"Creating a Culture of Wellness Among our Children"

Remarks as prepared; not a transcript.

RADM Steven K. Galson, M.D., MPH
Acting Surgeon General
U.S. Department of Health and Human Services

Remarks at the American Dietetic Association Public Policy Workshop Breakfast

February 6, 2008
Washington, DC

"Creating a Culture of Wellness Among our Children"

Good morning.

Thank you, Mary Lee (Mary Lee Watts, member of the A-D-A Legislative Public Policy Committee), for that gracious introduction.

It is my pleasure to share time this morning with the American Dietetic Association at this important Public Policy Workshop.

My gratitude to A-D-A, to your Chief Executive Officer Ron Moen and your President Connie Diekman for extending the invitation to speak to you today.

I have looked forward to this address today for a number of reasons.

Your organization and the Office of the Surgeon General are like-minded.

As the Acting Surgeon General, I serve as our nation’s chief “health educator” - responsible for giving Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury.

Priorities

The public health priorities of my office reflect many of the priorities A-D-A is also trying to accomplish.

They include:

Disease Prevention - what each of us can do in our own lives and communities to make ourselves and our families healthier.

Public Health Preparedness - an all-hazards approach to preparing America to meet and overcome challenges to our health and safety, such as those of human origin, an emerging illnesses or a natural disaster.

This includes being ready, physically, mentally, and spiritually; being able to exercise public health principles and practices, and resiliency of mind and spirit.

Eliminating Health Disparities - we note the disheartening data that too many of our people from minority groups still suffer from certain illnesses at a disproportionate rate.

While, overall, our nation's health has improved, not all populations have benefited equally. Many Americans who are members of racial and ethnic minority groups experience disparities in health outcomes and health care.

It is imperative that things change.

Accordingly, we are addressing these issues with numerous programs and initiatives and by increasing public awareness through H-H-S programs. To learn more about what we are doing, I encourage you to visit our Office of Minority Health website. The address is: www.omhrc.gov

Improving Health Literacy – steadily improving the ability of an individual to access, understand, and use information and services to make appropriate health decisions.

Dietary professionals are particularly well suited to improve health literacy.

I say this because, as registered dieticians, understand the relative relationship between family health history and one’s disease risk.

When you consult with a person who has, say, stroke, heart disease, diabetes or obesity in their family tree – you can, in turn, offer nutritional and dietary guidance with the potential to change patient behavior, improve their health literacy, and reduce their disease risk.

I am confident that the ADA as an organization and everyone here individually can appreciate and embrace the priorities have just described.

Our organizations are also motivated by the same overarching goal – creating a healthier Nation.

That common interest has made the ADA a valued partner of the Department Health and Human Services for many years.

The initiatives and projects that we have collaborated with the American Dietetic Association are far reaching and numerous.

Whether ...

• working together to articulate key messages;

• collaborating to update federal Dietary Guidelines;

• sharing emerging information on the quality that healthy eating adds to one’s life; or

• partnering to refine understanding of the association among between nutrition, physical activity and health outcomes;

... we have long been valuable allies.

Individually and together, the A-D-A and H-H-S are leaders who are focused on improving individual and community health.

Our cause is common.

Our constituency is the same.

Our purposes are similar.

• H-H-S and A-D-A both seek to create a culture of wellness and in the lives of those we serve.

• H-H-S and A-D-A are both in the business of emphasizing the health benefits of making appropriate choices as they pertain to food, diet, nutrition, and lifestyle; and the value of preventive care.

We recognize that good health doesn't just happen. Rather, it's a habit of smart choices and sound clinical care.

It is well established that good nutrition is vital to good health and is absolutely essential for the healthy growth and development of children and adolescents. We know as well that major causes of morbidity and mortality in the United States are related to poor diet and a sedentary lifestyle.

Together with physical activity, a high-quality diet that does not provide excess calories should enhance the health of most individuals.

That’s why observances like National Nutrition Month in March are so important.

It is through a nutrition education and information campaign like National Nutrition Month that demonstrably sound practices - like prevention…making healthy choices…following a good diet - are adopted by increasing numbers of Americans.-

Moreover, as American health care evolves in the 21^st century and beyond, as we enter a new era in service delivery, as technology advances, as systemic change takes place, effective collaborations among our organizations remain more important than ever.

H-H-S has begun the process for developing national health objectives for the next decade at an inaugural meeting of the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for Healthy People 2020.

We are also currently in the process of preparing for the next edition of the Dietary Guidelines for Americans. USDA and HHS will be asking for nominations for the 2010 Dietary Guidelines Advisory Committee this spring.

Overweight and Obesity

I want to next discuss one public health crisis of paramount importance

As many of you know, in 2001, the Office of the Surgeon General released a “Call To Action to Prevent Overweight and Obesity.”

The challenges which prompted issuance of the Call to Action still exist.

Our common efforts to reduce overweight among our Nation’s children are necessary for several reasons.

We must ensure that children have the greatest opportunity possible to enjoy good health, to reach their fullest potential, and a have fair chance to succeed now and later in life.

They deserve nothing less.

Our goal, as parents, health professionals, and caring adults, is to provide kids with the tools and knowledge to make positive and healthy choices.

When we released the Surgeon General’s Call to Action on Overweight and Obesity we knew it was the first step toward those ends.

Many steps have followed since, as H-H-S continues to forge creative and successful health promotion partnerships with stakeholders in states and communities, with federal government agencies and the private and non-profit sectors.

While some progress has been made, the results in the fight against obesity are mixed.

Our society has become more and more inactive and is seeing a rise in obesity rates. And chronic diseases have become a quiet catastrophe.

Chronic diseases cause 7 out of 10 deaths every year - and the costs are staggering.

Obesity remains an epidemic.

Food is abundant, portion sizes have increased, and society has become increasingly sedentary.

And trends among America's children are the most disheartening of all.

Our kids are growing up with unhealthy lifestyles, the consequences of which could be with them for the rest of their lives.

Childhood overweight prevalence has more than tripled for children ages 6 to 11 years since 1980. Today, approximately nine million children over the age of 6 are considered overweight in this country.

In addition to the psychosocial issues of stigmatization, overweight children are at far greater risk for numerous health consequences, including cardiovascular disease, type 2 diabetes and other chronic diseases.

Many of you are acutely aware of the disturbing physical activity rates among our youth: just a quarter of high school students were moderately physically active for 30 minutes a day, 5 days a week-half the time needed for youth, according to the federal Dietary Guidelines.

Because the factors contributing to overweight and obesity are complex, reversing the epidemic will take concerted action by researchers, providers of care, educators, civic leaders, employers, fitness professionals, our public health colleagues, indeed by all sectors of society.

Meanwhile, expenditures for health care in the United States continue to rise. Yet, every year millions of Americans die from preventable causes.

As a nation, we continue to spend too little on preventing disease and illness and we are losing too many lives.

That's because right now we've got it backwards.

We live in a treatment-oriented society. We need to change to a prevention-oriented society.

We wait years and years, doing nothing about unhealthy habits and lack of physical activity, until people get sick.

Then we spend lots of money on costly treatments to try to make people well, often when it is already too late.

We need to refocus our efforts on preventing disease, illness, and injury.

The good news is that most of the illness, disability, death, and resulting economic and human costs are entirely preventable with effective public health programs.

Think of the consequences of success in stemming childhood overweight. We could expect to see:

• obesity, as well as its social and economic costs, steadily decline;

• physical activity, and appreciation of its benefits, increase;

• community health and fitness programs now in place serve as models, their popularity and numbers increase, and they become routine in every state;

All of these benefits will cascade from our success in motivating children and young people to become and remain physically active.

There is no mission of greater importance.

That's why I am especially eager to move forward in leading the Surgeon General's coordinating council to prevent childhood obesity.

As the lead for the Department's childhood obesity prevention initiative, I can assure you that we at HHS intend to work pro-actively to identify interventions effective in addressing overweight and obesity.

Reducing obesity is a national necessity with profound implications.

We all have a stake in the outcome.

The ultimate result may not be apparent for years or even decades: a fitter, healthier, more physically active Nation in which the epidemic of childhood overweight and obesity is on the wane, due to the day-to-day efforts of dieticians, fitness professionals, physicians, public health advocates and other partners who care.

Goals

The individual, familial, social and opportunity costs of childhood overweight cannot be sustained.

We owe it to our children to encourage healthier habits in their lives without delay.

We must teach our children now about the importance of eating a healthy diet and being physically active.

We at HHS recognize that obesity in children is a crisis. We are taking it seriously. We, like you, are working to inform, advise, and educate: to win hearts and minds!

Federal Initiatives

HealthierUS is foremost among a host of federal wellness-related activities and resources

The pillars established by HealthierUS include -

• Be physically active each day

• Eat a nutritious diet

• Get preventive screenings, and

• Make healthy choices such as:

• Refraining from tobacco use

• Using alcohol moderately

• Using seatbelts and bike helmets

• Getting enough sleep – turn the TV off and getting to bed! If we got enough sleep, there wouldn’t be 24 hour coffeehouses around every corner

• Laugh a little – humor is good for us.

These 4 pillars guide federally-sponsored overweight and obesity activities for adults and children. They offer simple, yet profound ways to achieve better health.

In time, “Personalized Health Care” will combine the basic scientific breakthroughs of the human genome with computer-age ability to exchange and manage data. Increasingly, it will give us the ability to deliver the right treatment to the right patient at the right time -- every time.

Every one of us is biologically unique. We’ve always known that, but we haven’t had the knowledge or the tools to deliver health care at that kind of individual level. That’s what we are changing. HHS is encouraging and supporting these important developments.

But until we get there, we will use the best available scientific evidence and encourage small changes and sensible choices.

I just mentioned the importance of learning from family health history. The Family Health History tool is a feature of Personalized Health Care that is already available.

To help focus attention on the importance of family history, my office launched the U.S. Surgeon General's Family History Initiative.

My Family Health Portrait

Because family health history is such a powerful screening tool, my office created a computerized tool to help make it easy for anyone to create a sophisticated portrait of their family's health.

This tool, called "My Family Health Portrait" is a web-enabled program that runs on any computer that's connected to the web and running an up-to-date version of any major Internet browser.

The web-based tool helps users organize family history information and then print it out for presentation to the family doctor. It can be accessed at https://familyhistory.hhs.gov/.

For its part, the H-H-S childhood obesity initiative will develop and foster programs that share the goal of providing options for community-based interventions.

Some activities:

• The National Center for Physical Development and Outdoor Play will help Head Start programs evaluate their playgrounds, and educate children and their families about the value of healthy food and structured physical activity. HHS’ Administration for Children and Families (ACF) will oversee a competition for a $12 million, four-year grant to establish the center and will allocate up to $10 million to fund the construction or improvement of Head Start playgrounds.

• Centers for Disease Control and Prevention’s School Health Index: A Self-Assessment and Planning Guide;

• National Institutes of Health’s We Can! (Ways to Enhance Children’s Activity and Nutrition) program; an NIH program that offers tips and ideas for parents and caregivers to help children 8-13 years old stay at a healthy weight

• Indian Health Service’s diabetes prevention activities;

• Food and Drug Administration’s Using the Nutrition Facts Label to Make Healthy Food Choices activities; and

• President’s Council on Physical Fitness and Sports’ National Fitness Challenge.

At the same time, our Office of Minority Health (OMH) has developed a coalition to reduce obesity among racial/ethnic minorities. Healthy Weight, Healthy Lifestyle includes a community-based effort to encourage and support African Americans across all stages of life to eat properly and engage in physical activities.

It is also certainly true that the collaboration of the broader food, beverage and entertainment industries is critical to a successful and timely response to the national epidemic of childhood obesity.

In fact, everyone - from children, to their parents, teachers and role models, to community organizations to senior citizens, - can, should and needs to “be a player” in improving public health.

I use the phrase ‘Be a Player” for a reason: the National Football League and the Ad Council collaborated with H-H-S to release a PSA by that same name.

The NFL has also released ‘Play 60’, a promotional campaign to motivate young people to get the recommended 60 minutes of daily exercise into practice. The league will also support the establishment of Youth Fitness Zones in various communities.

Commitments like these make a difference.

Few organizations have the visibility, resources or cultural stature of the National Football League: untold millions of people tuned into watch the Super Bowl last Sunday.

Anyone Can Get Involved

Yet, any of one of us can be a player in helping to create a fitter, more physically active nation.

The process starts at home.

Parents, for one, must be on the front lines in the fight against childhood obesity. Their participation, their continued involvement, is critical.

Parents can begin by teaching their kids to read and understand a food label.

They can also emphasize how important it is that their kids stay active. They can encourage children to get the 60 minutes of moderately intense physical activity they need, preferably daily.

We need to get our children moving.

Most importantly, we need to model the behavior we want our kids to exhibit. How often do kids fail to listen to what we say; but how often do our kids imitate what we do.

Parents can encourage healthy eating habits.

There’s no great secret to healthy eating. To help develop healthy eating habits, parents should, for starters, provide plenty of vegetables, fruits, and whole-grain products; choose lean meats, poultry, fish, lentils, and beans for protein, serve reasonably-sized portions and limit the consumption of sugar.

Overweight children should also be encouraged to reduce the rate of body weight gain while allowing growth and development, instead of attempting to lose weight.

As we move forward, it is critical that H-H-S, ADA and our many partners continue to widely share what we know and what we have,

I am referring to the best available information on the benefits of physical activity and strategies to properly motivate children and families to make healthy lifestyle and eating choices.

With that in mind, the inaugural Physical Activity Guidelines for Americans scheduled for release later this year will provide a consistent message for the American public about physical activity, one which will be flexible enough for use by children as well as other specific population groups.

For the past 40 years, many organizations have issued recommendations for physical activity. And while it’s fine to call for physical activity, it’s even better to give guidance on what people – young and old – should do and how to do it.

The idea is to develop a unified set of guidelines for all Americans – speaking in one voice that will send the messages that wellness is a hard-won habit, physical activity is important, and the adoption of a healthy lifestyle begins with certain simple, but important steps.

It is no exaggeration to suggest that the degree of success that we, as a Nation, realize in reducing obesity in young people will be largely determined by our influence, our reach, and our ability to motivate parents and children alike, for years to come.

Closing and Charge

The ultimate result – a population of physically active Americans centered on prevention, routinely conscious of diet and nutrition whose healthy choices add years and quality to their daily lives - may not be apparent for years or even decades

Yet it is a result that “many players” can help realize.

This outcome is one which can best be achieved through day-to-day efforts, collaborations among nutritionists and dieticians, fitness professionals, the federal government, research scientists, corporate leaders, parents, and kids themselves.

Think again of what is at stake.

Consider the potential costs of childhood overweight and obesity left unabated.

The families and lives disrupted; potential of young people that is unmet; futures of young people diminished, their promise unrealized; the increased risk of heart disease, diabetes and other chronic illnesses; the lifelong impact on their health.

Think about it.

The need to act is a collective responsibility. The call is one which anyone can answer.

We can all be agents of cultural change.

Together, we can literally save lives.

Let us step up ‘as one’ to make a difference.

Again, I salute the A-D-A for hosting such an excellent public policy workshop. And, a reminder: For more information on activities in the Office of the Surgeon General, please visit our website. The address is www.surgeongeneral.gov

Lastly, please remember: We can all be agents of cultural change.

Together, we can literally save lives.

Thank you.

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Last revised: September 04, 2008