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Childhood Obesity -- Remarks to New Jersey School Nurses-D.C. Day, June 14, 2001

On behalf of my fellow food and nutrition professionals at the American Dietetic Association, I appreciate the opportunity to talk with you today about nutritional aspects of American children's health and safety -- and especially about childhood obesity.

I represent nearly 70,000 ADA members, the great majority of whom are, like me, registered dietitians. For those who may not know, the American Dietetic Association is the nation's largest organization of food and nutrition professionals.

Our mission is to promote optimal nutrition and well being for all people by advocating for our members. ADA members represent the full spectrum of food and nutrition practice, including pediatrics, school foodservice, sports nutrition, public health and geriatrics, among many more.

Our members are involved in patient care and client counseling in health-care institutions, restaurants, schools, businesses, government and educational settings.

ADA members and staff alike are committed to our association taking a leadership role in focusing the attention of health professionals -- and the public -- on finding new and lasting solutions to nutrition issues confronting all citizens.

Any list of these important issues would be quite long.

ADA's Board of Directors has designated five selected areas in food and nutrition as emerging areas of particular importance to dietetics professionals. On the list are complementary care and dietary supplements ... the quickly expanding retail food industry ... genetics ... and biotechnology.

All of these, I'm sure you agree, are serious issues deserving of ADA's full attention and leadership. But the issue that our Board prioritized at the top of the list was obesity, specifically including the prevention of childhood obesity.

I doubt that this group needs much convincing about the challenges we all face in combating what so many health experts have termed "the obesity epidemic." But let me offer a few telling facts and figures to help put things in perspective. You know these are true -- you see these statistics at your work every day.

The National Institutes of Health first recognized obesity as a chronic disease in 1985. Obesity is a contributing factor in numerous other diseases and conditions, including high blood pressure, diabetes, heart disease and some cancers.

Obesity affects people of all ages and most demographic groups. According to the Centers for Disease Control, excessive weight and physical inactivity account for more than 300,000 premature deaths each year in the United States -- second only to smoking.

Not only is excess weight one of the most pervasive health risks affecting Americans today, it is also a multi-billion dollar drain on the U.S. economy. Researchers put the cost of obesity at more than $100 billion annually. That includes almost $46 billion in direct costs such as hospital care and physician services -- that's nearly seven percent of all health-care costs directly attributable to obesity.

And obesity is on the rise. Studies indicate that many obese adults were obese children. More than half the adult population is overweight and the nation's childhood obesity rate has doubled in 20 years.

There are now about 5 million overweight or obese children in the United States -- that's up by 50 percent since 1991. Data from the National Center for Health Statistics suggest nearly 25 percent of children and adolescents are overweight or obese, or at risk for obesity.

Perhaps most troubling is evidence that excess weight in children is related to health problems later in life. Sixty percent of overweight children ages five to 10 have at least one risk factor for heart disease.

Epidemiological data from Harvard University indicates that overweight adolescents and young adults are at increased risk later in life for coronary heart disease, stroke, some cancers and early death.

Eating habits and a more sedentary lifestyle are often named as the prime suspects in the increased incidence of childhood obesity -- the key factor here is calorie or energy balance. You gain weight if you consume more calories than you burn.

That means physical activity is just as important as diet. Americans do appear to recognize that fact. A recent national survey conducted by the American Dietetic Association showed that people rank exercise as important as diet to them personally.

The problem is putting that understanding into action, for themselves or their children. Only about 40 percent of adults who took part in the survey said they are doing all they can to achieve a healthy diet.

As children reach adolescence, studies show the number of children involved in daily physical activity declines substantially. According to the Department of Health and Human Services, the increase in obesity in children is most likely associated with lower rates of participation in sports and other forms of physical activity.

But again, it's important to remember that neither diet nor lack of activity alone is responsible for the childhood obesity problem. They need to be addressed together.

Furthermore, the obesity epidemic didn't happen overnight and can't be eradicated that quickly either.

The good news is, childhood obesity is attracting the attention of government ... the health, science and education communities ... consumer advocacy groups ... the food and beverage industries and consumers.

The way we will win the battle of obesity is for these groups and individuals to form partnerships and work together. Efforts to prevent childhood obesity need to begin now, because it will take years to achieve and measure significant results.

The nation's schools are an excellent place -- in addition to the home, of course -- for these efforts to begin. Children aren't born knowing about nutrition. Kids need help learning how to plan their food choices for the day.

Children don't know if they have a healthy weight or not -- and studies show that even parents don't recognize overweight in their own children. But as health professionals, school nurses and dietitians, we can help identify when weight is an issue and help target positive action to address it.

Physical activity and healthy eating habits are two lifestyle practices that school-aged children need to learn to prevent obesity. The school setting is an excellent environment to help them do this. School curricula can be developed to incorporate both physical activity and good nutrition.

School-based physical activities can be designed to complement the Food Guide Pyramid's concepts of variety, proportionality and moderation -- in other words, partnering nutrition with physical education, at every grade level.

And it's a shame that more students do not take regular physical education classes. Does anyone have an idea how many states require daily physical education for all students in grades K through 12?

The answer is one state -- Illinois. The rest of us should be following their lead.

To challenge schools and communities to promote healthy eating among the nation's students, ADA has joined with the U.S. Department of Agriculture and four of the nation's leading medical associations -- the American Academy of Family Physicians, American Academy of Pediatrics, National Hispanic Medical Association and the National Medical Association.

These groups, individually and together, believe that preventing obesity begins with a coordinated, comprehensive program for school health, engaging everyone who works with children.

As school nurses, you are probably thinking, "That's right up our alley!" And we agree. The American Dietetic Association knows you are on the front lines in preventing childhood obesity.

Nutrition profoundly affects children's ability to learn, develop and stay healthy. There is no better time than the early years to make an impact on the lifelong eating and exercise habits that contribute to health maintenance and disease prevention.

Most schoolchildren do not meet USDA's recommendations, especially for fruit, vegetable, grain and dairy consumption. Students need to learn how to balance their food choices.

In our partnership, we have developed ten keys to assist each school community in writing its own prescription for healthy eating in schools. Meeting these goals would put our country well on the road to helping prevent the onset of many cases of obesity.

1. Student, parents, educators and community leaders will be involved in assessing the school's eating environment, developing a shared vision and an action plan to achieve it.
2. Adequate funds will be provided by local, state and federal sources to ensure that the total school environment supports the development of healthy eating patterns.
3. Behavior-focused nutrition education will be integrated into the curriculum from pre-K through grade 12. Staff who provide nutrition education will have appropriate training.
4. School meals will meet USDA nutrition standards as well as provide sufficient choices, including new foods and food prepared in news ways, to meet the taste preferences of diverse student populations.
5. All students will have designated lunch periods of sufficient length to enjoy eating healthy foods with friends. These lunch periods will be scheduled as near the middle of the school day as possible.
6. Schools will provide enough serving areas to ensure student access to school meals with a minimum wait time.
7. Space that is adequate to accommodate all students and pleasant surroundings that reflect the value of the social aspects of eating will be provided.
8. Students, teachers and community volunteers who practice healthy eating will be encouraged to serve as role models in school dining areas.
9. If foods are sold in addition to National School Lunch Program meals, they will be from the five major food groups of the Food Guide Pyramid. This practice will foster healthy eating patterns.
10. Decisions regarding the sale of foods in addition to the National School Lunch Program meals will be based on nutrition goals, not on profit making.

I mentioned a few minutes ago that the American Dietetic Association's Board of Directors has listed obesity, especially childhood obesity, as the top priority among ADA's five identified areas of special concentration.

Through our government affairs office, here in Washington, ADA is involved in a whole range of legislative and public policy initiatives that address childhood obesity.

We've been involved as the Surgeon General of the United States has begun a process to issue a "call to action" on obesity.

ADA has been direct in addressing the issue -- we want obesity classified as a disease. That's plain language in this city where a few years ago, Congress chose not to provide help to those overweight/obese individuals who wanted treatment. Then, some characterized the issue as a lack of individual willpower or self-control. Others saw it as a cosmetic issue, expressing concerns that treatment could have taxpayers covering the bills for weight center sessions.

To this day, there are no federal benefits for treating obesity -- although Medicare spends hundreds of millions of dollars each year on attendant conditions -- heart disease, cancer, diabetes, high blood pressure, hyperlipidemia, and a host of other conditions.

We have made progress, however. Today we know that treatment is good. But prevention would be better -- particularly among school-aged children.

We know that plain talk about the issue is important. But we also know that we must not stigmatize any individual about his or her size, shape or body image. This is so important to individuals' dignity, and it is critical to our being able to successfully help people find healthy weights.

ADA is on the forefront today in trying to establish a national commitment in food and agricultural programs so that Americans have information throughout their lives assisting them to make choices to be healthy and to implement strategies for disease prevention and disease management through diet and physical activity. We are encouraging Congress to commit to sound food assistance programs, food and nutrition research, nutrition education, and to provide adequate resources so that through these programs no person is left behind.

We believe strongly that schools can play an important role in a comprehensive approach involving nutrition experts, school nurses, health professionals and educators on site helping children and their families recognize and live what we call "healthy lifestyles."

Finally, ADA has been asked to help in this effort to identify ways of making sure that child obesity treatments are covered by public and private insurance. This is an enormous task but it is fundamental to addressing the epidemic of obesity and the short and long term impacts on people's lives.

In addition to our legislative efforts directed toward childhood obesity, ADA's Foundation is turning its full attention and resources to the issue. The Foundation's new Childhood Healthy Weight Task Force, which I serve on, is exploring a number of interrelated areas where the Foundation's fund raising and sponsorship capabilities could help.

In January, I had the opportunity to take part in a meeting in New Orleans of experts in the field of childhood obesity. Many good ideas were generated, revolving around:

• family nutrition and physical activity
• civic and community involvement
• developing a "road map" to guide the coordinated efforts of all organizations working in this field.

Some of the specific ideas under consideration include developing a Web-based children's self-assessment tool that could be provided either through schools or the Internet. Another idea would be educational programs to train people who have regular contact with children how to spot the early signs of obesity and how to obtain counseling or referrals for intervention, if appropriate.

You as school nurses are on the front line to help in the detection and prevention of childhood obesity. We want to partner with you. Our combined training and experience matched with school food service professionals', educators' and parents' involvement can make a difference in helping each child achieve a healthy weight, and a healthy life for all children.

Thank you very much.