professionals, and individuals in the HAES (health at
every size), non-diet, anti-weight discrimination,
anti-eating disorder, size acceptance, and fat activist
Subject: IMPACT Act (HR716) introduced in the US
House of Representatives, companion bill (no number yet)
soon to be introduced in the US Senate.
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
Read the arguments below, take one or two, and write
them into your letter.
The Honorable William H. Frist
Washington, DC 20510
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
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.
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
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
The bill would condone, and therefore increase,
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
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
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
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
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
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
A person's weight does not determine their medical
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
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