The Politics of Obesity
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Transcript of The Politics of Obesity
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.