20020521-Obesity -- Testimony to the Senate Health, Education, Labor and Pensions Committee, May 21, 2002

Obesity -- Testimony to the Senate Health, Education, Labor and Pensions Committee, May 21, 2002

May 21, 2002

Lifestyles that support and sustain the maintenance of a healthy weight, for both individuals and the population as a whole, are a major focus of the American Dietetic Association and its members. The rapid rise in the prevalence of overweight and obesity among all segments of the U.S. population is of grave concern as the health and quality of life of those afflicted plummets and health care costs and societal burdens continue to soar.

Dietetics professionals translate complex nutrition principles into a vast array of healthful and appealing food options for millions of Americans daily. Our unique education, supervised pre-practice experience, and mandated continuing professional education equip us to identify and address overweight, obesity and its health consequences at all stages of the lifecycle and in a myriad of educational, community, medical, commercial, and research environments. We commend the committee's pursuit of legislation that represents a community-based, thoughtful approach to the prevention and treatment of obesity for the American public. Federal legislation should focus on strategies to encourage local screening and intervention programs, and encompass the consensus achieved through the Surgeon General's "Call to Action" related to obesity and overweight. The public health focus of legislative proposals is extremely important. We recommend it be paired with a number of additional elements that will maximize its success.

Obesity is a complex disease state. Its definition must be evidence-based and appropriate to each segment of the population characterized. Modifiers such as age and ethnicity must be considered as general parameters for the U.S. population are established.

Not everyone who falls outside the upper limit of normal for defined parameters is obese even though their body weight may be higher than is recommended. We must be sure that weight reduction is promoted for those in whom weight loss would be of benefit. Individuals who make healthful food choices the majority of the time, who are physically active / physically fit, and at low risk for the development of diet-related disease should be urged to maintain the weight and lifestyle that is best for them.

The American Dietetic Association urges that obesity be designated a disease by federal agencies and institutions (i.e., Centers for Medicare & Medicaid Services, Social Security Administration, Centers for Disease Control and Prevention, etc.) with all of the attendant ramifications that such a designation implies -- including sanctioned insurance coverage for obesity treatment. Coverage will facilitate the timely provision of health services to treat obesity and its attendant comorbidities; i.e., hypertension, lipid abnormalities, diabetes mellitus. As interventions are implemented, parameters, in addition to weight change, must be identified as outcomes to be assessed. Examples include but are not limited to:

  • Normalization of blood pressure, blood sugar, lipid parameters
  • Normalization of respiratory rate, improved exercise tolerance
  • Reduced rates of admission or length of stay in institutional settings
  • Reductions in medications use
  • Reductions in frequency of visits to health care providers
  • Decreased incidence of obesity-related comorbidities.

Our knowledge of the genetic, environmental, cultural, behavioral, and emotional contributors to overweight and obesity is limited; current approaches to prevent or treat overweight and obesity are simplistic at best. An evidence-based approach to the development and implementation of strategies to prevent and treat overweight and obesity is necessary. Further, adequate annual appropriation of funds must accompany any demonstration project or research authorizations that are legislated.

Coordination among the numerous stakeholders -- government, academia, medicine, industry and others -- is vital if rapid progress is to be made. Within government institutions, we recommend strengthening the network of public officials who design and implement federal, state and local projects and programs so that nutrition and physical activity are fully integrated within them. The Secretaries of Agriculture and Health and Human Services would benefit from having senior advisors on nutrition and health involved in the design and review of broad array of agency programs -- not just those programs traditionally viewed as food, nutrition and health related. A deputy level position within the Surgeon General's office should ensure that nutrition and physical activity are fully integrated into federal health and research agendas. Within the states, individuals with expertise in food, nutrition, and/or physical activity, are needed at top levels with the authority to coordinate information and resources and make public health initiatives in nutrition and physical activity effective.

Losing weight and maintaining a healthy weight in our American society is difficult, and ADA has several science-based positions on healthful eating, the balance between energy intake and expenditure, weight management, and medical nutrition therapy for diet-related medical conditions.

While a number of individuals with moderate to morbid obesity studied in clinical research settings are able to loose weight, few -- perhaps only five percent of those studied -- maintain their weight loss over time. A recent University of Pittsburgh study suggests that in the general adult population, planned modest weight loss of 10 percent or more maintained for at least five years occurs at a rate of approximately 25 to 27 percent. Data such as this are promising but our ability to replicate them will depend on our willingness to understand and then act individually and as a nation.

The best way to combat overweight and obesity is to prevent it. We support efforts to prevent or to reduce the incidence of childhood obesity, and in fact, have directed the ADA Foundation to turn its attention toward this issue. When working with children, we also must work with their families. Family members, of all ages, must become involved and must practice the dogmas that they preach.

Prevention and intervention modalities targeted to children must incorporate the development of healthful eating practices and daily physical activity. As promising programs or programmatic elements are identified, school and community-based nutrition and physical education initiatives can be tested and those that are effective expanded through grants and appropriations. A preventive approach, rather than an approach that targets weight management only after one or more disease-specific consequences have become established, offers the opportunity for restoration of a healthy weight before the comorbidities associated with obesity become entrenched and target organ damage occurs.

ADA urges the committee to emphasize the importance of innovative approaches to the prevention and treatment of obesity throughout the lifecycle. This includes proactive work with adolescents and women of childbearing age to maintain a healthy weight prior to conception. It encompasses the promotion of weight gain during pregnancy according to established guidelines, and encourages breastfeeding during the first year of the infant's life. This type of approach should help to stem the tide of increased incidence gestational diabetes and Type 2 diabetes in our nation's mothers and children.

Finally, we want to emphasize that increased awareness, education and action are needed to ensure positive health outcomes. Opportunity and incentives to pursue a healthy lifestyle must be supported with

  • Reasonable access to a variety of low-cost nutritious foods for all Americans but especially for its children
  • Nutrition education and/or behavioral counseling to facilitate food choices that support optimal weight maintenance and life-long healthful eating habits
  • Physical activity curricula, programs and facilities that accommodate a broad range of individual interests and abilities and that are part of the established curriculum in elementary and secondary schools.
  • Public and private insurance coverage for weight management programs initiated prior to the development of diet-related disease.

The emphasis on the identification of individuals who would benefit from prevention and/or treatment must be matched with a comparable effort to ensure that there is adequate funding to support sufficient numbers of sound, multidisciplinary weight management options once obesity has been diagnosed. Obesity is multifactorial by nature; its management will require a team approach. Registered dietitians and dietetic technicians, physicians, nurses, psychologists, exercise physiologists, pharmacists and others will need to work collaboratively to ensure success. The nature and depth of counseling required to effectively intervene in youth and adults with moderate to morbid obesity greatly exceeds that which can be provided in the context of the routine office visit.

As a society, we must acknowledge the effect that our national "culture" has on the food and activity choices of the individual. We must collectively seek to improve it and to shift toward it toward health.

In summary, ADA and its members are uniquely positioned to assist in the development and delivery of individualized prevention and treatment programs, to participate in community and school-based programs, and to conduct basic and applied research related to overweight and obesity. Federal legislation to address overweight, obesity, nutrition and physical activity must have a public health focus at the community, school, family and individual levels; promote research to better understand contributing factors and solutions; and create opportunities for education and behavioral counseling for weight management, prevention, and treatment. Further, federal and private health programs should provide coverage for medical nutrition therapy and behavior modification to reduce obesity and diet-related disease.

We commend the committee for its work in bringing this issue to the forefront. Thank you, Mr. Chairman and members of the committee, for giving the American Dietetic Association the opportunity to share our views toward seeking and defining solutions to the epidemic of obesity that jeopardizes the health and well being of all.

For further information, contact Susan T. Borra, RD, ADA President; Julie O'Sullivan Maillet, PhD, RD; or ADA Policy Initiatives and Advocacy staff at 202/775-8277.