Remarks as prepared; not a transcript

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

American Enterprise Institute Obesity Conference

Tuesday, June 10, 2003 12:30p.m.
Washington, D.C.

Thank you for that kind introduction, Jim. [Jim Glassman, AEI scholar]

It is a pleasure to be here.

In the past 10 months since I was sworn in as Surgeon General, my life has been quite a whirlwind. I feel like Iíve aged in dog years. Iíve crisscrossed the country many, many times. Iíve even represented the United States at a conference in South America and at a meeting of the World Health Organization in Geneva.

I now sit at the table with people I used to read about in newspapers. They ask me for advice to address some of our nationís ó and the worldís ó most important issues and most pressing problems. Itís a tremendous responsibility and a tremendous honor.

I feel the enormity and responsibility of this job each and every day.

President Bush and Secretary Thompson asked me to focus on three priorities as Surgeon General. Iíll outline those for you today, and Iíll be 100% honest about my agenda ó Iím here to enlist your support.


As I mentioned, President Bush and Secretary Thompson asked me to concentrate on three priorities as Surgeon General. All three priorities are evidence-based. Iím fortunate to be able to work with two leaders who understand that the evidence must always guide the policy.

  • Prevention ó what each of us can do in our own lives and communities to make ourselves and our families healthier;
  • Public health preparedness; and
  • Health care disparities. Itís intolerable that in a nation as wealthy as ours, there are people who cannot access care.
  • Obesity

    Iím very pleased that the American Enterprise Institute is turning its attention to the problem of obesity in America.

    Secretary Thompson and President Bush have been pioneers in getting prevention into the American mindset.

    For example, from October to December 1999, there were fewer than 50 articles in the American press about obesity and overweight.

    Contrast that with three years later ó October to December 2002 ó when there were more than 1200 articles about obesity and overweight in the same sample of American magazines and newspapers.

    Awareness of obesity is growing, as the coverage becomes more and more high-profile, including the covers of TIME, Newsweek, USA Today, as well as numerous broadcast reports.

    This coverage is important because Americans need to understand that overweight, obesity, and their many related co-morbidities are absolutely preventable.

    Prevention is still a radical concept to most Americans. We are a treatment-oriented society.

    Poor eating habits and inactivity erode our quality of life, shorten our lifespan, and burden our health care system ó which is already stretched far too thin.

    In 2000, the total annual cost of obesity in the United States was $117 billion.

    Obesity is the fastest-growing cause of disease and death in America today.

  • Obesity has reached epidemic proportions. Nearly 2 out of 3 Americans are overweight or obese. Thatís a 50% increase from just a decade ago!
  • Roughly More than 300,000 Americans die every year from illness related to overweight and obesity. Thatís nearly 1,000 people every day, one every 90 seconds.
  • Obesity is creeping into our childrenís lives. More than 15% of Americans age
    6-17 are overweight or obese. Thatís more than 8 million young people. A direct result of the obesity epidemic is that type 2 diabetes, previously unheard of young people, is trickling into our schools ó and left unchecked, it leads to serious illness and possible death.
  • And minorities are faring worse than the overall population: 23% of Hispanic Americans are obese. And 30% of African Americans are obese.
  • Obesity causes so many of the diseases affecting Americans.

  • At least 17 million Americans have type 2 diabetes. Thatís about one out of every 20 people. At least 16 million more Americans have pre-diabetes. Each year, diabetes costs America $132 billion. It also accounts for thousands of deaths, thousands of hospital stays, and immeasurable grief and sadness for families across our nation.
  • At least a third of all cancers are caused by poor nutrition, overweight, and simply being inactive.
  • And hypertension, which is aggravated by obesity, contributes to the #1 cause of death in this country: heart disease.
  • The good news is that this health crisis is almost entirely preventable through proper diet and exercise.


    Everything I do as Surgeon General focuses on prevention first.

    As we look at the big picture of health care, even beyond obesity, there are perverse incentives in our health care system. We wait for people to get sick, and then we spend billions of dollars every year trying to make them healthy again.

    Iím grateful for the treatments generated by biomedical research. But we shouldnít have to rely on good science to undo many years of bad habits.

    Weíre at a crossroads in our nation. Weíre standing at the corner of health and disease.

    Are we going to sentence ourselves to being a society defined by obesity and disease? Or are we going to choose to be a nation of health and vitality?

    Every day, thereís new evidence about the harmful health effects of obesity.

    The C-D-C reported last month that women who are overweight or obese prior to and during pregnancy face significantly increased risks of having babies with birth defects.

    Compared with normal-weight women, overweight or obese women face double the risk of having babies with heart defects and also face double the risk of having babies with multiple birth defects.

    Women need to know this. Itís an incredible tragedy, and itís preventable. We must increase the number of women who are at a healthy weight before they become pregnant.

    We should also be particularly concerned about Americaís children. Itís absolutely unacceptable that type 2 diabetes is now found in children as young as 8 years old.

    And itís happening because our children are more sedentary and overweight than ever before.

    More than 25% of our children in America spend four or more hours every day watching television or playing video games.

    More than a third of American high-schoolers donít engage in any vigorous physical activity. Ever!

    We are seeing a generation of kids who grew up off the playground and on the PlayStation.

    Weíve got to teach our kids the benefits of physical activity: not just sports but things like taking the stairs, walking from the back of the parking lot, just getting out and playing every day!

    And as we are getting our kids to exercise, we need to do it ourselves. James Baldwin captured the essence of this when he said that we spend a lifetime trying to get our kids to listen to us, but they never fail to imitate us!

    Iíll be the first to say it wonít be easy. I have four kids. I know that families live such busy lives now that itís tough to prepare healthy meals and have enough time to get in some physical activity.

    But it is so important, because the choices kids make now, the behaviors they learn now, will last for a lifetime. As adults we must lead by example. Personally, I work out every day. I do my best to make healthy choices in all I do.

    My boss President Bush ó probably the busiest man in the world ó finds time to exercise.

    Secretary Thompson put H-H-S on a diet and has led by example by losing 15 pounds. The Secretary has his entire staff wearing pedometers, and heís always asking them how many steps theyíve taken. The last thing you want to do is walk by Secretary Thompson and not have your pedometer on. Heís relentless about this.

    President Bushís fiscal year 2004 budget proposal includes $125 million to prevent diabetes, obesity, and asthma through community-based healthier lifestyles.

    Through the Healthier U-S Initiative that the President introduced last year we are educating Americans about four essential principles:

  • First, be physically active every day. Even modest physical exercise like walking 30 minutes a day, five days a week can dramatically lower your risk of type 2 diabetes and help you in your fight against obesity.
  • Second, develop good eating habits. Remember to eat at least 5 fruits and vegetables a day. And those of you in corporate America are familiar with the "stretch goal." The stretch goal for fruits and vegetables is to eat nine a day.
  • Third, get regular check-ups and preventive health screenings.
  • And the fourth prevention principle is avoiding risk. If you smoke, stop. If you donít smoke, please donít start. And never, ever do drugs or drink to excess.
  • So many diseases are preventable if people would make better choices! Thatís why President Bush, Secretary Thompson, and all our colleagues at H-H-S are doing everything we can to encourage healthy habits.

    The Secretary is tag-teaming with the President through his initiative called "Steps to a Healthier U-S."

    Weíre also encouraging healthy habits through:

    • Our work to eliminate health disparitiesÖ
    • Our many initiatives designed to encourage exerciseÖ
    • Our nationwide campaigns to discourage smoking and drug and alcohol abuse.
    • and

    • My 50 Schools in 50 States Initiative, in which I am visiting schools across our nation to talk with kids about avoiding drugs and alcohol, avoiding tobacco in every form, exercising, eating right, and reducing other risks in their lives.

    Prevention is a major priority for the Department of Health and Human Services.

    Weíre seeing results, but we need your help.


    I refuse to accept the spread of obesity and all the diseases and heartache it causes for Americans. With President Bush and Secretary Thompson, I am committed to advancing the prevention agenda.

    We are encouraging behaviors to prevent illness instead of just trying to treat illness after it has occurred.

    And we need your help. Together, we can make the shift to putting prevention first in every home, every company, every school, and every health care setting across America.

    It will take all of us working together to find the solution to this growing problem.

    I caution people against playing the "blame game" when it comes to obesity.

    Some people want to blame the fast food industry for our growing waistlines, but the average person eats out only four times a week. That leaves 17 meals a week that most Americans prepare and eat at home.

    And even for the meals we eat out, itís still our decision what we eat, where we eat, and how much we eat. We need the progressive minds who will work to influence their school curriculums and implement changes in tpeople who are willing to talk about prevention, to promote health, and to improve the system rather than continuing to perpetuate the inefficient practice of treating disease rather than working to maintaining health. That concept is part of what I plan to include as I educate Americans about health literacy, which I feel is a huge deficiency in our society, especially among minority groups.

    I define health literacy as the ability of an individual to understand, access, and use health-related information and services.

    Starting this month, through the opportunities I have to speak to groups, I plan to bring the dialogue about health literacy into greater focus among health professionals and society as a whole. This is another piece in advancing the prevention initiative across America. All of us ó government, academia, health care professionals, corporations, and communities ó need to work together.

    Thereís a simple prescription that can end Americaís obesity epidemic: every American needs to eat healthy food in healthy portions and be physically active every day.

    Thereís more good news about ending the obesity epidemic: thereís no age limit on making healthy choices. Every person, regardless of age, can get some exercise and eat healthy foods! Good health habits donít have an expiration date.

    Iím asking you to work with me, to support our prevention initiative and programs, and to make healthy personal choices in your own life and set examples for all the children around you.

    Thank you for your partnership, and if you have time, Iím happy to answer questions.


    Last revised: January 9, 2007