Transcript The Politics of Obesity
The Politics of Obesity
Key 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
Priorities
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
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 Priorities
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
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.
Many players in obesity
NPLDS CCHIS Coverage Medicare Management Provider Information IHS CMS ACF FDA USPSTF AHRQ OS NIH CDC CCHP AoA REE ARS CSREES ERS FANRP
Obesity
FNCS CNNP FTC ATTTB IRS DOD Public Health And Science Surgeon General Health Promotion/ Disease Prevention President’s Council on Physical Fitness/Sports States
State regs impact RDs/DTRs
CMS Regulations Workplace P&Ps State Healthcare Facility Licensure and Certification RD Accreditation Standards
State
Legal Scope of Practice
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
Current conclusion:
Often Unsustainable Complexity Diabetes now a primary focus Social Stigma
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
Family Focus Professional Development Community National Planning
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
EBP REQUIRED
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
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 110 th Congress alone…
Food and food safety – 766 measures
Health and Nutrition - 1000
Diabetes – 43
Health and Obesity – 955
Child nutrition- 429