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

Remarks to the 2003 California Childhood Obesity Conference
Monday, January 6, 2003

Thank you, David (Souleles, Chief Deputy Director, California Dept of Health Services).

It is great to be here with all of you. Our mission is so important. I love to talk about children, because that is where our hope lies. That is where we have so much potential to change Ė for good Ė our nation and the health of our nation.

As those concerned with the health of our children and teens, you are helping to mold and shape the next generation of Americans. Many of you are parents, too, so you know the issues weíre dealing with at this conference arenít just Ďacademic;í they affect all of us.

Ed Asner (some of you may know him as Lou Grant) said, "Raising kids is part joy and part guerrilla warfare." As the father of four, I know heís right. Itís a constant struggle!

All joking aside, raising children is a great privilege and a great responsibility. And for those of us charged with protecting childrenís health and welfare in a professional capacity, the stakes are even higher.

In my new position, I feel a strong responsibility to all American children. I have been Surgeon General for about 5 months now, and not a day goes by that I am not struck by the enormity of the responsibility, and the privilege I have to be in this job.

You give up your private life. The world now owns you. All you say and do is recorded.

You may know my history. I have a strong background in public health, in the military, and law enforcement, though I did not follow a typical career pattern (I dropped out of high school. I promise not to recommend that career path to anyoneís children!)

Let me briefly introduce myself. I am probably the most atypical Surgeon general ever. Iím the oldest of four from a poor Latino family. . . all dropouts.

My vantage point on health has been formulated by my experiences: as a child, soldier, cop, paramedic, registered nurse, doctor, surgeon, chief medical officer, then CEO of a health care system. I draw on all of these experiences as Surgeon General.

President Bush and Health and Human Services (HHS) Secretary Tommy Thompson have charged me with traditional public health responsibilities, like preventing illness and injury, and with preparing our country for possible terrorist attacks with biological or chemical weapons.

In the case of terrorism preparedness, we are working hard on ways to fight possible weapons of mass destruction. We are getting local fire, police and EMT departments ready. Weíre strengthening hospitals and the public health system to get ready to meet any possible challenge.

But one thing is clear to me: Our preparedness as a nation depends upon our health as individuals.

My top priority as Surgeon General can be summed up in one word: prevention. Everything I do will have prevention first. As I see it, we can no longer, as a society, afford to tolerate poor health choices that have given us this huge disease burden and huge costs. We have a health care crisis now, in terms of cost and access to care. Everyoneís trying to decide how we pay for diagnosis and treatment. The bottom line is, there is no solution thatís simple for this problem.

As we look at the broad picture, there are perverse incentives in our nationís health care system. We are a treatment-oriented society. We wait for people to get sick and then we spend top dollar to make them healthy again.

We reward caretakers for doing extraordinary things that are very costly, to save somebody who largely could have made decisions years before that would have prevented that from occurring. The incentives are perverse. And the pendulum has to swing to the other side.

The changes we talk about today are essential to ensure that our children and grandchildren inherit a legacy of health and wellness from us.

Today Iím going to talk about disease prevention in children, particularly obesity, a largely behaviorally-induced condition that leads to disease.

Obesity

Letís look at obesity, a threat that is very real, and already here.

Did you know that itís the fastest-growing cause of illness and death in America today?

It is not smoking, drug abuse, or alcoholism, as terrible as those things are. It is not AIDS, or suicide, or motor vehicle injury.

Thatís right, the fastest-growing cause of illness and death in America today is being overweight or obese. 300,000 Americans a year die from its complications, nearly 1,000 every day, one every 90 seconds.

Obesity is an epidemic now, and itís growing.

If we donít do anything about it, we will have a morbidly obese dysfunctional population that we cannot afford to care for, because obesity leads to hypertension, heart disease, Type 2 diabetes and other problems. We canít afford the disease and economic burden we have today. . . what will our kids and grandkids do in the future?

Nearly 2 out of 3 Americans are overweight and obese; thatís a 50% increase from just a decade ago!

More disturbing: nearly 15% of our children and teenagers are overweight, about 8 million kids. And studies show that overweight children will grow up to be overweight adults.

Many of them will develop serious illnesses as a result. Type 2 diabetes is one weight-related illness. And it has increased almost 50% in just ten years, from 1990 Ė 2000. Minority populations are particularly at risk for this disease.

What can happen to the diabetic? Eye disease, blindness, kidney disease, amputations, heart disease and stroke. . . so-called end organ disease, all devastating and preventable.

Another weight-related illness that might surprise you: cancer. Up to one-third of breast and colon cancers, are attributable to poor diet, physical inactivity, and overweight.

Overweight and obesity and the health problems they cause hit some groups harder than others. On the national level and here in California we have data showing that obesity rates are higher among African American and Hispanic children than among their white counterparts. This means higher rates of weight-related illness for these children down the road.

Thatís not a future I want for my children. And I know you donít either. Especially since it is preventable.

Why are our kids overweight and obese? Very simple. They are not eating right and they are not getting enough physical activity.

Jonathan Swift put it this way: "Human brutes, like other beasts, find snares and poison in the provision of life -- and are allured by their appetites to their destruction." 

We are allured by our appetite for technology, like the computer or television.

We are allured by our appetite for convenience, like the elevator or close parking spot.

And we are allured by our appetite for ease, like fast food restaurants and microwave dinners.

We are a wealthy nation. A prosperous nation. A happy nation.

But we are killing ourselves through our growing Ďculture of excess and complacency.í

And whatís worse, we are passing this along to our children.

You know, in this country, people take better care of their cars then they do of their bodies. Why is it, then, that people are more concerned with getting regular, routine check-ups on their car then they are on their own bodies?

Why will people only use the best gasoline and oil in their vehicle, but then fill their bodies up with "junk food?"

More than 60% of young people eat too much fat, and less than 20% eat the recommended five or more servings of fruit and vegetables each day.

More than a third of high school-age kids donít engage in vigorous physical activity. Ever!

Here in California, the situation is dire, as your California Center for Public Health Advocacy report shows. In almost half of the 80 California State Assembly districts, one in four children is overweight, and 40 percent of children flunked the basic aerobic fitness test.

Whatís even more discouraging: in most communities fifth-graders did better on the fitness test than ninth-graders. This means that kids are becoming less fit as they get older, instead of stronger and healthier!

Why arenít the kids eating right or getting enough exercise? Let me read a couple of other statistics:

Only 25% of adults eat the recommended five or more servings of fruits and vegetables. Two out of three adults donít get enough physical activity to provide health benefits.

To quote James Baldwin, "Children have never been very good at listening to their elders, but they have never failed to imitate them."

What can we do about obesity, as a community, as parents, as health care practitioners?

Thereís a lot we can do about the problem of obesity in children.

Government can do some things, particularly at the local school level, but not everything. So much of the solution to the obesity problem is up to each individual, each family, and each community.

In most communities, school buildings are the center of their community. They generally have the best health facilities in a given town, whether itís the weight room, the gymnasium, or the natatorium.

Schools have an important role to play in the health of a community, even after the academic day is over.

Many schools give kids the opportunity to play with their friends after school in an after-care program instead of coming home to an empty house. Thatís so important. We know that kids who are supervised after school donít get into as much trouble as Ďlatch-key kids.í Kids who can stay at school are less likely to drink, smoke or use drugs than kids who go home alone.

Iíd like to see schools really push the healthy choices. Soda machines and candy machines may be fine once in awhile as a treat, but kids need to know they canít live on sugar alone.

I understand that many schools have become dependent on corporate sponsorships and vending machine sales to provide extracurricular activity to their students. And there is no reason why that has to interfere with healthier living.

Iíd like to see better, healthier choices in school vending machines. Instead of soda, how about fruit juices, and instead of candy bars how about healthier snack bars.

Weíve got the technology to make tofu taste like turkey and vegetable patties taste like meat- surely companies can create healthy alternatives to snack food.

And Iíd also like to see schools think outside the box about ways to keep kids healthy. Iíd like to see schools invite organizations like the boys and girls clubs, the rotary clubs or the Kiwanis, or local churches to sponsor activity nights in the gym. 

Or maybe have corporations sponsor programs after or before school where students or community members can use the gymnasium, or the weight room, or the pool for exercise.

More schools should implement the Surgeon Generalís recommendation (in 1996 Report on Physical Activity and Health) of at least 30 minutes of moderate physical activity on 'most if not all' days of the week for all ages, whether it is playing basketball in the gymnasium or just walking the hallways.

Physical Education class can be a vehicle for increasing physical activity in the young. Here again, we are talking money, but even schools that cannot afford a PE teacher can think creatively about ways to get kids more active outside during recess.

And most of all we need to resist the trend of some school districts to eliminate physical education periods and activities.

Those of you here who are health care providers play an important role in curbing childhood obesity. Many of you will see the kids as toddlers when the problem is just starting, then later as they move on to preschool and elementary school. You may have many opportunities to talk to the parents of these kids and educate them about the importance of making healthy choices.

For kids, the best leadership is leadership by example. We can all follow the boring recipe for good health passed down by our parents and grandparents ourselves.

Exercise. Eat right. Get plenty of sleep. And avoid alcohol and tobacco. This is the successful formula used for generations. Itís not exciting; itís not dramatic. Itís not a quick fix. You canít get it in a pill. But it has proven effective for preventing illness.

There are two things everyone Ė parents, kids, doctors, nurses, policy makers Ė can do to prevent overweight and obesity in children, ourselves: eat right and get some type of physical activity. You donít even have to call it exercise!

As HHS Secretary Tommy Thompson likes to say: "Small steps can bring big rewards." You donít have to run miles and miles to benefit from exercise; start with walking from a space at the back of the parking lot, washing the car, or playing with the kids. Encourage the kids to turn off the Play Station and head out to the playground.

President Bush, possibly the busiest person in the world, exercises daily. Secretary Thompson and I also exercise daily.

You donít have to starve yourself to lose weight. Start by choosing snacks that are low in fat, rather than high in fat. Iíll be the first to say it wonít be easy. Families live such busy lives now, and it is much easier to grab what is available than it is to prepare a healthy meal or snack.

Some would argue that French fries taste better than a salad- but thatís due more to our changing lifestyle. Weíve come accustomed to those flavors and our taste buds have become desensitized to the flavor of a salad.

Iím talking about a lifestyle change that will not only improve your childrenís lives, but it will also help save their lives.

It will give them more energy. It will enhance their immune system and allow them to better fight everyday disease and sickness. And it will reduce their risks of diabetes and cancer.

Those of us who are in the health care profession should lead by example, in my view. Put in practice the behavioral guidelines that we know work. Encourage the children you see and their parents to eat right and exercise.

The American people will make healthy choices when they have the information, and the incentive. Look whatís happened in the war on smoking. Itís taken decades, but a steady drumbeat about the negative effects of smoking has caused many Americans to quit smoking and many more not to start. The same is true with heart disease. Now weíve got to work on some of the other things that are holding us back from being the best society we can be: obesity, and sedentary behavior.

Today is January 6, so by now, most of you who made New Yearís resolutions have already broken them, forgotten them, or given up on them. But I want to challenge you to make a new dayís resolution.

I want you to eat and live healthier every day. Make it a conscious commitment when you go to the grocery store to pick up healthy foods.

Make a commitment to go for a walk or get some physical activity everyday.

Encourage your kids to get some exercise everyday- or better yet, organize an activity for kids or adults in your community or your church or neighborhood.

The U.S. federal government spends nearly half-a-trillion dollars of your money every year trying to improve our nationís health.

You can do it for just pennies.

We need to lead a cultural transformation. We have the scientific information. How we translate that into culturally competent messages that will effect the desired behavioral changes is the challenge before us.

I want to thank each of you individually and especially California DHS and UCBís Center for Weight and health for taking the lead and being so proactive in the development of collaborative and innovative programs and processes to address this epidemic.

And thank you for the privilege of joining you today at your conference.

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Last revised: January 9, 2007