"Addressing Childhood Overweight and Obesity: Never Too Young"

Remarks as prepared; not a transcript.

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

Address to the JCCs of North America Biennial Meeting

May 7, 2008
Miami, FL

"Addressing Childhood Overweight and Obesity: Never Too Young"

Good morning. Thank you, Noreen (Noreen Sablotsky, JCCA Board Member and Biennial Chair) for that gracious introduction.

I am delighted to have the opportunity to deliver this plenary address — and I am honored to be speaking before the Association of Jewish Community Centers.

My bosses, Department of Health and Human Services Secretary Michael Leavitt, and Assistant Secretary for Health Dr. Joxel Garcia also extend their greetings and best wishes.

At the outset of my remarks, I want to make sure you were aware of my personal and family connections to the JCC movement.

I spent what I am sure were many formative times in my early childhood at the JCC in Syracuse, NY where I grew up. The swimming classes I took there with my brother and sister helped, I am sure, put me the road to a life of physical fitness.

More recently, as the father of three children, the JCC in Montgomery County, MD was a welcoming environment for our family when we moved to the Washington area.

So I am familiar with the role that JCCs play as they enrich thousands of lives; I know the widespread respect you have as part of this country’s amazing network of faith-based community organizations.

So, to be presenting here at the JCCA biennial meeting has special meaning to me.

The health, well being and sound development of young people and activism to create a better community have been cherished traditions of the JCCs of North America since your inception.

My respect for that history is one reason I am immensely proud to be here today.

It is my privilege to give back, to share my thoughts and to enlist your help in creating a healthier nation.

I know that the JCCA is considering how you can best take the initiative to improve children’s health…to ensure the good health and fitness of the youngest and most vulnerable among us.

I commend your willingness to do what you can to ensure that today’s young people are prepared and physically able to reach the fullness of their potential tomorrow.

A real need exists: The prevalence of overweight in United States children, 2 to 5 years old, has increased 2-fold since 1975. (Warner ML, etal; Children's Environmental Health Research, School of Public Health, University of California; and Pub Med)

Moreover, toddlers who are markedly overweight are much more likely to become overweight/obese 12-year-olds when compared to their peers of normal weight.

The JCCA’s recognition of childhood overweight and obesity and your readiness to combat it reflects a pro-active vision any organization can emulate.

Before I move forward, I want to first talk to you about my office priorities.

I want also to discuss the strides we’re making at the community level and elsewhere in the prevention of overweight and obesity in children.

And I want to discuss ways that H-H-S, the J-C-C-A and like minded organizations can work collaboratively to improve community, family and individual health.

My Priorities

As 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.

The focus of my office and of H-H-S more broadly is premised on the understanding that we need to change the way we think about health care.

I am referring to the need to dramatically shift the culture of American medicine and public health.

We must move from a treatment-oriented society - where too little time, money and effort are invested in preventing disease - to a prevention-centered society.

[Slide 2: Disease Prevention]

My first priority is Disease Prevention.

While we spend the vast proportion of our health care dollars in this country treating preventable diseases — when greater emphasis on preventing these diseases will save lives and precious health dollars.

In preparation of this speech, I did a little reading in the Israeli Journal of Medicine and I am very grateful to Professor Michael Weingarten from Tel Aviv University, who published an article last year summarizing the concept of Prevention in Halakah, the Jewish Legal System.

Among Jewish theologians, the clearest support for the concept of preventive medicine as a religious obligation is — as most of you know — Maimonides. Maimonides saw the phrase “look after yourself carefully” — (from Deuteronomy) as a LAW.

Although he ranks well-being of the SOUL as being FIRST in rank of importance followed by well-being of the BODY, he places a slightly confusing caveat, which is that the SOUL’s well-being can only be attained AFTER that of the body is obtained.

So if you are thinking about whether religious writing exists to support our efforts at prevention — think no further….but then, in the best Talmudic tradition, keep in mind that most rabbis don’t seem to support this strong a interpretation.

[Slide 3: Public Health Preparedness]

My next priority is Public Health Preparedness — we must be prepared to meet and overcome challenges to our health and safety, whether natural or man-made.

Over the past few years, emergency preparedness has become a major part of our mission to protect, promote, and advance the health and safety of the nation.

The Office of the Surgeon General oversees the 6,000-member Commissioned Corps of the United States Public Health Service.

These officers are available to respond rapidly to urgent public health challenges and emergencies, and are becoming more highly trained to respond to all-hazards emergencies.

Preparedness must also involve planning by every level of society, including every family.

[Slide 4: Pandemic Flu checklist]

One important area that we continue to work on, even as the media has died down, is pandemic flu preparedness. We must do everything we can, every day, to be ready.

To help communities and families prepare, we have preparedness checklists on our website.

These include checklists for individuals, families, schools, businesses, hospitals, and community organizations.

[Slide 5: Health Disparities]

My next priority is the Elimination of Health Disparities. While overall, our nation's health has improved, not all populations have benefited equally - and too many Americans in minority groups still suffer from illnesses at a disproportionate rate.

A couple of illustrations:

• African Americans 50% more likely than non-Hispanic whites to have high blood pressure.

• And Hispanics have higher rates of obesity than non-Hispanic Caucasians.

• 1 in 2 Hispanic women born in 2000 will develop diabetes in their lifetime

It is imperative that things change, and we need to work collaboratively to make change happen.

[Slide 6: Health Literacy]

And woven through all of these priorities is an issue we call Health Literacy.

It is the currency for success in everything that we are doing in the Office of the Surgeon General.

We cannot make improvements in health care and prevention if our messages aren’t being understood because of language and educational barriers.

We need to steadily improve the ability of an individual to access, understand, and use information and services to make appropriate health decisions.

Unfortunately, our low health literacy is a major problem:

Every day, health care providers witness the health literacy gap…the chasm of knowledge between what professionals know and what patients understand.

Whether we are a public health professional, parent, mentor or all three, each of us can make sure that good health information is getting into the hands of our kids and others who need it.

Each one of us can be an ambassador for health literacy.

Overweight and Obesity

One pressing public health challenge cuts across state boundaries, geographic areas, age groups and socio- economic status.

I’d like to pause and show you an entertaining but serious video clip illustrating what has happened in American society.

(LAZY BONES CLIP)

The clip focuses on bone health, but you all know the health risks of obesity go way beyond the bones.

There has been a startling trend in adult obesity rates in our country just in the past decade.

[Slide 7: Obesity Maps Slide]

This slide depicts the startling trend in adult obesity rates in our country in the past decade. This is national survey data of the percent of the population of each state with a BMI greater or equal to 30, or about 30 lbs overweight for a 5’4” person.

[Slide 8: Call to Action Slide]

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

The Call to Action strongly urged all sectors of society to take action to prevent and decrease overweight and obesity.

The factors which brought about the C-T-A remain; some would say they are even MORE pressing today.

That is why, as the Surgeon General, I am committed to making the prevention of childhood overweight and obesity my top priority.

Childhood overweight and obesity is among the foremost health challenges of our time because children are the future of our nation. The data are telling.

• To date more than 12.5 million children and adolescents — 17 percent of people ages 2 to 19 years -- are overweight.

• Overweight increased from 7.2 to 13.9 percent among 2-5 year olds ALONE and from 11 to 19 percent among 6-11 year olds between 1988-94 and 2003-2004 (Source: National Center for Health Statistics).

Researchers also recently estimated racial/ethnic differences in overweight and obesity in a national sample of 3-year-olds from urban, low-income families.

• They found that 35 percent of the children studied were overweight or obese, and Hispanic children were twice as likely as either black or white children to be overweight or obese.

• The study concluded that problems with overweight and obesity begin as early as age 3, and Hispanic children and children with obese mothers are especially at risk. (Am J Public Health. 2007;97:298-305.)

Moreover, if a child is overweight at least once between the 2 and 4 years of age, he or she is five times more likely to be overweight at age 12 than a child who was never overweight between the ages of 2 and 4 (Nader, et al, Pediatrics, 2006)

We also know that overweight adolescents have a 70 percent chance of becoming overweight or obese adults.

Of course, as overweight children and adolescents grow older, they are more likely to have additional risk factors associated with cardiovascular disease such as high blood pressure and high cholesterol.

The situation here in Florida is another illustration of the seriousness of the problem.

• Only 30 percent of Florida high school students met currently recommended levels of physical activity in 2005; (Youth Risk Behavior Survey, 2005).

• HRSA’s 2003 National Survey on Children's Health found that:

  • Approximately 38 percent of Hispanic children in Florida were overweight or obese, compared to 31 percent of their non-Hispanic counterparts in the state; and
  • Nationally, 37.7 percent of Hispanic children were overweight or obese, compared to 29.5 percent of non-Hispanic children.

[Slide 9: HYHF Tour Map Slide]

Data like these suggest why I am visiting communities across the country to encourage discussions and implementation of best practices to address this alarming crisis.

This is part of an initiative called “Healthy Youth for a Healthy Future.”

As you can see from this slide, to date, I have visited the highlighted states and I look forward to visiting several more over the course of the next few months.

At each stop, (Miami/Dade County among them) I’ve learned about effective local childhood overweight and obesity programs; I’ve shared information about these programs at each subsequent stop on the tour.

Each stop includes discussion with public health professionals, community leaders, and other partners who are active in the fight against obesity.

We want to motivate and mobilize parents, kids and others who influence our children - mentors, caregivers, schools, public health leaders, and local community leaders.

It seems easy to say and more difficult to do.

During this “Healthy Youth” tour, I will recognize and bring attention to communities with effective prevention programs that motivate organizations and families to work together to promote the goals of this initiative which are to:

[Slide 10: Healthy Quadrants Slides]

• encourage kids to stay active,
• eat nutritiously
• make healthy choices

To those ends, communities are coming together to address childhood overweight and obesity prevention. They are developing programs and sharing ideas.

Make no mistake: improving children’s health, and changing their habits, is more critical than ever.

It is important to realize that physical activity rates among our youth are also declining: just a quarter of high school students are moderately physically active for 30 minutes a day, 5 days a week which is half the time recommended for youth.

This must change.

Parents need to encourage young people to spend less time in front of computer and television screens and more time getting up and moving around.

Well respected organizations must get involved to combat the obesity epidemic just as your Association is doing.

The JCCA is aware of the importance of starting early and TO “set the bar” appropriately high.

Another good example of an organizational of stature taking action in the obesity fight is the National Football League, Ad Council and H-H-S collaboration to produce a Public Service Announcement designed to motivate young people to get the recommended 60 minutes of daily exercise into practice.

[Slide 11: NFL Video Clip]

[Slide 12: NFL Slide]

So too is the Robert Wood Johnson Foundation a “good citizen” in combating obesity.

In April, 2007, RWJF pledged $500 million over the next five years to combat childhood obesity in the US - the largest commitment by any foundation to this issue.

Few organizations have the visibility, resources or stature of the JCCA, the RWJF or the National Football League, but anyone can get on board and join our effort.

The food, sports, beverage and entertainment industries must each step up to do their part.

The American Beverage Association has worked with educational administrators in public schools to establish guidelines which limit beverages available in public school vending machines during the school day.

Commitments like those I have just described CAN make a difference.

I expect to see more commitments — from all sectors of society.

…For the stakes are high in the fight against childhood overweight and obesity.

…As a matter of individual and community well being.

…For the sake of the futures of America’s young people.

…As a matter of public health …national productivity… and economic sustainability.

The outcome of the fight against child overweight and obesity is critical.

Just as clinicians and public health professionals are trained and positioned to reach out with accurate information about the added value of physical activity, nutritious eating and maintaining a healthy weight...

So too must we recruit parents, families, community organizations, teachers and mentors of kids if we are going to make real progress against the national overweight epidemic.

Our approach must be multi-faceted: clinical, educational, and ultimately transformational.

Again, the process starts in communities — like the cities and counties that JCCs serve.

[Slide 13: We Can! Slide]

It is enhanced when an interested partner formally becomes a “WE CAN” community or participant organization, like more than 600 others in the United States. WE CAN is an NIH/NHLBI program to motivate people on the local level to ‘become and remain” physically active.

It continues by offering healthy food and beverage choices in school vending machines as Austin, TX, certain West Virginia counties, the American Beverage Association and others are doing.

It is enhanced by projects like the ‘Big Fat Industries and Kidz Bite Back,’ a public awareness campaign nearby: in Pinellas County, Florida.

Participants in the campaign learn about food marketing practices and good health science; they are also taught techniques to increase their physical activity and healthy nutrition choices.

It gains momentum through North Carolina’s “Be Active Hops” program and others like it…which show kids that physical activity is user friendly and how much fun it can be.

By taking a look at what each of us can do in our lives and communities - whether a JCC parent, good neighbor, or Dade County business person - to make ourselves and our families healthier we can begin to tackle this epidemic.

H-H-S, for our part, is working on a number of fronts to do the same.

[Slide 14: President’s Challenge Slide]

The President’s Council on Physical Fitness and Sports is encouraging kids, adults, and organizations to log on to join the President’s Challenge at www.presidentschallenge.gov

[Slide 15: Closing Family Slide]

It is important to keep in mind that we will not achieve results against childhood overweight and obesity overnight.

But we won’t make any progress at all unless other organizations join you and make prevention and early child health education priorities NOW.

They must remain OUR priorities for as long as it takes.

That means as long as it takes to get a handle on overweight and obesity…to reduce its prevalence.

That means as long as necessary to end the spike of chronic conditions and cardiovascular disease risk factors.

That means as long as required to begin to routinely prevent disease and illness that imperil kids’ future.

In the meantime, for more information about federal activities, visit www.surgeongeneral.gov

Government needs the help of businesses, industries, and associations who care - leaders respected throughout North America and beyond, like JCCs - to create and sustain progress in combating overweight and obesity.

I challenge the JCCs of North American to step up to the plate to address your role in this crisis and to activate your membership to foster change and public health progress.

The end result of this work will NEED to be 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.

Together, let us resolve to make it happen.

Thank you.

- END -

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Last revised: September 04, 2008