national research trials. My focus is in the area of pediatric obesity, developing and testing preVerDate Nov 24 2008 11:31 Dec 18, 2009 Jkt 035165 PO 00000 Frm 00018 Fmt 6633 Sfmt 6621 S:\DOCS\45227.TXT DENISE
15 

vention and early intervention approaches. I also work as a clinician with children 

and families battling obesity every day. 

My testimony will summarize recent findings on the causes of pediatric obesity, 

provide insights from the National Forum on Pediatric Obesity held this month at 

Monroe Carell Jr. Children’s Hospital, and offer recommendations on the role that 

government should play to address this critical public health problem. 

Longitudinal studies demonstrate that childhood obesity is inextricably linked to 

health outcomes later in life. For instance, rapid infant weight gain often leads to 

excessive weight gain by age 4. Overweight toddlers are 5 times as likely to be overweight adolescents. Overweight adolescents have a 70 percent risk of becoming overweight adults. Furthermore, 60 percent of overweight children aged 5–10 already 

have one or more risk factors for heart disease and diabetes. In fact, the CDC predicts that without aggressive intervention, over 30 percent of children born in the 

year 2000 will go on to have type two diabetes. 

This will likely be the first generation where a child’s life expectancy is 

less than their parents due to obesity-related health problems. 

What has led to this emergence of pediatric obesity? Studies show there are three 

major factors: 

• First, we live in a fast-paced society. More families eat on the run than sit down 

together. More children sit in front of TV than play outside. The problem is that 

we are out of balance. We consume too much and exercise too little. In fact, we are 

more inactive than we’ve ever been in recorded history. The average American child 

watches 45 hours of media per week. That is more time than they spend in school 

or with their parents. Media has become a full time job for our children. 

• The second factor is that our bodies are adapting to this new lifestyle. We are 

born into this world with very little hardwiring. Instead, we adapt to our environment. For example, in a study published in 2007, the easy availability of supermarkets (where consumers have a greater abundance of healthy food choices) was 

associated with a lower body mass index (BMI) while the availability of convenience 

stores (where there are fewer healthy choices) instead of supermarkets was associated with a higher BMI. 

• The third and final factor is that children’s behavior is greatly influenced by 

their family and peers. We are meant to be social creatures. Children live in the 

context of their families; families live in the context of their communities; and communities live in the context of society. We influence each other by how we act. In 

a study in the New England Journal of Medicine, obesity appears to be socially contagious. If your spouse is obese, you have a 37 percent likelihood of being obese. If 

your sibling is obese, you have a 41 percent likelihood of being obese. And, importantly, if your friend is obese, you have a 57 percent likelihood of being obese. The 

challenge is to make being healthy socially contagious. 

On October 15, 2008, the Monroe Carell Jr. Children’s Hospital at Vanderbilt and 

Department of Pediatrics in conjunction with the Federal Communication Commission hosted a conference entitled, ‘‘The National Forum on Pediatric Obesity: Developing Unique Partnerships to Halt the Epidemic.’’ The Forum was structured on 

The Institute of Medicine’s (IOM) blueprint for action. The IOM report stressed that 

pediatric obesity can only be addressed effectively if multiple stakeholders act together, including: Government at all levels, Food and beverage companies, Advertising and marketing companies, Multimedia industry, Communities, Schools, 

Health providers, and Parents. 

With the IOM recommendations as our guide, the National Forum on Pediatric 

Obesity concluded the following: We live in a media-saturated world and media exposure influences both children’s and adults’ behavior. During children’s programming, advertisers should be responsible for presenting a balance of healthy to 

unhealthy food ads. Currently, 80 percent of the advertising is for unhealthy foods. 

FCC Commissioner and Forum participant Deborah Tate is leading the effort to encourage media to improve advertising for healthy food options. 

The media through self-regulation should encourage the use of common characters 

(such as Elmo and Mickey Mouse) to promote healthy choices. Senior executives 

from Sesame Workshop and Disney who participated at the Forum spoke of how 

their companies have voluntarily made important changes in both their programming and advertising approaches to focus on healthy lifestyles. 

While genetics is important, behavior plays a larger role in determining obesity 

outcomes. Easy access to recreational facilities is one area in which government can 

positively impact children’s health. Forum participant and Nashville Mayor Karl 

Dean discussed efforts to create built environments such as more green space for 

outdoor activities. Nashville has also built more community centers thereby increasing access to recreational facilities in all communities. 

16 

Stakeholders should discuss how they could partner together in innovative ways. 

One suggestion discussed was partnering media, scientists, food vendors and policymakers to create what are called ‘‘healthy default environments.’’ For example, children who request meals at Disney theme parks are now automatically provided with 

fruit as a side item instead of French fries. The great majority eat what they are 

given, rather than requesting anything different. Another example could be policymakers at the local level working with grocery chains to create incentives to build 

supermarkets in communities with limited access to food. 

Based on the recommendations of the IOM and the National Forum on Pediatric 

Obesity, I would like to respectfully put forth the following recommendations for 

governmental action. Government could: 

• Provide coordinated leadership to make pediatric obesity prevention a clear national priority. 

• Provide significant funding for research on childhood obesity and translation of 

these findings into sustainable programs designed to impact large populations of 

children. 

• Address the issue of food advertising imbalance for both children’s and adult 

programming through a combination of legislation and self-regulation. 

• Consider incentives to support built environments that encourage healthy living. 

Once again I would like to thank you Mr. Chairman and the other members of 

the committee for allowing me to appear before you today and for your strong leadership on this very critical issue. I look forward to serving as a resource to your 

committee, if ever you need me, in the future. 

Senator ALEXANDER. Thank you, Dr. Barkin. 

Dr. Tropez-Sims, thank you for being here. 

STATEMENT OF SUSANNE TROPEZ-SIMS, M.D., M.P.H., FAAP, 

ASSOCIATE DEAN OF CLINICAL AFFILIATIONS AND PROFESSOR OF PEDIATRICS, MEHARRY MEDICAL COLLEGE, 

NASHVILLE, TN 

Dr. TROPEZ-SIMS. Thank you for inviting me to be here. I’m 

proud to represent Meharry. 

As has been stated already, most of the statistics—one statistic 

that has not been mentioned is that Tennessee ranks first in 

deaths due to heart disease and strokes. If this is so, and most of 

our children are becoming obese, does that mean that we will have 

serious consequences of early heart disease and strokes in young 

adults? I believe it is so. 

The other thing, too, is that in African-Americans in Tennessee, 

43 percent are higher to die of strokes than our Caucasian partners, and for diabetes, the rate of death due to it in Tennessee is 

146 percent higher among African-Americans than in Caucasians. 

Hispanic Americans are also one of the fastest growing minority 

groups, and they, too, are obese and are having alarming rates of 

type-2 diabetes. 

Dr. Nicholas Stiffler, from the University of Pennsylvania, hypothesizes that rapid weight gain during early infancy is associated 

with obesity, especially in African-American young adults. The critical period is proposed to be between birth and 4 months of age, 

where there is a rapid increase in weight for age greater than one 

standard deviation. 

I don’t want to repeat everything that has been said previously, 

so I’m running through this. 

Senator ALEXANDER. No, no, we’re interested in whatever you 

have to say. 

Dr. TROPEZ-SIMS. All right. 

17 

One of the major contributing factors—they’re really multifactorial in this disease or problem—it’s environmental, behavioral, genetic, metabolic, cultural, socioeconomic status, and energy imbalance, which has been mentioned, where we consume more than the 

physical activity. 

Other health risk behaviors also play a major role. In Tennessee, 

36 percent of our Caucasian high-school students and 12 percent of 

African-American students smoked in 2001. As I see patients, most 

of them state that they smoke to keep from eating, because they 

do not want to become obese. They don’t realize that this causes 

them to be at risk for other health diseases, but it still increases 

their risk for heart disease and strokes. 

Fifty-eight percent of our students in Tennessee in 2001 were not 

enrolled in an organized physical education class. With our high 

rates of crimes and drive-by shootings, this hampers outside play 

for most of our children in this entire country. These students are 

prime set-ups for obesity and its consequences. 

One of the other things that I want to discuss is that the socioeconomic status plays a major role in obesity. For all racial and 

ethnic groups combined, women of lower socioeconomic status— 

that’s income less than 130 percent of poverty threshold—are approximately 50 percent more likely to be obese than of higher socioeconomic status. African-American girls from lower socioeconomic 

status experience a higher prevalence of overweight—obesity—than 

those from a higher socioeconomic status. The exact etiology is not 

known, but I hypothesize that the high cost of nutritious fresh 

fruits, vegetables, and lean meats prohibit the possibility of improving eating habits. 

In the past, the increase in television viewing or use of electronic 

games was proposed as the key factor. In McMurray’s study, he 

says it may play role, but it’s not the total answer. 

At Meharry, we have several programs that are looking at obesity. It ranges from pregnancy in mothers to adolescents to looking 

at communities and how, working with community agencies, that 

we can make a hallmark in changing the obesity rate. 

In conclusion, thus far we have learned that obesity is a 

multifactoral issue, and it will take everyone to become a part of 

the solution. As we see from some studies, the battle against obesity and its consequences begin as soon as we are born. It must be 

stated that not only overweight and obese children and adolescents 

are at risk for these consequences, but even non-obese individuals 

run similar outcomes, albeit lower rates secondary to inappropriate 

dietary consumption, smoking, and lack of physical activity. 

In our schools, not only the three R’s must be taught, but preventive and healthy lifestyles must be integrated as a lifelong learning 

experience. Good nutrition is not a diet, and changing the mindset 

of the population of this aspect is usually overlooked. 

Research must look at all aspects of obesity, including the psychological aspects. Going back to basics, as growing one’s own vegetables and fruits, even in a city, can assist in improving one’s 

health. Children and adolescents need guidance in lifestyle healthy 

behavior. Parents need to increase their knowledge first to allow 

children to inherit their example. Tennessee has multiple guidelines and plans in place to implement a change in behavior of its 

18 

constituents. It’s a daunting task, but with everyone playing a 

major role, the State can be successful. 

Thank you. 

[The prepared statement of Dr. Tropez-Sims follows:] 

PREPARED STATEMENT OF SUSANNE TROPEZ-SIMS, M.D., M.P.H., FAAP 

ABSTRACT

Tennessee is one of three States in the United States with an Obesity rate of 

greater than 30. It is the State who has the leading cause of death due to heart 

disease and strokes in the Nation. In Tennessee, deaths from strokes are reported 

43 percent higher in African-Americans than Caucasians. The rate of death due to 

diabetes in Tennessee is 146 percent higher among African-Americans than among 

Caucasians. Hispanic Americans are one of the fast growing minority group and 

they are obese at an alarming rate and suffer similar consequences. 

Children and adolescents are not unscathed in this dilemma. Obesity has risen 

threefold in this age group. In children, the prevalence increased from 5.0 percent 

to 13.9 percent; aged 6–11 years increased from 6.5 percent to 18.8 percent; and 

those aged 12–19 years increased from 5.0 percent to 17.4 percent. These children 

and adolescents are at increase risk of dyslipidemia, hypertension, metabolic syndrome and type 2 diabetes. In addition, CDC reports 80 percent of children between 

the ages of 10–15 years who are overweight or obese will persist to adulthood. Yet 

only 25 percent of obese adults were overweight as children. If a child of 8 years 

of age is obese, they will suffer severe obesity as adult. Metabolic syndrome is a useful tool in assisting to diagnose adults but it has not been documented to diagnose 

children and adolescents at risk. A serious consequence to early obesity is the risk 

of early heart disease and strokes. 

Children and adolescents have a multifactorial reason for their obesity. Contributing factors are environmental, behavioral, genetic, metabolic, cultural, socioeconomic status, energy imbalance (consuming more than physical activity). Other 

health risky behaviors also play a major role. In Tennessee, 36 percent of Caucasian 

high school students and 12 percent of African-American students smoked in 2001. 

Fifty-eight percent of high school students are not enrolled in an organized physical 

education class, but with the high rate of crime, as kidnapping of children, outside 

play is also hampered. These students are prime set-up for obesity and its health 

consequences. 

Children and adolescents need guidance in lifestyle healthy behavior. Parents 

need to increase their knowledge first to allow children to inherit their examples. 

Tennessee has multiple guidelines and plans in place to implement a change in behavior of its constituents. It is a daunting task but with everyone playing a major 

role the State can be successful. 

CHILDHOOD OBESITY

Obesity is a growing dilemma in the United States and specifically three States 

have the highest rate greater than 30 percent. They are Alabama (30.3), Mississippi 

(32) and Tennessee (30.1). However, the increase in health adversity is of major concern. Diseases such as coronary heart disease, stroke, dyslipidemia (high blood cholesterol and triglycerides), type 2 diabetes, some cancers (breast, colon and 

endometrial), osteoarthritis and sleep apnea are hallmark consequences. The National Vital Statistics report these diseases contributed $117 billion to the medical 

cost in the year 2000. According to the Center for Disease Control (CDC), Tennessee 

has the leading cause of deaths due to heart disease in this country. In 2002, 29 

percent of the States deaths were due to heart disease and in addition, stroke 

ranked 3rd causing 7 percent of the States deaths. Cancer caused 22 percent of the 

deaths. Despite the above statistics, in 2005 the Behavior Risk Factor Surveillance 

System revealed adults continue to have increase in health risk factors as 30 percent screened reported increase blood pressure, which ultimately leads to strokes 

and heart disease, and 32 percent of those screened had high blood cholesterol. In 

Tennessee, deaths from strokes are reported 43 percent higher in African-Americans 

then Caucasians. The rate of death due to diabetes in Tennessee is 146 percent 

higher among African-Americans than among Caucasians. Hispanic Americans are 

one of the fast growing minority groups and they are obese at an alarming rate and 

suffer similar consequences. 

Children and adolescents are not unscathed in this dilemma. Obesity has risen 

threefold in this age group. In children, the prevalence increased from 5.0 percent 

to 13.9 percent; aged 6–11 years increased from 6.5 percent to 18.8 percent; and 

19 

those aged 12–19 years increased from 5.0 percent to 17.4 percent. These children 

and adolescents are at increase risk of dyslipidemia, hypertension, metabolic syndrome and type 2 diabetes. In addition, CDC reports 80 percent of children between 

the ages of 10–15 years who are overweight or obese will persist to adulthood. Yet 

only 25 percent of obese adults were overweight as children. If a child of 8 years 

of age is obese, they will suffer severe obesity as an adult. Metabolic syndrome is 

a useful tool in assisting to diagnose adults but it has not been documented to diagnosing children and adolescents at risk. A serious consequence to early obesity is 

the risk of early heart disease and strokes. 

Dr. Nicolas Stittler out of the University of Pennsylvania School of Medicine 

‘‘hypothesized rapid weight gain during early infancy is associate with obesity in 

African-American young adults, a group at increase risk of obesity.’’ The critical period that he proposes, is between birth and 4 months where there is a rapid increase 

in weight for age greater than one standard deviation. Of the 29 percent patients 

with rapid weight gain, 8 percent were obese by age 20 years. This proposal requires 

further investigations. 

Contributing factors are multifactorial, environmental, behavioral, genetic, metabolic, cultural, socioeconomic status, energy imbalance (consuming more than physical activity). Other health risky behaviors also play a major role. In Tennessee, 36 

percent of Caucasian high school students and 12 percent of African-American students smoked in 2001. Fifty-eight percent of high school students are not enrolled 

in an organized physical education class, but with the high rate of crime, as kidnapping of children, outside play is also hampered. These students are prime set-up for 

obesity and its health consequences. 

In addition to behavioral and risky behaviors, socioeconomic status has shown a 

relationship to obesity. ‘‘For all racial and ethnic groups combined, women of lower 

socioeconomic status (income < 130 percent of poverty threshold) are approximately 

50 percent more likely to be obese than those of higher socioeconomic status. African-American girls from lower SES experience a higher prevalence of overweight/ 

obesity than those from higher SES families’’ (American Journal of Clinical Nutrition 2006 October; 84(4) 707–16). The exact etiology is not known, but the high cost 

of nutritious fresh foods as fruits and vegetables and lean meats prohibit the possibility to improve eating habits. In the past, the increase in television viewing or use 

of electric games was proposed as key factors. These items may play a role but it 

is not the total answer. (McMurray, et al., 2000). 

Tennessee has mounted a tremendous response to assist its constituents to decrease their risk of heart disease and stroke. It has partnered or collaborated with 

multiple agencies to improve the quality of care and institute preventive measures. 

The State is a part of the Delta States Stroke Consortium which is led by Arkansas 

Department of Health; the State formed a Heart Disease and Stroke Prevention 

Program (HDSP) Advisory Council Task force which has implemented guidelines for 

treatment of strokes, heart failure and coronary heart disease in 40 hospitals, as 

well as a comprehensive preventive plan for the entire State. HDSP has collaborated 

with Joint Commission on Accreditation of Healthcare Organization (JCAHO) to certify hospitals as primary stroke centers. HDSP has also partnered with American 

Heart Association to increase awareness of signs and symptoms and institute ways 

to decrease Tennesseans risk factors of heart disease and stroke. 

Meharry Medical College has two programs underway to address some of these 

issues. One is in Obstetrics and Gynecology where Dr. Sandra Torrente is the 

Project Investigator. She is investigating overweight and obese women who are 

pregnant to denote if they can safely go on a diet and have a good birthing outcome. 

Dr. Xylina Bean is beginning a project on overweight and obese adolescents by providing a mentor in addition to nutritional counseling and exercise to improve a successful outcome. Dr. Tropez-Sims has completed a study reviewing if overweight or 

obese mothers during pregnancy transfer their poor eating habits and produce overweight and obese infants during the first year of life. The conclusion of this study 

is there is no clear relationship in the first year of life. 

In conclusion, thus far, we have learned that obesity is a multifactorial issue and 

it will take everyone to become a part of the solution. As we see from some studies 

the battle against obesity and its consequences begins as soon as we are born. It 

must be stated that not only overweight and obese children and adolescents are at 

risk for these consequences but even non-obese individuals run similar outcomes albeit lower rates secondary to inappropriate dietary consumptions, smoking and lack 

of physical activity. In our schools not only the three ‘‘R’s’’ must be taught but preventive and healthy life styles must be integrated as a life-long learning experience. 

Good nutrition is not a diet and changing the mindset of the population of this issue 

is required. Research must continue to look at all aspects of obesity including the 

psychological aspects, which is mostly overlooked. Going back to basics as growing 

20 

ones own vegetables and fruits even in a city can assist in improving ones health. 

Children and adolescents need guidance in lifestyle healthy behavior. Parents need 

to increase their knowledge first to allow children to inherit their examples. Tennessee has multiple guidelines and plans in place to implement a change in behavior of its constituents. It is a daunting task but with everyone playing a major role 

the State can be successful. 

BIBLIOGRAPHY

Baba Reizo, Kokotsdu, Masaaki, et al. Role of Exercise in the Prevention of Obesity 

of Homodynamic Abnormalities in Adolescents, Pediatric International 2008 Oct. 

8. 

Bray, Jablonski Fajnoto, et al. Am J Clin Nut 2008 May; 87(5): 1212–8. 

Arch Pediatr Adoles Med 2007 July; 161 (7): 677–83. 

Chronic Diseases, Risk Factors, and Preventive Services, Tennessee, Burden of 

Chronic Diseases, CDC 2004; 1–4. 

Gianna Perez Gomez and Fatma G. Huffman. Risk Factors for Type 2 Diabetes and 

Cardiovascular Diseases in Hispanic Adolescents, Journal of Adolescent Health 

2008; 444–449. 

Gordon-Larsen P., Adair L.S., Papkin B.M. UNC Chapel Hill, The Relationship of 

Ethnicity, Socioeconomic Factors and Overweight in U.S. Adolescents, Obese Res 

2003 Jan; 11(1): 121–9. 

McMurray R.G., Harrell J.S., Ding S., Bradley C.B., Cox R.M. and Bangdewala S.I. 

The Influence of Physical Activity, Socioeconomic Status and Ethnicity on the 

Weight Status of Adolescents, Obese Res 2000 Mar; 8(2): 130–9. 

Moore D.B., Howell P.B., Treibis FA. Changes in Overweight Youth Over a Period 

of 7 Years Impact of Ethnicity, Gender and Socioeconomic Status, Eth Dis 2002 

Winter; 12(1): 51-83-6. 

Wang Y. and Zhang O. SEC and American Children and Adolescents of Low Socioeconomic Status of Obesity at Risk 1971–2002, Am J Clin Nutri 2006 Oct; 84(4) 

707–16. 

Senator ALEXANDER. Thank you, Dr. Tropez-Sims. 

David Griffin, we appreciate your coming and look forward to 

hearing more about your story, which by now is pretty well known 

across the country. 

STATEMENT OF DAVID GRIFFIN, PARTICIPANT, SEASON 4 OF 

NBC’S ‘‘ THE BIGGEST LOSER ,’’ CEDAR HILL, TN 

Mr. GRIFFIN. Unfortunately, sometimes it is a little too known. 

[Laughter.] 

Senator Alexander, I’d like to thank you for what you are doing 

for our great State and for inviting me to be involved in this witness panel. 

I’d like to make one thing clear, and I want this on the record. 

It’s not fair to put the former fat kid with all the smart people. 

[Laughter.] 

I definitely don’t have the statistics to prove what the epidemic 

is, but I do have eyes. All we have to do is take a walk through 

a shopping mall, we have to go to a school, and we can see what 

our problems are. They lie more than just in economic regions, 

more—more, to me, profoundly, is with our children’s health and 

the health of their parents. 

So, briefly, about me, I am 33 years old. I’m from Cedar Hill, TN. 

I was an obese child. I was the fat kid. I was the kid that was ridiculed. Even though I was an athlete, I was always heavier than all 

of my peers. It was important, growing up, you know, for the football coach to keep the defensive linemen heavy, ‘‘Give the kid an 

extra hot dog.’’ You know, I remember baseball coaches even saying, ‘‘I’ll buy you a hot dog for every home run you hit.’’ It wasn’t 

even about the hot dog. It didn’t hurt. 

21 

Those habits of eating unhealthy—because I grew up in the 

South, like most people here did. My grandmother could fry a banana, and it tasted good, so we ate it. 

[Laughter.] 

We knew nothing, you know, about healthy nutrition. I didn’t 

know, really, anything about healthy nutrition until I started my 

journey to get healthy. 

I grew up eating poorly. I exercised during the school year during 

athletics, but I did nothing outside of that. With all the knowledge 

that we have now—I mean, we have more knowledge about obesity, 

about health and fitness and nutrition, available to us in the world 

than we ever have, and we’re in a poorer State of health than our 

country’s ever been. 

With that being said, my weight continued to escalate. I stayed 

around 275 all through high school. I remember that, because I 

wrestled heavyweight, and there was a weight limit of 280 pounds. 

I didn’t cut weight. I just didn’t gain any. I remember laughing at 

the skinnier guys, the lighter-weight guys that would run around 

the gym with trash bags on and not eat for 3 days so they could 

make weight. I was eating an extra piece of pizza in the lunchroom. There again, that bad nutrition was available. It was readily 

there. I didn’t know any better. I could do it. It was comfortable. 

I got away with it. 

From graduating high school at 275 to age 31, I was 400 pounds. 

That was my heaviest. I know it’s kind of rude to correct a Senator, 

but, you know, leave it to the fat kid. 

[Laughter.] 

I went to the doctor as a scared adult. I was a heavy smoker. I 

never really passed by a fast-food restaurant without at least visiting to say hello. 

[Laughter.] 

I was on a first-name basis with most of the people at McDonald’s in the area. I didn’t exercise at all. We have a small place in 

Robertson County where we raise some livestock, and we are very 

physical in our daily lives, along with being, you know, full-time career people, my wife and myself. Even that work ethic never kept 

me slim, it never put me on the right direction to healthy life. 

At the point of 31, I didn’t go to a doctor, ever. I never got on 

a scale. That would be a joke. I fooled myself for a lot of years that, 

‘‘Maybe I’m 300 pounds.’’ Maybe. Then, when I went to the doctor 

and realized—you know, my doctor told me that I had two choices. 

I was 31. I could do one of two things. He said, ‘‘Your blood pressure is high, your sugar is borderline.’’ You know, I was a borderline diabetic. He said, 

‘‘You can leave today and make a decision to change your life 

and make gradual changes and lose some weight here and 

there and get active, do something besides what you do on a 

normal basis, because your body gets used to that. Talk to a 

dietician, talk to a nutritionist, get a personal trainer, go to the 

Y, workout, make it inexpensive,’’ 

because there are means in most communities that you can go to 

a facility fairly inexpensive, as a family. If not, there are a lot of 

parks that I have not seen a ticket booth at yet to get in to take 

advantage of the playgrounds and the basketball courts. He said, 

22 

‘‘You can either start now, or you can do nothing. In 5 years 

from now, when you fall dead on the sidewalk, it’ll be no medical mystery why.’’ 

That was a huge wake-up call for me. Being a father of four and 

a dedicated husband, it was important to me to do the right thing 

for my family. 

Even though I was extremely unhealthy—I didn’t watch a lot of 

television, I knew nothing about ‘‘The Biggest Loser.’’ But, I did get 

started. The only thing I did in the beginning was change my diet. 

From January 2007, I changed my diet. An old friend of mine, in 

February, suggested trying out for the show, ‘‘The Biggest Loser.’’ 

I’d never seen it, had no clue what it was. One—if I could give you 

guys any advice besides that obesity epidemic, if you’re going to try 

out for a reality show, just find out what it’s all about. 

[Laughter.] 

I went down in Nashville, went to an open casting call, stood in 

line with everybody, and was fortunate enough to be selected to go 

to Season 4. It wasn’t like we went out there and we just had a 

little medical test and they said, 

‘‘OK, you guys need to lose weight, and our chef’s going to 

cook this for you every day, and, you know, we’ll go to the spa 

after you work out, and you’ll get a back rub.’’ 

It was horrible. 

[Laughter.] 

Everybody thinks that being on television’s a great thing, you 

know, and it’s—it’s a flashy-type deal. There was nothing flashy 

about what I did. We trained 6 or 8 hours a day, boot-camp style. 

We were in the gym, we were in the sand, we were outside, were 

on the beach, we were in the mountains, whatever it took. The way 

we lost our weight there is not necessarily that I condone losing 

weight. It’s not healthy to work out 6 or 8 hours a day. It’s not 

healthy to lose 140 pounds in 6 months. It wasn’t about a game for 

me. I never played the game. I never focused on the cash prize. I 

do a lot of speaking, and people ask me, all the time, if I’m upset 

that I didn’t win the $250,000 or I didn’t win the $100,000. I did 

end up in the top 5 percent out of 18 people that were on our season. My answer to that is, I didn’t win a monetary prize, but what 

I did win was my health. And you can never put a dollar figure 

on that. 

Now I can lead the example for my children, what it is to be 

healthy, what we can do. Even though all my children are fit, were 

fit, have always been fit, I want to show them how their parents 

should live fit, the foods that should be in our cupboard at home. 

And yes, my kids hate me sometimes, because we don’t have PopTarts anymore, we don’t have sugary cereal at my house anymore. 

We all treat ourselves, from time to time, but it can’t be a daily 

treat, because then it becomes a habit, and those habits, along with 

the more sedentary lifestyles that we have in our new age, have 

put us where we are. 

I want to give you guys one example. I have recently passed my 

personal training certification, and, as a study—I’m not necessarily 

focused on children, but I have a niece who’s 10, who is about 45 

pounds overweight. That’s a lot of extra weight for a 10-year-old, 

23 

especially a little girl. For some reason, men have always been able 

to get away with a little extra weight, more than women. 

She’s, of course, close to my heart, because she was family. She 

always struggled—socially, personally—with her weight. All I did 

was sit her down, and I sat her mom and dad down, and we basically talked about nutrition. I’m not a dietician, I’m not a nutritionist, but what I’ve learned, I can give you commonsense advice. 

I gave her a cookbook. I told her, ‘‘Three days a week, do something 

different than just sit on the couch and watch television or play 

video games.’’ They have a park right across the street from their 

house, so I said, ‘‘Three days a week, it’s your job, 45 minutes you 

spend at that park.’’ It’s not like they’re just going to sit over there 

for 45 minutes on the ground and twiddle their thumbs; they’re 

going to find something to do. In the last 6 months, she’s lost 25 

of those 45 pounds. That’s pretty fast. She’s a child, she can lose 

it faster and get away with it. Just simply changing her diet and 

getting her out of the house, it’s changed her whole life. 

That’s what we can do to change the lives of the children that 

we affect. I do my spokeswork with Get Fit Tennessee because it 

is important to me to get in front of the children. We’re going to 

win our war with obesity with this generation. We need to affect 

their parents, because that’s going to affect what they have in their 

homes, that’s going to affect their lifestyle, that’s where their examples are going to come from. As adults, it’s our job to reach out 

to these children personally and try to find a way to help. We can’t 

move them all in our house, we can’t save them, necessarily, we 

can’t capture them, but we can help them. We can lead by good examples, and we can continue with the great programs that we’ve 

started in this State and reach more people. 

I do think some of the things in this panel—well, actually, everything that I’ve heard were great examples, but one thing that’s 

really near and dear to my heart is the nutrition in our schools. 

I know there are budgetary concerns, but I know that buying in 

mass quality [sic], you can get better rates on anything. There are 

a lot of schools, even where my children go to school, in Robertson 

County, that physical education is not mandatory. I think it’s 90 

minutes a week for our kids. I think we’re focusing a lot on their 

formal education, which is extremely important, but if we don’t 

focus on their health education, it doesn’t matter how much book 

smarts they have, because without their health, they’re not going 

to go anywhere. 

And that’s about as smart as I get. Thank you, guys. 

[Laughter.] 

[The prepared statement of Mr. Griffin follows:] 

PREPARED STATEMENT OF DAVID GRIFFIN

Good morning. My name is David Griffin. I am 33 year’s old and live in Cedar 

Hill, TN in Robertson County with my wife, Sheri and four beautiful children. 

I know what it feels like to deal with childhood obesity. As a child, around age 

9 or 10, I started to rapidly gain weight. I didn’t receive nutritional education from 

my parents. And although I was in athletics, I didn’t exercise outside of athletics. 

As a child, I was ridiculed for being the big kid, the fat kid. 

During my childhood I developed stressed eating habits. I turned to food for comfort, and I continued to gain weight throughout my high school years. I graduated 

high school weighing 275 pounds. The problems didn’t stop when I left high school, 

and at 31, I weighed 400 pounds. 

24 

I went to see my doctor and he gave me the bad news—my blood pressure was 

borderline high, my blood sugar was borderline, and it was a wake-up call for me. 

As I mentioned, I have four children, and I knew I needed to get busy getting 

healthy, so I could spend time with my children and be here to see them grow up. 

My children were all fit, but I wanted to lose the weight and get healthy to set 

a positive example for them. I wanted to form the healthy habits I wanted to see 

in them, and set them up for a healthy future. 

An old friend of mine suggested trying out for the television show, ‘‘ The Biggest 

Loser.’’ I had never watched the show before. I went down, tried out, and I was 

lucky enough to be selected for Season Four. I lost 30 pounds before the show, because my doctor said I needed to get healthy, and there was no guarantee that I 

would get on the show, so I began working even before being accepted for the show. 

We began filming the show in May 2007. From that time until December 2007, 

when it ended, I lost 140 pounds. After the show, I lost about another 10 pounds. 

To date, my total weight loss is about 180 pounds! 

Losing the weight and getting healthy has transformed my whole life. It wasn’t 

about a diet; it was about learning what to do to be healthy, for my family to be 

healthy. We restructured our lives together. We removed sodas, teas and junk food 

from our home. Our children are not exposed to it because they know it’s not 

healthy for them. 

For me it was a choice to get healthy. Everyone has to make the decision for 

themselves. Knowing what I know now, I have learned that you can treat yourself 

from time to time and it’s important to do that so you don’t binge eat. If you are 

training hard and staying on track with your exercise, you feel it when you eat 

unhealthy foods. 

I went from not working out at all before ‘‘The Biggest Loser,’’ to spending 6 to 

8 hours a day working out on the show. Today, I do an hour every day, 6 days a 

week. No excuses. In moments of weakness I try to remind myself that nothing 

tastes as good as fit feels. 

Since the show it’s been important to me to sign on with Get Fit Tennessee, and 

get in front of children to talk about healthy choices. I recently passed my certification exam to be a trainer to teach people to be healthy, and I am starting a boot 

camp aerobics class in the middle Tennessee area in November. 

In my opinion the war with obesity will be won with this generation of children. 

As you know, statistics show us this generation of children is the first that won’t 

outlive the life expectancy of their parents. Our society and our government must 

push for more physical education testing in our school systems. I believe children 

need physical education 5 days a week. 

I think moving soft drink and vending machines from schools will be very effective. If they want it that badly they can bring it to school. And to the critics who 

say they need these vending machines for revenues to pay for things at school, I 

say put water and sugar-free drinks or juices in them. Work with vendors to offer 

healthier alternatives. 

Our children’s health should be a priority in school systems. School nutrition also 

needs to be addressed. The menu choices should be healthier. Again, working with 

vendors to make healthier selections to offer to children is an important step we can 

take. As far as children go, a healthy mind is an open mind. 

Now that I am healthy, I can do so much more with my children. We play outside, 

I can run and play touch football, go for a walk, or roll around on the floor with 

my children. My wife and I are closer, too, because we can get closer. We take cycling class together, walks, and those are things we couldn’t do together for a long 

time. I wouldn’t trade these things I have now for any food out there today. 

Senator ALEXANDER. Thank you, David. That’s very impressive. 

Thank you. Thank you. 

Let’s talk a little bit more. To let you know, we’re recording all 

of this, so your testimony will be given to all the other Senators 

on the committee, and it’ll be a part of the public record, and they’ll 

have a chance to review it. This builds our record for what we’re 

hoping to do later. 

Let’s talk about ways to make a difference. I’ve always been curious about—money seems to be a pretty good incentive in our society. How has the insurance plan worked? Has it been in effect long 

enough—you said—it’s part of Cover Tennessee, right? 

Ms. COOPER. That’s correct. 

25 

Senator ALEXANDER. And Cover Tennessee is the State of Tennessee’s program to spend Federal—well, explain what Cover Tennessee is and who’s a part of it. 

Ms. COOPER. There are three different components to the overall 

Cover Tennessee program. There’s the CoverKids Program, which 

is the SCHIP Program. 

Senator ALEXANDER. Right. 

Ms. COOPER. There is Access Tennessee, which is—— 

Senator ALEXANDER. Which is a combination of Federal and 

State money. 

Ms. COOPER. Correct. Then, there’s Access Tennessee, which is a 

high-risk pool for those persons who are classified as uninsurable 

by insurance standards. Then, there’s CoverTN, which is a limited 

benefits plan for the working uninsured, so small businesses or 

those folks that had worked sometime in the past year—— 

Senator ALEXANDER. These all are part of Cover Tennessee. 

Ms. COOPER [continuing]. That’s correct—and now would be unemployed. 

The way it works for CoverTN, which is the working uninsured 

program, the average premium is about $150 a month; a third is 

paid by the person, a third is paid by the employer, and then a 

third is paid for by the State. And your premium, based on your 

age, which, unfortunately, we haven’t figured out what to do with, 

but your weight or tobacco use either—it comes down, basically, if 

you are at a healthy weight or if you do not use tobacco products. 

Senator ALEXANDER. Now, how do you determine healthy weight? 

Ms. COOPER. A healthy weight is a BMI under 30, so it’s not that 

we’re asking everybody to be marathon runners and all be very 

lean. 

Senator ALEXANDER. Well, how do you determine that, even? 

Ms. COOPER. The BMI? 

Senator ALEXANDER. Yes. 

Ms. COOPER. Through a physical screening—— 

Senator ALEXANDER. OK. 

Ms. COOPER [continuing]. A physical exam. 

Senator ALEXANDER. So, you go in for a physical exam, and they 

measure your body mass. 

Ms. COOPER. Correct. It’s self-reported at first, and then everyone 

has a physical exam during that first year, to verify that. Same 

way with tobacco usage. Self-reported, ‘‘Do you smoke? Yes or no.’’ 

Then, if you do or if your weight is above 30—if you’re enrolled in 

a program and you’re taking action to reduce your rate, and the 

healthcare provider can see a change over the first year, you’ll pay 

a lower premium the next year. 

Senator ALEXANDER. Does this—the insurance is a factor in one 

of the three—— 

Ms. COOPER. Yes. Well—— 

Senator ALEXANDER. Cover Tennessee—— 

Ms. COOPER [continuing]. Also in Access Tennessee. The kids 

program, you can’t use weight and tobacco usage as a modifier, it’s 

just—everybody qualifies if their income is less than 250 percent 

of the Federal poverty level. 

Senator ALEXANDER. Now, you can’t because of the Federal rules? 

Ms. COOPER. Right. 

26 

Senator ALEXANDER. Although, Dr. Barkin, what we’ve heard, or 

what both of you said, I think, was that there’s this link between 

babies who are overweight and—and one of you said it was the 

first 4 months. How pronounced is that? 

Dr. TROPEZ-SIMS. Dr. Stiffler said that if you were overweight or 

if you gained weight at a rapid pace between the first 4 months of 

life, then 8 percent of those will be obese by the time they’re 20. 

Senator ALEXANDER. Well, now, what is a way to get at that? I 

remember when I was Governor, my wife was working on a—we 

were working on prenatal healthcare, because it made so much 

sense to do it that way. Probably the most effective thing we did 

was to form an alliance with pediatricians and try to make it possible for every mother—every pregnant woman to find a pediatrician before the baby’s born, if we could. We made a lot of progress 

with that. Is that—does the profession of pediatrics use a healthy 

weight as part of its advice to young mothers? 

Dr. TROPEZ-SIMS. Yes, we do. We follow a growth chart, that’s 

national, from out of the CDC, and we’re able to plot—and it’s expected that every child, for every visit, whether it’s a well or a sick 

visit, that they—we plot their weights, their heights, and their 

head circumferences, so we can tell if a child is gaining weight 

more rapidly than they should. 

Senator ALEXANDER. I guess I’ve heard that, my own children 

and many of my grandchildren, but I’m not sure I had heard before 

about the link. Is that a new understanding, or do mothers and fathers of babies know that now? 

Dr. BARKIN. The link actually has been shown in longitudinal 

studies, many of them done in other States, such as—— 

Senator ALEXANDER. Yes. 

Dr. BARKIN [continuing]. Finland, over 30 years. I believe when 

we’re counseling our families, we know, and through our research, 

that families see a chubby baby. And I work with a lot of Latino 

families—we call these ‘‘gordito babies,’’ they’re chubby babies— 

that equals health. While information is an important part, it is a 

necessity, but not sufficient for changing behavior, so that while we 

might both, in our clinic settings, talk, as we do every time we see 

families, on growth and what is healthy growth, our perception 

versus parental perception is quite different, and that has been 

shown over and over again in studies. 

Senator ALEXANDER. Well, going back to the insurance for a 

minute, that would seem such an obvious thing to do. Has it been 

in place long enough where you can make any judgment now about 

whether it has any effect or not? 

Ms. COOPER. I think it’s still very new. It’s about 2 years old. 

We’ve got our first year of data, and I think it’s made some difference. Whether it’s replicable across other populations, it’s too 

early to tell. 

Senator ALEXANDER. It seems to me like Governor Huckabee in 

Arkansas were doing some of the same kind of thing, were they 

not? 

Ms. COOPER. They were. They actually have quite a bit of interest, in Arkansas, around our Cover Tennessee program—— 

Senator ALEXANDER. Yes. 

27 

Ms. COOPER [continuing]. The way we’ve stratified and identified 

risk. 

Senator ALEXANDER. Maybe he had a program for State employees insurance, where he tried to introduce healthy weight into that. 

Ms. COOPER [continuing]. I can’t speak to that. I know, in Alabama, they’re getting ready to charge State employees if they’re not 

at a healthy weight or if they use tobacco. There’s some type of an 

increase in premium. I can’t speak to Arkansas. 

Senator ALEXANDER. We would have to introduce that into various insurance policies for a few years and see what difference it 

makes. 

Ms. COOPER. I think, look at the data. I also think, again, a lot 

of our solutions are community-based. I think insurance will come, 

down the road. It gets back to some of the cultural differences we 

see. When you talk about money, one of the things we hear is, ‘‘It 

costs too much to be healthy.’’ You know, it costs too much to eat 

healthy. It costs too much to join a gym. I think David hit on something that was really important. This ability to create a healthy environment for people, where they eat, where they work, where they 

play, where they live, where they study. This ability to link all of 

that, to open school playgrounds at night, where families could go, 

to make linkages with the great State parks we have in—certainly 

in our State—to create healthy grocery stores in these food deserts 

that we have, to create healthy foods in schools—as David said, you 

know, when you look at the foods that come down from the USDA 

in the free breakfast and lunch programs, there are some limits to 

the healthfulness of the food, because of the trans fats and the calorie count that all come down. I think, to be able to incent schools 

to have healthier meals is certainly important. 

Senator ALEXANDER. David, let me ask you—a lot of this is about 

changing behavior, which is something the government has a hard 

time doing, at least in a relatively free society. What was the one 

thing that turned you around? Was it that visit to the doctor? What 

caused you to make the visit to the doctor? 

Mr. GRIFFIN. My health was poor. I was constantly out of breath. 

Like I said before, I was a heavy smoker, which was a no-brainer 

why I was out of breath. I just continually got more sluggish and 

was worried about my activity. I couldn’t even go outside and play 

with my kids. You know,—get on the floor—— 

Senator ALEXANDER. So, that took you to the doctor. 

Mr. GRIFFIN. It really did. 

Senator ALEXANDER. Then the doctor’s message is what got you 

turned around? 

Mr. GRIFFIN. Yes, that was a big part of it. And, too, it was important to me—I had made a promise to my wife, a long time before, that, you know, ‘‘I’ll get healthy.’’ I just kept—like, I had lost 

100 pounds one time before, and I gained 160 back. So, to me, it 

was a trend. And—— 

Senator ALEXANDER. Yes. 

Mr. GRIFFIN [continuing]. All the history and all the studies will 

show that changing human behavior is never easy. 

Senator ALEXANDER. No, it’s not. Now, you’ve talked to a lot of 

people since then, and—— 

Mr. GRIFFIN. Yes, sir. 

28 

Senator ALEXANDER [continuing]. People have talked to you. 

What’s your guess about what are the most effective ways to 

change human behavior in this case? 

Mr. GRIFFIN. The things that I’ve found in my studies is, people 

change when it becomes easier to change than it does to stay the 

same. 

Senator ALEXANDER. Easier to change. 

Mr. GRIFFIN. Yes. When it’s easier—— 

Senator ALEXANDER. Oh, easier—— 

Mr. GRIFFIN [continuing]. For them to change their behavior or 

their habit than it is to stay the same. The medical studies show 

that people change when they get to that point that if they don’t 

do something, they’re going to die. 

Senator ALEXANDER. Yes. 

Mr. GRIFFIN. It’s easier for them to get healthy then, or to try 

to attempt it, when, I think, we’re going to win the battles more 

on the forefront when we’re getting in front of our children and 

we’re getting in front of our adults with healthier programs. I 

think, too, if—I don’t have a vision for this. As a thought, I think 

if we could find more programs that put our children and adults 

together—parents, families doing healthier activities, doing 

things—you know, there’s always these walks, these 5K’s and these 

runs, and—but, there are so many other things that, as communities and as a State, I think we can try to create some programs 

to keep our families closer. 

Senator ALEXANDER. Well, you all have emphasized that there 

are a multitude of factors. As someone my age can look back to an 

era where there was no television, no video games, walk to school, 

Boy Scouts every week, hiking on the weekends, playing every day. 

I had to do my piano lessons—practice the piano in the morning 

so I could play all afternoon. That was sort of the incentive—I 

didn’t want to be practicing the piano while all the boys were out 

playing in the afternoon. There was an incentive to be outside. Now 

today, we’ve gone a couple of generations, and we have parents 

who know so little about the outdoors, they’re even afraid to take 

their children outdoors, they’re afraid they’ll see a bear or something and won’t know what to do. 

[Laughter.] 

No, really. I grew up in an area where all the adults had outdoor 

experiences, and so, they were eager to teach them to us, and then 

we became confident in the outdoors. 

Dr. Barkin, you were about to say something. 

Dr. BARKIN. May I comment on something? 

Senator ALEXANDER. Yes. 

Dr. BARKIN. First, I see that David, to me, is the biggest winner, 

not the biggest loser. And you hear his story, which is so compelling, because he found his own motivation to change, and then he 

was pushed over, he was nudged toward action by both his family 

and his physician and, I’m sure, every time he looked at his children. He made a lot of choices, and it was hard, but he kept striving for it. We see—at our weight management clinic, we see 3-yearolds who weigh 200 pounds, who have fatty livers. 

Senator ALEXANDER. Three-year-olds? 

29 

Dr. BARKIN. Three-year-olds. We see families who don’t see this 

as a problem. We show them our growth curves and the body mass 

index is determined by a weight-to-height ratio, so we’re able to 

give them that information, show them the curves that you heard 

Dr. Tropez-Sims discuss, and show them that they are way outside 

of the curve, that they’re far away from health. When they look at 

their child, they see an active child who looks cherubic and healthy 

to them. While we provide them with information, at that stage— 

so, David tells a very important story as an engaged adult, an engaged father—for these families, they see health. The problem with 

so many of these diseases, like hypertension and diabetes, which 

we are diagnosing right and left in our clinic, for young children, 

is that you can’t see them, they’re invisible. 

Senator ALEXANDER. Has anything been successful? What’s been 

most successful for you in changing the minds of these parents? 

Dr. BARKIN. It’s something very important that David said and 

what the literature shows. If obesity is socially contagious, how can 

you create health to be socially contagious? Much of that is done 

through social networks, by developing programs that are sustainable in communities and in schools that bring the community together—the child, in the context of their family; and the family, in 

the context of their community. 

Dr. TROPEZ-SIMS. I was going to add that I’ve found that, especially with my adolescents, the more children that lose weight, it’s 

because the mother was also overweight and they worked together 

to try to lose the weight. If they can make it a family affair, they 

can be much more successful. If you have parents who say, ‘‘Well, 

you know, I’m not changing my cooking habits, they can just not 

eat the foods that I buy,’’ those children have no support, and, 

therefore, they do not lose weight. 

Sometimes the adolescents don’t even see themselves as being 

overweight. You have to get them to the mindset to understand 

that they are overweight and they need to do something about it. 

Senator ALEXANDER. I wonder if any of you want to comment on 

the—I was very attracted to the idea of healthy weight being a goal 

that every child have by the year 2018. It’s always a conflict between whether you scare people to death or whether you tell them, 

‘‘Here’s a goal. We can do this together.’’ I know, in my case, I 

stopped smoking when my friend John showed me a picture of a 

pair of lungs of a smoker. The next day, I quit. Some nice-sounding 

goal probably wouldn’t have done it for me before. It would seem 

to me that having such a goal would at least be a good way to 

start, and then, after that, you can develop various horrible stories 

about 300-pound 3-year-olds and the consequences of that, to help 

people see it. Tell me what you’re doing with that goal. 

Ms. COOPER. What we’ve found is—we’ve traveled across the 

State and talked to Tennesseans, mothers and their kids, dads and 

their kids—is that people want to do the right thing, but they’re 

bombarded by the media, by the restaurants, supersize, biggie-size, 

value-size. They get all of this information coming at them, and 

they don’t necessarily know what the right thing is. You have to 

put something out there that’s achievable for them. You know, if 

you came to me and said, ‘‘You’ve got to lose 100 pounds,’’ I 

wouldn’t hear anything else you said. If you came to me and said, 

30 

‘‘Look, let’s just start where we are. Did you get up and move at 

all today? Did you do any physical activity? ’’ Well, if the answer 

is no, then you can say, ‘‘Well, how about 5 minutes of playing with 

your kids in the backyard,’’ or, ‘‘Are you willing to go out for a 

walk? ’’ Then, what we’ve found is, 5 minutes becomes 10 minutes, 

10 becomes 30, 30 becomes and hour. It’s something that families 

can do together. 

We also hear that people want to know that they’re valued. I 

mean, as we’ve traveled across the State, again, people appreciate 

that you go out and spend time with them, with a message that, 

again, is attainable: get fit, healthy ways. Not, ‘‘ You’re fat, you 

don’t do this, you don’t do that, you don’t do that.’’ The message 

just doesn’t resonate. You take those teachable moments, and then 

you build upon that. As you said, we’ve seen this in the literature 

with tobacco, over and over again, about creating the environment 

of health. If you take tobacco out of a restaurant, more people tend 

not to smoke, because it becomes what is known. I think the same 

thing works for obesity. 

Think about the labels on food, as you drive through your favorite fast-food restaurant. If you saw, on a kid’s meal, that that kid’s 

meal—not an adult meal—contained 1,400 calories, that’s 1,400, 

not 140—you know, for an average adult—I mean, I need about 

1,500 calories a day; getting it in one kid’s meal, think what it’s 

doing to a child. Unacceptable. Thinking about what we could do 

with our restaurant foods is important. 

Senator ALEXANDER. Let me do this. We’ve about gotten to the 

point where we should conclude, but I want to ask each of you if 

you have a minute or two, any other thought that you’d like to add 

to the record or something you’d like to say. 

This has been a very important discussion. I think it’s enough of 

a startling thought to say to anybody that this is the first generation of children that may live a shorter life than their parent, and 

that we know what the cause is. We’ve got to figure out how to deal 

with it, and each of you, in your own ways, have made a very significant contribution to this. I’ll do my best to make it a part of the 

Senate record and a part of how the Federal Government supports 

what you’re doing. 

As a former Governor, you know, I’m very skeptical of the Federal Government’s ability to change behavior. I really think we do 

more, locally and individually and in our families. Obviously, the 

Federal Government can help create an environment in which it’s 

easier for this to happen. You’ve mentioned two or three examples, 

school lunches as an example. That is certainly a very important 

place, where we’re in everybody’s face with that, so we ought to be 

very careful about what is served there. 

Let me thank you for your work and for taking your time today, 

and thank Meharry for being such a great host. Let me start at the 

other end, if I may this time, and start with David Griffin and go 

back to Commissioner Cooper and see if you have any last word 

you’d like to leave with us here. 

Mr. GRIFFIN. Just a couple of things. Thank you, again, for allowing me to be here today. It’s been a pleasure. It’s nice to be on the 

good side of the law for a change. No. 

[Laughter.] 

31 

When I was talking about nutritional education before, and me 

not really knowing, and—I’m sorry, Dr. Barkin—I can’t see your 

name tags, it’s not fair—Dr. Barkin had talked about the food 

deserts north of Nashville. We live in Robertson County. There’s 

two grocery stores in Springfield, a Kroger and a Wal-Mart. And 

I, still today, shop there, but when I learned what to read on labels 

and what to look for in the grocery store and how to eat healthy 

and how to feed my body, to train the way I was trained—because 

all that 140 pounds was not lost in that 6 months in California; 2 

months of it was there, the other 4 was home, after I was eliminated from the show. I did my healthy eating from a Wal-Mart 

shelf. It can be done if we educate our people. They can shop where 

they have the means. It can be done more cost-effectively than eating at McDonald’s 4 to 5 days a week. It really can. A can of tuna 

fish is, like, 80 cents. You know? Tuna’s healthy. 

The other thing that—when we were talking about school 

lunches, it’s not just the school lunches, it’s also the unhealthy 

things that they have available to them at schools. I don’t think 

that I’ve walked through a high school that I’ve done a talk at that 

I didn’t see at least four soda machines. I mean, they’re a treat 

from time to time, and kids can get away with a lot more than 

adults can. That’s where we’re going to have to start their healthy 

education, in their schools. 

Senator ALEXANDER. Thank you, David. And your—— 

Mr. GRIFFIN. Thank you. 

Senator ALEXANDER [continuing]. Comment about the availability 

of food, Wal-Mart’s the largest seller of groceries in the country. 

The percentage they sell is—I heard it the other day, and I don’t 

remember it, but it’s surprisingly high, maybe 15 or 20 percent or 

10 percent of all the groceries in the country. 

Dr. Tropez-Sims. 

Dr. TROPEZ-SIMS. Yes, two comments I wanted to make. One is 

that I think we need to make sure that people no longer think that 

eating fruits and vegetables is a diet, that that is just normal food 

that should be incorporated in daily life, and that we need to try 

to change our perception of a diet. 

The other thing is, is that, a lot of times, with parents, especially 

new parents, when they take their children home, when the baby 

cries—they think that every time the baby cries, they need to feed 

them. We need to try to encourage them that every time a child 

cries does not mean they need to eat. Every time that child, as a 

toddler, asks for something to eat does not mean that you need to 

give them the junk food that they’re requesting. We need to make 

sure that, as adults, we feel more self-assured, ourselves, that 

we’re not starving our children, but they do not have to eat every 

time we think that they are hungry. 

Senator ALEXANDER. Thank you. 

Dr. Barkin. 

Dr. BARKIN. Thank you, again, Senator Alexander, for allowing 

us to have this kind of really engaged discussion. 

I would like to focus that information is necessary, but not sufficient. It’s not that people don’t know. For example, smokers know 

they shouldn’t smoke. It’s not that parents don’t know that their 

32 

children shouldn’t be eating every meal in a fast-food place. Knowledge is necessary, but not sufficient. What is sufficient? 

When we look at behavior-change theory, people do what’s easy. 

If you can find ways to support healthy default environments, such 

as the examples made about school lunches—if we’re not offering 

tater tots or french fries there, our children won’t be eating it. Considering how we create those healthy default environments is really 

critical for changing behavior that is sustainable. 

And last, this notion of affordable and accessible food—because 

if we say, for example, for insurance, you will get a lower premium 

if you are a lower weight, but, as you heard from Dr. Tropez-Sims, 

that lower socio-economic-strata individuals have a harder time 

with weight, and they don’t have access or affordability, then we’ve 

given them a goal that’s unattainable, which we don’t want to set 

forth as a precedent. 

Here’s just an example. I know that our surgeon general has 

been working with the National Institute of Child Health and 

Human Development. One of the things that they’re looking at is 

the economics of obesity. I just have a picture here of a plate of 

broccoli and a tiny little dollop of peanut butter. They have exactly 

the same amount of calories, 200 calories. For that dollop of peanut 

butter, it costs 17 cents. For this plate full of broccoli, it costs almost $2. We have to consider affordable and accessible access to 

food. 

Senator ALEXANDER. Commissioner Cooper. 

Ms. COOPER. Well, I’m going to take it, I guess, a different place. 

We’re going to move Tennessee, and we’re going to move it from 

being one of the unhealthiest States in this Nation to becoming one 

of the healthiest States in this Nation. And I will tell you, it’s also 

not really a goal that is sufficient, because our Nation is not the 

healthiest Nation in this world, and there’s no excuse for us not to 

be. We need to build health in all of our policies, whether they’re 

health policies, education policies, transportation policies. Health 

should be included in all of them. 

We should address those areas where we eat, where we learn, 

where we play, where we work, how we commute, where we live. 

I would challenge us to find the world that we move, to close our 

eyes and remember the time when it was OK to turn off the television, where it was great to go out to the backyard and play. Do 

you remember lying down on the ground and looking up at the sky 

and seeing these great, wonderful things you made out of clouds? 

Kids don’t know how to do that today. You’ve got to figure out how 

to influence their behavior to get them outside more. 

You know, I believe, fundamentally, we have to make a commitment in this Nation to change, to say that this is unacceptable, and 

to move, not just our State, but every State in this Nation to look 

at those children born in the year 2000 and their graduation date 

in 2018 and say, ‘‘All children, not just Tennessee children, will 

graduate at healthy weight in 2018.’’ 

Senator ALEXANDER. Thank you very much, Commissioner Cooper. 

Thanks, to each one of you. Thanks, to all of you for coming. And, 

Dr. Riley, thank you, again, for making Meharry’s great facilities 

available. 

33 

The hearing is adjourned. 

[Whereupon, at 11:21 a.m., the hearing was adjourned.] 

Æ