Testimony

September 30, 2003

Good afternoon, Mr. Chairman and distinguished members of the Subcommittee. My name is Dr. Arthur Lawrence, and I serve as Assistant Surgeon General and Acting Principal Deputy Assistant Secretary for Health. My professional background is clinical pharmacy and pharmacology. Thank you for the opportunity to speak with you today.

Most Americans make choices about what to eat throughout the day, every day. Making healthy food choices for themselves and their families is key to Americans' overall health and well-being, and essential to reducing risk of long-term diseases and conditions. That is why the Dietary Guidelines for Americans were developed in 1980 and are so important today.

The Dietary Guidelines for Americans form the scientific and medical basis of what Americans need to understand to make healthy eating choices. So many diseases and conditions are preventable when Americans adopt and maintain healthy lifestyles. That is why HHS Secretary Tommy G. Thompson is passionate about making sure that Americans have access to science-based information about diet and nutrition in understandable formats.

Today I will highlight dieting patterns and nutrition habits of Americans, provide a brief history of the Dietary Guidelines, and illustrate the importance of scientific consensus in the ongoing effectiveness of HHS health and nutrition programs.

DIETARY TRENDS

A healthy diet is balanced and includes all major food groups. Based upon the best scientific evidence available, we know that a diet that includes a variety of fruits, vegetables, and grains, especially whole grains; is moderate in sugars, salt, and total fat; and is low in saturated fat and cholesterol is a diet that promotes health and helps prevent disease. Total calories consumed must be balanced with physical activity to maintain a healthy weight. And, food must be kept safe to eat in order to provide nourishment and avoid food-borne illness.

Unfortunately, few Americans are meeting the national consensus objectives presented in Healthy People 2010 for fruit, vegetable, and grain intake, and most Americans' diets exceed saturated fat recommendations. Yet, according to a National Cancer Institute Survey, these problems are not primarily due to a lack of "awareness" - as awareness of the need to eat five or more servings of fruits and vegetables per day has nearly tripled since 1991.

More than half of all Americans are not meeting objectives for physical activity. The prevalence of overweight and obesity has increased. Over 60 percent of American adults are overweight or obese and 15 percent of our children and adolescents are overweight. Four of our country's leading killers - heart disease, some cancers, diabetes, and stroke - are linked to poor diet and inadequate physical activity. More than 300,000 deaths each year are linked to poor diet and inadequate activity patterns.

Americans spend $33 billion a year on weight-loss products and services. According to a 1999 survey conducted by the Centers for Disease Control and Prevention, more than two-thirds of American adults are trying to lose weight or keep from gaining weight, but many do not follow guidelines recommending a combination of fewer calories and more physical activity. Only 15 percent of Americans have received advice from a doctor or health professional about their weight.

Although these statistics are of great concern, progress has been made. More people are reading food labels. Over the past decade, consumption of fruits and vegetables has increased and saturated fat consumption has decreased. Although reversing the trends in overweight and obesity will require change at the societal and environmental levels, as well as at the individual level, efforts to educate and to promote behavioral change at the individual level must continue.

HISTORY OF THE DIETARY GUIDELINES

Assuring a continuing evaluation of the current science and translating that science into messages that Americans can understand and apply is essential, and it's a dynamic process. The Guidelines are a reflection of the current preponderance of the scientific and medical knowledge, and therefore must be continuously and vigorously reviewed.

The Dietary Guidelines for Americans are jointly developed by the Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA). The Guidelines have been issued every five years since 1980. The current edition focuses on three principles: Aim for fitness, Build a healthy base, and Choose sensibly.

HHS and USDA have begun the process of developing the sixth edition, which will be published in 2005. For the 2005 edition, HHS has the lead for chartering the advisory committee. The goals of this edition of Dietary Guidelines are the same - to promote health and reduce disease risk for Americans based upon state-of-the-art scientific evidence.

Early nutrition policy in the United States focused on preventing nutritional deficiencies such as iron deficiency anemia and hunger. Throughout the 1970s, as deficiency diseases became less common, there was growing recognition of the role of excesses and imbalances of certain dietary components related to disease risk and the occurrence of chronic diseases.

In 1977, after years of discussion, scientific review, and debate, the Senate Select Committee on Nutrition and Human Needs recommended what they viewed as Dietary Goals for the American people. The issuance of the Dietary Goals by Congress was met with a great deal of debate and controversy - both from industry groups and from the scientific community. These groups questioned the scientific support for the specificity of the quantitative aspects of the Dietary Goals.

To support the credibility of the science utilized by the committee, the U.S. Department of Agriculture and the Department of Health, Education and Welfare assembled scientists from the two departments and from throughout the nation. In February of 1980 the Dietary Guidelines for Americans were issued. They represented the best scientific perspective at that point in time. However, the debate continued about the scientific evidence used to support the Dietary Guidelines. This led to Congressional report language directing the two departments to convene a Dietary Guidelines Advisory Committee to assure that a broad based perspective across the continuum was formally solicited.

Since 1985, external science advisory committees composed of food and nutrition experts from outside of government have been relied upon to provide expert and objective scientific assessment of the need to revise the Dietary Guidelines for Americans and to propose suggested changes for departmental consideration based upon new scientific findings. Since the issuance of the 1985 Dietary Guidelines, much less debate over the scientific basis for the guidelines has ensued either from industry or the scientific community.

In recognition of the fact that nutritional science evolves, in 1990 Congress formally directed HHS and USDA to issue these guidelines every five years (Public Law 101-445).

The Dietary Guidelines Advisory Committee was established to assist in the preparations of the 1990, 1995, 2000, and now 2005 versions of the Dietary Guidelines. A new Committee has been jointly appointed by HHS and USDA for each edition.

DIETARY GUIDELINES FRAMEWORK FOR HHS PROGRAMS

The information contained in the Dietary Guidelines for Americans report is based on the current preponderance of the scientific and medical knowledge. Thus, in two decades, the Dietary Guidelines for Americans have moved with only minor changes from a contentious document to one that represents broad scientific consensus and provides the statutory basis of Federal nutrition programs, policies, and education efforts. These changes reflect the growing emphasis on health promotion and reducing disease risk.

The Dietary Guidelines serve as a framework for many federal initiatives. Amidst multiple messages that are confusing to the public, the Dietary Guidelines for Americans provide a vehicle for the government to speak with one clear voice. All Federally issued dietary guidance for the general public is required to be consistent with the Guidelines. For example, the Dietary Guidelines for Americans serve as the basis of numerous physical activity and nutrition campaigns throughout HHS. Highlights include:

• NIH's National Cancer Institute=s 5-9 A Day for Better Health, a campaign to increase the average consumption of fruits and vegetables to at least 5 daily servings;
• NIH's National Heart, Lung, and Blood Institute's Cooking the Heart Healthy Way Recipes and Interactive Menu Planner, which are tools for consumers to meet the nutrition goals of the guidelines;
• NIH's National Heart, Lung, and Blood Institute's Red Dress Project, designed to raise awareness that heart disease is the #1 killer of women and provide tools for women to reduce their risk of heart disease;
• NIH's National Institute of Child Health and Human Development's Milk Matters, a nationwide campaign dedicated to increasing calcium consumption among America's children and teens;
• NIH's National Institute of Diabetes and Digestive and Kidney Diseases' Take Charge of Your Health: A Teenager's Guide to Better Health that encourages teenagers to take charge of their health by eating better and being more physically active; and
• The Centers for Disease Control and Prevention's National Bone Health Campaign, Powerful Bones, Powerful Girls, which promotes optimal bone health among girls aged 9-12 years in an effort to reduce their risk of osteoporosis later in life.

The Dietary Guidelines are also used to develop nutrition policies and guidelines. The Food and Drug Administration uses the Dietary Guidelines to address food-labeling policies. The Dietary Guidelines for Americans serve as the basis for the national health objectives, as outlined in Healthy People 2010, for nutrition and physical activity. The Dietary Guidelines for Americans influence dietary and physical activity variables measured in the National Health and Nutrition Examination Survey (NHANES), a survey conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. This survey collects information about the health and diet of people in the United States.

CONCLUSION

The HHS-USDA Dietary Guidelines Advisory Committee that will assist our Departments to prepare the 2005 edition of the Dietary Guidelines held its first meeting last week. The members of this committee are recognized experts in human nutrition and physical activity and have demonstrated their commitment to the public's health and well-being. After preliminary discussions of key recent developments in nutrition and physical activity they concluded that further review of the scientific literature is needed. They began to chart the course of their deliberations for the next several months. We know that scientific results may vary, sometimes seem counter-intuitive and are rarely clear enough to speak for themselves. That is why the experts we have enlisted are focused on a transparent, evidence-based review that will guide their recommendations to the Secretaries of the Departments.

The epidemic of overweight and obesity led President Bush to launch a HealthierUS initiative in June 2002, based on the premise that increasing personal fitness leads to the improved health of our nation. HealthierUS has identified four key dimensions: be physically active each day; eat a nutritious diet; get preventive screenings; and make healthy choices. As part of HealthierUS, the President announced two new Executive Orders that direct key federal departments and agencies to develop plans to better promote fitness and health for all Americans.

In response to that directive, HHS created Steps to a HealthierUS, directing all agencies within HHS to make prevention of chronic disease a top priority. Secretary Thompson is committed to advancing the goals of HealthierUS by giving the public and policy makers clear, scientifically proven steps to embrace prevention. While the primary goal of the Steps to a HealthierUS initiative is to help Americans realize that even small steps can make a dramatic difference in good health, HHS is committed to specific goals to prevent diabetes, obesity, and asthma through this Department-wide initiative. Steps to a HealthierUS will achieve these outcomes by improving nutrition, increasing physical activity, and preventing tobacco use and exposure. The Steps grants program is the centerpiece of this initiative. Last week, Secretary Thompson announced the four states, seven cities, and one tribal council that were awarded these grants. The messages in the Dietary Guidelines for Americans will be used to promote healthy eating and physical activity in these communities.

Additionally, the Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity concludes that a healthy diet and regular physical activity, consistent with the Dietary Guidelines for Americans, should be promoted as the cornerstone of any prevention or treatment effort.

These are all examples of how the Dietary Guidelines serve as the framework for many federal nutrition programs, policies, and initiatives.

Mr. Chairman and distinguished members of the subcommittee, thank you for the opportunity to discuss the importance of the Dietary Guidelines for Americans.

Last Revised: October 2, 2003

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