about where everyone has been but where they are going. the guy in front of you could win an academy award some day. the girl behind you could be a future president of the united states or even, better than that, the mayor of new york city. the guy sitting to your right could be a future nobel laureate. okay, maybe not the guy to your right but certainly the one to your left. >> memorial day weekend, watch commencement speeches on c-span. politicians, white house officials and business leaders share their thoughts with the graduating class of 2012. saturday through tuesday at noon and 10:00 p.m. eastern. >> the consumer federation of america hosted its annual food policy conference here in washington last friday. the agriculture undersecretary for food and nutrition and the cdc's director for obesity discussed recent legislation to combat rising obesity in this country, and improve nutrition

standards for schools. the discussion focused on the healthy hunger-free kids act which increases the focus of nutrition in school lunches. this is just over an hour. >> good morning. thank you again for being here at the food policy conference. we're moving on to our last session. we have a terrific panel lined up to talk to you about some really key issues on the nutrition obesity fund and administrative efforts on that and kind of give us an update of where things are and where we're headed. to begin the panel, i would like to introduce sally squires, vice president at pal-tate and she will be moderating the panel and introducing our speakers. sally? >> good morning and i hope you're all enjoying this conference as much as i have.

we were talking a little bit before this and just saying that this is kind of our, for those of us in the nutrition world and food world, this is our conference. there are a lot of different conferences that occur, but it's really a pleasure to be here and see so many people. so thanks very much. we have a terrific lineup this morning. in 2009, kevin concanon was nominated by president obama and secretary vilsack and confirmed to serve as undersecretary for food, nutrition and consumer services at the usda. fncs, for those of you who don't know, has the principle responsibilities for the food service which feeds one in four americans. it also has responsibilities for promoting healthful diets

through the center for nutrition policy and promotion which as i'm sure everybody in this room knows, is responsible with hhs for the dietary guidelines. our second speaker is dr. william dietz, director of the division of nutrition, physical activity and obesity at the centers for disease control and prevention in atlanta. prior to his appointment to the cdc, he was a professor of pediatrics at the tufts university school of medicine and director of clinical nutrition at the floating hospital of new england medical center -- i'm sorry, the floating hospital of new england medical centers hospitals. for those of you who have been watching either at weight of the nation last week or have been watching hbo, you know he's played a really important role in all of that. without further ado, i would like to introduce kevin

concanon. thank you. [ applause ] >> thank you very much, sally. i think i will stand up. i see folks over this way more readily. it's a pleasure for me to be here with all of you and at this conference, but both also added feature to be here with sally and with bill dietz again. we were together a week or so ago at weight of the nation here in d.c. as well. i'm particularly pleased to have the opportunity to share with you some of the very important initiatives we are in the midst of at the food and nutrition service, particularly starting with the focus on the healthy hunger-free kids act of 2010. passed just a little more than a year ago, this legislation has provided us with an abundance of new tools to help create healthy lives for our nation's children. we know that nutritious food is

critical to meeting -- to feeding the minds of hungry children and the importance of our efforts is further highlighted again this month with the release of the institute of medicine report that said that schools are key to fighting obesity in our country. i'm mindful as well of a corcoran collaborative systematic review done just about a year ago, finding in other parts of the world that school nutrition programs have many beneficial effects in this space. while the healthy hunger-free kids act which is championed by first lady michelle obama as part of her let's move campaign has one of its primary areas of focus the transformation of the total school/food environment in order to promote better nutrition and to reduce obesity. this law enabled us to make major improvements to school meals. the first major changes, by the way, in about 15 years. in january of this year, just one year after the law was

passed, record time for federal regulatory prophesies, if you're familiar with them, we issued the final updated standards for school meals. those standards built upon recommendations from the institute of medicine, ensured that students are offered both fruits and vegetables every day of the week. that's a first. it increases the offerings of whole grain rich foods, offers only fat-free or low fat milk, limits the calories based on the age of children. this is a first, strikingly. in the past the school nutrition requirements had minimum calories, no maximum calories, as strange as that may seem. well, now starting with this july across the country, based on age, minimums and maximums. it also increases the focus on reducing the amounts of saturated fats, transfats, added sugars and sodium. the standards go into effect in july but many schools are already well on their way to

meeting those standards. i was in several in north carolina just this past week. usda were fully committed to providing all the assistance we can to help the 101,000 american schools, public and private, that participate in the national school lunch program. we're committed to provide that kind of assistance to help them to get from where they are today to where they all need to be. well, the changes in the school, in the standards for the school breakfast program, there are 12 million children that have breakfast at school each day and that number is on the rise, those changes will be phased in over three years to make it easier for schools to comply. but the act also strengthened local wellness policies. as i travel the country i try to meet with state health directors, typically physicians or people trained in public health, to emphasize for them the opportunity they have as public health authorities or

health directors to reinforce and to support the effort in schools to promote healthness. just a week or so ago, we published what many schools across the country have been awaiting, a so-called six cent rule, meaning for the first time, again starting in october of next year, schools will be reimbursed an additional six cents per meal over and above the reimbursement rates that have been adjusted for inflation each year, as long as they meet the new meal standards. they are intended to be incentives and these incentives are the first increases in 30 years in the school lunch program. but a topic that i'm sure many people and your colleagues in this room are interested in, so-called competitive foods, those foods that compete with the standard fare offered in the national school lunch program. we're working on those. equally important, healthy

hunger-free kids act rule gave us the authority to set standards for all of the foods sold in schools during a school day, including those that are not part of a federally reimbursed meal. i know you're especially interested in this, we are very actively working on that right now and i hope to have the preliminary rule out within the next two weeks or so. some states and many local communities have already led the way in establishing these policies pertaining to competitive foods, requiring all foods and beverages served at the school during the school day that will help promote public health and fight obesity. schools are extremely influential in this environment. we know from research done by the corcoran collaborative and others that school-based interventions can have a most positive impact on improving kids' diets. community eligibility, another aspect of our school-based programs. we're wanting to make sure that children across the country in

fact have access to the school meals program, particularly so during the period of extended challenges we've been living through in the jobs environment and i was pleased to learn when i was in carolina last week meeting with the top state officials that north carolina is a state, each day runs data in the evening to make sure that a child whose household, that household income changes, that that child is immediately eligible for free or reduced price meals. what we're referring to is direct certification. that's one of the priorities in the healthy hunger-free kids act, a which to once again make sure that children have access to affordable meals and carolina, north carolina, i should say, i think is leading the nation in doing that daily. we also are making and have made changes in our women, infants

and children's program. women, the women, infants and children's program targeted pregnant women lactating moms, young infants, children up to age 5. that program, the wic program, now serves 53% of all the infants in the united states, the first year of life. and so it has a huge preventive health role, and that program, we made changes in the so-called food package a year ago last october that have been successfully implemented across the country. we have about 65,000 wic stores, so-called, across the country. they're required to have more depth of stock, as we just described it, in terms of healthy foods and that has been successfully implemented. each month, about nine million american moms and their children participate in the wic program. well, that new food package was

based on recommendations that were made to us by the institute of medicine. well, that same institute of medicine has made recommendations to us to improve the nutrition standards in the foods served in child care centers across the country, through a program that we operate called the childhood outcare feeding program. we're very anxious to move forward with that. each day, about 3.3 million children attend child care, are served in child care either before or after or during school hours, based on age, and we know this is a very vulnerable group of children in terms of the need to make sure that they have sustained access to healthy foods. just as we did, as i mentioned earlier in the wic program, we commissioned the iom to help us with that. well, another aspect of the healthy hunger-free kids act redirects us in our snap or the supplemental nutrition

assistance program, our food stamps as it's still called in 22 states, the direction we received was to put an additional focus in our s.n.a.p. education, nutrition education on obesity prevention. we have been working closely with partners, this is where bill dietz and his colleagues have been an invaluable resource to help us review standards, to provide counsel and advice to make sure that we are using the latest science and findings and incorporating those into the nutrition education programs that we finance. we're also of course the source of the my plate, the icon that is just about a year old, it was released a year ago, the first week in june. that anniversary's coming up. i'm pleased to see it's gone viral across the country. i saw in several of those schools i visited just last week

in north carolina. well, we are looking to do even more on that front as a way of again reminding americans, you know, enjoy your food, but eat less, make half your plate fruits and vegetables, look for alternative, drink more water. don't drink so many sugar-sweetened beverages. there are a number of basic messages that can make a difference over time. additionally, this past week, we announced the availability of $4 million in grants to expand the use of ept or electronic benefit, the ebt cards for farmers markets across the country. again, part of an effort, an adjunct, to encourage low income folks to have better access to healthier foods. we have similarly a farm to school grant program we are promoting as well. i want to make reference to the food, farm and forestry bill, the so-called farm bill that is

looming, i hope it's going to take place this year, but we are particularly interested and i am a very strong advocate of the senate version of that bill, for a number of reasons. one, it doesn't make the kind of cuts that the house proposes in the s.n.a.p. or nutrition programs, but i am particularly attracted to an element that is very much part of that senate ag proposal for the farm bill that would give us the authority to require local stores that participate in the s.n.a.p. or food stamp program to increase their depth of stock. another way of describing those stores would be required to have more fruits and vegetables, more healthier foods and more of them, and the reason i'm very attracted to that, there are now more than 230,000 stores across the country that participate in the s.n.a.p. program.

s.n.a.p. is now an $80 billion a year program so it's a major part of the business line for these stores, and i think these are tax dollars going into those stores, i think we have the right to say if you're going to participate, happily so, but we want to make sure that you are enabling low income persons who avail themselves of that benefit to have more routine access to an array of healthier foods. so we're watching that very carefully. summer food, we're entering into the period of the year in which an american child is more likely to face food insecurity or hunger than any other time of year. how so? why so? schools will be out shortly. and we have a summer food service program that we are promoting this time of year. we have about three million, again, american kids who participate in that program. we're also promoting again the

most nutritious, for those summer food service programs, to make sure that they are providing access to nutritious foods. the my plate as i mentioned, one year old. we spend about $1 billion a year in the food and nutrition service on nutrition education, $1 billion. our flagship effort in that regard are the dietary guidelines for all americans. we issue those jointly with the department of health and human services and we alternate every five years, which federal agency takes the lead. we took the lead in 2010. now it shifts over to our colleagues at hhs, but we work very, very closely with them and i do want to mention that dr. howard coe, who is the assistant secretary for health, he oversees that ultimately at the upper level of the hhs with his colleagues at cdc and nih, but

we are -- we have a gap in the dietary guidelines in that they currently provide advice to americans for people from age 2 through the life span, and we are both committed, both federal agencies, to in the 2015 versions, to have available shortly thereafter recommendations for infants from birth through age 2, to address a gap that currently exists. so those dietary guidelines, we address obesity in very, very different ways. i've mentioned some of the advice that are characterized by that -- by the my plate. we also have a super-tracker. we have almost 700,000 americans who are registered with our super-tracker which can give you advice, you can punch in what you're eating, what kind of exercise you're having and it

will give you some direct information that we think can be very, very helpful to people. we have also been encouraging partnerships with health groups, with corporate groups and others on the my plate, again, as a way of institutionalizing it, if you will, as part of efforts right across public and private agencies. finally, i want to say that every so many years, the center for nutrition policy and promotion issues something called a healthy eating index. i'm very mindful of this because if you were to fully adhere to it, exercise but also eat all the healthy foods, you would get a score of 100. well, i don't know if there are any 100 scores across the country, but i can tell you that groups of americans throughout the demographic income groups, nobody gets higher than a 58. and low income people, the folks on the s.n.a.p. program or food stamp program get a 52.

so they are marginally lower, but just so. we have a challenge as a country. it isn't both in the overall food environment but also in just habits and culture that we really need to address and overcome. there access to healthy foods, and also encouraging access on a regular basis to reduce food insecurity. so thanks for all for being here today and look forward to our questions. >> thank you, for that introduction, and it really is a great pleasure to be here with you today talk an cdc's efforts

in obesity. before i do that i just want to the acknowledge the extraordinary work you've done, kevin, at usda in terms of leading the efforts to change the programs that supply so many individuals in this country. it really has been an extraordinary couple of years and i can't think of another time in our history, in our recent history when the changes have been as profound. i'll begin with three facts regarding the prevalence, cost and caloric deficits we need to get to and move on to what the targets are and the strategies that we use to implement those targets in a variety of settings and close with where i think we need to go in the very near future. first observation is that the prevalence in adults and children is relatively flat with one exception, african-american boys, in whom the prevalence of obesity is still increasing. that's been true for most groups

for about ten years. suggesting that we are maybe at a corner. but still obese and as they grow will generate additional costs of obesity. those costs in a paper we published three years ago approximated about $150 billion a year or 10% of the national health care budget and two recent papers suggests that that, if anything, is an underestimate of those costs. and finally, a recent paper in the "american journal of preventive medicine" suggested the caloric deficit necessary to return mean bmi of children to where it was in 1970, before the epidemic started, is relatively achievable. that deficit on a daily basis for the next eight years is about 30 calories in 2s to 5 year olds. 150 calories in 6 to 11 year

olds and 180 calories in adolescents. that's the deficit over time to restore mean bmi to that level. that's not going to change very much the deficits necessary to reduce the obese individuals to a healthy weight. that deficit is more in the neighborhood of 700 to 800 calories a day over that same time period, and that's not going to be achieved by the kind of policy systems and environmental changes that the cdc is focused on. our efforts are to prevent obesity. we are the nation's prevention agency. and those same strategies necessary for prevention are also essential to sustain weight loss after it occurs, and the issue about excess body weight is not that people can't lose weight, but that they can't sustain the weight losses over time. many of the same strategies we're going to use for prevention are also strategies relevant to weight maintenance after loss. now, the target behaviorses that

we're focused on are physical activity, breast feeding, fruit and vegetable intake, reduced screen time. reduced energy density foods and reduced sugar drink intake. those are targets. examples of the potential strategies we're using, for example, are to increase walking. as a way of increasing physical activity. to put in place baby-friendly hospitals in which breast feeding rather than the provision of formula is the default. or healthy food financing initiatives which put in supermarkets or other healthy food choices in smaller stores as kevin was describing, in underserved areas. restoring water to schools. i mean who would have thought 20 years ago having water available in schools would be a significant issue? in boston only about 30 schools from potable water in existence of the lead that exists in the

pipes, and the mayor menino, bans sugar drinks in all public settings controlled by the city. with respect to energy density procurement poemses that change the food availability in setting and we've just initiated and it's moving through the general services administration a procurement policy which sets standards for the food served in federal agencies and one of the most notable groups that is getting onboard with that is the department of defense, which serves millions of people around the country, and their dependents. and abroad. screen time is the biggest challenge, and the place where we're looking to limit screen time is really in settings where there are, there's a regulatory approach to controlling television time. the places where we're trying to implement those strategies are a variety of settings in which people spend time and no single strategy and no single setting is likely to be successful. so our perspective is we need to

implement multicomponent, multisek turl efforts. i'll give you a sense what those might be. because the caloric deficit is so small among 2 to 5 year olds, early education is an important target, and with kevin's assistance, several years ago we initiated an effort to focus on early care and education by convening a variety of groups that were invested in the delivery of early care and education. that has subsequently been adopted by the let's move child care challenge, the first lady's initiative and focuses on elimination of shooler drinks, provision of no fat or no-fat milk, control of television time. 60 minutes a day of active play and the provision of water in place of sugar drinks. schools. kevin has already mentioned the healthy hunger free kids act, which is going to help to transform those meals that are available. we're equally focused on the importance of physical

education, because schools are one of the few places remaining where children can be physically active and safe at the same time. a good example of work sites that we're invemsted in, creatig healthy hospitals. hospitals should be the healthiest work site on the planet. it's part of their mission, and yet we see fast-food impoor yums in children's hospitals across the country, but an increase be engagement to provide healthier options like the procurement policy going across the federal government in those hospitals. one of the new initiatives around communities was one started by the stimulus bill, which provided cdc with funds to fund a number of communities around the country to invest in nutrition physical activity strategies in addition to tobacco prevention and control. that has been replaced now by the community transformation

grants as part of the affordable care act, but the principles are the same. to begin to implement strategies which increase excessability of healthy foods and improve physical activity as part of those strategies. those trends, i think, have, are beginning to turn the corner, and there is suggested data from a number of states and communities around the country that the prevalence of obesity, certainly the rate of increase has stopped, and there's some suggestion that we're beginning to see modest decreases in the prevalence of obesity, particularly in children, where as i said, that deficit offers much more promise than i think the strategies in adults. so the question becomes where do we go next? the sustainability of the cdc programs i mentioned is particularly those in communities and within states, it's dependent on continued

funding of the affordable care act and particularly in the affordable care act the prevention in public health fund, which is what was supposed to grow to $1.5 billion by 2015. and as those of you who have followed the student loan issue carefully know, that there was an effort to deplete those funds to pay for maintaining the student loan funds that are reduced interest rates. that now has been pushed back, but that, the affordable care act and particularly the prevention in public health fund in the affordable care act is highly vulnerable and therefore our efforts in communities are highly vulnerable. kevin mentioned at our weight of the nation conference last week that ion released a report entitled entitled progress and obesity prevention, five goals and a number of recommendations under each of those goals. these included making physical