Testimony

Statement by
Richard H. Carmona, M.D., M.P.H., F.A.C.S. Surgeon General
U.S. Public Health Service
Department of Health and Human Services

on
Reshaping America's Health Care for the Future
before the
Joint Economic Committee
United States Congress

October 1, 2003

Thank you, Mr. Chairman. It is a pleasure to be here with all of you. And I commend you for your leadership in calling for this discussion.

Nearly 2 out of 3 of all Americans are overweight and obese; that's a 50% increase from just a decade ago.

More than 300,000 Americans will die this year alone from heart disease, diabetes, and other illnesses related to overweight and obesity.

Obesity-related illness is the fastest-growing killer of Americans. The good news is that it's completely preventable through healthy eating — nutritious foods in appropriate amounts — and physical activity. The bad news is, Americans are not taking the steps needed to prevent obesity and its co-morbidities.

The same is true for other diseases related to poor lifestyle choices, such as smoking and substance abuse. Put simply, we need a paradigm shift in American health care.

There is no greater imperative in American health care than switching from a treatment-oriented society to a prevention-oriented society. Right now we've got it backwards. We wait years and years, doing nothing about unhealthy eating habits and lack of physical activity until people get sick. Then we spend billions of dollars on costly treatments, often when it is already too late to make meaningful improvements to their quality of life or lifespan.

As American waistlines have expanded, so have the economic costs of obesity, now totaling about $93 billion in extra medical expenses per year. Overweight and obese Americans spend $700 more a year on medical bills than those who are not overweight.

We simply must invest more in prevention, and the time to start is during childhood — even before birth. Fifteen percent of our children and teenagers are already overweight. Unless we do something now, they will grow up to be overweight adults.

None of us wants to see that happen.

We can't allow our kids to be condemned to a lifetime of serious, costly, and potentially fatal medical complications associated with excess weight. Being overweight or obese increases the risk and severity of illnesses such as type 2 diabetes, heart disease, and cancer.

Those are the physical costs. There are also social and emotional costs of being overweight.

We first see this emotional pain on the school playground, when a child's self-esteem drops because he is teased, or on the dance floor, because she is never asked to dance.

None of us wants to see our kids go through that.

The science is clear. The fundamental reason that our children are overweight is this: Too many children are eating too much and moving too little. The average American child spends more than four hours every day watching television, playing video games, or surfing the web. They know more about the running style of ‘Sponge Bob Square Pants' than Gail Devers or Maurice Green.

Instead of playing games on their computers, I want kids to play games on their playgrounds.

As adults, we must lead by example by being responsible, and adopting healthy behaviors in our own lives.

We've got to show kids it doesn't matter whether they're picked first or last, only that they're in the game. Not all kids are going to be athletes, but they can all be physically active.

We've got to show them how to reach for the veggies rather than the fatty, sugary snacks.

We've got to show them how to encourage their peers to adopt healthy behaviors rather than ridiculing them.

As James Baldwin put it, "Children have never been very good at listening to their elders, but they have never failed to imitate them."

Our commitment to disease prevention through healthy eating, physical activity, and avoiding risk is one our entire society must be prepared to make in order for it to be effective.

President Bush is leading the way through the HealthierUS prevention initiative.

HealthierUS says, "Let's teach Americans the fundamentals of good health: physical activity, healthy eating, getting check-ups, and avoiding risky behavior."

Secretary Thompson is leading the Department of Health and Human Services' efforts to advance the President's prevention agenda through Steps to a HealthierUS, which emphasizes health promotion programs; community initiatives; and cooperation among policy makers, local health agencies, and the public to invest in disease prevention.

Steps also encourages Americans to make lifestyle choices that will prevent disease and promote good health from youth such as avoiding tobacco use, which is still the leading preventable cause of death and disease in America, and avoiding alcohol, drug use, and other behaviors that result in violence, unintentional injuries, and chronic disease.

Congress has approved funds for Steps in FY 2004 for community initiatives to reduce diabetes, obesity, and asthma-related hospitalizations. Last week, Secretary Thompson announced the four states, seven cities, and one tribal council that were awarded $13.7 million in Steps grants.

As important as these efforts are, we cannot switch America's health care paradigm from treatment to prevention through government action alone. This fight has to be fought one person at a time, a day at a time.

All of us must work together, in partnership, to make this happen.

Secretary Thompson has asked employers to make health promotion part of their business strategy. In September, he released a report, Prevention Makes Common Cents, highlighting the significant economic toll preventable diseases take on businesses, workers, and the nation.

A key finding of the report: obesity-related health problems cost U.S. businesses billions of dollars each year in health insurance, sick leave, and disability insurance. The report highlights the need for, and cost-effectiveness of, employment-based prevention strategies.

Recently I joined former Surgeon General David Satcher and the National Football League in kicking off their partnership to promote school-based solutions to the obesity epidemic.

I also joined basketball star LeBron James in launching Nike's PE2GO program, which provides equipment and expertise to schools so that they can offer fun physical activity. School-based programs that focus on physical activity offer one of our best opportunities to improve children's health — today and in the future. We welcome partnerships like these to improve the health of children from the earliest ages.

As Members of Congress, you can influence the behavior of your constituents in many ways, starting through your own example. Secretary Thompson put himself on a diet and challenged all HHS employees to get in shape by being physically active for at least 30 minutes a day. You could issue the same challenge to your staff members.

You can also help educate your constituents about the importance of prevention through Town Hall Meetings and by establishing partnerships in your own communities.

As I said, it will take all of us to switch from a treatment-oriented society to a prevention-oriented society, but the effort will be worth it, for individuals, families, and for the overall health of our nation.

I'm a doctor, not an economist, but I know we can save both the human costs in pain and suffering, and economic costs in dollars and cents by investing in prevention.

Think about it: the total direct and indirect costs attributed to obesity is about $117 billion per year, or $400 for every man, woman and child in this country.

I'm a doctor, not an economist, so I've seen the cost in more than just dollars and cents. It's about a mother who can no longer provide for her children. It's about a child who can no longer ask a father for advice. It's about real human costs: 300,000 American lives lost each year.

Just a 10% weight loss — through healthier eating and moderate physical activity —can reduce an overweight person's lifetime medical cost by up to $5,000, even save his or her life. Not to mention what it will do for their self-esteem and sense of well-being, and for the well-being of their loved ones.

Where else can you get that type of return on investment?

Thank you and I look forward to our discussion.

Last Revised: October 2, 2003