Tuesday, May 11, 2010

First Lady Michelle Obama & Childhood Obesity Task Force Launch Action Plan For Let's Move!

A summation of the new President's Report from the White House Task Force on Childhood Obesity, and Administration officials' response to questions from reporters...
At the White House this morning, First Lady Michelle Obama unveiled the President's Report from the White House Task Force on Childhood Obesity. Called an "Action Plan" for the Let's Move! campaign, Mrs. Obama cited the Report and its ambitious recommendations as a comprehensive road map for moving forward, and lauded all those who had helped make it a reality. Still, Mrs. Obama noted that her initiative is a work in progress. (Above: Mrs. Obama, flanked by Task Force members Health and Human Services Secretary Kathleen Sebelius and Education Secretary Arne Duncan)

"We're going to keep needing to have this conversation," Mrs. Obama said. "Our work has only just begun."

Three months in the making, the 86-page Report has 70 specific recommendations spread over ten additional pages, with 22 pages of end notes. There is one overriding goal: Returning to a childhood obesity rate of 5% by 2030, down from the current level of about 31 percent of children who are identified as overweight, with a little more than 17 percent of these identified as obese.

"For the first time--we’re setting really clear goals and benchmarks and measurable outcomes that will help tackle this challenge one step, one family and one child at a time," Mrs. Obama said of the Report.

It reflects input the Task Force received from 12 federal agencies, as well as 2,500 submissions from parents, teachers, doctors, nurses and others; the broad recommendations of the Report are below.

If successful in achieving all the recommendations in the Report, Let's Move! could well change the fundamentally obesogenic nature of American culture. But many recommendations rely on primarily voluntary action. Or, as Mrs. Obama noted, willpower.

"All we need is the motivation, the opportunity and the willpower to do what needs to be done," Mrs. Obama said. She pointed out, as she has in the past, that "we don’t need new discoveries or new inventions to reverse this trend."

*DOWNLOAD the Report [PDF]

As she unveiled the Report, Mrs. Obama was joined by Task Force Chair Melody Barnes, Director of the Domestic Policy Council, and Task Force members, who took questions from reporters following Mrs. Obama's remarks. (From L, above: Office of Health Reform Director Nancy-Ann DeParle; Federal Trade Commission Chairman Jon Leibowitz; Sebelius; Duncan; Housing Secretary Shaun Donovan; and Deputy Agriculture Secretary Kathleen Merrigan. Barnes is in green)

Focusing government resources, but limiting government interventions
To achieve its ambitious 5% goal, the Report advises a combination of public and private sector action, as well as concrete metrics and benchmarks to measure progress. As she has done in the past, Mrs. Obama emphasized that Let's Move! is not about government intervention, but rather about training government resources like a high-power spotlight on ending childhood obesity.

"The effort starts with using the resources across the federal government in the most effective ways possible--not just talking about making a difference, but actually doing it," Mrs. Obama said. She added that the campaign must include everyone to be successful.

"We are calling upon mayors and governors; and parents and educators; business owners and health care providers," Mrs. Obama said. "Anyone who has a stake in giving our children the healthy, happy future that we all know they deserve."

According to the Report, all campaign efforts should be tweaked to accommodate local and regional differences, as well as racial and economic differences. And the campaign must include rural areas, too, which is in keeping with the Administration's new plans to profoundly revamp rural America. During her own remarks, Melody Barnes also noted the focus on non-governmental intervention.

"We aren't moving into people's homes," Barnes said.

Indeed, the Report has an allergy to most legislative action, with the exception of the reauthorization of the Child Nutrition Act, which impacts about 31 million children covered under school-based feeding programs.

What the Report covers, and how progress will be charted...

The Report notes that to achieve its goal of a 5% childhood obesity rate by 2030, there must be a rapid "bending the curve," with a 2.5% reduction in overweight and obese children by 2015, and by 2020, a 5% reduction. Progress will be charted through weight surveys taken through the National Health and Nutrition Examination Survey, which is aggregated every two years.

This is possibly problematic: These surveys have historically relied on self-reporting of weight from those queried, and thus can be flummoxed by a high level of variability that is not accounted for statistically. The Report covers food and physical activity in the nation's schools, food access, food deserts, how foods are marketed to children through advertising, breastfeeding, care giver issues, pre-natal and pre-school issues, insurance issues, and advice for medical professionals.

There is also advice on the "built environment," meaning how communities are designed and used. There is a recommendation for creating safer neighborhoods, and locating schools so these are within walking distance of students homes. There are recommendations for studying the role of chemicals and genetics in obesity, and tweaking agriculture policy. Of course there is plenty of advice for how nutrition information should be made available to parents, and what the role of government should be in this.

The broad recommendations of the Report, in 5 categories:

1. Getting children a healthy start in life

*Good prenatal care

*Support for breastfeeding

*Limiting "screen time" for children with TV, video games, etc.

*Quality childcare settings with nutritious food and opportunity for physical activity

2. Empowering parents and caregivers

*Simpler "more actionable" messages based on the Dietary Guidelines for Americans

*Improved labels on food menus

*Reduced marketing of unhealthy products to children *Improved health care for children, including BMI screening for all children

3. Providing healthy food in schools
*Improvements in federally supported lunches and breakfasts

*Upgrading nutritional quality of all foods sold in schools

*Improving nutrition education and overall school environment

4. Improving access to healthy, affordable foods

*Eliminating "food deserts" in urban and rural America by 2017

*Lowering the relative prices of healthier foods

*Developing or reformulating food products to be healthier

*Reducing hunger

5. Getting Children more physically active

*Quality physical education, recess, and fitness opportunities in and after schools , and in communities

*Addressing aspects of the built environment to make these more fitness-friendly

*Making communities safer and improving access to indoor outdoor recreational facilities

Goals defined by category...

Schools: Highlighting farm to school programs, school gardens, nutrition education, physical fitness

Improving school feeding programs, and the need for more physical activity in schools are cited as primary goals. But the Report expands this purview. Recommendations for other facilities that are focused on children are included, too, such as juvenile justice centers.

States should adopt more stringent licensing for child care centers, the Report notes, especially those for pre-schools. Uniform nutrition guidelines should be adopted nationally, the Report maintains, and all foods sold in schools should meet these specific guidelines, including those sold in vending machines and a la carte lines.

School gardens
are advocated, as is nutrition education as a standard part of curriculum. Connecting local farmers and growers with school food programs is recommended, as a way of boosting healthy food use. Farm to School programs should be created wherever possible, the Report notes. USDA's Know Your Farmer, Know Your Food program should be used for this.

Even the architecture of school cafeterias is noted in the Report: This should be reviewed and changed, the Report recommends, so children who are getting free or reduced price meals do not have to stand in a special line that calls attention to their status.

Much of the food recommendations in the Report suggest using the 2010 Dietary Guidelines for Americans, which are still under construction; the current Guidelines are from 2005, and in the process of being reviewed and updated for 2010.

Major eating recommendations: Boosting consumption of fruit and vegetables

Children, inside and outside of school, should consume far more fruits and vegetables. The Report notes that on average, children consumed only 64% of the recommended level of fruit and 46% of the recommended level of vegetables in 2003-2004.

"To encourage children to eat healthier, we’re setting a goal to increase the amount of fruits that children consume to 75 percent of the recommended level by 2015," Mrs. Obama said.

"We want to increase that again to 85 percent by the year 2020, and then by the year 2030 we hope to be at 100 percent. We’re using a similar scale to increase the percentage of vegetables that our kids are eating as well."

Also of note: "We’re also working to decrease the amount of added sugar that our kids consume from a whole range of products," Mrs. Obama said.

When speaking to the Grocery Manufacturers Association in March, which includes the nation's largest food makers, Mrs. Obama called for a complete reformulation of food products, to dramatically reduce salt, fat, and sugars. That's an ongoing goal, obviously. Whole grains and low fat dairy also receive privileged notice in the Report.

Improving nutrition information for parents, and how government agencies can help

As has been the case since the campaign launched, the Report has an emphasis on improving nutrition information available to parents, through improving labeling for foods, as well as encouraging communities and schools to make this kind of information widely available.

Schools, too, should participate in this, as well as restaurants. This is one of the pillars of Let's Move!, and the report suggests increased focus and rapid action on improving nutrition information labeling for foods, using the combined resources of FDA and USDA's Food Safety and Inspection Service.

Still, this is left on a primarily voluntary basis, so far, with the exception of the requirement for posting calorie counts on the menus of fast food chains, which is included in the new health care legislation.

New elements for the Let's Move! campaign from the Report, and questions from reporters

Following the First Lady's remarks, the floor was thrown open for a limited number of questions to the Administration officials present. In the section below, details of some new elements that are now part of Let's Move! on the recommendation of the report, as well as some of the questions that were asked.

Approaching a National Breastfeeding Policy

The Let's Move! campaign has expanded to include recommendations for pre-natal care for mothers, baby care and for pre-school children. Something approaching a National Breastfeeding Policy is recommended, but again, there is no desire to legislate this on the part of Task Force members.

Breastfeeding should be encouraged and supported by health care providers, communities, and workplaces, according to the Report, because breastfeeding has been shown by some studies to reduce the chances of childhood overweight and obesity. Dramatically increasing the percentage of infants who are breastfed is a goal.

Farm policy is addressed in the Report

--But not in the way many food advocates would expect. Rather than trimming federal subsidies for the kinds of crops that are usually blamed for causing obesity because they are cheap and widely used (such as corn), something widely recommended by many advocates, there is a suggestion in the Report that planting more acreage of fruits and vegetables across America is needed, and that this should be studied.

Obesogenic chemicals

--Mentioned in the Report are those chemicals that can lead to overweight and obesity, with a recommendation that endocrine disruptors be studied further. Federal and State agencies should prioritize research into the role of potentially obesogenic chemicals in childhood obesity, the Report notes.


The role of sleep in childhood obesity is mentioned. A number of studies have found that children who do not sleep enough are at a higher risk for childhood obesity. The Report suggests 10.5 hours of sleep each night for toddlers, something that could well make many parents laugh.

Insurance coverage

Insurance should be expanded to include preventive care for child obesity, including screenings for BMI, the Report states. The Report notes that BMI is not necessarily the best indicator of overweight and obesity, but still endorses its value as a screening tool.

When queried by a reporter on why only children should be included in this kind of insurance coverage, rather than overweight and obese adults, too, HHS Secretary Kathleen Sebelius responded.

"A lot of people believe that is you intervene at an earlier age, you do not have future problems," Sebelius said.

She added that recommendations are still being developed for insurance coverage.

"This report focuses on childhood obesity," Sebelius added, meaning that adult issues are not included, and thus no recommendations are made for adults.

Perhaps the most pathbreaking idea in the Report:
Government subsidies for healthy foods should be considered as a way of making these more affordable, building on the idea of doubling the value of WIC and SNAP coupons, which occurs at select areas around the country.

Thanks to the goal of increasing childrens's consumption of fruits and vegetables, the Report suggests that the government funding for healthier foods is money wisely spent.

But when queried about the idea that fruits and vegetables are too expensive for the average American, Deputy Secretary Merrigan pushed back, somewhat undermining the Report's focus on the idea that food deserts need to be eliminated, and that money needs to be spent on the Healthy Food Financing Initiative, which dedicates $400 million to building new supermarkets in underseved areas and helping already existing outlets provide healthier foods, as a way of boosting food access and affordability.

"I actually think that fruits and vegetables are not as expensive as people think they are," Deputy Merrigan said. "Getting people to eat more fruit and vegetables is complicated, and it's not about price alone."

She noted that what is needed is a "whole of government approach," and pointed to a program in Somerville, Massachusetts, "Shape Up Somerville" that encourages increased consumption.

Tricky Food Deserts

The Report goes into a tricky area regarding food deserts, which have been identified by the Administration as places where healthy, affordable food is not easily accessible.

According to USDA's own analysis, "food deserts" effect a relatively small number of Americans. And on page 52, the Report newly identifies some places that can be categorized as food deserts: Amusement parks, county fairs, sports arenas, etc...

At this rate, everywhere will soon fall into the category of a food desert. If you're having a bake sale and there are no fruits and vegetables present, that's a food desert.

Marketing unhealthy foods to children

The Report has decisive recommendations about limiting the marketing of foods to children on television, in video games, in entertainment media, etc., and for eliminating the use costumed characters, etc. to market less than healthy food products.

But it maintains that changes should be accomplished on a voluntary basis by food companies, which, theoretically, should work in the public's best interest.

Federal Trade Commission Chairman Jon Leibowitz received some heat from New York Times/Rodale reporter Marian Burros on this subject. Noting that voluntary changes in marketing have historically been "a flop," Burros wondered why FTC will not legislate unhealthy food marketing aimed at children, especially because Mrs. Obama has repeatedly chastised companies for engaging in the practice--and the Report sets out specific guidelines for limiting this.

"You're right," Liebowitz responded, about past strategies having "flopped."

Food companies have not "done as much as we would have liked," Liebowitz said, but added that "a regulatory approach is not where we want to start."

He said this would lead to "endless litigation."

Liebowitz also noted that Congress has removed all power from FTC to be an enforcer.

"You start by using your bully pulpit, as the First Lady is doing, by commending companies that are stepping up to the plate," Leibowitz said, about what the action plan will be in this area.

The FTC, he noted, will be subpoenaing companies to see if they have fulfilled voluntary pledges at changing advertising practices. In future, more action will be taken, if companies do not act in a voluntary way to make changes, he said. He did not add when this would be.

Missing from the report

The Report contains no mention of eating disorders playing a role in childhood obesity, something the Task Force was urged to consider during the White House Child Obesity Summit.

Also, there is no mention of the role psychotropic medications play in children's weight; a number of studies have noted that the uptick in children's weight since the 1970s is coincident with the increase in medication prescriptions for children, particularly low-income children. Weight gain is an expected "side effect" of these medications.

Will all of America have enough willpower to enact this ambitious action plan?
That is the multi-billion dollar question, of course. Because in addition to child health concerns, billions of dollars are at stake in the federal budget, in terms of eliminating all the costs of dealing with chronic diet related diseases connected to obesity. Administration officials variously cite $147 billion or $150 billion as the figure to run away from, depending on whom is doing the talking.

>The transcript of Mrs. Obama's full remarks is here.

Above: Audience members at the press conference. Mrs. Obama's Food Initiative Coordinator, Sam Kass, is second from left at top of photo.

More on Let's Move! is at www.letsmove.gov.

Read about the White House Childhood Obesity Summit here

*Photos by Obama Foodorama