Statement Prepared For ADA President Martin M. Yadrick, MS, MBA, RD, FADA, American Dietetic Association
House Agriculture Committee
Subcommittee on Department Operations, Oversight, Nutrition, and Forestry
Public hearing to review the state of obesity in the United States
March 26, 2009
Good morning. My name is Marty Yadrick. I am a registered dietitian from Los Angeles and the President of the American Dietetic Association.
ADA is the world's largest organization of food and nutrition professionals, with more than 69,000 registered dietitians, dietetic technicians, registered and advanced-degree nutritionists. Every day, the members of our professional association work with Americans in all walks of life – from before birth through old age – providing care, services and knowledge to help people optimize their health through food and nutrition.
Others at this hearing are clearly identifying the national imperative to address obesity and the overall health of our population. I will not repeat statistics or the conclusions. I do ask that you add my name and that of the American Dietetic Association to the list of Americans who are committed to improving the health of our citizens.
Let me urge that we begin by focusing on prevention.
Nutrition and diet are known to be associated with seven of the top 10 leading causes of death in the United States today, including the Big Three: heart disease, cancer and stroke.
Diet and nutrition are also factors in other chronic conditions such as pulmonary disease, diabetes, liver disease, arteriosclerosis and kidney disease. Seven of every 10 Americans who die each year – more than 1.7 million people – die of chronic disease.
Furthermore, diet and nutrition affect the mortality rates associated with pneumonia and influenza, septicemia, prenatal complications and other conditions that are leading causes of death in our country.
How best to reduce the incidence of these diseases and conditions that take so many lives? A big step would be to reframe our understanding of the role of nutrition and health in the United States and the world.
Traditionally, we have tended to view nutrition in terms of the adequacy of the diet. And hunger remains an issue for millions of Americans.
But now, the primary manifestation of malnutrition in the United States has become excess weight and obesity. These conditions coexist with and at times overshadow hunger as the most significant nutrition problem facing the nation.
For those of you wondering about "dietetics," there are a few specifics you should know. Dietetics is the science that directly connects food to nutrition and health. Registered dietitians study multiple hard and social sciences, including those that quantify nutrients that people need and nutrients' effects on health. But RDs become experts in dietetics in order to help people optimize their health by choosing foods in a healthful pattern of eating. Of course, to stay healthy, food choices need to be matched with physical activity and a series of personal decisions – like choosing not to smoke and refraining from high-risk behaviors.
ADA is guided by a philosophy of sound science. Our association analyzes, publishes and disseminates scientific breakthroughs and information that is applied in dietetics practice every day throughout the nation. ADA was one of the first professional groups to embrace evidence-based practice, creating the world's first evidence-analysis nutrition library and producing guides for condition-specific nutrition care. ADA strongly believes that, as the public becomes knowledgeable and informed about food, nutrition and health, our profession can contribute more significantly to make Americans healthier. It is time that we as a nation take action to address food, nutrition and health.
It is time to become alarmed when nearly half the people in the United States suffer from preventable chronic conditions and when we see the life expectancy of our children declining from our own – largely due to overweight and obesity.
Obesity is a problem that defies an easy cure. We know that it is a better strategy to prevent overweight and obesity, rather than simply attempt to treat them. And that means that we should pay particular attention to the issue of childhood obesity.
ADA's own research illuminates the challenge ahead. American parents have erroneous perceptions of their children's nutritional condition and frequently, they are disengaged from their kids' eating habits. Parents are reluctant to help their children because they don't know how to help. It has been only the luckiest of families who are able to see a registered dietitian for nutrition assessment and intervention where families' insurance plans will provide coverage.
ADA's research also documents that most Americans have no idea of their own nutritional status, weight or eating patterns. Even when a diet-linked condition as serious as pre-diabetes is identified, a patient is likely to encounter very real barriers to professional nutrition care and services. To explain: Medicare is the template for most insurance plans. Medicare currently covers screening for prediabetes. A beneficiary can be tested as frequently as every six months to check his or her status. However, there is no referral – no covered care by Medicare or most private insurance – until prediabetes deteriorates to full blown diabetes. Only once the diagnosis has reached a dire situation will Medicare meet beneficiaries' needs through covered diabetes services. If the patient is very lucky his or her physician may send them to a registered dietitian for Medical Nutrition Therapy or an accredited Diabetes Self Management Training program.
So why would I call patients "lucky" to be referred? Fewer than 5% of Medicare beneficiaries eligible for MNT are referred, as doctors' offices frequently pass out literature rather than encourage the patient to get proven-effective, intensive nutrition assessment, personalized intervention and ongoing counseling. DSMT reflects similarly dismal referral statistics.
Fortunately we have just seen the development of a pilot program to help overweight children see their physicians and then registered dietitians to learn better nutrition and activity habits. Several health insurance organizations are part of this ground-breaking effort which will reach nearly one million children during the first year. The long-term goal of the initiative is that within the first three years, 25% of all overweight children (approximately 6.2 million) will have access to the benefit. This is thanks to the work of the Alliance for a Healthier Generation.
This subcommittee also is in a position to address barriers to better public nutrition and nutrition care. We recommend the committee focus on research, nutrition labeling and education, and child nutrition.
The first is research. This committee can make an enormous contribution by focusing on and investing in food and agricultural research across the board. ADA is a member of National CFAR which educates how federal research contributes to improved standards of living. After all, research was a key reason that President Lincoln established the U.S. Department of Agriculture. Unfortunately, what was once the gold standard for government research has atrophied. We all have a role in bringing our food and agriculture research programs back so that they can lead the U.S. food and agricultural sector successfully in the 21st century.
Government-funded nutrition research is especially imperative. It is the basis for nearly everything we know about food, nutrition and human health. The private sector does little of this kind of research – and the public is skeptical of much of it. Only the federal government has the public mandate to carry out research on human nutrition needs and motivators, as well as biological, epidemiological, social and environmental factors. The federal government has a unique responsibility to evaluate nutrition policies and programs. It's time to invest much needed resources into our Human Nutrition Research Centers. I can only imagine how much healthier we might be today if we had invested as much in human nutrition as we have spent for bovine, swine, poultry, aquaculture and other animal nutrition research over the years!
Nutrition Education and Labeling
The second is nutrition education and labeling. Some have observed that there is a reason why we call this the "information age" and not the "knowledge age" or "wisdom age." Consumers are drowning in nutrition "information." Related to that is that the consumer cannot easily evaluate the quality of the information. As often as not, on their own, consumers are likely to end up misinformed.
The United States has a statute on the books called the Nutrition Labeling and Education Act – a fine law that has never lived up to its promise. Labels are everywhere, but if consumers don't know how to use them and what they mean – then we must ask how to bridge the gap.
Nutrition information does not translate into knowledge or knowledge necessarily into appropriate action. If labels and pamphlets do not lead to behavior change, then people have to be taught.
The good news is that nutrition education is a worthwhile investment. Research documents that nutrition education can help people choose and prepare healthier food options, but the education components of NLEA are chronically underfunded by Congress and virtually ignored. Nutrition education has been integrated into some of the food assistance programs such as SNAP and WIC, but support for nutrition education lags behind for school meals and child care settings.
Children need to learn early in life about choices and behaviors that will keep them healthy for life. They need to be taught nutrition, how to choose and enjoy food and they need to be taught how and encouraged to engage in physical activity. They need reinforcement of healthy eating and activity in order to make healthy living a habit. We need to teach nutrition in a way that is meaningful, culturally aware, individualized and personal. PSAs and motivational messages have short-lived impact, if any.
School environments may not be teaching healthful nutrition or even offering healthful choices beyond the reimbursable school meal. Rushed meal times, pressure to increase revenues, calorically dense vending and elimination of physical education all send the message that health is not really a priority.
ADA recommends amendments be made to the Child Nutrition Act to:
- Ensure the Dietary Guidelines are the foundation of federal food assistance and nutrition programs. The Secretary of Agriculture should have the authority to extend nutrition standards to all foods and beverages sold on school campuses throughout the day for schools that are participating in the school breakfast, lunch and after school programs. You can help that happen by supporting HR 1324, The Child Nutrition Promotion and School Lunch Protection Act.
- Provide adequate funding for program implementation. School reimbursements have fallen far behind the costs of production and are inadequate to maintain the high nutrition standards established in law. And adequate funding is needed to ensure implementation of the new WIC food packages.
- Strengthen nutrition education and promotion. In the last Child Nutrition Reauthorization, Congress approved the Team Nutrition Network, a state-level infrastructure and networking component to coordinate nutrition education activities across child nutrition programs, conduct evaluations and enhance program operations. Funding is now needed for the benefits of that infrastructure to be realized. Nutrition education must continue to be a key component of the WIC program services.
- Increase funding for Child Nutrition Program research. Funding would allow USDA to conduct and fund research on and evaluation of their programs and allow USDA's Food and Nutrition Service to collaborate with research agencies in USDA and extramurally to develop and implement a comprehensive research agenda.
- Place trained professionals in roles where they make policies. Directors of the School Nutrition Program at the district level should be certified as registered dietitians, dietetic technicians, registered or School Nutrition Association school nutrition specialists. It is not simple to balance student satisfaction with nutritional needs and to do so cost-effectively. The extension of nutrition standards to all foods and beverages sold in schools, in conjunction with the local wellness policy requirement, will only increase the need for trained professionals in schools. Planning for nutritious intakes for children with special food and nutrition needs requires the biochemical and food science knowledge that only registered dietitians possess in school settings. Registered dietitians have the expertise needed to provide education to high-risk WIC recipients.
Speaking for the American Dietetic Association, I am asking our elected leaders to make the paradigm shift in which prevention plays a more balanced role in our health system. Nutrition is the cornerstone of prevention.
As a registered dietitian, I can tell you that many of the most-costly disabling conditions can be prevented through nutrition strategies. And with proper nutrition support, many complications can be averted or delayed. Federal attention to public nutrition and investment in nutrition care, education and research is essential. From these small, practical steps, great benefits may accrue to people, their families and the nation.
Thank you for holding this important hearing. I am honored that I have been invited to speak and to learn from you and my fellow panelists.