The Politics of Obesity

1. The Politics of Obesity Key Considerations for Decision Makers M. Stephanie Patrick, American Dietetic Association May 6, 2007

2. Who is the ADA? • Largest professional association of food and nutrition professionals in the world • Founded in 1917 • Total membership of 66,600 • 50 state affiliates • Plus WDC, Puerto Rico & international affiliates • Chicago Headquarters; Washington, DC

3. ADA works strategically & proactively in these areas judged to hold greatest potential for advancing nutrition and with that, the profession. Aging Child nutrition Food & food safety Health literacy & nutrition advancement MNT, Medicare & Medicaid Nutrition monitoring & research Obesity, overweight, healthy weight management Priorities

4. ADA principles for public policy • Food and nutrition are the foundation of the health of the population. • ADA's Code of Ethics is the foundation for dietetics practice. • Advocacy serves to improve the health of the public and enhance the status and role of the profession. • A safe, nutritionally adequate, and personally acceptable diet must be available to all individuals. • Sound science and its application in technology contribute to effective food, nutrition, and health policy. • Disease prevention as well as disease treatment are critical for health promotion. • Evidence-based medical nutrition therapy is an integral part of disease treatment, management, and rehabilitation.

5. 2007 Agenda • Expansion of Medicare MNT • Where “reasonable and necessary” in treatment of diseases/conditions • Redefine “diabetes” for purposes of MNT to include pre-diabetes • Expand Medicaid to include screening and MNT for diabetes • Farm Bill • NIFA to expand investments in food and agriculture research • Modify the release of Dietary Guidelines to incorporate research and education of the public • Make food stamps available to those in need and offer incentives for recipients to improve their diets

6. Shape programs, such as “Federally Authorized / Locally Administered” Money Follows the Person OAA Ryan White School Wellness Policies School Meals WIC Food Package Labeling Evidence-Based Practice 2007 Regulatory Priorities

7. State Initiatives • Recognize unique value of registered dietitians and DTRs. • Bring ADA’s members to the table in decision making. • Assist with licensure – HA, DE, NY, WI – Scope in TX. • Increase Reimbursement. • Enflame passions. • Build grassroots.

8. CDER CFSAN FDA Devices CDC CCHIS CMS NIH CCHP REE Medicare Management AoA CSREES FNCS ERS ARS ACF IHS CNNP AHRQ FTC USPSTF OS DOD ATTTB Public Health And Science IRS Surgeon General President’s Council on Physical Fitness/Sports States Health Promotion/ Disease Prevention Many players in obesity NPLDS Coverage Provider Information Obesity FANRP

9. Workplace P&Ps State Healthcare Facility Licensure and Certification Accreditation Standards Legal Scope of Practice State regs impact RDs/DTRs CMS Regulations RD State

10. ADA’s Advocacy • Know the environment for food, nutrition and health initiatives and know member priorities and needs • Shape that environment to create support for public policies that recognize the value of nutrition services • Develop messages to policy makers and opinion shapers about the role of RDs and DTRs

11. What do decision makers want to know? What is IT?

12. Why does IT matter? To whom? What is the price of acting? What is the price of doing nothing? What are the unintended consequences of acting or simply ignoring IT?

13. Is there a constituency for IT? Are they my base? What will I get out of IT? Oh! Are there alternatives to address IT? Will they work? Will the solutions annoy my base?

14. Executive Branch Initiatives • CDC and Surgeon General identify epidemic • 2001 Call to Action • “Obesity is not considered an illness” reversed • HHS articulates obesity as a top priority • Directs all agencies to address obesity and related problems • USDA articulates obesity in its priorities for nutrition, research, education

15. Congress & Obesity • Great rhetorical strides since the 1990s • IMPACT • School Wellness • More than 2,000 obesity bills introduced in each of the past five Congresses

16. Congressional Action • School Wellness – passes & enacted! • IMPACT – passes Senate. • Other measures – stall. Why?

17. Could It Be?

18. Barriers on the Hill • Difficult to solve / No immediate political ROI • Many MOCs want the credit as their own • No central focus • Multiple levels of responsibility / venues • Multiple committees of jurisdiction • Competing viewpoints • Competing issues for floor time • Cost

19. Deficit

20. Other Realities • Obesity is complex, multifaceted, and difficult to “treat” • High rate of recidivism • Social stigmas

21. Prevention is the Better Strategy Target on children Diabetes now a primary focus Current conclusion:

22. ADA’s Action • 2000 Strategic Plan • 2000 decision to embrace evidence-based practice • Multiple partnerships • Multiple initiatives • ADA led in advocating for policy change – “Obesity should be designed as a disease” • Competitive Foods Task Force • School Wellness in Child Nutrition Act • 2007 endorses application of Dietary Guidelines in all food assistance programs: incentives and education • Members designated as experts

23. Leadership in 4 Areas of Obesity ADA and ADAF

24. Family Focus • Family nutrition and physical activity screening tool • Child and family nutrition and physical activity study • Activate partnership • Healthy lifestyle research study • Evaluation of coverage of MNT for obesity in North Carolina • Healthy parenting initiative

25. Community • We Can! (Ways to enhance children’s activity and nutrition) • Champions youth nutrition and fitness grants • Wellpoint initiative – 2 million copies circulated Briefing policymakers in Washington in May!

26. Professional Development • Weight management DPG • Position papers • Weight management certificates • FNCE sessions • Publications • Evidence-based analysis and guides for practice • On-line case for educators for overweight adolescents • Tele-seminars

27. National Planning • Public policy strategies to reduce prevalence of obesity/overweight and overview of obesity related government relations activities • Healthy school summit • Exploring alliances for behavioral change

28. Other Approaches • School policies • Workplace policies • Regulation of marketing to children and adolescence • Product bans • Product labels • Disclosure • Lawsuits • Infrastructure

29. FCC media and childhood obesity task force Dietary Guidelines and MyPyramid Called to confer/testify in Congress on childhood obesity NANA lobbying CDC Nutrition and Physical Activity obesity prevention grants Child Nutrition Promotion and School Lunch Protection Act Other WDC coalition groups AHK, HEAL, “Friends of…”, NC-FAR … Successful policy venues for ADA

30. Some say… ADA has been weak on overweight, obesity and healthy weight management issues. Others might say… ADA has had opportunities to lead – and we have helped shaped the discussion. ADA is consistently sought out to remain a part of the discussion to find the solutions. You judge:

31. A consensus on… IT. Also… Data Success stories Precision in knowing “success” A strong environment for action What’s missing?

32. ADA’s role: professional association “ADA works strategically & proactively in areas judged to hold greatest potential for advancing nutrition and with that, the profession.”

33. Broadly and strategically focused. Reliant on the science. Moving ahead with EBP. Creating “indispensible” resources to make members the preferred providers. Speaking directly to the issues, the problems, the opportunities. Bound by its words and outcomes. Disciplined. ADA’s role: professional association

34. 2007 Agenda • Expansion of Medicare MNT • Where “reasonable and necessary” in treatment of diseases/conditions • Redefine “diabetes” for purposes of MNT to include pre-diabetes • Expand Medicaid to include screening and MNT for diabetes • Farm Bill • NIFA to expand investments in food and agriculture research • Modify the release of Dietary Guidelines to incorporate research and education of the public • Make food stamps available to those in need and offer incentives for recipients to improve their diets EBP REQUIRED

35. 66,600+ ADA members in scores of practice venues Well regarded in key circles, but not even known in others Lack critical mass in macro and micro environments Overwhelming opportunities in 110th Congress alone… Food and food safety – 766 measures Health and Nutrition - 1000 Diabetes – 43 Health and Obesity – 955 Child nutrition- 429 Food for Thought

36. Thank you.