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Obesity and the Federal Government’s Role in Combating the Epidemic

On June 3, the House Government Reform Committee held a hearing to examine the federal government’s role in combating obesity. “The facts are, quite frankly, frightening: obesity-related diseases kill 400,000 Americans each year. Medical treatment of obesity and its more than two dozen associated conditions costs nearly $100 billion annually, according to some estimates,” stated Chair Tom Davis (R-VA). “As officials at all levels of government contemplate what message to convey to an increasingly overweight U.S. population, and how to convey it, the questions we want to ask today are many and complex: what should the government’s role in fighting obesity be? If we agree the government should have a role in advocating healthy living, what should that role look like? To what degree should we act, and at what cost to our pocketbooks and quality of life?” he added.

Ranking Member Henry Waxman (D-CA) agreed that “obesity rates are rising at an alarming rate” and stated that the government should create opportunities for individuals and communities to access appropriate information. However, he expressed his concern that politics was trumping science and mentioned several instances where he believed federal agencies had reversed direction based on pressure from the food industry. “Obesity and overweight are public health issues and have public health consequences,” he said, adding that policy “should be weighed against the science.”

Acting Commissioner of the Food and Drug Administration (FDA) Lester Crawford discussed the Department of Health and Human Services’ (HHS) initiatives to combat obesity. In 2002, President Bush launched the Healthier US initiative, which “helps Americans to take steps to improve personal health and fitness and encourages all Americans to: 1) be physically active every day; 2) eat a nutritious diet; 3) get preventive screenings; and 4) make healthy choices concerning alcohol, tobacco, drugs and safety.” Building upon that initiative, Secretary of Health and Human Services Tommy Thompson created the Steps to a Healthier US in 2003. “This program aims to help Americans live longer, better, and healthier lives by reducing the burden of diabetes, obesity, and asthma and addressing three related risk factors—physical inactivity, poor nutrition, and tobacco use,” stated Dr. Crawford. According to his testimony, in FY2003, $15 million was provided to 23 communities to “support community-based programs that are proven effective in preventing and controlling chronic diseases.” In FY 2004, HHS plans to allocate $44 million for such programs.

Dr. Crawford also discussed the work of the FDA’s Obesity Working Group, which was established in August 2003 and released its final report, “Calories Count,” in March 2004. “The group’s long- and short-term proposals are based on the scientific fact that weight control is mainly a function of the balance between calories consumed and calories expended,” he said. Specifically, the working group made the following recommendations: 1) the FDA should reevaluate food labels with respect to calories, serving sizes, carbohydrates, and comparative labeling statements; 2) HHS should initiate a “Calories Count” educational campaign geared toward children and young adults; 3) the FDA should encourage the restaurant industry to provide nutrition information on their menus; 4) the FDA should undertake stricter enforcement activities against food manufacturers that declare inaccurate serving sizes; 5) the FDA should revise and reissue its 1996 draft Guidance for the Clinical Evaluation of Weight-Control Drugs; and 6) there should be increased collaboration among federal agencies on obesity research.

Finally, Dr. Crawford noted that in March 2004, the National Institutes of Health (NIH) released its Strategic Plan for NIH Obesity Research. The plan identifies four areas of research: prevention and treatment through lifestyle modification; prevention and treatment through pharmacological, surgical, or other medical approaches; breaking the link between obesity and its associated health conditions; and cross-cutting, interdisciplinary research.

Chair of the President’s Council on Physical Fitness and Sports Lynn Swann emphasized the need to prioritize physical activity, noting that today there are fewer opportunities for children to participate in organized sports unless they are the most talented athletes. He suggested that people schedule exercise as they would schedule an appointment. “For me, it’s [exercise] not an elective,” Mr. Swann told the committee. “I schedule exercise because it’s important to me…We have to set an example. If the adults aren’t taking their kids out for physical activity, then who is?”

Representing the U.S. Department of Agriculture (USDA), Eric Hentges discussed recent efforts to update the Dietary Guidelines for Americans and the Food Guide Pyramid. By law, the USDA and HHS are required to jointly review and publish new dietary guidelines every five years. The sixth edition of the guidelines is set to be released in early 2005. “On a separate but parallel track, we are in the middle of also updating the Food Guide Pyramid, our current food guidance system. While the Dietary Guidelines for Americans recommend nutrition guidance, the Food Guide Pyramid was created as a teaching tool to assist the public in eating a healthful diet,” he said.

Additionally, Mr. Hentges said that the USDA’s Food and Nutrition Service (FNS) “plays a critical role in promoting healthy diets and healthy lifestyles for federal nutrition assistance program participants through nutrition education and promotion.” Examples of recent efforts include breastfeeding promotion; the Eat Smart. Play Hard initiative, which focuses on the importance of breakfast and balancing food intake with exercise; nutrition education within the Food Stamp program; the Team Nutrition campaign, which provides training and technical assistance for school food service professionals to help them prepare healthier meals; the Fit WIC project, which developed five interventions to prevent overweight in young children; and the Changing the Scene action kit, which helps local schools and communities assess the school’s environment to make changes to support healthier eating and active lifestyles. Finally, Mr. Hentges said that the FNS provides over $8 billion “in support for fruit and vegetable consumption” to encourage program participants to increase their fruit and vegetable intake.

The committee also heard testimony regarding two well-known diets: the South Beach Diet and Atkins. Dr. Arthur Agatston, author of The South Beach Diet, told the committee he developed his diet plan in response to his “own frustration with low fat dieting and counseling,” in addition to new information on the positive health effects of Mediterranean oils. “We developed a simple and flexible diet approach for our patients that followed the principles of good, nutrient-dense carbohydrates, good fats, and lean proteins,” he said, adding, “There was no counting of calories, grams of fats or grams of carbohydrates…Our hypothesis was that, when proper food choices were made, hunger and cravings would diminish and fewer calories would be consumed.”

Dr. Stuart Trager of the Atkins Physicians Council said that Atkins “stresses nutrient dense carbohydrates as part of a balanced eating plan that includes proteins and good fats while restricting carbohydrates with the greatest impact on blood sugar.” Dr. Trager added, “Simple, straightforward and safe, controlled carbohydrate nutrition offers a scientifically validated solution to the challenge of weight reduction and maintenance, and one that can help many people maintain their weight management goals.”

However, Dr. Susan Finn of the American Council for Fitness and Nutrition said that the “ultimate solution to the obesity problem is energy balance. Energy balance is attained when calories burned equal calories consumed. In order to accomplish this seemingly simple objective, people must moderate their caloric intake to match their energy expenditure by eating less, being more physically active, or—ideally—doing both.”

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