WASHINGTON—Donna J. Mazyck, a former high school nurse, recalled an experience in which a student asked her if she could weigh herself. Mazyck directed the student to the scale, but before she could assist her the student got on the scale and declared that the scale was broken.

The problem, however, was not the scale.

“I realized that her weight was over 250 pounds, which was the highest measure registered on the scale. Her weight was the source of embarrassment for this student as she endured teasing by classmates for her large size,” Mazyck told a congressional subcommittee.

At a March congressional hearing on obesity in the United States, Mazyck, who serves as the board president of the National Association of School Nurses, and several other panelists recounted the challenges that obesity presents to the country. They asked the House Agriculture Committee’s Subcommittee on Department Operations, Oversight, Nutrition, and Forestry for help in addressing the problem. “Knowing that obese adolescents have up to an 80 percent chance of becoming obese adults, a major investment in prevention must take place from multiple sectors of society to become a healthier America,” Mazyck said.

Members of the subcommittee agreed there is a weight problem among children and adults that needs to be addressed in this country. “America is overweight, there’s no question about it,” said Rep. Steve Kagen, D.-WI., at the hearing.

Obesity in America

According to the Centers for Disease Control and Prevention, between 1976 and 1980, approximately 5 percent of youth ages 2 to 19 years were obese. By 2006, that rate had increased to 16.3 percent. Mexican-American boys and African-American girls have the highest levels of obesity. CDC statistics indicate that 25 percent of Mexican-American boys between the ages of 12 and 19 and 27.7 percent of non-Hispanic black females are obese.

William Dietz, M.D., Ph.D., director for the Division of Nutrition, Physical Activity and Obesity at the CDC, told the subcommittee the one cause of “mild optimism” is that that the rates of obesity among youth in the U.S. appear to have leveled off. He attributed this plateau to a greater awareness of the epidemic by the public and pediatric providers, as well as changes in a number of schools that include reducing the availability of soft drinks and increasing the availability of lower fat foods.

Still, he said, this plateau is “not a cause for complacency.” He noted that obesity is an epidemic in this country accounting for rising medical costs. “More than 25 percent of the rise in medical costs between 1987 and 2001 has been attributed to obesity,” he said.

The medical system cannot bear the burden of increased obesity and its associated diseases, he added. “Sixty percent of adults are overweight or obese, 30 percent of children and adolescents are overweight or obese. That far exceeds the capacity of the medical system,” he said.

The Challenge of Obesity

Countering obesity in youth may come down to reducing as little as 150 calories a day from their diets. “Recent calculations suggest that the imbalance necessary to counter obesity in adolescents amounts to about 150 calories a day,” Dr. Dietz said.

The challenge in addressing this calorie imbalance is that in many communities there is a lack of healthy food available and an environment that is not hospitable to outdoor activities. “Behavior changes in large proportions in the pediatric and adult populations are highly unlikely unless they are supported by changes in the environment that provide access to healthy eating and active living,” Dr. Dietz explained. “People must make good choices, but they must have good choices to make. Children can’t walk to school in our suburbs because of the lack of sidewalks in centrally located schools. Inner city populations are surrounded by fast food restaurants and lack access to grocery stores.”

In addition, he said that food and security may also contribute to obesity in some communities. “A family may make decisions to eat more when food is available to account for deficits of food when it is not, and in an era of financial instability this becomes an important potential contributing problem,” he said.

Dr. Dietz gave an example of a 13-year old girl he treated for obesity who lived with a single parent who was on welfare. Their first paycheck of the month went for housing and so they would run out of money, making purchasing food difficult by the middle of the month. “By mid month they were hungry, and this mom was so concerned that her daughter not go to bed hungry that she was feeding her pasta with added oil or butter. That was instrumental in causing that girl’s obesity,” he explained. “So, in that case, it wasn’t a question of education, it was a question of food availability and a uniform distribution of that.”

Addressing Obesity

Subcommittee Chairman Rep. Joe Baca, D.-Calif., asked what types of nutrition education efforts are most effective in combating obesity. “I am not very optimistic that additional nutrition education is going to make a big difference,” Dr. Dietz responded. “It may cause people to make better choices, but only if those choices are available.”

“Is it a form of child abuse to continue to feed children things that are not good for them?” asked Rep. Kagen. “It’s an odd form of abuse because it comes from giving too much rather than giving too little,” Dr. Dietz replied.

He also told the subcommittee that television watching has an impact on childhood obesity. “The more television a child watches the more likely they are to consume foods while watching television and the more likely those are foods that are advertised on television,” he said.

In his written testimony, Dr. Dietz added that CDC’s efforts to address obesity for the U.S. population are focused on six target areas that include: increasing physical activity; increasing fruit and vegetable consumption; increasing breastfeeding initiation, duration and exclusivity; decreasing television watching; decreasing consumption of sugar-sweetened beverages and decreasing consumption of foods high in calorie and low in nutritional value.

For example, in Mississippi CDC worked with the Department of Education and other partners to impose a ban on sugar-sweetened beverages in schools. In addition, Dr. Dietz noted in his written testimony that in Mississippi “forty-one school districts purchased 104 combination oven steamers, replacing the traditional deep-fat fryers and thereby substantially decreasing the amount of high-calorie, fatty foods eaten by almost 65,000 of the state’s school children.”

Prevention Efforts

Richard Hamburg, director of government relations for Trust for America’s Health, told the subcommittee that investing in community disease prevention programs is critical in preventing weight problems. His organization released a report, “Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities,” which examined how healthcare costs could be saved.

“The report concludes that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save the country more than $16 billion annually within five years,” he told the subcommittee.

Such prevention programs can reduce the rates of type 2 diabetes, high blood pressure, heart disease, kidney disease and stroke and reduce the rate of other conditions, he said.

Mazyck emphasized the important role that school nurses play in educating students about healthy eating. She recommended that school nurses serve in every school. “School nurses have a critical role in teaching about and providing healthy food choices and teaching skills and knowledge to motivate participation in lifelong physical activities,” she said.