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Briefing and Opinion
April 29, 2005

Richard Carmona and Celeste Ford
Surgeon General Dr. Richard Carmona speaks with Celeste Ford about the obesity epidemic and the federal governments efforts to curb it.

Q: What is the federal government doing to combat obesity?

A: I am visiting schools across the country -- one school in each state -- dealing with healthy living, including nutrition. I have spent a great deal of time speaking with school administrators, principals, and school boards about not eliminating physical activity. I have spoken with parents about staying physically active. All of my efforts are to change behavior. If children grow up seeing their role models making those healthy choices, it's likely they'll make the same choices.

Q: In Arkansas they came up with a Body Mass Index report to help give parents some information because they were grasping for ways to deal with this. Is that a good answer -- a BMI report sent home to a child's parents?

A: Yes and no. If the parents are educated as what BMI means, health literacy again, then it can be instructional. It can be something that mom and dad sit with and say, "Gee, how come this number is going up? It means that little Johnny or Jane is gaining weight." On the other hand, if you sent them statistics that they have no knowledge of, it's going to get put into the trash can. We're largely a health illiterate country. Passing policy that would direct government to do something without a citizenry that understands what the issue is before them probably is a waste of time.

Q: How would you rate the USDA's efforts with the school lunch program?

I think philosophically the school lunch program is okay. However, we need to incorporate new findings and we have to make sure that schools follow that. As I've gone around the country, I'll go in the school line with the kids and ask them questions. They really don't know what they are eating or why, and in some of the schools I've seen, they are not following the guidelines.

Q: Shouldn't there be consequences for schools that are not serving healthy meals?

A: If schools are taking federal money for the school lunch program, they can be held accountable for certain agreed-on guidelines. The fact is, it's school boards that make the decision as to what chips, what sodas, what snacks are sold and they can easily change that.

Q: If school districts are contributing to a pubic health problem with these vending machines and other types of sales, why can't you intervene?

A: There's no federal statute that would give me the authority to intervene. We've had some very positive responses where we recognize early on that a consequence of eliminating the machines in schools would be that they might lose their library. They might lose their band. They might lose an extra-curricular activity, because the machines generate revenue. We thought the smarter way to be was to say "How about putting healthy foods in the machine?" Many schools have started that trend, so they keep their revenue, but give the kids healthier choices.

Q: The federal government has got highly involved with school curriculum. Why can't it include nutrition?

A: Again, it's a tough one, because school boards generally are the ones determining the curriculum. School boards like their autonomy. They like to be able to determine what a child will learn. I have gone out of my way to suggest that and to suggest other healthy inputs as it relates to the curriculum for all children.

Q: Is there Congressional will to deal with this on a policy level?

A: I think it's the same issue with any regulatory authority. People need to ask, "Do we want the government controlling this aspect of our life, or is this something we should take control of ourselves, because we have the information? My sense is we should be exhausting all remedies that the public can be engaged in, rather than sit there passively and have a government tell them, "You will do this." Then you get resistance.

Q: One suggestion is that the marketing targeting young children would only be for foods that meet a certain nutritional standard. Would that be a reasonable option?

A: It certainly could be an option, but we have to define what that standard is. We still have to build the health literacy into society so that people will make the right choices based on the information. Right now we have a citizenry that largely doesn't know how to read a food label, doesn't know the difference between a gram of fat or a gram of protein and doesn't know how much of each of those they should have in their diet.

Q: Would you support a fat tax on unhealthy foods?

A: The Surgeon General doesn't deal with taxes. The Surgeon General deals with health and science.

Q: What would be the one policy change or initiative you would wish for to help you fight obesity?

A: As a society, we are moving from treatment-oriented to prevention-oriented. But, it's going be an intergenerational endeavor. It's not going to happen in one year or five years or 10 years. We're talking about changing the culture of the United States, our citizens' eating habits and their activity habits.

Q: Where does personal responsibility fit into this discussion?

A: I used to be a trauma surgeon before I went into public health. I spent days and nights resuscitating people who made bad decisions that day, or bad decisions their whole lives. I saw the ravages of those bad decisions. We spend lots and lots of money and resources to have the best health care system in the world, where we can resuscitate almost anybody back to life when they come in and save them from themselves essentially.

I think that people have to recognize that their health is not something that just happens, but for most people, it's something that they can actually contribute to, positively, or negatively, if they make the right decisions.

It is government's responsibility to make sure that they have the information to make those good decisions. I can do it through education. I can do it through raising health literacy. I can do it through changing culture. And, as a last resort, certainly regulation.

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