"Adolescent Obesity: Everyone's Business"

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 to the College of Physicians of Philadelphia

April 3, 2008
Philadelphia, Pennsylvania

"Adolescent Obesity: Everyone's Business"

Good morning. Thank you, Dalton (Dalton Paxman, Ph.D., H-H-S Regional Health Administrator, Philadelphia, PA) for that gracious introduction.

And I thank you also, Dalton, for all that your office does and especially for your hard work to make today's event a successful one.

Region III is in excellent hands.

And to everyone here today...it is my pleasure to be here with you.

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.

I am always pleased to spend time and compare notes with fellow health professionals – and I am especially grateful to have the opportunity to share my thoughts with representatives of the American College of Physicians.

Some of you may think my address to you is like preaching to the choir, and there's an aspect of this, but improving communication among the Office of the Surgeon General professional groups, and the Officers of H-H-S Regional Health Administrators is critically important to me.

Similarly important is the commitment of my hosts today: your dedication to advancing the health of Pennsylvania's children, adolescents and adults is important to the people of your great state and to the Nation.

I commend you for this.

Your visibility is essential.

Your support in encouraging the use of best practices that secure the health status of young people is sending the right messages to our health care system.

In a real sense, you are on the front lines of the fight against America's youth obesity epidemic.

You are agents of change.

I know many of you join me in the necessary and ongoing effort to shift the culture in 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.

Chronic disease prevention should be our number 1 priority in health care.

I am confident that you - like my colleagues at H-H-S - recognize much work remains if we are to move from a treatment-based system of health care delivery to one which emphasizes preventive medicine.

Our work is reflected in the priorities we have in the Office of the Surgeon General.

Before I move forward, I want to first talk to you about these priorities and my role as the Acting Surgeon General. I want to talk to you about is the progress we're making at the community level and elsewhere in the prevention of overweight and obesity in children and teens.

And...how clinicians and practitioners fit it.

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.

My first priority is Disease Prevention. As I said earlier, we spend the vast proportion of our health care dollars in this country treating preventable diseases.

Yet, a modest increase in investment in preventing these diseases will save lives and precious health dollars.

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.

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

To help you prepare we have preparedness checklists on our website.

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

However, our need to prepare doesn't stop there.

That is why the President has requested $507 million in his fiscal year 2009 budget to achieve the goals of his pandemic flu preparedness plan and another $313 million for ongoing pandemic flu preparedness efforts across H-H-S.

I encourage you to explore our pandemic flu website to find more information on how your family or organization can prepare.

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 are 1.5 times as likely as non-Hispanic whites to have high blood pressure.
• Cancer is the second leading cause of death for most racial and ethnic minorities in the United States.
• For Asians and Pacific Islanders, cancer is the number one killer.
• And Hispanics have higher rates of obesity than non-Hispanic Caucasians.

It is imperative that things change, and we need to work collaboratively to improve health care access.

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:

• More than 90 million Americans don't know how to take care of their own health, or how to prevent disease. 7
• And low health literacy impacts all sectors of our society. People of all ages, races, incomes, and education levels are challenged by it.

Basic health literacy is fundamental to the success of each interaction between health care professionals and patients - every prescription, every treatment, and every recovery.

Every day, health care professionals are witnessing the health literacy gap...the chasm of knowledge between what professionals know and what patients understand.

We have to make sure that good health information is getting into the hands of the people who need it.

Each one of us – indeed, any public health professional – can be an ambassador for health literacy.

Overweight and Obesity
The primary reason I am here today is to discuss the pressing public health challenge that cuts across state boundaries, geographic areas, age groups and socio- economic status.

The following slides depict 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" adult.

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 of the US, 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.

In addition to the social burden on our kids, overweight children are at far greater risk for numerous health consequences, including cardiovascular disease, type 2 diabetes and other chronic diseases.

Moreover, overweight adolescents have a 70 percent chance of becoming overweight or obese adults.

That's why I am visiting communities across the country to encourage discussions and implementation of best practices to address this alarming crisis as part of an initiative called "Healthy Youth for a Healthy Future"

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:

1. Help kids be more active
2. Encourage healthy eating habits, and
3. Promote availability and selection of healthy choices.

I know it seems easy to say and much more difficult to do.

However, it is important to remember that as health professionals, whether physicians or specialists in another area, we each have a role.

For instance, as physicians you can promote nutritious eating, healthy choices and physical activity in every interaction you have with patients and their families.

And it is vitally important that you continue to do so.

As you are well aware, our society has become more and more inactive and is seeing a rise in obesity rates.

Chronic diseases linked to obesity have become a catastrophe.

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

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

Our efforts to reduce overweight among our Nation's children are critical.

You have first-hand familiarity with the problem:

An estimated 17 percent of adolescents between the ages of 12 and19 are overweight (NHANES).

And 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.

Your state offers an illustration of what we are facing:

Approximately 18 percent of Pennsylvania youth are reported overweight (Pennsylvania Assessment of Overweight Children and Youth).

And

...Only about 38 percent of Pennsylvania high school and middle school students get at least 240 minutes of exercise/physical activity per week; by comparison an estimated 70 percent of high school and middle school students got two or more hours of computer or TV screen time every week (2006-2007 Pennsylvania Youth Nutrition and Fitness Fact Sheet: High School; 2006-2007 Pennsylvania Youth Nutrition and Fitness Fact Sheet: Middle School).

Because these factors and others that contribute to overweight and obesity are complex, reversing the epidemic will take concerted action, by parents, educators, and youth - indeed by all sectors of society.

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

Our "Healthy Youth for a Healthy Future" initiative seeks to change children's eating and activity habits by working with all sectors of society who influence children.

The primary focus of "Healthy Youth for a Healthy Future" will be programs and campaigns through which local communities address the problem of overweight and obesity.

It is critical that we identify and share information about approaches that are working.

Our success in addressing teen overweight and obesity will depend on our ability to communicate and collaborate effectively.

Just as family, internal medicine and adolescent medicine physicians are trained and able to reach out to patients with important information about 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. One example of action on the federal level is a new national fitness challenge initiated by the President's Council on Physical Fitness and Sports.

This "National President's Challenge" is a 6 week physical activity challenge to get America moving – 30 minutes a day, five days a week. It's designed to help people live healthier by finding activities they really like to do.

ANYONE HERE can sign up on the web...

I urge you to do so promptly because today (April 3) is the deadline.

However, the federal government cannot fight overweight and obesity alone.

There are some examples of leaders in the food, sports, beverage and entertainment industries who are doing their part.

For instance, 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.

Local communities are doing their part, too.

For instance:

During my visit to last week to North Carolina, I learned more about one such program which enables kids to have fun and stay healthy at the same time.

The "Be Active HOPS" initiative trains, evaluates, educates and entertains students of all ages while delivering critical health awareness information. they need to live healthy, active lives.

The Austin, Texas School District offers another ‘front' the fight against childhood overweight. The district has prohibited the sale or distribution of "Foods of Minimal Nutritional Value," during the school day, at all grade levels.

Similarly, the state of West Virginia has declared certain of its counties DRY – and it's not what you think – these are counties throughout the state who have removed high calorie beverages from school vending machines.

Another good example 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.

Robert Wood Johnson Foundation offers another illustration what I am talking about.

In April of 2007, RWJ 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 RWJ or the National Football League, but anyone can get on board and join our effort.

Commitments like this - and I expect to see more of them - CAN make a difference.

However, the process starts in communities.

It starts "close to home" through organizations like Pennsylvania Advocates for Nutrition and Activity (PANA) and

... Its Pennsylvania Growth Screening Program (GSP) – one which requires schools to weigh and measure all students and to calculate and record Body Mass Index (BMI) in the school health record.

School nurses then inform parents about their child's results and recommend that they share the information with their healthcare providers.

It starts with organizations...

...like the Health Promotion Council of Southeastern Pennsylvania

And

... The Philadelphia Urban Food and Fitness Alliance (PUFFA)

...It starts with the promotion of healthy lifestyle activities in familiar settings.

One way to jump start this locally is to become a WE CAN community or participant organization, like 555 others nationwide (including PANA). We CAN! is an NIH program to motivate people on the local level to ‘get up and move.'

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

Later this year H-H-S will issue an inaugural Physical Activity Guidelines for Americans.

The guidelines 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.

The message is that wellness is a hard-won habit, physical activity is important, and the adoption of a healthy lifestyle begins with simple steps.

I have met with the committee working on these guidelines, and they're really interested in making the key link between activity and overall health.

Their work will be enormously helpful.

Closing and Charge
In closing, we will not achieve results against childhood overweight and obesity overnight.

But, we will make progress, thanks to commitments from physicians and care givers like you.

I look forward to working your membership in every possible way to prevent and reduce overweight and obesity trends in America.

The end result of this work will NEED to be a population of physically active young people who are centered on prevention, increasingly conscious of diet and nutrition and whose healthy choices add years and quality to their daily lives.

This outcome is one which can best be achieved through day-to-day efforts, collaborations all across this country – among practitioners, scientists, government at every level, parents, teachers and kids themselves.

As I close – a final web address for your reference, one I hope will be easy to remember. You can find more information on the Surgeon General's website: www.surgeongeneral.gov

We can all be agents of cultural change to reduce and prevent childhood overweight and obesity.

I look forward to working with you and other professional organizations to achieve a change that will result in a healthier nation.

Let us step up together to make a difference.

Thank you.

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Last revised: December 30, 2008