Testimony

• Dr. Richard Carmona
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  Testimony

  Dr. Richard Carmona

  Good afternoon Mr. Chairman and distinguished members of the Subcommittee. My name is Dr. Richard Carmona, and I am the Surgeon General of the United States. I want to take this opportunity to thank you for your service to our nation. I’ve had the honor of working with many of you, and I look forward to strengthening our partnerships to improve the health and well being of all Americans. Mr. Chairman, thank you for your leadership in children’s health and education. As the nation’s doctor I thank you for taking steps to combat a growing epidemic in our country: childhood obesity. By calling this hearing you are telling Americans that there is a problem and that we need to work together to solve it. I am joined by my colleague Dr. William Dietz, Director of the Division of Nutrition and Physical Activity at the Centers for Disease Control and Prevention. Dr. Dietz and I will be available to answer any questions you may have. President Bush, Secretary Thompson, and I have worked to raise public awareness of the need for a comprehensive recommitment to public health through prevention. The science is conclusive: by taking a few simple steps in our personal lives we can greatly improve our health and our nation’s health, both today and in the future. For example, the findings of the Department of Health and Human Services’ Diabetes Prevention Program clinical trial showed that people with pre-diabetes can delay and even prevent Type 2 diabetes by losing just 5 to 7 percent of their body weight through moderate changes in diet and exercise. These lifestyle changes worked for people of every ethnic or racial group who participated in the study. The changes — such as walking for 30 minutes a day five days a week — are simple, and prove that small steps can bring big rewards. We must increase our efforts to educate and encourage Americans to take responsibility for their own health. Over the past 20 years, the rates of overweight doubled in children and tripled in adolescents. Today nearly two out of every three American adults and 15 percent of American kids are overweight or obese. That’s more than 9 million children — one in every seven kids — who are at increased risk of weight-related chronic diseases. These facts are astounding, but they are just the beginning of a chain reaction of dangerous health problems — many of which were once associated only with adults. Today pediatricians are diagnosing an increasing number of children with Type 2 diabetes — which used to be known as adult-onset diabetes. Research indicates that one-third of all children born in 2000 will develop Type 2 diabetes during their lifetime. Tragically, people with Type 2 diabetes are at increased risk of developing heart disease, stroke, kidney disease, and blindness. These complications are likely to appear much earlier in life for those who develop Type 2 diabetes in childhood or adolescence. Because of the increasing rates of obesity, unhealthy eating habits, and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents. And the economic costs of obesity are staggering — second only to the cost of tobacco use. The annual cost of obesity is now estimated at up to $117 billion in direct and indirect costs. The good news is that there is still time to reverse this dangerous trend in our children’s lives. Today I will discuss two key factors to reduce and eliminate obesity in America: increased physical activity and healthier eating habits. I’ve traveled the nation talking to students as part of my “50 Schools in 50 States” initiative, and I’ve seen all kinds of kids. Kids of different races and ethnicities, backgrounds and upbringings. But one thing is constant: too many of them are living unhealthy lifestyles. You can tell just by looking at them. I love seeing their bright smiling faces, full of hope and happiness. But what they don’t know about excess weight could end up killing them in a few decades. We at HHS are taking aggressive measures to educate Americans about healthy living and provide incentives to encourage healthy choices. ? In June 2002 President Bush launched the HealthierUS initiative to help Americans take steps to improve their personal health and fitness by encouraging children and adults to be physically active every day, eat a nutritious diet, get preventive screenings, and make healthy choices. ? In support of the President’s initiative, Secretary Thompson launched a bold initiative called Steps to a HealthierUS. This program focuses attention on the importance of prevention. ? In 2003 the HHS Steps to a HealthierUS Community Program awarded $13.7 million to 23 communities to implement action plans. These community initiatives include walking programs, smoking cessation programs, and increasing healthy foods in schools. The number of applications for the 2003 funding far exceeded what we were able to award. Secretary Thompson and I thank you for increasing the Steps to a HealthierUS funding to $44 million in 2004, and ask you to support the President and Secretary’s request that Congress increase the funding for this program to $125 million in 2005. ? Last year Secretary Thompson initiated a challenge to HHS employees to be physically active for 30 minutes a day, five times a week. Many Governors are issuing similar challenges in their states. Many Americans are using the President’s Council on Physical Fitness and Sports web site to track their physical activity. These challenges raise health awareness and teach individuals to be responsible for their own health. ? HHS and USDA are revising the Dietary Guidelines for Americans. The Guidelines give advice on food choices, based on recommendations of a panel of health and nutrition experts, and serve as the basis for the U.S. Government’s nutrition policy. The revised Dietary Guidelines will be released in 2005, and a new Food Guide Pyramid will be released shortly thereafter. ? HHS is also partnering with private-sector groups such as the Girl Scouts and Boys and Girls Clubs to make the best use of resources for targeted prevention-related initiatives. ? In addition, HHS is developing a national action plan on diabetes. The plan will promote better coordination of HHS efforts in diabetes research, detection, prevention, and treatment, and explore ways to promote similar activities in the private sector. ? In April 2003, NIH Director Elias Zerhouni established the NIH Obesity Research Task Force to develop a strategic plan for obesity research. The plan will be released soon, and will put forth a research agenda for addressing obesity. ? Also in 2003, FDA Commissioner Mark McClellan formed the HHS FDA Obesity Working Group. He charged the group with preparing an action plan to address the obesity problem. That plan will also be released this spring. ? Finally, the CDC remains at the forefront of collecting data on prevalence and trends for obesity and overweight individuals in the United States and in developing tools to improve nutrition and physical activity and prevent chronic disease, including in children. In addition to these HHS initiatives and activities, it is very important for parents to take responsibility. We must teach our children to enjoy healthy foods in healthy portions and encourage them to be physically active for at least 60 minutes a day. The average American child spends more than four hours a day looking at some kind of screen. Parents, make the healthy choices: turn off the TV and the video games, go outside with your kids, play ball, go for a walk. Talk with your kids, spend quality time with them, and when you’re together as a family, do something active. Kids don’t automatically know how important it is to be physically active for an hour a day. They don’t all know that they need five to nine servings of fruits and vegetables a day. That concept is part of what I’m talking about with Americans of all ages: increasing our health literacy. Health literacy is the ability to access, understand, and use health-related information and services to make appropriate health decisions. We must close the gap between what health professionals know and what parents and children understand about physical activity and healthy eating. Every morning people wake up and, while they’re sitting at the kitchen table, they read the newspaper and the cereal box. Throughout the day they read the nutritional information on their meals and on their snacks. But do they really understand the information they’re reading? Can parents explain it to their children, who see tantalizing “kid food” products that they don’t know are loaded with sugar and fat? To make healthy choices, parents and children need easy-to-understand information that fits into their busy lifestyles. Many people, even educated Americans, don’t know what a calorie is, or how to burn it. It’s our job to make that kind of health information meaningful and helpful. For example, Secretary Thompson recently announced that food labels will list trans fat content. This will give American families information to make smart choices to lower their intake of these unhealthy fats. I ask you to work with the President, the Secretary, and me, as well as every mom and dad in America, to promote healthy living, improve health literacy, and encourage healthier lifestyles so that we can end our nation’s obesity problem before it has a chance to reach into another generation of Americans. Working together, industry, government, and individuals can achieve these goals. Industry can help by providing healthier choices for customers and including better information about its products. Secretary Thompson is working with industry to assure that healthy choices are developed and made available to all Americans. Scientific leaders in government and the private sector need to make sure that people have accurate, science-based information about the factors that contribute to overweight and obesity. This testimony has outlined for you HHS’ efforts to combat the obesity epidemic. Most importantly, parents need to be good role models by being physically active and by encouraging their children to exercise and make healthy choices about what they eat and how much they eat. Thank you. I’ll be happy to respond any questions you may have.

• Dr. William Dietz

Witness Panel 2

• Mr. Robert Liodice
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  Witness Panel 2

  Mr. Robert Liodice

  Good afternoon, Mr. Chairman and members of the subcommittee. My name is Bob Liodice and I am the President and CEO of the Association of National Advertisers (ANA). ANA is the industry’s premier trade association dedicated exclusively to marketing and brand building. We represent more than 340 companies with over 8,000 brands that collectively spend more than $100 billion annually in marketing communications and advertising. Our members market products and services to both consumers and businesses. Most of America’s largest food marketing companies and many restaurants are members of ANA. More information about our association is available at www.ana.net We appreciate the opportunity to testify on the important and complex issue of childhood obesity. As the Surgeon General concluded in his 2001 report, “There is no simple or quick answer to this multifaceted challenge.” The groundbreaking report contained page after page of specific recommendations on how to address the obesity challenge in a balanced, comprehensive way. The report called on all of us: companies, individuals, families, schools, governments, and the media to work together to build solutions that will bring better health to everyone in this country. The advertising community accepts the Surgeon General’s challenge. We are working proactively to help implement many of his recommendations and to seriously address the problem of childhood obesity. ANA is proud to be a member of the American Council for Fitness and Nutrition (ACFN). ACFN is a coalition of food and beverage companies and several important trade groups that is working together to encourage a healthy balance between fitness and nutrition. More information about the Council is available at www.acfn.org. I would like to focus today on two other areas: the work of The Advertising Council and the self-regulatory efforts of the Children’s Advertising Review Unit (CARU). In 1942, the ANA was one of the key organizers of the non-profit Advertising Council. The Ad Council provides over a billion dollars worth of public service ads over a wide range of public issues every year. The Ad Council’s numerous ad campaigns can be found at http://www.adcouncil.org/. The non-profit Ad Council is working with government and non-profit organizations to develop and present several effective lifestyle messages in order to prevent obesity, and to educate the public about steps every person can take to avoid and combat obesity. These campaigns should be launched within the coming months. The ANA supports the Ad Council's efforts, and we will continue to encourage all of our members and partners to do the same through significant donated media and creative resources. The advertising community has an important proactive responsibility to help assure that advertising is truthful and nondeceptive and that special consideration is given to the needs of children in the marketplace. In the mid-1970’s, the advertising community developed the National Advertising Review Council, which sets the policies for the National Advertising Division/National Advertising Review Board self-regulatory system, housed within the Council of Better Business Bureaus. This program allows for quick action on any national ad that is claimed to be false or deceptive. FTC Chairman Timothy Muris has described the NARC system as an excellent model for effective industry self-regulation. Realizing that children are not miniature adults, the NARC, NAD/NARB program has been supplemented by the Children’s Advertising Review Unit (CARU), an organization focused on the special needs of young people. Marketers realize that material that might be truthful and nondeceptive for adults might still mislead young people. CARU has devised a detailed code to assure that children are not taken advantage of in the advertising marketplace. That code is available at www.caru.org/guidelines. It’s important to note that 25% of CARU’s Advisory Board is drawn from the academic sector, including psychology and communications deans from UCLA and the University of Texas and a child psychiatrist. CARU has published “Advertising and Your Child,” a guide for helping parents teach their children about the role of advertising in our society. CARU carries out its own monitoring and receives complaints from regulators, consumer advocates, Attorneys General, competitors and the public at large. The record of industry’s compliance with CARU’s guidelines demonstrates an extremely high level of effectiveness. CARU has brought formal cases or informal inquiries on a number of food advertising campaigns directed at children. For example, a commercial for a snack food showed a well-known skateboarder waking up, showering and heading out the door eating a bag of chips, with no depiction of any other breakfast. CARU’s guidelines state that snack foods should be clearly represented as such and not as substitutes for meals. After an inquiry from CARU, the marketer removed the commercial from all children’s programming, to comply with the CARU guidelines. In virtually every case where CARU is involved, marketers voluntarily change the ads or withdraw them. Our self-regulatory system is an active cop on the beat, working to see that food marketing aimed at children is appropriate. At the same time, a large number of food companies have responded in the marketplace to the growing societal concerns about obesity. Consumers are looking for ways to incorporate variety, balance and moderation in their diets and food companies are responding to their customers. Companies are reformulating products to be lower in cholesterol, fat and calories. Many restaurants are providing new salad and other lower calorie offerings in all of their stores. In fact, in the highly competitive food and restaurant industries, the advertising for many companies now prominently features the health or nutritional benefits of their products. So the marketing community is actively working to help implement many of the recommendations from the Surgeon General’s report. One important topic that was never mentioned in that report was food advertising. Not a single word. But that certainly has not stopped our critics and some other groups from arguing that the solution to the childhood obesity crisis is to tax, ban or restrict food advertising. We strongly reject those calls. The advertising community and individual food marketers are committed to being part of the solution to the serious problem of obesity. But it would be counterproductive and ineffective for the government to impose new taxes, bans or restrictions on food marketing. Those actions would also raise extremely serious First Amendment concerns. For many of us in the advertising community, the calls for bans on children’s food advertising create a sense of déjà vu all over again. In 1978, the Federal Trade Commission began an extensive rulemaking on concerns about large amounts of TV advertising to children and the possible adverse health effects of advertising sugared products. The charge was that TV advertising aimed at children is inherently unfair or deceptive. One of the proposals was to ban all TV ads for children aged 6 and under. The FTC held numerous hearings and received hundreds of comments, building a record of more than 60,000 pages. In September of 1981, the Commission voted to end the children’s advertising rulemaking, concluding it was not in the public interest to continue the proceeding. The FTC also concluded that the evidence of adverse affects of advertising on children was inconclusive. In addition, the FTC said that even if it could resolve these issues in a way that would support a rule, substantial questions would remain about the Commission’s ability to develop an effective remedy that could be justified on both legal and policy grounds. Congress ultimately barred the FTC from adopting any broad rulemaking restricting advertising on the basis of “unfairness.” Fast forward to today and the arguments are much the same: food advertising aimed at children is claimed to be somehow inherently unfair or deceptive and leads to obesity, so it should be taxed, banned or seriously restricted. The Center for Science in the Public Interest (CSPI) argues that food marketing is unfair because it encourages children to “pester” their parents to buy specific products; that parents cannot compete with advertising and that the need for parents to say “no” can strain the parent-child relationship. We believe it is critical to emphasize the importance of personal and parental responsibility when looking at the problem of childhood obesity. Adults make the vast majority of food purchases. While some parents provide money to children under eight, those parents are either supervising their children’s purchases or are willing to allow their children to make their own purchasing decisions. Therefore, to suggest that parents who fully understand the purposes of advertising do not have control of this process is totally misleading. Parents need to be parents and the government cannot replace their responsibility by censoring advertising. Every parent in this room has had to say “no” to their child. Sometimes we say “no” about a food product or a toy that our child wants. We also have to say “no” about movies, or clothes, or a party, or hundreds of other things our children ask for. That’s part of our responsibility as parents, to help set boundaries and make those “yes” or “no” decisions for our children. Parents are responsible for the emotional health of our children; for their socialization; for their religious development. It’s also part of our responsibility as parents to make sure that our family has a well balanced diet and gets plenty of exercise. Parents have more information now about food products than they have ever had, due to the Internet and the requirements of the Nutrition Labeling and Education Act (NLEA). We strongly reject the premise that the so-called “pester problem” is sufficient basis for the government to tax, ban or restrict food advertising. The critique of food advertising to children rests on a fundamentally flawed premise that demonizes certain food products. There is nothing inherently unhealthy about foods from quick service restaurants, or cereals, or soft drinks or candy or the myriad of other food choices, so long as those products are consumed in moderation as part of a well-balanced diet. The majority of food experts agree that the best solution to the obesity problem is to promote healthy, well-balanced diets, rather than attempting to characterize some products as “good foods” and others as “bad foods.” So parents don’t have to always say “no” to snack foods or fast food. Parents control the purse strings and they should set the rules for their family on when these products are purchased. The Kaiser Family Foundation released a report last week on the role of media as it impacts childhood obesity. The report found that studies were all over the map on the relationship between the amount of time children spend watching TV and obesity; some studies found a direct relationship and others did not. One thing was clear: there was no consensus that TV viewing caused obesity. Here are their words: “Exactly how media may contribute to child obesity has not been conclusively documented.” The report calls for more research and we support the development of an accurate scientific record in this area. However, in the very same sentence, the Kaiser report then makes the huge leap to assert that “it appears likely that the main mechanism by which media use contributes to childhood obesity may well be through children’s exposure” to food advertising. Terms such as “appears likely” and “may well be,” particularly when these differing standards appear in the same sentence, are very far from being precise or conclusive. It’s important to note that the Kaiser report did not make any specific policy recommendations, although the headlines will likely obscure that fact. Clearly, while there is a need for more research in this area, the Kaiser report cannot be a legitimate basis for any definitive policy decisions on advertising issues by Congress. The First Amendment requires far more than “appears likely” or “may well be” to justify any ban or restriction on food advertising. The American Psychological Association (APA) also released a very provocative report last week, calling for restrictions on all advertising aimed at children under the age of eight. The APA report, like the Kaiser report, alleges that the average child watches more than 40,000 TV commercials each year. By contrast, the American Academy of Pediatrics recently estimated that the typical American child sees 20,000 TV commercials a year. That’s a major difference; which number is accurate? The APA recommendations also raise a number of serious legal and policy issues. As noted above, the vast majority of food purchases are made by adults, who do understand advertising and the needs of their children. Children under eight years of age make very few of those purchases. There is clearly a need for more research in this area so that any policy changes are based on sound science. The APA report, by the way, “enthusiastically” affirmed and endorsed the value of the CARU marketing guidelines. Also, there is strong reason to believe that governmental manipulation of food marketing does not effectively combat obesity. In fact in several countries, most notably in Sweden and the Canadian province of Quebec, broad bans on advertising to children have been imposed. However, recent analysis of these bans suggests that they have had minimal, if any, impact on obesity levels. Additionally, in societies such as the Netherlands and other European countries where there are no ad restrictions and relatively high levels of food advertising, obesity levels are far lower than in either Quebec or Sweden. In the United States, the amount of national advertising for food products is relatively uniform across the country. Yet there are significant differences in obesity levels in different regions. According to 2002 figures from the Centers for Disease Control, the city with the highest rate of obesity among adults was San Antonio, Texas at 31.1%. By contrast, the rate of obesity among adults in another southwestern city, Santa Fe, New Mexico, was only 15.1%. While the obesity rate was 28.8% in Gary, Indiana, it was only 14.2% in Denver, Colorado and 15% in Portland, Maine. This strongly suggests that food marketing is not a primary factor in the growth of obesity among children or other groups, or obesity rates would be far more uniform. Any effort to tax, ban or restrict food advertising aimed at children raises very serious First Amendment concerns. The FTC noted this fact when it closed consideration of the children’s advertising rulemaking in 1981. Further, the U.S. Supreme Court has greatly strengthened the First Amendment protections for advertising in the intervening years. The Court has made it clear that truthful, nondeceptive commercial speech cannot be banned or restricted unless the restriction “directly and materially advances” a “substantial governmental interest” and is “narrowly tailored” to “reasonably fit” that interest. See Central Hudson Gas and Electric Corporation v. Public Service Commission of New York, 447 U.S. 557 (1980). Any government restriction on commercial speech must also be “no more extensive than necessary.” Lorillard Tobacco Company v. Reilly, 533 U.S. 525 (2001). In a series of cases, including Greater New Orleans Broadcasting Association v. U.S., 527 U.S. 173 (1999) and 44 Liquormart Inc. v. Rhode Island, 517 U.S. 484 (1996), the Supreme Court has ruled that all products and services have the same protection under the First Amendment. In a decision in the Western States case, the Supreme Court ruled that a federal law prohibiting pharmacists from advertising compounded drugs violated the First Amendment. See Thompson v. Western States Medical Center, 535 U.S. 357 (2002). Writing for the majority, Justice O’Connor stated: “If the First Amendment means anything, it means that regulating speech must be a last – not first – resort.” Given the complex and multifaceted causes of obesity and the welter of inconsistent studies on the role of advertising and media, we do not believe that a ban or restriction on food advertising aimed at children could meet the Central Hudson test. Assuming a substantial governmental interest in protecting the health of children, it is not likely that a ban on food advertising would directly advance that interest. In addition, it would be very difficult to craft a “narrowly tailored” restriction on advertising to children that is no more extensive than necessary. What would be the appropriate age cutoff—six or nine or something in between? How do you determine if an ad is targeted at a six year old or a nine year old? Clearly, bans or restrictions on children’s advertising will impact adults. No child is going to drive himself to a quick service restaurant or supermarket, so the ads seen by these children are also intended for adults. The U.S Supreme Court has refused to allow a “child protection” rationale to justify blocking information from reaching adults. In Bolger v. Youngs Drug Products, 463 U.S. 60 (1983), the Court noted that communication in society cannot be lowered to the level of the sandbox under the guise of protecting children. Congress and the FCC have already imposed time limits on the amount of commercials that air during children’s programming. The FCC’s rules limit the amount of commercial matter that may appear in children’s programming to 10.5 minutes per hour on weekends and 12 minutes per hour on weekdays. These restrictions apply to both broadcast and cable programs that are originally produced and aired primarily for an audience of children 12 years old and younger. It is simply not possible to hermetically seal children in a protective cocoon where they will not be exposed to any advertising. Even if Congress attempted to ban all advertising during children’s programming, however defined, children will continue to watch TV and will continue to see commercials for food products during other programs. Those commercials, however, will be directed to adults, with none of the features sensitive to the unique needs of children. How can this be a positive result? Banning or seriously restricting advertising aimed at children certainly would have a devastating impact on the development of children’s programming. The economic health of most of our media outlets rests primarily on the strong financial foundation provided by advertising revenues. A ban on advertising during children’s programming would make it much more costly for both broadcast and cable channels to continue to provide that programming. Children’s programming on free-TV would almost certainly migrate to subscription based cable, thereby limiting its access primarily to more affluent families. There are numerous non-speech steps the government can take to directly address the childhood obesity problem. We commend Congress for increasing funding for the Carol M. White Physical Education for Progress (PEP) Grants as part of the 2004 omnibus appropriations bill. ANA supports Senator Frist’s legislation, the Improved Nutrition and Physical Activity Act, or the IMPACT Act. This legislation will provide grants for training of health professionals on how to promote positive changes in health behavior. It would also provide grants to communities so they can work to increase physical activity and improve nutrition; to help schools develop curricula on nutrition and physical education; and to healthcare delivery systems for overweight and obesity treatment and prevention programs. It also would authorize a youth media campaign aimed at changing the health behavior of children. We commend the Subcommittee for holding this hearing to focus attention on this serious public health issue. Childhood obesity is a complex and multifaceted challenge. There is no silver bullet or simple solution to the problem. For almost three decades, the advertising community has recognized the importance of marketing to children in an appropriate and responsible way. While food advertising is an easy target, new taxes, bans or restrictions on food marketing will not solve the problem of obesity. We stand ready to work with the Congress and all other interested parties to come up with solutions that work.

• Ms. Margo Wootan
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  Witness Panel 2

  Ms. Margo Wootan

  Thank you for the opportunity to testify this afternoon about childhood obesity. I am Dr. Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, a health advocacy organization that specializes in food and nutrition. Support Parents’ Efforts to Feed their Children Well The rise in child – and adult – obesity rates is not due to a decline in Americans’ willpower or because parents love their children any less than parents did in 1980. The odds are stacked against parents. Life in modern America promotes unhealthy eating and does not require people to move as much as in the past. The U.S. transportation system is built around cars. Neighborhoods are designed for driving, not walking. Labor-saving devices like elevators and TV remote controls reduce the need for physical activity. Companies use aggressive and sophisticated techniques to market foods to children and the overwhelming majority of food ads are for high-calorie, low-nutrition foods. Schools bridge budget gaps by selling junk food to kids. Restaurants serve large portion sizes, most options on children’s menus are unhealthy, and few restaurants provide easy-to-use nutrition information. Of course, it is ultimately the responsibility of parents to feed their children well. However, parents could use some help. Governments, schools, industry, and health professionals all need to do their part to give parents a fighting chance at helping their children to eat well, be active, and maintain a healthy weight. Improve School Foods There are a number of promising policy options to promote and support healthy eating and physical activity and reduce obesity. First, Congress should give the U.S. Department of Agriculture (USDA) the authority to implement nutrition standards for foods sold in fund raisers, vending machines, a la carte lines, and school stores anywhere on campus, throughout the school day in schools that participate in the National School Lunch or Breakfast Programs. Such standards would help to ensure that all school foods are healthful. I urge members of this committee to cosponsor Senator Harkin’s bill, S1392, which would address this issue. The odds are stacked against children and parents when it comes to school vending. When a parent sends their child to school with lunch money, they do not know if the child will buy a balanced school lunch or a candy bar and a Coke. Virtually all high schools, three-quarters of middle schools, and even 40% of elementary schools have vending machines or a school store, canteen or snack bar. Three-quarters of the beverage options and 85% of snack options in those machines are nutritionally poor choices, such as soda pop, imitation juice drinks, chips, candy, snack cakes, and cookies. While soft drinks and snack foods are certainly not the sole causes of childhood obesity, they are important contributors. Between 1989 and 1996, children’s calorie consumption increased by approximately 80 to 230 extra calories a day (depending on a child’s age and activity level). Over that timeframe, children’s soft drink consumption increased by 40%. Studies show that soft drink consumption increases children’s calorie intake and contribute to obesity. Importantly, they also displace healthful foods from children’s diets and contributes to dental caries and tooth erosion. Snacks now provide approximately 610 calories to teens’ diets each day, versus 460 calories in 1977. Though some argue for state or local control of school foods, since the 1940s, school foods have been a federal issue – a decision made by Harry Truman. When states agree to accept any of the $8 billion in federal funding for school meals, they also agree to follow detailed federal regulations that direct how much vitamin A and what size vegetable portion to serve. Others claim that schools will lose money if federal regulations are strengthened. However, they provide no evidence to support this claim. As middle and high schools in Minnesota, Maine, Pennsylvania, California, and other states have replaced soda with water and 100% fruit juice in vending machines, schools have not lost money. In any case, it is shortsighted for schools to raise money at the expense of children’s health. Market Healthy Foods to Children Companies argue that although they market their products directly to children, parents ultimately decide whether to purchase the products. The reality is that marketing aimed at children makes it much harder for parents to feed their children well. Parents can model and encourage healthy eating, but companies use aggressive and sophisticated marketing techniques to get into children=s heads, manipulate their food choices, and prompt them to nag their parents to purchase products. Studies demonstrate and companies know that food advertising is effective. If companies were marketing broccoli and bananas to kids, there would be no reason for concern. But that is not the case. Marketing has a negative effect on children’s diets because virtually all of the foods marketed to children are high in either calories, salt, saturated fat, or refined sugars and low in nutrients. Those foods are marketed aggressively. Over the last ten years, overall marketing aimed at children doubled, from $7 billion to $15 billion a year – about half of that is for food. As a result, kids these days are exposed to a tremendous amount of marketing from morning until night, wherever they go, whatever they do. Harry Potter, SpongeBob Squarepants, Elmo, games, contests, prizes, websites, television and magazine ads, and sports stars are enlisted to entice children to request low-nutrition foods. The sale of junk food in schools and advertising on school scoreboards, vending machines, book covers, Channel One, and school publications have become commonplace. Food manufacturers and restaurants are not marketing their products to children responsibly. Self-regulation is not working. The current regulatory system and case-by-case enforcement are inadequate. To help protect children and support parents: U Congress should give the Federal Trade Commission the authority to work with the U.S. Department of Health and Human Services to set nutrition standards for the kinds of foods that can and cannot be marketed to children, and limit the marketing of high-calorie, low-nutrition foods aimed at children on television, in magazines, and in schools. U The Centers for Disease Control and Prevention (CDC) should be funded to sponsor national media-based campaigns to promote healthy eating and physical activity to balance the pressures to eat low-nutrition foods, campaigns like the CDC’s VERB campaign. U Industry should agree not to market junk foods to children and should place low-nutrition foods in retail stores at parents= eye level rather than at children=s eye level. Companies should not take advantage of schools= financial problems by offering cash in exchange for the opportunity to market or sell junk food in schools. Enable Parents to Make Informed Choices in Chain Restaurants Parents’ ability to feed their children well is also undermined at restaurants. First, parents are lucky if they can find one healthy entrée on children’s menus at the largest chain restaurants, and most meals are served with French fries. Children’s meals often provide 600 to 1,000 calories, about a half a day’s worth for a 4 to 8 year old, and a whole day’s saturated plus trans fat. Parents can order something for their child off the adult menu, where there are usually healthy options, but adult meals cost significantly more money. In addition, restaurants make it harder on parents by not providing nutrition information menus or menu boards. Two-thirds of the largest chain restaurants do not provide any nutrition information to their customers. The approximately one-third of chain restaurants that do provide nutrition information do so on websites, which means you have to decide what you and your children will eat before leaving home. Some chains have posters or brochures in their stores, but that information is inconvenient and hard to use. If restaurants can provide nutrition information on websites and posters, they should be able to put those numbers on the menu. Restaurant foods are an important contributor to childhood obesity. Children eat almost twice as many calories when they eat a meal at a restaurant compared to at home (770 calories versus 420 calories). Studies also show that when children eat at restaurants they tend to eat more saturated fat and less calcium, fiber, fruits, and vegetables than when foods are prepared at home. In the past, when eating out was an occasional treat, parents did not have to worry about the nutritional quality of restaurant foods. But families are eating at restaurants twice as often as in 1970. Eating out now provides about a third of American children’s calories. To help families make informed decisions at restaurants, Senator Harkin has introduced a bill to require calorie and other nutrition labeling at fast-food and chain restaurants. Small businesses, which typically do not have standardized menus, would be exempt. I encourage you to cosponsor that bill. Promote Healthy Eating and Physical Activity Eating well and being active require skills. Yet resources for nutrition and physical activity promotion and education pale in comparison to their impact on health. Congress should increase funding for the Division of Nutrition and Physical Activity at the Centers for Disease Control and Prevention (CDC). For FY 2004, the budget is $45 million, which will allow CDC to fund approximately 28 states for nutrition, physical activity, and obesity. The 265 member organizations of the National Alliance for Nutrition and Activity are recommending $75 million for FY 2005 to move CDC closer to funding every state. Congress also should strengthen nutrition education in schools by expanding USDA’s Team Nutrition Program to add state-level funding and nutrition education coordinators. In conclusion, there are a number of promising policy option to help reduce childhood obesity and support parents’ efforts to feed their children well. Given the urgency and magnitude of the problem, I hope this Congress will take bold steps to protect children’s health. Thank you for the opportunity to testify today. I would be happy to answer any questions and provide additional information and background.

• Mr. Manly Molpus
  Read statement

  Witness Panel 2

  Mr. Manly Molpus

  Thank you, Mr. Chairman and members of the Committee. It is a pleasure to be here this afternoon to describe what grocery manufacturers are doing in the battle against obesity. I am Manly Molpus, President and CEO of the Grocery Manufacturers of America, or GMA. GMA is the world's largest association of food, beverage and consumer product companies. Led by a board of 42 Chief Executive Officers, GMA applies legal, scientific and political expertise from its more than 140 member companies to vital public policy issues affecting its membership. The association also leads efforts to increase productivity, efficiency and growth in the food, beverage and consumer products industry. With U.S. sales of more than $500 billion, GMA members employ more than 2.5 million workers in all 50 states. The Issue of Obesity GMA Is Committed to Doing Its Part in the Battle against Obesity in the U.S. and around the world Obesity, and particularly childhood obesity, is an issue of paramount importance to GMA and its member companies. The increasing incidence of obesity is a trend that troubles us all, especially the companies that sell the food that Americans put on their tables, and we are doing a great deal to help our consumers meet the challenge to stay healthy and fit. In my testimony today, I will describe for you the commitment we have made and a number of the actions we have taken. On our commitment, I can assure you that I am speaking for the leadership of the grocery manufacturing industry. The CEOs on the GMA Board have adopted a global strategy on food and health that states our resolve in no uncertain terms: "The food and beverage industry is committed to helping arrest and reverse the growth of obesity around the world. Achieving this goal will require multiple strategies, the integrated efforts of many sectors and long-term resolve. We are committed to doing our part and will support others in doing theirs." As you know, we have already supported the efforts that Congress has undertaken. We worked with Senate to help pass the “Improved Nutrition and Physical Activity Act,” or “IMPACT Act,” sponsored by Majority Leader Frist and Senators Bingaman and Dodd. The IMPACT bill provides much needed funding to develop innovative programs at the community level to aimed at helping individuals eat right and become more active and ultimately to improve the overall health of our nation. The Senate passed the bill just last December. We are now encouraging Members of the House of Representatives to do the same and look forward to working with them to achieve final passage of this important legislation. GMA was an original and enthusiastic supporter of the Congressional Fitness Caucus, chaired by Reps. Zach Wamp (R-Tenn.) and Mark Udall (D-Colo.). The bi-partisan caucus was created to boost understanding of physical activity’s benefits for good health. So far the Caucus counts only members of the House on its roll. We encourage the members of this Committee to join the Caucus or start a similar caucus in the Senate. We applaud Congress for its initiatives in the form of IMPACT and the Congressional Fitness Caucus. But these are just two of many strategies that GMA believes the country should consider. There is a great deal more that we can do. And there is an important role for everyone – manufacturers, employers, educators, nutrition and health experts, public health officials, parents and, of course, children. GMA is working and will continue to work long and hard with every sector of society to battle obesity. GMA is Doing its Part Grocery manufacturers will play an essential role because of who we are and what we do. It is our job to provide consumers with safe, nutritional, enjoyable and affordable food. We can make a significant contribution by intensifying our efforts to provide a wide range of nutritious product choices and marketing these choices in ways that promote healthy lifestyles. We are committed to using our scientific knowledge and technological expertise to continue to research, develop and offer, in all distribution channels, a range of food products to meet many consumer needs, including nutrition, taste, convenience and value. We believe that maintaining a healthy weight and achieving optimal health and wellness throughout life requires a balance of physical activity and nutrition, tailored to meet each individual’s needs, preferences and lifestyle. Balancing calorie intake and energy output is essential to maintain a healthy body weight. We recognize that “food” is the “energy input” side of the healthy weight equation and will work with other stakeholders to promote improved understanding of nutrition. You will see our communications take many forms: § We will communicate clearly in labeling, packaging and advertising to enable consumers to make informed choices that best meet their lifestyle needs and physical activity levels. § We will employ a variety of communication tools, including nutrition labeling, in-store communications, customer care line and web-site information. § We will advertise responsibly, and will continue to take into account the special needs of children. We will encourage effective voluntary, national self-regulatory mechanisms promoting responsible advertising and marketing. § We will work with partners, including retailers, government and health professionals to extend the healthy lifestyle message. § We will support efforts to increase physical activity, and to enhance nutrition education through partnerships with other stakeholders including public health authorities, healthcare, educational, government and others. As we intensify our efforts to communicate the benefits of healthy lifestyles, let us not lose sight of a very simple but essential truth – food is not just the source of the energy we need to live; it is one of the things that brings joy to our lives. Remember the first bites we persuaded our babies to eat, the birthday cakes they shared with their excited friends, the trick-or-treat bags they brought home on Halloween, the Thanksgiving dinners, the summer picnics, or just one of those many meals that brought the family together for a little while. These are things people have been enjoying for centuries. Grocery manufacturers want to make sure our consumers continue to enjoy them, and we will strive to provide and promote the foods and beverages that make eating not only healthy, but enjoyable. GMA Recommendations to Combat Obesity You have already heard from the experts that fighting obesity is going to involve many strategies and many stakeholders. GMA agrees. In fact we have formulated 10 recommendations – not just for us, but for all stakeholders – that we think can take Americans a long way toward healthier lifestyles. In particular, we need to help students to develop and to maintain healthy lifestyles for the long-term, and we must give them the tools and resources to do so. We need a balanced approach, focusing on providing sound nutrition information to parents, students and teachers; encouraging and funding more physical education and recreation opportunities; and funding the research we need to determine ways to encourage healthy lifestyle choices. We do not suggest that the following are comprehensive recommendations, but they give good examples of the variety of challenges we face. Briefly they are these: § Raise awareness among the general public about the increasing rates of obesity and its harmful effects on health. § Implement the Surgeon General’s recommendations that every school-aged child, grades K-12, receive at least 30 minutes of physical activity each day. § Enforce existing USDA regulations that limit the sale of foods with minimal nutritional value during the school day. § Provide incentives for schools to ensure a wide variety of food options, including those low in fat and calories, are available throughout the school day. § Support full funding for the Physical Education for Progress Act to help communities and schools improve the quality of physical activity programs. § Increase funding for research on the behavioral factors that contribute to the development of obesity so that effective and appropriate responses can be identified. § Increase funding for research and evaluation on intervention programs that are proven effective in combating overweight and obesity. § Overhaul nutrition education programs to give children and parents the tools to eat moderate, balanced diets and to develop nutrition-related programs that recognize cultural diversity. § Continue to support the President’s Council on Physical Fitness and Sports to encourage all Americans to adopt a physically active lifestyle. § Create financial incentives for cities and states to provide more opportunities for nutrition education and physical activity for schools, communities and families. Of course recommendations are only the starting point. We need to work to achieve them. GMA is working on many fronts. Improving the U.S. Dietary Guidelines Consumers need sound and consistent advice on balancing diet and activity. As you know, the federal government is an important source of that advice. In comments submitted last September to the U.S. Dietary Guidelines Advisory Committee, the Grocery Manufacturers of America called for Americans to moderate their diets based on their level of physical activity in order to maintain a healthy lifestyle. For Americans to lead healthier lives and to reduce the risk of chronic disease, they need to find the right balance between what they eat and what they do. GMA and its members believe it is important for Americans to understand that to be healthy they must eat a nutritionally-balanced diet, must be physically active and moderate their food intake to match their level of physical activity. In some cases, this means consumers will need to eat less to achieve the balance. GMA submitted a statement and 10 principles to the Dietary Guidelines Advisory Committee for consideration as revisions are made for the 2005 Dietary Guidelines. GMA emphasized three key points, saying the Guidelines should: § Stress the importance of a nutritionally-balanced diet, physical activity and the need for Americans to moderate their food intake to match their level of physical activity. § Seize the opportunity to learn from past lessons and to develop a workable, common-sense approach that fits how consumers live, work and play today. § Help all Americans lead healthy and active lives by giving them information about nutrition and physical activity that is understandable and relevant to their daily lives. There is little doubt that American consumers are looking for reliable information about how to improve their health. We have a unique opportunity to map out the path that could help Americans strike the right balance between nutrition and physical activity using the best science available. If the Dietary Guidelines follow the principles we communicated to the Committee, we believe they will achieve the objectives for which they were designed. Reinforcing this advice, GMA urged the U.S. Department of Agriculture (USDA) in October, as USDA began their review of the Food Guide Pyramid, to formulate nutrition and activity guidelines that can be realistically met by all Americans. “USDA must ensure that consumers of all socioeconomic and cultural backgrounds can meet the recommendations as they purchase foods and prepare meals for themselves and their families,” we said. The guidelines USDA proposed would require such drastic changes in diet that they would be all but impossible for most Americans to follow. It is regrettable that during its 11 year existence, relatively few Americans have used the Food Guide Pyramid to shape their diets. We can do better. As we said when we filed our comments to USDA, “For the first time since 1992, USDA has an opportunity to formulate guidelines that can help people improve their overall health and reduce the risk of major diet-related diseases.” Consistent with the 10 principles GMA responded with specific recommendations to several USDA Center for Nutrition Policy and Promotion proposals for changes to the Food Guide Pyramid. Among those recommendations were these: § Encourage increased physical activity and help individuals moderate their caloric intake to meet their energy needs. The guideline should not be based on sedentary lifestyles as USDA has proposed. § Set realistic consumption recommendations for sugars and fats. Consumers are far more likely to choose nutrient-rich foods if they can also use some fats and sugars for added flavor and enjoyment. § Reduce confusion by aligning the Food Guide Pyramid, the Dietary Guidelines for Americans and the food label. § Rename the Food Guide Pyramid the “Diet & Physical Activity Guidelines” to better reflect the need to balance nutrition and fitness in order to achieve a healthy weight. GMA also urged USDA to follow the 10 principles it submitted to the Dietary Guidelines Advisory Committee for the 2005 Dietary Guidelines. Americans must understand the importance of balancing nutrition and fitness, and of leading healthy and active lives. Information about nutrition and physical activity must be both understandable and relevant to consumers if they are to get those messages. GMA will continue to participate in the processes for revising both the Guidelines and the Food Guide Pyramid, providing industry insight and continue to work with the Departments of Agriculture and Health and Human Services in their critical effort to help Americans live healthier lives and reduce the risk of chronic disease. Improving Food Labels Last year, FDA announced two significant changes in food and beverage labeling: mandatory quantitative labeling of trans fat and voluntary qualified health claims. GMA is fully supportive of these initiatives as they have already begun to spur additional competition among food companies to develop more and better foods to meet consumer demand for nutritious foods and beverages. We also support FDA’s other efforts to improve nutrition labeling, including setting regulatory standards for low-carbohydrate nutrient content claims. In addition to providing specific comments to FDA, GMA is conducting consumer research regarding consumer perceptions of calories and serving sizes, which should provide valuable assistance in developing labels that consumers can comprehend. Food Label Consumer Research – As with other aspects of the label, calorie and serving size information within the Nutrition Facts panel must be conveyed to consumers in a way that is meaningful and relevant to consumers. In order to address emerging questions about consumer perceptions of the Nutrition Facts box, calories and servings sizes, GMA is conducting consumer research that will explore several points, including: § How consumers use the food label to obtain calorie information. § How to more effectively communicate calories in single serving packages. § How calorie labeling might impact consumer behavior. § How consumers react to and incorporate low- and reduced-calorie products in their diets. When completed, GMA hopes to work with the FDA to use the findings to develop improved consumer education messages about the caloric value of foods in a way that is applicable to consumer’s daily lives. Nutrient Content Claims -- For years, our member companies have quietly and consistently reduced the level of calories and certain nutrients in the brand-name products. This includes finding ways to make incremental, continued reductions of sodium and fats in foods. In many cases, these reductions are not significant enough to warrant nutrient content claims such as “Reduced Sodium” or “25 Percent Less Fat.” GMA believes that these incremental changes, when adopted broadly, will have a significant impact on consumer health and has encouraged FDA to examine this issue. Identifying Trans Fats -- In the case of trans fatty acids, GMA supports FDA’s decision to require quantitative labeling of trans fat as a separate line within the Nutrition Facts box. We believe this regulation provides consumers with concise information about the content of trans fat in their foods, and will allow them to make informed choices about which products to purchase based on their own preferences and health needs. Carbohydrate Nutrient Content Claims – Whether it is a new diet book, a favorite cooking program or news about the latest nutrition research, consumers have been bombarded with sometimes inconclusive and contradictory information about carbohydrates and their impact on health. And whether they are choosing low-carb, high-carb or something in between, consumers need accurate dietary information to help them meet their nutritional goals. To address this demand, GMA has petitioned the FDA to set regulations for a full-range of nutrient content claims that will allow food companies to make accurate statements about carbohydrate content. Rather than focusing on only one type of claim, GMA has recommended that the FDA establish federal standards for “carbohydrate-free,” “low carbohydrate,” “good source of carbohydrate” and “excellent source of carbohydrate.” By requesting labeling standards for the entire range of nutrient content claims, we hope to establish a level playing field to communicate with consumers about the amount of carbohydrates in certain foods and beverages. As detailed in the National Academy of Sciences’ Macronutrients Report, carbohydrates are a key component of good nutrition. In fact, the NAS recommends that carbohydrates contribute 45 to 65 percent of total caloric intake for healthy Americans. It is therefore important to establish accurate and consistent nutrient content claims for a range of products that not only meet the needs of dieters following a low-carb regimen, but also fit the diets of consumers looking for good sources of nutrient-rich carbohydrates. These claims are, in effect, flags to alert consumers about the particular characteristics of a product. As with other nutrient content claims such as “low fat” and “excellent source of fiber,” carbohydrate labeling claims are meant to help consumers identify products that suit their individual needs and preferences. Carbohydrate labeling claims will also make in-store comparisons between products easier by providing consumers with science-based information about carbohydrate content. By setting rational definitions, we will be able to guarantee that all consumers have consistent information about carbohydrate content for a wide range of foods. Qualified Health Claims -- GMA strongly supports FDA’s pre-market notification system for proposed qualified health claims submitted by food companies and others. As longtime supporters of qualified health claims for foods, GMA firmly believes this system will allow the food industry to get the newest health information on to the food label and into the hands of consumers – empowering them to make in-store comparisons. More importantly, the ability to use qualified health claims (e.g.; “Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.”) will provide food manufacturers with yet another incentive to develop and market new nutritious products. In each of these initiatives, GMA’s recommendations are based on a fundamental objective – empower consumers to make smart choices by providing clear, accurate information about nutrition. The ultimate decision-makers in the battle against obesity are the consumers themselves. They have heard the news about obesity and its consequences, and they want to do something about it. We believe their interest in nutrition is keen, and that they will look for additional information about it. We all can help in getting that information to them. American Council for Fitness and Nutrition Last year GMA and many of our member companies founded the American Council for Fitness and Nutrition (ACFN) – a nonprofit organization dedicated to improving the health of all Americans, especially children, by encouraging a healthy balance between nutrition and fitness. The Council is led by Dr. Susan Finn, a past president of the American Dietetic Association, and is guided by an Advisory Board of 24 experts in the fields of nutrition, physical activity and behavior change. The members of the Council and its Advisory Board are listed in Appendix A of this statement. Over the past 12 months, ACFN has played an important role in raising awareness about the critical need for energy balance – that is, calories consumed must equal calories burned – if Americans are to maintain a healthy weight. ACFN has worked directly with policy makers at every level of government to encourage a comprehensive approach to addressing the obesity issue. ACFN is also seeking out and recognizing “Best in Class” programs across the country that focus on nutrition education and physical activity. ACFN believes that successful local, regional and state initiatives can serve as models for other communities. Here are just a few examples: § The Carol M. White Physical Education for Progress grants distributed by the U.S. Department of Education provide local communities with funding to improve existing physical education programs, hire and/or train staff to oversee physical activity programs, or to launch and run youth activity programs. § The 5-a-Day Better Health Program is a national program to encourage all Americans to eat 5 to 9 servings of fruits and vegetables every day for good health. The national 5-a-Day for Better Health Program, established in 1991 as a partnership between the National Cancer Institute and the Produce for Better Health Foundation, is the largest public-private partnership for nutrition and health in the United States and in the world. § Kidnetic.com is a communications and web-based program designed to provide important nutrition and physical activity information for children and their families. Kidnetic.com, funded in large part by food and beverage companies, provides children, parents and teachers with creative resources to specifically address the challenges of childhood obesity. § America on the Move is a national program developed by the University of Colorado’s Center for Human Nutrition in response to the national obesity epidemic. The program promotes simple steps to be more physically active and to eat more healthfully, such as using a pedometer to keep track of your steps. For many people, by walking an extra 2,000 steps (about 1 mile) a day or cutting out 100 calories a day, a positive energy balance can be achieved. States and local communities can join this movement, and customize the program to meet the need of their own community. This year, ACFN is actively seeking partnership opportunities with organizations that work with populations at particular risk for obesity, especially the Hispanic and African American communities. We hope to work with these at-risk populations to develop culturally appropriate educational materials and programs to proactively address the obesity issue in their communities. In January, ACFN answered the call from the U.S. Department of Health and Human Services to partner with them in promoting the HealthierUS program. HHS is undertaking a number of important initiatives focused on health prevention by encouraging Americans to take small steps to improve their lifestyle by eating a balanced diet and increasing their levels of physical activity. We agree with HHS Secretary Thompson’s assessment that obesity prevention will lead to significant reduction in chronic diseases ranging from diabetes to cardiovascular disease to stroke. Through a formal partnership, ACFN hopes to serve as a megaphone for the very important messages HHS is trying to convey to all Americans. Companies Are Responding to the Call for Foods that Will Help Strike a Healthy Balance Health, Wellness and Obesity Consumers constantly demand new products that combine taste, convenience and nutrition. GMA members compete intensively to meet that demand. Around the country, companies are: § Removing trans fat from products; § Offering new choices for smaller product serving sizes; § Promoting nutrition education and physical activity, particularly aimed at schools and local communities; § Reformulating products to reduce calories, fat and sugars, lower cholesterol and add vitamins. Examples of the many projects and products that have been announced by our members are listed in Appendix B. Food advertising will play an important role in the battle against obesity. GMA members are constantly researching and developing new ways to improve nutrition without sacrificing the enjoyment of eating – again, the success of a healthy diet depends on the satisfaction that the food delivers. The examples described in Appendix B are just a few of the thousands of products that provide options for consumers looking for ways to incorporate variety, balance and moderation in their diets. And you are going to see many more – if we can tell our consumers about them. Informing consumers about products and services available to them is essential if they are to enjoy the benefits of the options that food companies provide. Educating consumers, especially parents and their children, how to meet their individual needs, tastes and preferences through the proper balance of activity and nutrition empowers consumers to maintain a healthy weight. Advertising is an important means of communicating that information and a critical element of the competition that drives innovation. Every advertiser knows that effective advertising depends on consumers’ trust and respect. Accordingly, the members of GMA have a longstanding commitment to responsible advertising and marketing practices. The food industry is continuing to ensure that its communications with consumers accurately portray the products, their intended uses and the benefits they deliver. The industry is continuing to ensure that its advertising and marketing practices do not encourage overeating or inappropriate consumption of foods. In addition, the industry is seeking ways to utilize its marketing capabilities to communicate healthy lifestyle messages to consumers through multiple media (from labeling to advertising to websites) and many channels (from retail customers to workplace environments). The self-regulatory system managed by the National Advertising Review Council (NARC) deserves much of the credit for the truthful and responsible advertising that consumers see today. In the food sector, voluntary compliance with the decisions of the National Advertising Division (NAD) and the Children’s Advertising Review Unit (CARU) ensures that advertising meets the highest standards of truth and accuracy. Moreover, adherence to CARU’s Self-Regulatory Guidelines of Children’s Advertising has fostered advertising that promotes balanced diets and healthy life styles. No wonder that Federal Trade Commission officials have praised NAD and CARU as the best system they have seen. Despite these successes, the public is largely unaware of CARU’s positive impact on children’s advertising and NAD’s influence on advertising to general audiences. The effectiveness of self-regulation derives from stakeholders’ appreciation of its role and advertisers’ participation in its procedures. To this end, GMA has sent a formal request to NARC asking that it embark on a campaign to raise the visibility of its role and to expand its monitoring of food and beverage advertising through the NAD and CARU. More specifically, we are urging CARU to publish a white paper explaining its principles, guidelines and decisions applicable to food advertising. GMA has also urged all of its members to support CARU, and to adhere to CARU’s “Self-Regulatory Guidelines for Children’s Advertising,” several of which apply directly to diet, health and nutrition. Conclusion The food and beverage industry is committed to helping arrest and reverse the growth of obesity around the world. Achieving this goal will require multiple strategies, the integrated efforts of many sectors and long-term resolve. We are committed to doing our part and will support others in doing theirs. We look forward to our continued partnership with Congress and all other stakeholders in achieving our shared goal of combating obesity in America. Thank you for hearing the report from the grocery manufacturers. I would be happy to answer any questions you may have. Appendix A American Council for Fitness and Nutrition American Council for Fitness and Nutrition ADVISORY BOARD · Mary Austin, RD, MA, CDE, American Association of Diabetes Educators · Keith Ayoob, EdD, RD, FADA, Albert Einstein College of Medicine · Tom Baranowski, Ph.D., Baylor College of Medicine · Sue Borra, RD, International Food Information Council · Benjamin Caballero, M.D., Ph.D., Center for Human Nutrition, Johns Hopkins University · Mary Lee Chin, MS, RD, Nutrition Edge Communications · Kristine Clark, Ph.D., RD, FACSM, Penn State University Sports Nutrition · Cecilia Pozo Fileti, MS, RD, FADA, C.P. Fileti Associates, Inc. · Anne Flannery, P.E.4Life · Molly Gee, American Dietetic Association · G. Ken Goodrick, Ph.D., Baylor College of Medicine · David Heber, M.D., Ph.D., UCLA Center for Human Nutrition · Jim Hill, Ph.D., University of Colorado Health Sciences Center · Lisa Katic, RD, K Consulting · Elizabeth Lascoutx, Children’s Advertising Review Unit · Phil Lawler, P.E.4Life Institute · Lisa Mosing, MS, RD, FADA, Nutrition Works · Francis Smith, Consumer Alert · Kathy J. Spangler, CPRP, National Recreation & Park Association · Maureen Storey, Ph.D., Center for Food and Nutrition Policy of Virginia Tech · Lisa Sutherland, Ph.D., UNC Department of Nutrition · Wendell Taylor, Ph.D., M.P.H., University of Texas Health Science Center at Houston · Hope Warshaw, RD, CDE, Diabetes/Nutrition Consultant · Judith Young, Ph.D., National Association for Sport and Physical Education American Council for Fitness and Nutrition GENERAL MEMBERSHIP American Advertising FederationAmerican Association of Advertising AgenciesAmerican Association of Diabetes Educators American Bakers AssociationAmerican Dietetic AssociationAmerican Frozen Food InstituteAmerican Meat InstituteAmerican Wholesale Marketers AssociationArcher Daniels Midland CompanyAssn. of Fund-Raising Distributors & SuppliersAssociation of National AdvertisersBiscuit & Cracker Manufacturers AssociationBurger King Corporation Cadbury Schweppes, PLC.Campbell Soup CompanyCoca-Cola Enterprises Inc.ConAgra Foods, Inc.Corn Refiners AssociationDel Monte FoodsEgg Nutrition CenterFood Marketing InstituteGeneral Mills, Inc.Grocery Manufacturers of AmericaHershey Foods CorporationH.J. Heinz CompanyIndependent Bakers AssociationInternational Advertising Association International Bottled Water AssociationInternational Dairy Foods AssociationJack in the Box, Inc.Kellogg CompanyKraft Foods, Inc.McKee Foods CorporationMasterfoods USAMcDonald's CorporationNational Automatic Merchants AssociationNational Confectioners AssociationNational Council of Chain RestaurantsNational Grocers AssociationNational Restaurant AssociationNational Soft Drink AssociationNestle USA, Inc.Pepsi-Cola CompanyPepsiCo, Inc.Sara Lee CorporationSnack Food AssociationSugar AssociationThe Coca-Cola CompanyThe Procter & Gamble CompanyThe Quaker Oats CompanyU.S. Chamber of CommerceUnilever United States, Inc.William Wrigley Jr. CompanyYum! Brands, Inc Appendix B Samples of GMA Members’ Responses to the Call for Foods and Programs to Help Americans Achieve a Healthy Lifestyle Cadbury Schweppes Cadbury Schweppes is supporting health and wellness through new product development as well as by providing significant support to community programs aimed at physical activity. Some of these efforts include: Snapple 100% Juiced!: during the latter part of 2003 Cadbury Schweppes developed and launched a series of specially fortified 100 percent fruit juice products for the New York City school system. These products were designed and developed with input from NYC school nutritionists. These products, along with Cadbury Schweppes Snap 2 O water are now distributed through vending machines in NYC public schools. These products provide NYC kids with "healthy beverage alternatives" within their schools. Through the Snapple business and brand, Cadbury Schweppes has guaranteed to the Public School Athletic League in NYC approximately $17 million in financial support over the next 6 years, including funding for adding teams, coaches, upgraded facilities/playgrounds, etc. Also through the Snapple business and brand Cadbury is involved in others activities that support "kids activities and well-being", these include: · Building skateparks (one in NYC, another upstate NY during 2003). This was done in conjunction with a nonprofit organization called KaBoom! which builds skateparks in disadvantaged communities. · Sponsoring NYC Police Athletic League youth summer camp programs. Campbell Soup Campbell Soup’s Pepperidge Farm division announced in November 2003 that Goldfish crackers will be transitioning its entire cracker product line to become free of trans fatty acids (TFA). More than 90 percent of the Goldfish cracker line will be transitioned to zero trans fat by May 2004, with the remainder of the line converting by late summer. Goldfish will provide consumers with the first line of zero-trans fat crackers from a major brand. To lead off the transition to zero-trans fat, Goldfish is adding a brand new offering to the line – Goldfish Crisps. Goldfish Crisps will be available nationally in three varieties – Cheddar Jack, Four Cheese, and Cheesy Sour Cream & Onion – and will hit supermarket shelves in March. Then, over the next few months, all existing varieties of Goldfish snack crackers will be converted to zero-trans fat recipes. The transition – which will involve reformulation of almost 165 individual products – will be largely complete by May 2004 and fully complete by September. Cargill GMA member companies, like Cargill, are working aggressively to offer safe and effective products that promote human health and well being. Cargill Health and Food Technologies, a division of Cargill, Incorporated, has developed a key micro-ingredient for use in food and beverage production proven to reduce cholesterol. Cargill CoroWiseÔ plant sterols inhibit the absorption of cholesterol. Health conscious consumers are able to help maintain their health by using products, which contain CoroWiseÔ. Companies like Cargill are reaching out to consumers to provide them with the information needed to make healthy choices. www.corowise.com educates consumers on the latest advancements in phytosterols and their role in a healthy diet and provides links to important sites such as the U.S. Department of Health and Human Services’ National Cholesterol Education Program and the American Heart Association. Cargill’s Soy Protein Solutions made a significant breakthrough in the use of soy proteins in foods and beverages. Cargill’s line of soy isolates, named ProlísseÔ, successfully provides all the benefits of soy protein without the soy taste. Food manufacturers are able to meet the increasing demand for soy protein while at the same time improving the taste of the product. Packed with protein and low in fat, ProlísseÔ soy isolates are used in nutrition bars, weight-loss and energy beverages, meat alternatives, baked goods and more. Coca-Cola North America Coca-Cola is addressing consumers concerns with health and wellness through it products, policies and programs. Recent new products and packaging options that expand the choices offered to consumers include: § Introduced in fall 2003, Swerve is a new beverage made with non-fat milk and it is packaged in 11-ounce cans that provide 30% of the Reference Daily Intake (RDI) of calcium, vitamin D, vitamin A and vitamin C, but has just 150 calories per can, and is being made available initially in middle and high schools. The label bears the “Real” milk seal and carries the American Heart Association emblem, signifying that Swerve meets the AHA’s criteria for saturated fat and cholesterol for healthy people over the age of two. § Expanded products from Minute Maid, the first leading juice brand to make juice products that contain the same amount of calcium and vitamin D as in an 8-ounce glass of milk, and 100 percent of the RDA for vitamin C. § Minute Maid Premium Heart Wise™, a 100% orange juice with plant sterols, clinically proven to help lower cholesterol with continuous use of two 8-fluid-ounce servings per day with meals. § Minute Maid Light Lemonade, with 5 calories per 8-ounce serving. § POWERADE, a sports beverage that provides hydration and carbohydrate fuel and is a good source of vitamins B3, B6 and B12. § Organic juices (orange, carrot and apple) from Odwalla. § Dannon Fluoride to Go in 8.5-ounce bottle packages for kids’ lunches. A Variety of Packages & Portion Sizes § Eight-ounce carbonated soft drink cans and plastic bottles in selected markets. § Various flavors of Minute Maid 6.75-fluid-ounce juice boxes, Hi-C Blast 6.75-fluid-ounce pouches and Minute Maid Coolers 6.75-fluid-ounce pouches are available; in some markets Minute Maid orange juice is available in an 8-ounce “to go” plastic package. Policies In November 2003, the Coca-Cola system released its Model Guidelines for School Beverage Partnerships, which will apply going forward to all relationships between Coca-Cola and K-12 schools in the U.S. Developed in direct consultation with leaders from the education community, the Guidelines are designed to help school decision-makers respond to concerns about commercialism and nutrition while maintaining their ability to raise critical resources for their schools. They address four key issues that are of special concern to school administrators: contracts and financial arrangements; beverage availability and a wider variety of choice in schools; logos and signage on school grounds; and, program and product promotions. Programs Obesity is a complex issue, with no simple solutions. Simply banning or further restricting availability of certain foods or beverages will not solve the problem. The primary reason that our children are gaining weight is our sedentary lifestyles. The Coca-Cola system has a long history of supporting physical activity for youth. One example is Step With It! – a program rolled out to 1,000 middle schools and 1 million students in 2004. Developed by The Coca-Cola Company and the National Association for Sport and Physical Education, the program provides participants with a “Stepometer,” a small pedometer, to track the number of steps taken in a typical day. So, whether the students are running, dancing, stepping or walking, the idea is to make physical activity fun even for those who aren’t involved in athletics. Step With It! encourages participants to take a minimum of 10,000 steps a day to maintain good health through a more active lifestyle. ConAgra Foods ConAgra Foods, Inc., the maker of the popular “Healthy Choice” line of products, has initiated a Wellness Initiative, involving a review of their product lines to determine how to further increase the healthfulness of their stable of brands. General Mills The General Mills Foundation in partnership with the American Dietetic Association Foundation and the President’s Council on Physical Fitness and Sports has created the Champions Youth Nutrition Fitness Program. Each year, this program offers grants of $10,000 to 50 different community-based groups around the country with innovative programs designed to help our youth develop and maintain a balanced diet and physically active lifestyle. Outlined below is a description of the Champions programs in many of the communities represented by members of the Subcommittee. Stepping Out Together Wasco-Sherman Public Health Department/OSU & Wasco County Extension Service The Dalles, Oregon A six week program helping children ages 2-5 and their parents become active and make good food choices. Stepping Up Physical Activity & Nutrition Practices Among North Dakota Youth North Dakota 4-H Foundation Fargo, North Dakota A two-part program intended to educate both high school and elementary school students about nutrition and physical activity. Food, Fun, and Fitness Richland County Consortium After-School Program Wahpeton, North Dakota Provides K-12 children and adults opportunities to participate in consistent fitness activities and nutrition classes at six rural school sites. Fit Factor 5 Los Angeles Unified School District (LAUSD) Five elementary, middle, and high schools’ Nutrition Advisory Councils (NACs) participate in the pilot Fit Factor 5 program, receiving physical fitness kits containing balls, cones, and jump ropes to be used in the design of school-specific fitness programs. Intergenerational Health Support University of California Cooperative Extension, Riverside County Improves the nutrition and fitness of children being raised by grandparents using materials from the Five-a-Day Power Play curriculum for nutrition and the President’s Challenge for physical activities. Fun, Food and Fitness Benedictine University Lisle, Illinois A 21-hour summer session employing active learning techniques and hands-on activities in a targeted and supervised manner, teaching children nutrition basic food preparation skills. Cristo Rey School-Based Nutrition Program Loyola University of Chicago School of Nursing The program provides weekly after-school sessions addressing weight management, diabetes, cardiovascular risk, and other topics for Hispanic youth. Eat Healthy, Stay Fit Young Women’s Leadership Charter School Chicago, Illinois Combines education, behavioral strategies, and peer support to promote healthy eating habits and regular physical exercise in young women ages 14-18. NEETO (Nutrition Exercise Education Training of Orlando) Orlando, Florida Teaches children nutrition and physical activity through a weekly, 90-minute class over a four-month period. Food is Fuel Lakewood Elementary School St. Petersburg, Florida Students document food intake, plan future meals, track physical activities, and evaluate progress; a fitness trail on school grounds provides supportive, non-competitive environment for teaching students regular exercise. Signs for Life Program: A Children’s Roadmap to Nutrition and Fitness YMCA of Florida’s First Coast, Inc. Jacksonville, Florida Follows children on a “roadtrip” of nutritional choices and fitness activities. Bake and Shake: Promoting Healthful Cooking and Physical Activity Kansas Dietetic Association Foundation/Heartland Programs Topeka, Kansas Bake and Shake: Promoting Healthful Cooking and Physical Activity teaches parents basic nutrition concepts while showing the whole family how to enjoy physical activity together. H.J. Heinz Company Heinz has many well established brands that address consumer concerns with nutrition, obesity and public health such as Smart Ones and Weight Watchers from Heinz low-calorie frozen entrees, Heinz and Plasmon baby foods, John West and Petit Navire seafood, Tegel chicken, and Heinz and Wattie’s beans and soups, among others. Heinz is committed to – and has established – global communications guidelines to promote responsible and appropriate marketing practices for its brands, with particular sensitivity to children’s issues. Heinz is looking at each of its product lines in relation to trans fatty acids and is currently assessing ways to address this issue where appropriate without compromising the quality for which its brands are known Kraft Foods Kraft has undertaken a broad based systematic global initiative to improve the nutrition of both its new and existing products. The company is eliminating trans fat where possible; making small but meaningful modifications in amount of calories, fat, sugars and in new and existing products; providing appropriate nutrient fortification; and looking at the best way to inform consumers about how many servings and total calories are contained in 2-3 serving snack and beverage packages. Kraft has eliminated all in-school marketing and set criteria for products sold in in-school vending with respect to fat, saturated fat, trans fat and sugar. Additionally, Kraft has developed and is following voluntary guidelines to assure that all marketing programs depict appropriate portion sizes, eating and activity behaviors. In the first half of 2004, Kraft will introduce new products focusing on Weight Management, Nutrient Delivery, Performance Nutrition, and Natural and Organic. Examples include: § Nabisco 100-calorie packs, a four-item line featuring the Wheat Thins, Chips Ahoy!, Cheese Nips and Oreo brands. These portion-control, single-serve products are thin, crisp snacks that are formulated to have three grams or less of fat, zero grams of trans fat and no cholesterol. § Triscuit crackers with zero grams trans fat, the first in a series of biscuit products that will be reformulated to have zero grams or reduced levels of trans fat. § Kraft CarbWell salad dressings and barbecue sauce, the first items in a new line of products for consumers interested in limiting their carbohydrate intake. § Kool-Aid Jammers 10, made with real fruit juice, containing 100% of the daily value of vitamin C and only 10 calories per serving. § Creme Savers Smoothies, a dairy beverage that combines unique flavor and calcium fortification technologies, is 98% fat free and has 25% of the daily value of calcium. § Balance GoMix, a mix of snacking ingredients with 11 essential vitamins and minerals with twice the protein and one-third less fat than leading trail mixes. Nestlé USA Nestlé has a long-standing, worldwide commitment to nutrition, health and wellness, research, education and awareness. Nestlé’s research and development resources extend around the globe, employing biologists, biochemists, physicists, food technologists, microbiologists, nutritionists and others to collaborate on food science. Nestlé is also one of the world's largest publishers of scientific literature on infant and adult nutrition, having produced over 200 volumes in as many as 10 languages. The Nestlé Research Centre provides research for improving the nutritional value of Nestlé products. Nestlé also has worldwide research and development resources, including the Nestlé Nutrition Institute. The company has a broad portfolio of products that fit into any healthy lifestyle which includes a balanced diet and regular exercise. For example Stouffer's Lean Cuisine, the number one calorie/portion controlled frozen entree, and Carnation Instant Breakfast nutritional energy drinks to calcium fortified Nesquik 100 percent milk products and Libby's Juicy Juice 100 percent juice products. Last year, Nestlé launched an initiative to introduce Nestlé Nesquik milk to schools as a healthy beverage alternative. Nestlé Nesquik is a 100 percent milk product, so it offers the nutrients of milk plus additional calcium fortification in a variety of flavors that kids love. A recent study by the University of Vermont found that children who drink flavored milk consume more calcium. Nestlé takes a responsible approach to communicating to children by following internal guidelines, as well as by complying with external guidelines established by the Children’s Advertising Review Unit, a self-regulatory organization which defines guidelines for advertising to children under 12 years of age; and the Children’s Online Privacy Protection Act, a law regulating collection of information from children. PepsiCo PepsiCo was the first major food company to eliminate trans fats from the entire line of Frito-Lay snacks, eliminating 50 million pounds of trans fats from the American diet, well in advance of the FDA mandate. It has announced its commitment that 50 percent of new products will comprise essentially healthy ingredients or offer improved health benefits. It is a national presenting sponsor of America on the Move, which recommends small, achievable changes to achieve energy balance. PepsiCo has extensive investments in developing and piloting programs that help kids achieve healthy lifestyles: YMCA programs, Cooper Institute Activitygram and Fitnessgram, and a University of North Carolina four-year program to research and pilot programs addressing childhood obesity. In partnership with American School Food Service Administrators, PepsiCo has developed the “Health is Power” initiative that provides products, program information and personal wellness tools that enable food service administrators to lead by example and bring wellness solutions to schools. A Blue Ribbon Advisory Board on Health and Wellness comprising renowned experts advise PepsiCo on key initiatives. It is organized under the leadership of Dr. Ken Cooper of the Cooper Aerobic Center and Dr. Dean Ornish of the Preventive Medicine Research Institute. * * *

• Mr. Lee Culpepper
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  Witness Panel 2

  Mr. Lee Culpepper

  Mr. Chairman and members of the Subcommittee, I appreciate the opportunity to testify this morning on the issue of obesity in children. I represent the National Restaurant Association, the leading business association for the nation’s 878,000 restaurant locations. The restaurant industry is the nation’s largest private sector employer – providing career and employment opportunities for 12 million Americans. The National Restaurant Association proudly represents all segments of the restaurant industry, from fine-dining and family-run “mom and pop” restaurants, to quickservice and sit-down chain restaurants as well as other foodservice outlets. Let me begin with a general overview of the issue of obesity from the restaurant industry perspective. The issues of nutrition and healthy lifestyles are top-of-mind for our industry. We recognize that obesity is an issue that some Americans struggle with. Many restaurateurs have begun to see a growing health-consciousness among their customers. In 1999, we found that more than half of all operators were reporting that their customers were more interested in nutritious menu choices than they were two years earlier. This trend certainly has continued, and will drive major expansions in restaurant menus for the foreseeable future. Seventy-six percent of all meals are still eaten in the home – not in restaurants. Yet when Americans do dine out, they find a wide variety of foods in a selection of portion sizes – all of which meet customers’ demands for choice, value and flexibility, as well as their tastes and dietary needs. The National Restaurant Association has long been committed to supporting initiatives that convey the importance of living a healthy lifestyle. For example, the Association developed a consumer brochure titled, “3 Steps to a Healthy Lifestyle,” which was positively reviewed by the U.S.D.A. This brochure promotes balance, moderation and exercise as keys to a healthy lifestyle and has reached thousands and thousands of consumers. It also contains tips on how to reduce calories or fat while dining out. The Association also formed a partnership with Foodfit.com, the leading healthy eating Internet company, to launch Dine Out Smart, an online resource for the growing number of American consumers who are looking for even more ways to dine out nutritiously. The restaurant industry is an industry that is all about hospitality; an industry where choices abound and consumers rule. Restaurants want and need to accommodate people on specific diets: You don’t ignore an estimated 25 million Americans following the Atkins diet, for example, regardless of how you feel about the diet. We also need to and willingly do satisfy the parents who bring their children into our restaurants. We accommodate vegetarians and vegans. We serve people who demand value for what they spend. People who want to take their leftovers home to turn tonight’s dinner into tomorrow’s lunch. Restaurants serve an increasingly diverse and well-traveled population, people with sophisticated palates, looking for a range of ethnic cuisines, foods that blend different cultures, new flavors, and new textures. There are 280 million Americans voting in the marketplace every day about how and where to spend their food dollar. If restaurants do not offer the choices that meet people’s needs, they do so at their own peril. Quite simply, any restaurant that fails to meet customer demand will not survive. That is why the restaurant industry has taken steps -- market-driven steps -- to add even more menu items, many of which are lower in fat or calories or carbohydrates. This is nothing new: The industry has prided itself on having a variety of menu items for some time. But let me list some of the most recent examples: · Burger King introduced three chicken sandwiches recently, all coming in at 5 grams of fat and under 350 calories. · Taco Bell’s 6,000 restaurants offer a “Fresco Style” menu – 15 selections with 10 or fewer grams of fat. · Subway’s 19,000 stores offer the famous “7 Under 6” menu – seven different sandwiches with fewer than 6 grams of fat. The chain’s new Kids’ Pak meal includes the option for a fruit roll rather than a cookie, and juice instead of a soft drink. · Wendy’s, long a leader in salad offerings, is now test-marketing milk and fruit as Kids’ Meal options. · McDonald’s introduced its premium salads last year and has developed an all-white-meat version of its Chicken McNuggets lower in calories and fat. · Darden Restaurants has opened its first Seasons 52 restaurant in Orlando, where everything on the menu is under 475 calories. · Applebee’s has teamed up with Weight Watchers International to develop eight to ten new menu items for nationwide launch by 2004. · P.F. Chang’s, one of the quickest-growing new “fast-casual” ethnic chains, offers a “Training Table Menu” with both high-protein and high-carbohydrate options. · Don Pablo’s, a Mexican chain, is testing low-carbohydrate fajitas. · Pizza Hut’s new “Fit ‘N Delicious” pizzas help customers build pizza slices with under 5 grams of fat. · Then there’s Baja Fresh’s “Lighten Up,” Chili’s “Guiltless Grill,” Denny’s “Fit Fare,” Olive Garden’s low-fat “Garden Fare” and nutrition kiosks in more than 100 Au Bon Pain’s restaurants. The list goes on, and you can find more examples of these market-driven solutions on the National Restaurant Association’s Web site, www.restaurant.org. These menu changes have been driven by consumers, not the restaurants themselves. The Atkins diet has been around for many, many years. However, only in the past few years has the diet become popular, and only now are you seeing restaurants respond to it by offering low-carbohydrate menu items. Several years ago, one of our largest members invested millions of dollars to develop and then market a lower- fat menu item. You might remember the McLean Deluxe sandwich at McDonald’s. This nutritionally desirable product failed to gain acceptance in the marketplace despite the extensive marketing resources put behind it. In the same vein, I can only imagine what Americans would have thought five years ago if restaurants had begun touting hamburgers without buns. Yet today, thousands of people on the Atkins diet order them. These examples underscore my point: our industry responds to consumers. Indeed, if people want more carrot sticks instead of French fries, that is what they will be served by restaurants trying to satisfy their customers. This same premise applies to what children eat in restaurants. I am the father of two little boys, ages 6 and 2. My wife and I monitor every meal they eat. We are working very hard to educate them about a healthy diet of foods and the importance of exercise. As every parent here will attest, this can be challenging. Nevertheless, my wife and I take the responsibility very seriously whether we are eating at home or dining out. We don’t hesitate to customize an order for our children when we are in a restaurant. And restaurants always respond. I think the most important way to address obesity is through education. Educating people on the importance of putting together a healthy lifestyle – one built on balance, moderation and exercise – and providing them with accurate information on how to do so is crucial. Likewise, it is important for the parents to educate their children about a healthy lifestyle, and to take an active role in achieving it. Along these lines, restaurants for decades have played a role in voluntarily providing nutritional information to those customers who request it. While this is not possible in every restaurant concept nor is it possible with every menu item because many people customize their order, it is a trend that we expect to continue. Again, what drives more and more restaurants to try to provide this information is customers and parents who want and need it. Restaurants do and will respond to parents, and we are confident that many of the changes you are seeing in menu items which I noted earlier will begin appearing on children’s menus, as well. For example, Red Lobster recently unveiled a new children’s menu with grilled fish and chicken, snow crab legs and fresh steamed vegetables. Also, parents may substitute steamed veggies for fries on any kid’s meal. McDonald’s is test-marketing fruits and vegetables in their Happy Meals. These are only two examples. But the success of all of these new menu items will rely upon parents and children purchasing them. While the problem of obesity in children is not caused solely by food, restaurants are very willing to be a part of the solution. We will do so “arm in arm” with the consumer – in this case, the parent. Thank you, Mr. Chairman, for the opportunity to testify today.

• Ms. Victoria Rideout
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  Witness Panel 2

  Ms. Victoria Rideout

  Good afternoon. My name is Victoria Rideout, and I am a vice president of the Henry J. Kaiser Family Foundation, where for the past seven years I have been the director of the Foundation’s Program for the Study of Entertainment Media and Health. For those of you who don’t know us, the Kaiser Family Foundation is a non-profit, private operating foundation focusing on the major health issues facing the nation. The Foundation is an independent source of facts and analysis for policymakers, the media, the health care community, and the general public. Through our policy research and communications programs we work to provide reliable information in a health system in which the issues are increasingly complex and the nation faces difficult challenges and choices. The Foundation is not affiliated with Kaiser Permanente or Kaiser industries. The program area I direct conducts research on the relationship between media and health, particularly with regard to children. According to the Centers for Disease Control and Prevention (CDC), over the past two decades the proportion of children ages 6 to 11 who are overweight has more than doubled, and the rate for adolescents has tripled. Today, 15% of all children 6 and older are overweight. Even pre-schoolers are affected: according to the CDC, 10% of 2-5 year-olds are already overweight. Taking into consideration the proportion of children who are “at risk” of being overweight, the current percentages double to 20% for children ages 2–5 and 30% for kids ages 6–19. According to the American Academy of Pediatrics, the increase in childhood obesity represents an “unprecedented burden” on children’s health, and the Surgeon General has predicted that preventable morbidity and mortality associated with obesity may soon exceed those associated with cigarette smoking. Given that an estimated 80% of overweight adolescents continue to be obese in adulthood, the implications of childhood obesity on the nation’s health—and on health care costs— are huge. Indeed, the American Academy of Pediatrics has called the potential costs associated with childhood obesity “staggering.” Experts have pointed to a range of important factors that are likely to have contributed to the rise in childhood obesity: a reduction in gym classes and after-school athletic programs, an increase in the availability of sodas and snacks in public schools, the growth in the number of fast-food outlets across the country, the trend toward “super-sizing” food portions in restaurants, and the increasing number of highly processed high-calorie and high-fat grocery products. The purpose of my testimony this afternoon is to explore one other potential contributor to the rising rates of childhood obesity: children’s use of media. By focusing on the media, I don’t in any way mean to imply that media’s role may be more important than many other critical factors. But the challenge childhood obesity poses for our country is so significant that it is important for every sector of society to look at what it can do to help address the issue. During the same period in which childhood obesity has increased so dramatically, there has also been an explosion in media targeted to children: TV shows and videos, specialized cable networks, video games, computer activities and Internet Web sites. Children today spend an average of five-and-a-half hours a day using media, nearly the equivalent of a full time job, and more time than they spend doing anything else besides sleeping. Even the very youngest children, preschoolers ages six and under, spend as much time with screen media (TV, videos, video games and computers) as they do playing outside. Last week the Kaiser Family Foundation released a new report titled The Role of Media in Childhood Obesity, which I would like to submit for the record at this point, along with a copy of my remarks. In this report, the Foundation reviewed the major research that has been conducted over the past twenty years in this country on media and childhood obesity, pulling together for the first time research from such fields as public health, marketing, media studies, and child development, and evaluating just what the research does and does not indicate about this important subject. Let me share with you now a few of our key conclusions from that review: Our first conclusion is that most research indicates that children who spend more time with media are significantly more likely to be overweight than other children, even when controlling for other factors such as SES, parental obesity, or the child’s own prior weight. The first major evidence that children’s media consumption may be related to their body weight came in a 1985 article in the journal Pediatrics, and it was dramatic. In an analysis of data from a large national study of more than 13,000 children, the authors concluded that, among 12- to 17-year-olds, the prevalence of obesity increased by 2% for each additional hour of television viewed in a typical day, even after controlling for other variables such as prior obesity, parental body weight, race, and socio-economic status. In a commentary published in 1993, the authors went on to note that another interpretation of their findings is that “29% of the cases of obesity could be prevented by reducing television viewing to 0 to 1 hours per week.” Since then, most major national studies have also found such a relationship. For example, analysis of data from a nationally representative survey of more than 700 kids ages 10-15 concluded that “the odds of being overweight were 4.6 times greater for youth watching more than 5 hours of television per day compared with those watching for 0–1 hours,” even when controlling for prior overweight, maternal overweight, race, and socio-economic status. The authors concluded, “Estimates of attributable risk indicate that more [than] 60% of overweight incidence in this population can be linked to excess television viewing time.” While these studies are impressive, the best way to demonstrate a causal relationship is through an experimental trial; for example, reducing the time children spend with media and then measuring whether this intervention affects their body weight, when compared to a control group. During the 1996–’97 school year, Stanford University researchers conducted a randomized controlled trial in which they reduced the amount of time a group of 3rd- and 4th-graders spent with TV, videos, and video games. Two matched elementary schools were selected to participate, one of which served as the control group. The intervention involved encouraging children to participate in a “turnoff” period of no screen time for 10 days, followed by limiting TV time to 7 hours per week. At the end of a 6-month period, children in the intervention group had reduced the time they spent watching TV and playing video games by about a third, down from nearly 30 hours a week to about 20 hours. The intervention group also experienced a 50% reduction in weight gain as compared to the control group, an average of 2 pounds less in weight and one inch less in waist measures as compared to the control group. These findings do appear to demonstrate the feasibility of decreasing body weight by reducing time spent with screen media. The second conclusion we reached in our review of the literature is that contrary to popular assumptions, research does not currently support the hypothesis that the reason media contributes to childhood obesity is because it displaces physical activity. While logic would suggest that kids who spend a lot of time in front of the TV set or the video game player are probably spending less time running around burning up calories, our review of the research indicates that the evidence for this relationship has been surprisingly weak. It may be that the effects are more subtle, or more long-term than those studies have been able to detect; or it may be that kids who aren’t watching as much TV as just substituting some other sedentary activity; but at this point we cannot conclude that media use displaces physical activity. What the research suggests instead is that it may well be children’s exposure to food advertising that is behind the link between media use and obesity. While there have been many studies documenting the extent and effectiveness of food advertising aimed at children, to date there has been no study that has directly compared groups of children who spend equal amounts of time with media, but are exposed to different amounts of advertising in those media. Such a study would be useful in helping to compare and sort out the various possible mechanisms through which media may be contributing to obesity in children. In recent years, there has been an intense new focus in the marketing world on marketing to kids – there are marketing consultants and research firms, newsletters, conferences, books, you name it. And the reason for that is that marketers predict children under 12 will spend $35 billion of their own money this year, and will influence another $200 billion in household spending. It has been estimated that the fast food industry will spend $3 billion this year in advertising aimed at kids, and that the food industry as a whole will spend a total of $10 billion in advertising and marketing aimed at young people. Every year, children see an estimated 40,000 TV ads; most of those ads are for food; and most of the foods advertised are things like cereals, candies, sodas, chips and fast foods – probably not what most nutritionists or doctors would be recommending given the rates of childhood obesity we’re facing in this country today. One study documented approximately 11 food commercials per hour during children’s Saturday morning television programming, estimating that the average child viewer may be exposed to one food commercial every 5 minutes. We put together a short tape of some TV ads from children’s programming for you to see now. Research indicates that the ads children are exposed to do influence their choice of foods; they influence how many products they beg their parents for in the grocery store, they influence which products they beg for, and ultimately, those requests do indeed have a fairly high rate of success in influencing what parents buy and bring home for their kids to eat. Obviously, the food industry believes advertising to children is effective, and that’s probably something most parents who’ve walked down a grocery aisle with a child recently would attest to as well. Experimental studies have demonstrated that even a brief exposure to food commercials can influence children’s preferences. In one study, researchers designed a randomized controlled trial in which one group of 2- to 6-year-olds from a Head Start program saw a popular children’s cartoon with embedded commercials, and the other group saw the same cartoon without commercials. Asked to identify their preferences from pairs of similar products, children who saw the commercials were significantly more likely to choose the advertised products. Another study found that among children as young as 3, the amount of weekly television viewing was significantly related to their caloric intake as well as their requests and parent purchases of specific foods they saw advertised on television. Children who watch more TV have been found to drink more sodas, eat more fast food, and eat fewer fruits and vegetables than other children. Most researchers agree that children do not understand commercials in the same way adults do. In 1995, the American Academy of Pediatrics reviewed the research about children and advertising and concluded that “advertising directed toward children is inherently deceptive and exploits children under 8 years of age.” Last week the American Psychological Association called for restrictions on advertising to children under age 8. One trend in advertising is using children’s favorite media characters to help sell food products, either in TV ads, on food boxes, or through toys that are offered with a grocery store purchase or a fast food meal. Fast food outlets have tie-ins with Teletubbies, Rugrats, Shrek, and Pokemon, and there are hundreds of food products in the grocery store aisles associated with TV and movie characters, from SpongeBob Pop Tarts to Bob the Builder crackers to Scooby Doo cereal, some of which you can see on the table set up at the front of the room. The TV ads we saw a few minutes ago also reflected this trend, featuring TV cartoon characters, free toys, and movie tie-ins. A recent article in the New York Times Business section noted that “aiming at children through licensing is hardly new. What has changed is the scope and intensity of the blitz as today’s youth become unwitting marketing targets at ever younger ages through more exposure to television, movies, videos and the Internet.” One food industry executive was quoted as saying that licensing “is a way to… infuse the emotion and popularity of a current kids’ hit into a product.” A recent example of the effectiveness of this technique is the growth in the dried fruit snack market. Almost half (45%) of fruit snacks had licensing agreements in 2003 compared to 10% in 1996. Sales have increased substantially every year since 1999: 5.6% in 2000, 8.7% in 2001, 3.2% in 2002, and 5.5% in 2003. Marketing to kids is also moving to the Internet, where more and more food companies have sites for kids with games, prizes, and other activities. In the video of TV ads we just saw, you may have noticed the Honeycombs ad that directed kids to their website. Some other companies that have websites geared toward kids include candystand.com, Hershey’s kidztown.com, and Ronald McDonald’s Happy Meal site. According to Nielsen NetRatings, one such site, nabiscoworld.com, attracts about 800,000 kids a month. On the sites, kids play what are known as “advergames” – games about the food products being promoted. Some consumer advocates are concerned that advertisers are collecting information about kids – their age, gender and favorite foods – that will be used to target them even more effectively with food ads in the future. One example is the popular Neopets Web site, where children earn points by answering Marketing surveys and playing games like the HoneyNut Cheerios game or the Reese’s Puffs game. Another way of reaching children is through product placements for foods in some of the movies that are popular among young people, and we’ve pulled together two quick examples to show you now. The first is a little subtle, from Spy Kids, but if you look closely you’ll see the little McDonald’s arches on the side of the girl’s cup, and the second – from Spiderman – is quite a bit less subtle. Let’s take a look. The final conclusion from our report is that there is evidence that media can play a positive role in helping to address childhood obesity, and that some networks have already begun efforts in this regard. Research indicates that public service campaigns can be effective if they are well-crafted and if they get enough airtime to get through to the audience. Campaigns to help motivate kids to get active and to teach them about eating right can be part of the solution to the obesity crisis. The Nickelodeon network’s Let’s Just Play campaign is one prominent example. The CDC’s Verb campaign and the National Cancer Institute’s Five A Day campaign are other examples. The challenge with these efforts, of course, is that they are relatively small compared to the amount of food advertising that is out there. For example, just by way of comparison, Pringles, one among many chip products, spends $29 million a year in advertising; M&Ms, one among many candy bars, spends $74 million a year; Coke, one among many sodas, spends $209 million, and McDonald’s, one among many fast food companies, spends an estimated $665 million. In addition to public service campaigns, some kids’ shows are designed to get kids up and active: materials for the Disney Channel’s JoJo’s Circus describe it as being designed to get kids moving, and the creators of the new PBS show that just premiered this month called Boohbahs say it is designed in part to motivate kids to exercise. And even Elmo has an exercise video. Finally, our report also reviewed some of the suggestions that various health or advocacy groups have made concerning media and childhood obesity. Our purpose is not to endorse any of these policy options, but simply to pull them together and put them on the table for policymakers and other decision-makers to consider. These options essentially fall into three different categories. The first is to reduce the time kids spend with media, either by parents working harder to set limits, or through planned interventions such as the one conducted on an experimental basis at Stanford. In its recently issued policy statement about childhood obesity, the American Academy of Pediatrics advocates restricting children’s television viewing to less than 2 hours a day, as a specific strategy for preventing pediatric overweight and the risk of obesity. Other health experts concerned about childhood obesity endorse having parents limit their children’s media time, including the Surgeon General’s action plan on obesity; Healthy People 2010, the nation’s prevention agenda for the first decade of the 21st Century; and the USDA’s Dietary Guidelines. In addition to general efforts to encourage parents and children to limit the time kids spend with media, health advocates also have suggested childhood obesity can be curbed by specific interventions that help children reduce screen time. Local and state governments, nonprofits, school districts, or the federal government could provide additional financial support to develop curricula and promote adoption of such interventions as a way of reducing the incidence of child obesity. The second major policy option that has been proposed is to reduce children’s exposure to food advertising. These suggestions take a wide array of forms, from voluntary action taken by media companies or the food industry to government regulation. Among the specific proposals that have been suggested are: · A ban on any advertising to preschoolers; · A ban on advertising of so-called “junk” foods to children; · Reducing the number of TV ads that are allowed to air in children’s programming; · Prohibiting food product placements in children’s TV shows, movies, or video games; · Providing “equal time” for messages on nutrition or fitness, to counteract food ads in children’s shows; · Including parental warnings about the nutritional value of advertised foods; · Changing the wording of disclaimers in children’s advertising to make them more understandable; and · Repealing the tax deduction for company expenses associated with advertising so-called “junk” food products to children. The final option we discussed is increasing support for the positive media campaigns discussed above – whether through increased amounts of donated airtime, or through significant increases in government funding. In closing, let me just reiterate that there are many very important factors that have contributed to the problem of childhood obesity; today, we are exploring just one of those factors, the role of media. And the good news is that it appears that there are a number of options for parents, for the media and food industries, and for policymakers to consider, that could well reduce the negative and enhance the positive impact of media on childhood obesity. Thank you very much.