Testimony

Statement by
Richard H. Carmona, M.D., M.P.H., F.A.C.S
Surgeon General, U.S. Public Health Science, Acting Assistant Secretary for Health, Department of Health and Human Services
on
The Obesity Crisis in America
before the
The Subcommittee on Education Reform, Committee on Education and the Workforce, United States House of Representatives

July 16, 2003

Good morning Mr. Chairman and distinguished members of the Subcommittee. My name is Dr. Richard Carmona, and I am the Surgeon General of the United States.

As an American, I want to take this opportunity to thank you for your service to our nation. I've had the honor of working with many of you during my first 11 months as Surgeon General, and I look forward to strengthening our partnerships to improve the health and well-being of all Americans.

Mr. Chairman, you have been a leader in developing innovative approaches to combat childhood obesity. Thank you for your commitment to the health and well-being of our children. The hearing you have called today will draw further public attention to this growing pediatric health crisis.

As Surgeon General, I welcome this chance to talk with you about a health crisis affecting every state, every city, every community, and every school across our great nation.

The crisis is obesity. It's the fastest-growing cause of disease and death in America. And it's completely preventable.

  • Nearly two out of every three Americans are overweight or obese.
  • One out of every eight deaths in America is caused by an illness directly related to overweight and obesity.

Think of it this way: statistics tell us that of the 20 members serving on this subcommittee, at least two will die because of a completely preventable illness related to overweight or obesity. Because of overweight or obesity, two of you will spend less time serving your communities and enjoying your children and grandchildren.

America's children are already seeing the initial consequences of a lack of physical activity and unhealthy eating habits. Fortunately, there is still time to reverse this dangerous trend in our children's lives.

Let's start with the good news: I am pleased to be able to report that most of America's children are healthy.

Overall, 82 percent of our nation's 70 million children are in very good or excellent health. Infant mortality is at an all-time low, childhood immunization is at an all-time high. Our children are less likely to smoke, and less likely to give birth as teenagers.

These are important gains in pediatric health.

But the bad news is that an unprecedented number of children are carrying excess body weight. That excess weight significantly increases our kids' risk factors for a range of health problems, including diabetes, heart disease, asthma, and emotional and mental health problems.

As a father, I work hard to teach my children about the importance of physical activity and healthy eating. Every parent in this room wants the best for their children.

But the fact is that we have an epidemic of childhood obesity. A study conducted in May by the New York City Department of Health and Mental Hygiene and the Department of Education found that, adjusted to National Standards, nearly one in four of the children in New York City's public elementary schools is overweight.

Today I will discuss the three key factors that we must address to reduce and eliminate childhood obesity in America. They are:

  1. Increased physical activity;
  2. 2. Healthier eating habits; and
  3. 3. Improved health literacy.

Mr. Chairman, I ask that my statement and the scientific information contained in it be considered as read and made part of the record. In the interest of time, this morning I will present only part of that statement to the subcommittee.

Looking back 40 years to the 1960s, when many of us in this room were children, just over four percent of 6- to17-year-olds were overweight. Since then, that rate has more than tripled, to over 15 percent. And the problem doesn't go away when children grow up. Nearly three out of every four overweight teenagers may become overweight adults.

I'm not willing to stand by and let that happen. American children deserve much better than being condemned to a lifetime of serious, costly, and potentially fatal medical complications associated with excess weight. The facts are staggering:

  • In the year 2000, the total annual cost of obesity in the United States was $117 billion. While extra value meals may save us some change at the counter, they're costing us billions of dollars in health care and lost productivity. Physical inactivity and super-sized meals are leading to a nation of oversized people.
  • This year, more than 300,000 Americans will die from illnesses related to overweight and obesity.
  • Obesity contributes to the number-one cause of death in our nation: heart disease.
  • Excess weight has also led to an increase in the number of people suffering from Type 2 diabetes. There are at least 17 million Americans with diabetes, and another 16 million have pre-diabetes. Each year, diabetes costs America $132 billion. It can lead to eye diseases, cardiovascular problems, kidney failure, and early death.

Why are we facing this epidemic of overweight and obesity? Over 50 genes associated with obesity have been located in the human gene map. But the ever-increasing problem of overweight among American children cannot be explained away by changes in genetic composition.

Studies conducted by HHS' National Institutes of Health and the Centers for Disease Control and Prevention are already yielding important clues about the multiple factors that contribute to overweight and obesity. Studies are also providing new information about potentially successful interventions.

We know more than ever about the combination of genetic, social, metabolic, and environmental factors that play a role in children's weight.

But the fundamental reason that our children are overweight is this: Too many children are eating too much and moving too little.

In some cases, solving the problem is as easy as turning off the television and keeping the lid on the cookie jar.

Our children did not create this problem. Adults did. Adults increased the portion size of children's meals, developed the games and television that children find spellbinding, and chose the sedentary lifestyles that our children emulate. So adults must take the lead in solving this problem.

I'm pleased that businesses like Kraft Foods, Coca Cola, and Nike are supporting major efforts and making significant changes to help kids make healthier choices.

These and other business leaders, foundations, schools and universities across our nation are starting to make a difference in children's health. I encourage other organizations and every parent in America to join the fight against childhood obesity.

We must teach our children to enjoy healthy foods in healthy portions. As parents, we should never use food as a reward or punishment.

And especially now, during the summer, we need to encourage all children to be physically active for at least 60 minutes a day. Not only sports, but simple things like taking the stairs, riding their bikes, and just getting out and playing.

And as we are getting our kids to make healthy choices, we also need to make them for ourselves. James Baldwin captured the essence of this when he said: "Children have never been good at listening to their elders, but they have never failed to imitate them."

I'll be the first to say it won't be easy. My wife and I have four kids. I know first-hand that families live such busy lives that it's tough to prepare healthy meals and have enough time to get in some physical activity.

But it's so important, because the choices that children make now, the behaviors they learn now, will last a lifetime.

As adults we must lead by example. Personally, I work out every day. I do my best to make healthy choices in all I do. My bosses President Bush and Secretary Thompson also find time to exercise. In fact, Secretary Thompson put the Department of Health and Human Services on a diet and has led by example by losing over 15 pounds.

President Bush, Secretary Thompson, and I have made disease prevention and health promotion a priority in our roles as leaders. As Surgeon General, prevention comes first in everything I do. Prevention is the vision behind the President's HealthierUS Initiative and the Secretary's Steps to a HealthierUS Initiative.

One of the many challenges is that there are so many more incentives in our current health care system for treatment than for prevention. When I was a practicing physician in a hospital, I made a good living treating people who could have avoided my hospital entirely if they had made better lifestyle choices.

Benjamin Franklin was absolutely right back in the 1700s: an ounce of prevention is worth a pound of cure. But more than 200 years later, prevention is still a radical concept to most Americans.

At the Department of Health and Human Services, we're encouraging healthy habits more than ever through our work to eliminate health disparities; our many initiatives designed to encourage physical activity, healthy eating, and regular checkups; and our nationwide campaigns to discourage smoking and drug and alcohol abuse.

To help promote healthy lifestyles, I am visiting schools across America in my 50 Schools in 50 States Initiative to talk with kids about avoiding drugs and alcohol, avoiding tobacco in every form, being physically active, eating right, and making healthy choices every day.

Each time I'm out on the road, whether at a school or passing through an airport, I meet young people who are making choices that affect their health and well-being. I believe that what they see and hear in the media can have a profound effect on their choices.

Secretary Thompson also appreciates that, and it's why he focused the Youth Media Campaign on getting young people excited about increasing the physical activity in their lives and on showing parents that physical activity and healthy eating are essential to their children's well-being.

This week, the President's Council on Physical Fitness and Sports will launch a brand-new Presidential Champions Award. The award encourages a lifetime of activities for children and their parents or other role models.

We need initiatives like the Youth Media Campaign and the Presidential Champions Awards because the average American child spends more than four hours every day watching television, playing video games, or surfing the web. We are seeing a generation of kids who grew up off the playground and on the PlayStation.

We must all work together to help our children lead healthy lives. I caution people against playing the "blame game." Instead of blaming children for being overweight, we need to encourage them and help them to make healthier choices.

We need physical activity and healthy food choices in every school in America. We need better food choices at affordable prices in every neighborhood in America. And we need community planning that includes neighborhood playgrounds and safe walking paths.

Some people want to blame the food industry for our growing waistlines. The reality is that restaurants, including many fast food restaurants, now offer low-fat, healthy choices.

For the meals we eat at home, and the meals we eat out, it's still our decision what we eat, where we eat, and how much we eat. That concept is part of what I'm talking about with Americans of all ages: increasing our health literacy.

Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.

Low health literacy contributes to our nation's epidemic of overweight and obesity. For example, some mothers are unaware that they can promote their baby's health through breastfeeding. Experience with my own patients and students indicates that many Americans don't understand the impact of caloric intake versus expenditure.

Every morning people wake up and, while they're sitting at the kitchen table, they read the newspaper and the cereal box. Throughout the day they read the nutritional information on their meals and on their snacks. But do they really understand the information they're reading?

The labels list grams of fat. But do you know how many grams of fat you should eat in a meal? Or in a day? Or how many is too many? Or too few? These are seemingly simple questions, but we're not giving Americans simple answers.

Parents are hearing about overweight and obesity. So they're trying to figure out how much food they should feed their children. How much is too much? How much is not enough? They're concerned and confused about everything from calories and carbohydrates, to vitamins and portion sizes.

When children are growing and developing, a restrictive diet may not be the best choice for every child. Just as with adults, one diet does not fit every child.

As parents, we know that. But when we see a child gaining weight and not exercising enough, we see the social and psychological pain it causes. When we see a child's self-esteem drop by the day because she's left out of schoolyard games, or because he just can't keep up with the other kids on their bikes, we know that we need to help that child.

I'm pleased to hear from parents and pediatricians that moms and dads are asking about how to establish healthy eating habits for kids.

Parents should always talk to a pediatrician or family physician before putting any child on a diet or beginning any vigorous exercise plan.

The reality is that often, if a child is overweight but still gaining height, the best thing parents can do is maintain the child's weight. Kids come in all shapes and sizes, and sometimes a child just needs a little more physical activity and a little less food intake. Again, it's not about blame it's about balance.

And to make healthy choices, parents and children need easy-to-understand information that fits into their busy lifestyles. All of us government, academia, health care professionals, businesses, schools, and communities need to work together to ensure that straightforward information about healthy eating and physical activity is available.

For example, Secretary Thompson announced last week that food labels will list trans fat content. By putting trans fat information on food labels, we're giving American families information to make smart choices to lower their intake of these unhealthy fats.

The food pyramid is another great example. It's probably the most-recognized nutrition guideline tool in America. HHS is looking forward to working with the Department of Agriculture to evaluate and update the food pyramid based on the latest scientific evidence.

I don't have all the answers today. But we can figure this out together. We can increase health literacy and reduce childhood obesity. Secretary Thompson has been a pioneer in getting prevention into the American mindset. We're starting to see some results, and we need your help. As members of Congress, as members of your communities, and as parents, you are role models and leaders.

As Surgeon General, I charge you to make healthy personal choices in your own lives, and to set good examples for all the children around you.

And I ask you to work with me to support our efforts to improve Americans' health literacy, to put prevention first, and to end our nation's obesity epidemic before it has a chance to reach into another generation of Americans.

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

Last Revised: July 17, 2003