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Position Paper: Need to amend the IMPACT Act

To: Organizations, professionals, and individuals in the HAES (health at every size), non-diet, anti-weight discrimination, anti-eating disorder, size acceptance, and fat activist movements.

Subject: IMPACT Act (HR716) introduced in the US House of Representatives, companion bill (no number yet) soon to be introduced in the US Senate.

Action required:

1. Please write, phone, fax, or email Senate Majority Leader Bill Frist, MD.
2. Send the same letter to your two US Senators.

What to say in your letter

Give your credentials, expertise, and experience.
State whether or not you are a constituent of the Senator. (Senator Frist is from Tennessee)
Say that you support some of the goals of the IMPACT Act but that it needs to be amended.
Say the bill should target poor health habits rather than overweight.
Read the arguments below, take one or two, and write them into your letter.

Sample letter

The Honorable William H. Frist
US Senate
Washington, DC 20510
Phone: 202-228-3344
Fax: 202-228-1264

Dear Senator Frist,

I am a school nurse with a Masters degree in nursing and an RN. I have been working in the XYZ school for fifteen years, serving a population of 1,000 kids in grades K through 12. Although I am not one of your constituents, I am writing to you as someone with expertise in the problems of children's health.

I support your goal of improving the nutrition and physical activity of children and adults in the United States. But I do not agree with legislation that targets overweight kids. I see these kids every day, and they already have enough bullying and harassment to deal with. If the government tells schools to promote weight loss, those bullies will make these kids' lives even more difficult.

A better approach would be to introduce legislation that promotes nutrition education and physical activity opportunities for children and adults of all sizes. That would improve the public health without stigmatizing those who are heavier than average.

Thank you for your consideration.

Sincerely,


A. Miller, MS, RN

The IMPACT Act

The goal of the IMPACT Act

The IMPACT Act (HR716) has been introduced in the US House of Representatives, and a companion bill (no number yet) will soon be introduced in the US Senate. The goal of the bill is to improve the health habits of adults and children in the United States, specifically in the areas of nutrition and physical activity. It would do this by offering grants through several government entities to qualified agencies for public education, professional training, environmental changes (such as building bike paths), and many other possible activities.

As written, the bill is counterproductive.

The Council on Size & Weight Discrimination supports many of the basic goals of this bill. However, because it targets those who are "overweight" or "obese," it fails to meet the criteria of legislation that will promote the public good. The terminology and target populations of this bill are ill-conceived and will in fact cause hardship and poor health outcomes rather than the health improvement which it claims to promote. Unless substantial changes are made to the wording of this bill, we feel it is counterproductive, and we cannot support its passage.

(Note on use of terminology: The terms "overweight" and "obese" have implied judgments in them, so we generally avoid them where possible. In this article, however, we will use the terms overweight, obese, and obesity because they are the terms used in this bill, and the standard terms used by medical practitioners.)

Problems with the bill.

After the short title--The Improved Nutrition and Physical Activity Act or the IMPACT Act--(to which we have no objection), Section 2 of the IMPACT Act makes it clear that those who are "overweight" and "obese" will be targeted. This is a problem for many reasons, some of which are enumerated below.

False statistics are used.

In the findings (Section 2) it is incorrectly stated that 300,000 deaths a year are associated with being overweight or obese. This statistic has been challenged many times by our organization and others. The figure was incorrectly stated by the media, and has taken on the undeserved status of a fact. The scientists who did the original analysis have themselves stated that the 300,000 deaths are associated not with obesity but with poor nutrition and lack of physical exercise. One need not be heavy to have poor nutrition and lack of physical exercise. Conversely, one can be heavy and, with good nutrition and physical exercise, be in good shape and in good health.

The bill would condone, and therefore increase, weight discrimination.

The inaccuracy of this bill's scientific basis is not the only problem. Today, in the US, people who are larger than average suffer significant discrimination and unfair treatment in all areas of life, including employment, medical care, insurance, education, and social interactions. By making weight loss (rather than good health) a national priority, this bill would excuse, justify, and in fact intensify such weight discrimination. Programs under this bill would unfairly target those who are heavier than average for "intervention strategies." The probable outcome would be employer-sanctioned and government-sanctioned weight discrimination. Such intervention strategies in the workplace would put pressure on those who failed to lose weight. Employers would feel justified in refusing to hire, to promote, or to keep workers who were large, since the government had pronounced their body size to be a health hazard. This would be blanket permission for unfair discrimination based solely on body weight. Among children, the bill would result in a greater incidence of bullying and harassment aimed at kids who are larger than average.

The bill would fail to provide assistance to average size people with poor diet and nutrition.

Serious health conditions and elevated risk factors can be found among those who happen not to be heavier than average. This is especially true for those who live sedentary lives, and for those whose nutrition is poor, whether by choice or because of lack of available resources, poverty, or other factors. The public good would be best served if programs were aimed at people of all ages, all socio-economic levels, and all sizes.

It is certainly quicker to weigh a person than to measure that person's blood pressure, blood glucose, or cholesterol. But responsible medical and scientific authorities confirm that weight is not an accurate measure of health or of risk factors for disease. Making a blanket statement that "overweight" people are unhealthy would stigmatize many perfectly healthy larger people.

The bill would result in an increase in the incidence of eating disorders.

Another problem with this approach is that an emphasis on weight loss can have the effect of increasing the epidemic of eating disorders in our country. Of all the psychiatric diagnostic categories, including suicidal ideation, eating disorders have the highest mortality rate (estimated between 5 and 20 percent). One hundred percent of anorexia nervosa cases started with a reducing diet, with a desire to lose weight. Young girls (who are the population group at the highest risk for eating disorders) would have official government recognition that weight loss is a reasonable goal and an ideal for which to strive.

The bill would not help those most in need of assistance.

The IMPACT Act would target all overweight and obese individuals rather than those who are at greater risk for serious disease, or those who already have health problems. Some larger people eat well and are fit, thereby reducing their risk for health problems. Some heavy people are blessed with strong genetic profiles, and live long and healthy lives. Preventive health promotion should be aimed at the general public, and specific health intervention strategies should be aimed at those with existing health risk factors such as hypertension or high cholesterol, and at those with existing medical conditions or diseases.

The bill would cause people to delay or avoid needed health care.

Studies have shown that larger patients, especially women, often delay needed health care because they fear the dreaded "diet lecture". By equating obesity with poor health, this bill would tell doctors to press their heavier patients to lose weight no matter what their health status. Patients' fear of the medical system would be perfectly justified. The bill would thus keep people from seeking the health care they need, which would result in a deterioration, not an improvement, in public health.

Weight is not the determining factor for health.

The idea behind the Impact Act is flawed. We do have a serious health problem in the US. Chronic diseases are on the rise. Type II diabetes, which was once restricted to adults, is now seen more and more among children. Most scientists feel that the major risk factors are sedentary lifestyles and poor nutrition. Weight is not the determining factor.

Diet and exercise, not weight, are the risk factors.

A clear distinction must be made between the risk factors of exercise and nutrition and the separate factor of body weight. Those who get no exercise and eat a nutritionally deficient diet will be at much greater risk for chronic diseases no matter what their body size. Conversely, people who weigh more than average but get exercise and eat well are likely to enjoy better health than the average person.

A person's weight is not necessarily an indicator of the healthfulness of their lifestyle.

The problem with the IMPACT ACT is that it uses body weight as a sort of shorthand for poor nutrition and lack of exercise. It makes the incorrect assumption that if a person is heavy, that person must be eating poorly and getting no exercise. This is inaccurate and misleading.

A person's weight does not determine their medical condition.

It also assumes, without scientific evidence, that weight is a marker for diseasethat one can assess a person's healthfulness simply by measuring his or her BMI. Again, the facts are clear in opposition to this view.

The bill promotes reducing diets, which are known to have poor long-term success rates.

The IMPACT Act would perpetuate the misconception that reducing diets, behavior modification, and exercise programs are effective methods to achieve permanent weight loss. The scientific evidence is clear that no more than 8% of dieters actually maintain their weight loss on a long-term basis. The scientific fact is that there is no currently known method of safe, effective, and permanent weight loss. Until there is an intervention strategy that has clinically significant rates of success, it is not productive to prescribe ineffective, unsafe, and temporary methods for weight loss. It is not rational to spend government moneys on unproven and possibly counterproductive measures. It makes sense for the government to promote healthy eating and more physical activity. It does not make sense for the government to promote weight-loss dieting.

The bill does not address the health problems of obese people, just their weight.

There are health problems associated with, and in some cases caused by, obesity. The IMPACT Act would not address the health problems of the overweight and obese, but would concentrate solely on their body size. If health improvement is the goal, it would make more sense to encourage larger people to get the health care they need. These people, like people of all sizes, should be given medical treatment specific to their medical conditions. For chronic conditions that require self-management, larger patients should be taught ways that they can improve their health, fitness, and well-being, whether or not those ways result in weight loss..

The Council on Size & Weight Discrimination would strongly support, and urge others to support, legislation that would establish nutritional, exercise, and other strategies designed to promote health and well-being and to prevent disease in people of all sizes. If references to overweight, obesity, and weight loss were removed, we would be in full support of this bill.