The Politics of ObesityKey Considerations for Decision Makers

M. Stephanie Patrick, American Dietetic Association

May 6, 2007

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

ADA works strategically & proactively in these areas judged to hold greatest potential for advancing nutrition and with that, the profession.

AgingChild nutritionFood & food safetyHealth literacy & nutrition advancementMNT, Medicare & MedicaidNutrition monitoring & researchObesity, overweight, healthy weight management

Priorities

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.

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

2007 Regulatory PrioritiesShape 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

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.

State Initiatives

ProviderInformation

NPLDS

FANRP

Coverage

Many players in obesity

Surgeon General

Health Promotion/Disease Prevention

President’s Council onPhysical Fitness/Sports

CSREESMedicareManagement

USPSTF

Public HealthAnd Science

CNNP

ARS

ERS

CFSAN CDERDevices

CCHP

CCHIS

States

CDCFDA

CMS

ACF

OS

NIH

FNCS

REE

IRSATTTB DOD

FTCAHRQ

IHS

AoA

Obesity

State regs impact RDs/DTRs

RD

CMS Regulations

Workplace P&Ps

Accreditation Standards

Legal Scope of Practice

State Healthcare FacilityLicensure and Certification

State

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

What do decision makers want

to know?

What is IT?

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?

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?

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

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

Congressional Action School Wellness – passes & enacted! IMPACT – passes Senate. Other measures – stall.

Why?

Could It Be?

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

Deficit

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

Prevention is the Better Strategy

Target on children Diabetes now a primary focus

Current conclusion:

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

Leadership in 4 Areas of Obesity

ADA and ADAF

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

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!

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

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

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

Successful policy venues for ADA

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 …

You judge: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.

What’s missing?A consensus on…

IT.

Also…

Data

Success stories

Precision in knowing “success”

A strong environment for action

ADA’s role: professional association

“ADA works strategically & proactively in areas judged to hold greatest potential for advancing nutrition and with that, the profession.”

ADA’s role: professional association

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.

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

Food for Thought 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 measuresHealth and Nutrition - 1000Diabetes – 43Health and Obesity – 955Child nutrition- 429

Thank you.