Remarks to the University of Kansas Annual Obesity Conference

Remarks As Prepared, Not a Transcript

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

Address to Kansas City University of Medicine and Biosciences 

September 5, 2008
Kansas City, Missouri

Good morning. 

Thank you Barbara (Dr. Barbara Atkinson, Executive Vice Chancellor, Kansas University Medical Center,) for that gracious introduction.

And I also thank also RADM John Babb, H-H-S Region VII Health Administrator for all that your office does.

John, I appreciate all your hard work and the efforts of your collaborating partners to make my visit to Region VII a most successful one.

H-H-S Region VII is in excellent hands.  

At the outset of my remarks, I want you to know how much I appreciate this opportunity to share my thoughts with you at this annual conference.

It’s a special treat to be here with people like Dr. Joseph Donnelly.

Dr. Donnelly, of course, has been the prime mover behind this conference for the past ten years. 

Joe, I thank you for your leadership.

I know that Dr. Donnelly now has two full-time jobs – directing the Energy Balance Laboratory, a center dedicated to overweight and obesity research at the University of Kansas in Lawrence, Kansas, and directing the Center for Physical Activity, Nutrition and Weight Management here in Kansas.

Just as doing what is necessary to protect kids’ health and to secure their futures has long been Dr. Donnelly’s commitment – so too it’s what this conference is all about.

For that, I salute the organizing committee of this obesity conference for a job well done!

We need more conferences like this one...in every state...because getting a handle on childhood overweight and obesity is a national imperative.

I know my audience is a diverse one that includes clinicians, academicians, dietary specialists, students and others who share an interest in a healthier Nation.

I appreciate your singleness of focus: your interest. What brings you – collectively – here is an interest in instilling healthy habits and ensuring that young people achieve and maintain the best possible health status.

My activities while in your state include not only my address here; I had the opportunity to speak yesterday to the Children’s Mercy Hospital of Kansas City and visit the Kansas City University of Medicine and Biosciences.

What I have seen and heard certainly confirms that our cause is common.

I’m pleased that health professionals throughout H-H-S Region VII are on the front lines of the fight against America’s obesity epidemic.

They and you understand why it is necessary to encourage and sustain a cultural change to first reduce pediatric overweight, and, in time, entirely prevent it.

You know what is at stake.

You know how critical resources - like the Kansas University Center for Physical Activity and Weight Management - are to creating a culture of wellness in Kansas, Missouri, Iowa  and nationally.

Value-Driven Health Care

Before I review in more detail the formidable challenge which is childhood overweight and obesity - I first want to discuss the H-H-S vision for American health care.

H-H-S Secretary Leavitt and I, indeed the entire leadership of the H-H-S, have been talking about the critical need for change in American health care and how important it is that we have a system which is value driven.

As the Secretary says, “...consumers know more about the quality of their television than about the quality of their health care.”

At H-H-S, we are committed to bring about a future in which consumers:

...can compare doctors, not just on what they charge, but also in the quality of the care they give, and

...approach health care the way they would any other major purchase.

We foresee a future in which:

... Personalized health care - service delivery carefully tailored to meet an individual’s needs - is the norm.

 ... Every American is insured – every citizen, without exception, has access to basic health insurance at an affordable price.

This leads me to discuss the priorities that we have in the Office of the Surgeon General.

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.  

[Slide 2: Disease Prevention]

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

Seven out of 10 Americans die each year of preventable chronic illnesses such as heart disease, diabetes and cancer.

The medical care costs of people with chronic diseases account for as much as $1.4 trillion of the nation’s medical care costs.

A modest increase in the time, emphasis and resources we invest to prevent chronic diseases will save lives and potentially reduce healthcare costs.

 [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.

Emergency preparedness has increasingly become a major part of the H-H-S mission to protect, promote, and advance the health and safety of the nation.

In fact, my office 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 preparedness is multi-dimensional. It must also involve planning by every level of society, individuals, families, and communities.

[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]

Another 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.

Some illustrations:

[Slide 6: Health Disparities Graph]

• African American babies are twice as likely as white babies to die within their first year of life.
• Cancer is the second leading cause of death for most racial and ethnic minorities in the United States. For Asians and Pacific Islanders, it is the number one killer.
• African Americans are 1.5 times as likely as non-Hispanic whites to have high blood pressure
• Hispanic women were 2.2 times as likely as non-Hispanic white women to be diagnosed with cervical cancer.

And there are far too many more statistics like these; the trends they illustrate are unacceptable; they compel our attention - and we must act aggressively to change them.

[Slide 7: 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.

In 2003, an estimated 77 million American adults, about 36 percent of the population, were reported to be at or below basic health literacy levels(Source: National Center for Education Statistics, Institute for Education Sciences).

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

You more than most know what a profound difference it can when a young person is able to identify Nutrition Facts on a food container and use them to better manage their diet.

Dietary professionals are particularly well suited to improve health literacy.

I say this because, registered dieticians - widely represented in audience today - understand well the relative relationship between family health history and one’s disease risk.

When dieticians 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.

Every day, you and your colleagues witness the health literacy gap...the chasm of knowledge between what professionals know and what patients understand.

However, whether a dietician, professional in another health specialty, or concerned parent, each of us can do our part to ensure that accurate 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.

[Slide 8: 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 9: 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 10: 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.
• Overweightincreased 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).

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.

A snapshot of the situation here in the Midwest is telling.

The 2007 Missouri Youth Risk Behavior Survey (YRBS) indicated that among 12 percent of all high school students were obese, 56 percent did not meet recommended levels of physical activity, and 21  played video or computer games or used a computer for something other than school work 3 or more hours per day on an average school day.

A YRBS survey also found that 11 percent of Kansas high school students were obese; 55 percent did not meet recommended levels of physical activity; 26 percent  watched television 3 or more hours per day on an average school day’ and 20 percent played video or used the computer for something other than school work on an average day.

The data for Iowa is comparable; that this is the case in virtually every one of the 50 states reflects the breadth and scope of the challenge.

[Slide 11: HYHF Tour Map Slide] 

Data like these are 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, 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 - resources that motivate organizations and families to work together to promote the goals of this initiative which are to:

[Slide 12: Healthy Quadrants Slides]

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

I am talking about resources like your Center for Physical Activity and Weight Management.

The Center addresses the well-documented decline in physical activity rates among our youth: 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.

You are working to change this.

However, to create achieve and create lasting change you - WE - need a larger number of allies. 

Moms and dads are the most important among them.

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 Region VII states are doing.

You are more aware than most just how critical it is to start early and “set the bar” appropriately high.

A good example of an organization 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 13: NFL Video Clip]

[Slide 14: 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 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 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.

[Slide 15: We Can! Slide]

It is approach that 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 benefited 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 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 16: 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.org

Moreover, H-H-S will issue inaugural Physical Activity Guidelines for Americans this fall.

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 one that should be shared by anyone who cares about creating and maintaining a Nation of physically active young people.

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.

[Slide 17: 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 us 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

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

The end result will be a nationwide culture of wellness.

It is a culture which we can create.  Once we do, Americans will benefit for decades to come.