Remarks as prepared; not a transcript.

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services

American Bakers Association

Monday, March 21, 2005
Orlando, Florida

"Food, Family, and Culture: Bringing Home the 2005 Dietary Guidelines for Americans"

Good afternoon.

Thank you, Paul, for that wonderful introduction. [American Bakers Association President Paul Abenante]

It's great to be among so many friends. Thank you for inviting me to lunch. There's no better way to form new friendships than by breaking bread.

Last year my friend and colleague Melissa Johnson joined you at this meeting. As you know, Melissa is the Executive Director of the President's Council on Physical Fitness and Sports. We both have the great pleasure of being part of the Health and Human Services family.

Melissa is doing a great job for President Bush, our new Secretary Mike Leavitt, and most of all for the American people. I'm so pleased to be able to join you this year. The work that you do is so important to the health and well-being of our nation.

My mission as Surgeon General is to protect, promote, and advance the health and safety of the Nation. It's a big job. Fortunately, I have the great privilege to serve under leadership whose integrity and compassion make it possible to maintain the high standards set by the 16 former Surgeons General who established the credibility of the Office of the Surgeon General.

I'm not saying it's easy: the position of Surgeon General is in many ways the true intersection of politics and public health. The reality is that there are infinite needs and finite resources. Like you, I recognize that we must all focus efforts and resources where they are most needed, and where they can do the most good.

That was a lesson I learned well in the Army: I know that if I have the right plan and the right resources, I can accomplish any mission. That is the approach that I now bring to the Office of the Surgeon General.

U.S. Public Health Service Commissioned Corps

For example, part of my job is to lead the United States Public Health Service Commissioned Corps on behalf of the Secretary of Health and Human Services.

The Public Health Service is one of our nation's seven uniformed services, like the Army and Navy. We are a Corps of public health professionals, dedicated to our mission of protecting and advancing the health and safety of the nation.

Our officers work around the world to help in times of disaster, as we did when the hurricanes battered this beautiful state last year. Our officers also provide day-to-day healthcare for underserved populations, and to build capacitance and resilience through infrastructure building.

It's a tremendous honor to serve in the Corps, and it's especially gratifying because of the level of support that we receive from our Commander in Chief.


When President Bush nominated me to be Surgeon General, he asked me to focus the Public Health Service and the Office of the Surgeon General on three priorities. I'm fortunate to work with a leader who understands the importance of health, who insists that evidence and the best science always guide our policies and what I do.

All three of my priorities are very strongly evidence-based. They are:

  • First, Prevention. - What each of us can do in our own lives and communities to make ourselves and our families healthier. Prevention is part of everything that I am doing as Surgeon General. Right now we've got it backwards. We wait years and years, doing nothing about unhealthy eating habits and lack of physical activity until people get sick. Then we spend lots of money on costly treatments to make them well, often when it is already too late.
  • Second, and new to the Office of the Surgeon General, as none of my 16 predecessors had to deal with these issues: Public Health Preparedness.
  • The third priority I'm focusing on relentlessly is Eliminating Health Disparities, an issue that is very near to my heart and the President's. Notice that President Bush didn't just charge me with reducing health disparities. He said we will eliminate health disparities.

Health Literacy

Woven through all of these priorities is health literacy: I've been working with colleagues throughout our Departments and across academia and the private sector to improve Americans' health literacy.

Health literacy is the currency for everything that I am doing as Surgeon General. Most of the preventable diseases that are cutting healthy years off lives could be eliminated if people had access to better health information, and understood and acted on that information.

People of all ages, races, incomes, and education levels are challenged by low health literacy. Even the seemingly simple things that we can all do to stay healthy and safe, such as getting regular medical check-ups and eating healthy foods, can be struggles for many people. The reality is that to be able to do these things, we must have a basic infrastructure and understanding of why these choices are important to our health and safety.

Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.

Dietary Guidelines for Americans

Let's look at the leading public health problem in America today. Nearly two-thirds of Americans are overweight or obese, and more than 365,000 Americans die of obesity-related diseases each year. More than 50 percent of Americans do not get the recommended amount of physical activity - 30 minutes a day for adults and 60 minutes a day for children. And if you want to reduce weight, you should put in 60 to 90 minutes at least five times a week.

Obesity contributes to four of the 10 leading causes of death in the United States, including our nation's biggest killer: heart disease.

Overweight and obese individuals are at an increased risk of developing heart disease, some types of cancers, and type 2 diabetes. Today, 15 percent of American children are overweight or obese - that's 9 million children who are developing risk factors for chronic illnesses that may reduce the length and quality of their lives.

We obviously have a problem, and I think that it's all tied back to low health literacy. People don't know how to balance calories in versus calories out.

The popularity of diet books and products that represent about a $42 billion in annual spending in the United States shows that Americans are interested in leading healthier lives. But we need more credible, consistent, and coherent information to help them make the best possible choices.

So what can we do to help Americans to understand and act on the need to eat healthy foods in healthy portions and get the physical activity they need every day? The contributors to obesity are multi-factorial. In addressing these causes, we must rely on evidence-based scientific information.

This year, the U.S. Department of Health and Human Services, in conjunction with the U.S. Department of Agriculture, released the sixth edition of the Dietary Guidelines for Americans. The newly updated Guidelines emphasize balancing caloric consumption with physical activity.

The 2005 Guidelines emphasize physical activity and calorie control more than ever before, and rightly so. If you want to do what is necessary to lose weight, you watch your calorie intake and you also do the necessary work, the work of physical exercise.

The Guidelines are available online, with a consumer-friendly brochure to help Americans make healthy nutritional choices, maximize the benefit of their calories, and balance food intake with physical activity.

The brochure was created because not every American is a scientist or a health care professional, and we cannot expect everyone to understand what it takes nurses, doctors, nutritionists, and other health professionals years of training to learn.

Food, Family, and Culture

I look back at my own years growing up in New York City. My grandmother was the matriarch of our family. Everyone her called Abuelita, which is a Spanish term of endearment for grandmother. Abuelita always had a can of lard at the back of the fridge that she used in preparing every meal. Were Abuelita's meals delicious? Sure. Were they healthy? That's another question.

Did Abuelita prepare calorie- and fat-dense meals to hurt the next generation? Of course not. She loved us, and we all loved her. On Saturdays, she would take me with her on the New York subway to the market. It was over 100 years old at the time, and judging by how old I feel, it's probably about 300 years old by now.

Abuelita and I would go from stand to stand in that market and would fill two big shopping bags with everything that she would need to prepare the Sunday feast.

She bought fresh fruits and vegetables, chickens they would kill right there while we waited, flour, sugar, teas, herbs everything.

We would carry all these foods home and she would start baking and cooking, and that would last all day on Sunday. Everyone would start showing up by midday, eager for taste of this, a small plate of that. There would be all the family, friends, and new immigrants to this country whom she was always helping to get set up as others had helped her when she immigrated. She made delicious arroz con pollo, mouthwatering empanadas, and something special for me. She made rice with a beef filete for me. A small piece of meat, breaded with egg and breadcrumbs. That was my favorite Sunday dinner, and I'll never forget the taste of Abuelita's food. It tasted like love.

But if the first ingredient was love, the second was lard. That was how her mother and grandmother had cooked, and how she cooked. That lard was not the best thing for us. Now we know that. But Abuelita didn't use the lard thinking that she could just cut this one corner. She was 100 percent committed to providing the best food for us. She was, after all, not only our chief nutritionist, she was our head nurse and physician. She was the one who would treat us with herbs and other home remedies because we didn't have a doctor, or the money to pay for one. For my abuelita, the problem was never a lack of love or a lack of caring - but a lack of health information and a lack of health literacy.

The challenge for you today as leaders in providing foods for America's lunchboxes and dinner tables and for me as Surgeon General is to apply cultural traditions and deliver useful information in ways that promote healthy choices.

Each time that your companies take health information and package it in a culturally competent manner, you are making a positive difference. By communicating health messages in ways that people can understand, individuals can change any poor health behavior, reduce morbidity and mortality, and improve their health and well-being.

By improving health literacy, we can save lives through obesity prevention. I ask you to find creative ways to distribute the 2005 Dietary Guidelines consumer brochure, or at least the information in it. If you want to talk with someone about that, I would be happy to introduce you to a young lady who is leading our Office of Diseases Prevention and Health Promotion. She is Captain Penny Royall, and she's an officer in our Public Health Service Commissioned Corps. She and her team of nutritionists are working with organizations nationwide to partner on innovative ways to make sure that the Dietary Guidelines for Americans actually reach Americans.

For example, HHS funds programs to train community health workers to help increase health literacy among groups that have traditionally lacked understanding about health and the healthcare system. They may be called community health advocates, lay health educators, community health representatives, or, in Spanish, promotores de salud. We need these knowledgeable people to serve as connectors between community members and healthcare professionals in culturally competent ways. In the future, I expect that these community health workers will be helping to spread the word about the Dietary Guidelines. Please find ways for your companies and your industry to support the work of community health workers, especially in communities of color.

We are a diverse nation, enriched with many cultures, and we must respond every day to our communities' diverse needs.

Improving health literacy will save lives, save money, and improve the health and well-being of millions of people. With improved health literacy comes the ability to make informed choices, and the Guidelines offer Americans achievable goals for controlling weight, building stronger muscles and bones, and preventing chronic diseases.

Health and nutrition impact every aspect of our lives, from how children learn to how productive business can be, to how we maintain our health and independence into our senior years; and how we eat impacts our pocketbook with the cost of health care.

The choices we make every day of what to eat and how much to exercise will really determine how long we live, how much energy we have, and how healthy we really are. The Dietary Guidelines give Americans the information they need to make the right choices each and every day.

Some highlights from the Guidelines include:

  • Number one, Get the most nutrition out of your calories, based on the fact that there are a correct number of calories for you to eat each day. If you use up the entire amount on a few high-calorie items the chances are you will not be able to get the full range of nutrients that your body needs.

  • Two, find your balance between food and physical activity. Regular physical activity, at least 30 minutes for adults, 60 minutes for children most days of the week, is important for your overall health. Physical activity also helps you control your weight.

  • Make the smart choices from every food group. Eat a variety of the nutrient-packed foods to give your body the balanced nutrition that it needs. Just stay within your daily calorie needs, depending upon your body size and your daily physical activity. Mix up your food choices- variety is really the spice of life.

We can live by the 2005 Dietary Guidelines and be healthier for it because the guidelines are a solid combination of research science and, more importantly, common sense. It truly is all about good sense and healthy choices.

Good Sense: the story of Dennis Yohnka

You may have heard about the documentary film "Super Size Me." Filmmaker Morgan Spurlock went on a 30-day diet of nothing but McDonald's fare for breakfast, lunch, and dinner.

The film made headlines because this young man gained a lot of weight and suffered a number of physical ailments. But now, an Illinois man, Dennis Yohnka, is flipping "Super Size Me" upside-down: He's lost 40 pounds in 50 days by eating McDonald's salads. He says he was just tired of weighing 269 pounds, at 6 feet 1 inch. He'd tried all the fad diets, from A for Atkins to Z for Zero Sense.

Then he realized he could simply modify his regular diet, which included lots of McDonald's hamburgers and fries, and make a healthier choice of salads with chicken, while continuing to eat at his favorite place.

Mr. Yohnka says he was actually inspired by "Super Size Me." He says that he saw the movie and thought, "Gee, I don't get it. If you make good decisions instead of bad decisions, it's more up to us than it is the food chain or anybody else."

So he began eating Cheerios or oatmeal for breakfast, and McDonald's salads with chicken for lunch and dinner. After a McDonald's employees suggested to him that he should try the low-fat dressings, he took to ordering those as well.

Mr. Yohna's goal is to lose another 10 to 15 pounds. And as high school administrator, he says he was doing this partly to point out to kids that what the adults tell them about making smart choices really is true. It's what you and I also tell our kids: "If you make good decisions, that's how you get ahead. Making bad decisions keeps you somewhere else."

Mr. Yohnka is a walking, talking example of that lesson. I'm looking forward to recruiting him to help with our very ambitious agenda for 2005.

The Year of the Healthy Child

This year's agenda for the Office of the Surgeon General is "The Year of the Healthy Child." The prosperity and future of our nation rest upon the health and well-being of all our children. This is the most comprehensive agenda ever set forward by a U.S. Surgeon General for a single year. It includes all aspects of a child's life - body, mind, and spirit - starting with prenatal care and going through the developmental stages of childhood and adolescence.

The health of a child is a family affair, and preventing obesity starts with the nutrition and physical activity habits that are established at home.

People say that children are our future. I say that children are also our present. They are today. Their dreams are today's dreams. Their hopes are today's hopes. Their needs are today's needs. To help children grow to be healthy and self-sufficient members of society, we must work together to promote good health in all its forms - mental, physical, and spiritual.

The good news is that 82 percent of our nation's 70 million children are in very good or excellent health. Childhood immunization rates are at an all-time high. Our children are less likely to smoke and less likely to give birth as teenagers.

These are important gains in pediatric health. But we still have some troubling problems. That is why this year I will be taking a hard look at ways to improve the health of children both domestically and internationally.

A healthy child begins before birth, so we are highlighting steps that women should take to keep themselves healthy, especially when they are considering becoming pregnant. This includes exercise, a healthful diet that includes folic acid, and eliminating tobacco use and alcohol consumption.

We are focusing attention this year on every aspect of a child's life. We are addressing - among other things - breastfeeding, on-time immunizations, oral health, preventing obesity, preventing child abuse and neglect, drug and alcohol use prevention, smoking prevention, youth violence prevention, healthy indoor environments, and safe teen driving.

We will also focus on the child's growing mind. Through my "50 Schools in 50 States" Initiative, we are working with school districts and other partners to encourage students to stay in school. In addition, we will encourage more students, especially minorities, to focus on excelling in math and in the hard sciences, areas in which the United States is falling behind.

The final area that we will focus on during "The Year of the Healthy Child" is spirit. The enthusiasm of children and teens is often overlooked in their communities. We must work to harness their energy and partner them with local and national organizations to promote volunteerism, civic responsibility, and patriotism.

Together, with your help, we can ensure the best possible health, and the greatest productivity and independence for every child. We are already working with the American Academy of Pediatrics, the March of Dimes, Nike, The YMCA, The Boy Scouts of America, Discovery Health, NASA, SAFE KIDS, the Department of Education, and numerous other partners. I hope that you will join us. We need you - your expertise, your experience, and your passion.

Charge and Closing

In closing, I want to thank you for the wonderful work you do. Let's keep working on increasing prevention and improving health literacy, particularly for the newest generation.

The President has given all of us who work for him at the Department of Health and Human Services a clear charge: to help Americans live longer, healthier lives and to do it in a way that maintains our economic competitiveness as a nation.

This will require a transformation of many of our systems, including our healthcare infrastructure. The improvements to Medicare, the Medicaid reforms that Health and Human Services Secretary Mike Leavitt is working on with state and national leaders, and the steps we can all take to increase prevention and improve health literacy are vital to healthcare transformation.

Secretary Leavitt shared something with me recently that I think you will all appreciate. An entrepreneur he respects once told him that in an atmosphere of change and transformation, there are three ways you can respond:

  • You can fight it and die.
  • You can accept it and survive.
  • Or you can lead it and prosper.

Now is the time for us to lead.

That is what the American Bakers Association is all about, and I look forward to working with you in the months and years ahead.

Thank you.


Last revised: January 8, 2007