Nancy Glick

The Obesity Bill of Rights: Priorities for government action

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

Americans need and now have an Obesity Bill of Rights for a reason: People with obesity do not receive the same concern, level of attention, and quality care as those with any other serious chronic disease.  

Put into real-life terms: Though the adult obesity rate now exceeds 42 percent – the highest level ever recorded – obesity is still viewed as a problem of lack of willpower; too many health professionals act in discriminatory ways based on people’s size; and those seeking obesity care often face exclusions in insurance plans, restrictive practices that delay or deny treatment, or are not factored into decisions regarding medicine use.   

The consequence is that only 10 percent of people with obesity get help from medical professionals and only 2 percent of those eligible for treatment with Food and Drug Administration (FDA)-approved anti-obesity medicines (AOMs) have been prescribed these drugs, meaning the disease remains undiagnosed and undertreated. Compounding the impact, untreated obesity worsens the outcomes of more than 230 other chronic diseases, which is why obesity is responsible for as many as 400,000 Americans dying from obesity annually and costs the nation $1.72 trillion a year  in direct and indirect health expenditures – more than what Social Security paid in retirement benefits in 2022. 

It does not have to be this way. 

And this is where the Obesity Bill of Rights enters the picture. Developed by the National Consumers League (NCL) and the National Council on Aging, in consultation with leading obesity specialists, the bill of rights establishes eight essential rights with the core requirements so adults will receive the same person-centered, quality care for obesity as those with other chronic conditions. As such, the bill of rights serves as a blueprint for necessary changes in medical practice and government policy, starting with actions that can happen now. 

One immediate action item is pressing Congress to pass the Treat and Reduce Obesity Act (TROA), an important legislation that will allow more seniors to be treated with FDA-approved anti-obesity medications under the Medicare program. This matter is a high priority because obesity rates have nearly doubled among older adults to include two in every five Americans ages 65 and older. 

Another priority is ensuring that health professionals have the prescribing information to effectively treat people with obesity when they are taking drugs for other conditions, such as depression, schizophrenia, infections, and cancer. The simple fact is that certain drugs work differently in people with obesity and the consequences can be underdosing, a delay in response time, or the drug remaining in the body too long, potentially causing side effects. For example, studies show the drug brexpiprazole (Rexulti®), which treats depression and schizophrenia, takes significantly longer to reach effective levels in people with obesity – and some patients never reach these levels. Fortunately, the same research provides an improved dosing regimen so all patients with obesity can achieve efficacy. 

A different challenge involves drugs like posaconazole (Noxafil®), an antifungal often prescribed by oncologists to prevent infections. Two separate clinical trials show that obesity significantly increases posaconazole’s “half-life” – a term reflecting the amount of time it takes to rid the drug from the body. Half-life is an issue with posaconazole because many oncology medications must be delayed until the drug is out of the body’s system. Thus, if the package insert does not flag this matter when patients have obesity, doctors prescribing posaconazole may not know about the increase in half-life and start using oncology medicines too soon.  

These problems are not rare, but drug labels to guide safe and effective prescribing are dismissing people with obesity. For this reason, the Obesity Bill of Rights includes language to make accurate prescribing a requirement for receiving person-centered obesity care. Moreover, because increasing research validates the consequences of “flying blind” when drugs behave differently in the bodies of people with obesity, the obesity community is raising alarm bells, supported by a position statement from the American College of Clinical Pharmacology (ACCP), which urges FDA to close gaps in the testing and approval process for new drugs intended for use by people with obesity.  

However, because more immediate action is needed, five leading obesity organizations – American Society for Metabolic and Bariatric Surgery, the Obesity Action Coalition, the Obesity Medicine Association, the STOP Obesity Alliance, and The Obesity Society – issued a joint statement calling on drug manufacturers to update their labeling immediately to provide correct usage instructions for people with obesity when there should be a difference in dosing.  

NCL stands with the obesity community in calling for this sensible action and urges FDA to be a catalyst in ensuring that health professionals have the prescribing information needed for their patients with obesity to take important therapeutics safely and achieve the maximum benefit. For more information, visit right2obesitycare.org.

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 About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Food fight: NCL lauds VP Harris’s push for fair grocery pricing amidst corporate greed

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August 23, 2024

Media contact: National Consumers League – Melody Merin, melodym@nclnet.org, 202-207-2831

WASHINGTON, DC – The National Consumers League (NCL), with a 125-year history of advocating for transparency and fairness in the food marketplace, praises Vice President Kamala Harris’s focus on price gouging within the grocery industry. While critics have argued that banning price gouging is a campaign ploy and economic gibberish, NCL has long witnessed the numerous ways corporations can deceive and overcharge consumers. Harris’s plan tackles the abuses within the grocery industry head-on.

For too long, American consumers have been exploited by deceptive corporate practices that erode purchasing power and trust. Without guidelines and accountability, these practices will continue unchecked. Harris’s call to action is a shot across the bow, a powerful reminder to corporations that the Biden-Harris (and potentially a Harris-Walz) Administration is committed to addressing kitchen-table issues, like rising grocery costs.

This is not a new issue, nor is it the only issue leading to higher consumer prices at the supermarket check-out line. Price gouging, particularly during emergencies or disasters, is already regulated in thirty-seven states, with enforcement entrusted to state attorneys general. Harris’s plan would expand these protections, putting the Federal Trade Commission in charge of preventing unfair pricing tactics.

In February 2024, U.S. Representative Jan Schakowsky and U.S. Senator Elizabeth Warren reintroduced the Price Gouging Prevention Act of 2024 to combat corporate price gouging citing American families’ financial struggles amid rising grocery costs and corporate profits.  Expanding the FTC’s authority, as outlined in the Price Gouging Prevention Act, would not be considered price fixing. Rather, the proposed legislation empowers regulatory agencies to enforce fair pricing practices, protect consumers from unjustified price hikes, and promote a competitive and transparent market without interfering with lawful price setting by businesses.

Equally egregious to price gouging is the practice of shrinkflation, where companies reduce product sizes or contents while maintaining or increasing prices. The Shrinkflation Prevention Act, introduced by Senator Bob Casey and supported by the NCL, is a crucial measure to protect consumers from this form of corporate exploitation. Surveys confirm that 73% of consumers are concerned about shrinkflation, and 79% feel cheated.

Another betrayal of consumers is the lack of, or hidden, unit pricing. Unit pricing is a cornerstone of consumer purchasing, providing the cost per pound, quart, liter, or another unit of weight or volume. Unit pricing is a vital tool for budget-conscious consumers. Currently, only nineteen states and the District of Columbia have enacted unit pricing laws or regulations, according to the National Institute of Standards and Technology, leaving consumers in other states without the essential information needed to make informed purchasing decisions.

A lack of competition within the grocery industry also negatively impacts consumers. The recent FTC action to block Kroger Company’s $24.6 billion acquisition of Albertsons Companies, Inc. illustrates the negative impact of reduced competition.  The merger of these two grocery giants, who together own 5,000 stores across forty-eight states, would reduce competition, drive up prices, lower food quality, and degrade customer service. NCL believes that competition benefits consumers, ensuring they receive quality products at fair prices.

Corporate greed almost certainly plays a role in rising grocery prices. One analysis found that over half of the increase (53.9%) in prices in the nonfinancial corporate sector (i.e., companies that produce goods and services) during the height of the COVID pandemic – could be attributed to bigger profit margins. Since the pandemic, mark-ups have remained “extremely elevated relative to historic norms.” Other analyses have found similar results, with corporate profits driving 53% of inflation.

Weekly grocery bills are higher than before COVID-19, and while many factors contribute to this—including supply chain disruptions, pandemic recovery, and interest rates—the bottom line is that consumers are paying more and getting less. The U.S. Department of Agriculture reports that Americans now spend about 11% of their income on food, the highest level in 30 years. Although food prices are expected to rise by 1% this year, consumers are still reeling from last year’s 5% increase.

More work needs to be done at the federal level to understand why inflation rates and the rise in food prices are out of sync. However, one thing is clear: empowering the FTC and state attorneys general to hold companies accountable is a step in the right direction.

The notion that the market will self-correct is not just naive—it is dangerous. Without strong regulatory action, companies will continue to prioritize profits over people, especially in essential sectors like groceries, where families cannot afford price hikes or size reductions. NCL lauds Vice President Harris for taking a stand against corporate greed.

It’s time to put an end to these deceptive practices and ensure that every American has access to affordable, transparent, and fair food pricing. Vice President Harris’s plan is a bold and necessary step toward achieving that goal.

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 About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

NCL and the National Council on Aging worked with health leaders and obesity specialists to establish a set of rights for people with obesity.

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Nancy Glick

It’s time to care about obesity care

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

Every year, the calendar is full of national health observances – special months, weeks and days that raise awareness of serious diseases and health issues. While all are valuable to advance the health of the Americans, Obesity Care Week taking place March 4-8 is especially significant.

Why?  Because even though the adult obesity rate now exceeds 42 percent – the highest level ever recorded – obesity is still viewed as a problem of lack of willpower, too many health professionals act in discriminatory ways based on people’s size, and those seeking obesity care often face exclusions in insurance plans or restrictive practices that delay or deny treatment.

The consequence is that that only 10 percent of people with obesity get help from medical professionals, meaning the disease remains largely undiagnosed and undertreated.

It doesn’t have to be this way. There are a variety of safe and effective treatment options. And medical societies, including the American Medical Association (AMA), agree that obesity is a complex disease requiring ongoing quality care. The key is for society – including health professionals, insurers and policymakers – to care about obesity and agree that treatment matters. Here are the reasons why.

It is long past time for health professionals, employers, insurers, policymakers and the American public to care about obesity and work collectively to break down the barriers that prevent people from accessing proper care and treatment. This is the purpose of Obesity Care Week – to shine a light on a disease that no one has wanted to talk or think about and shift the way society views obesity and treats the disease.

Obesity Care Week is also an opportunity to call attention to the first Obesity Bill of Rights for the nation, developed by NCL and the National Council on Aging in consultation with leading obesity specialists and issued in January 2024. Starting with the recognition that obesity is a treatable disease, the Obesity Bill of Rights establishes eight essential rights so adults will receive the same level of attention and care as those with other chronic conditions and have access to all treatments deemed appropriate by their health providers. Now is the time to advance changes in federal, state, and employer policies that will ensure these rights are incorporated into medical practice.

More information about the Obesity Bill of Rights is available at: www.right2obesitycare.org.

*Links are no longer active as the original sources have removed the content, sometimes due to federal website changes or restructurings

A coalition of consumer, health groups – including NCL – call for nutrition, ingredient, and allergen labeling on alcoholic beverages

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February 27, 2024

Media contact: National Consumers League – Melody Merin, melodym@nclnet.org, 202-207-2831

Washington, DC – A coalition of consumer and health groups is urging Treasury Secretary Janet Yellen to ensure that the agency responsible for regulating most alcoholic beverages in the U.S. – the Alcohol and Tobacco Tax and Trade Bureau (TTB) – keeps its commitment to require standardized alcohol labeling on all beer, wine, and distilled spirits products by initiating three promised rulemakings on nutrition, ingredients, and allergen labeling on an accelerated basis.

The appeal comes in the form of a February 27 letter from five leading public interest groups as TTB begins a series of “listening sessions” on labeling and advertising of alcoholic beverages on February 28. Raising concerns that the listening sessions are no more than a delay tactic to maintain the status quo and “slow walk deliberations for months,” the organizations – the Asthma and Allergy Foundation of America (AAFA), Center for Science in the Public Interest (CSPI), Consumer Federation of America (CFA), Food Allergy Research and Education (FARE), and National Consumers League (NCL) – called for TTB to publish the rulemakings by June 2024.

The Treasury Department promised that TTB would issue mandatory alcohol labeling rules in a November 17, 2022 letter in response to a lawsuit filed by CSPI, NCL, and CFA. The Department stated its intention to publish the three rulemakings before the end of 2023.

“We write … to express our dismay and serious concern that TTB has backtracked from its written undertaking of the November 17, 2022 agreement,” the groups wrote to Secretary Yellen. “TTB has, in effect, enabled recalcitrant companies by delaying indefinitely rulemakings on mandatory alcohol labeling while opting for a voluntary rule under which labeling “Serving Facts” or “Alcohol Facts” and ingredients are optional.”

Focusing on the health consequences of delaying action on alcohol labeling, the letter from advocates to Secretary Yellen describes how better alcohol labeling will benefit the 84 percent of U.S. adults who drink alcoholic beverages – 216 million people – and who currently do not have the facts about the alcohol they are consuming to protect their health and safety. Overconsumption of alcohol is a costly public health problem that has become much worse in recent years, as alcohol-related deaths have risen substantially. Among the key concerns, alcohol is involved in about 30 percent of all traffic crash fatalities in the U.S, is a source of empty calories that contributes to obesity, can impact blood sugar control in people with diabetes, and labeling can be a life-or-death matter for people with food allergies. Additionally, excessive drinking increases the risk of liver disease, hypertension, cardiovascular disease, alcohol use disorders, certain cancers and severe injuries.

“The consensus among public health and nutrition experts and consumers themselves, in favor of mandatory and complete alcohol labeling is overwhelming,” said Thomas Gremillion, Director of Food Policy at the Consumer Federation of America. “By reneging on its promise to initiate rulemakings, TTB continues to deny Americans the same helpful and easily accessible labeling information now required for conventional foods, dietary supplements, and nonprescription drugs.”

The letter to Secretary Yellen also stresses that alcohol manufacturers have the capability to put standardized Serving Facts labels on their products, when required. This is the case for products such as some hard ciders, hard seltzers, and wine coolers that are regulated by the Food and Drug Administration, which requires such products to have the same Nutrition Facts panel and ingredients statements on nonalcoholic beverages, from soft drinks to juices.

“To date, TTB has taken the position that requiring standardized nutrient content labeling on alcoholic beverages is too costly and burdensome for beverage alcohol manufacturers,” said Sally Greenberg, CEO of the National Consumers League. “However, the inconvenient truth for the industry is that some of the very same companies whose products do not include a Serving Facts statement if they are regulated by TTB already put complete alcohol labeling on their hard ciders, hard seltzers, wine coolers, and other FDA regulated wines and beers.”

Highlighting that the time has come for mandatory alcohol labeling, the letter makes clear that the agency’s current voluntary labeling rules are not working. Although the rule gives companies the option of putting “Serving Facts” or “Alcohol Facts” and ingredients information on their products, new research from the Center for Science in the Public Interest finds that most manufacturers have opted out of TTB’s voluntary program. Using TTB’s COLA database to examine the labels for 132 of the nation’s top beer and wine brands, CSPI’s study found that only 11 labels of the 65 beer brands examined (17%) and none of the 67 wine brands included ingredients lists while 18 beers (28%) and no wines used the voluntary “Serving Facts” label, and one additional beer brand carried the voluntary “Alcohol Facts” label. CSPI’s review also showed that even when serving information is included on beer and wine labels, there is no standard format for where and how the disclosures appear, making it hard for consumers to find information easily and compare different brands.

“We have the data that demonstrate that Treasury’s voluntary rule has failed to adequately improve transparency in alcohol labeling,” said Dr. Peter G. Lurie, President of the Center for Science in the Public Interest. “Ensuring that the agency ends this ineffective voluntary regime by issuing mandatory labeling rules necessitates national leadership. This is why we are appealing directly to Secretary Yellen to intercede personally to require the agency to commit to publish all three proposed rules by June 2024.”

The 2022 letter whereby TTB undertook to publish standardized alcohol content, calorie, and allergen labeling by the end of 2023 resulted from a lawsuit filed by Center for Science in the Public Interest, Consumer Federation of America, and the National Consumers League on October 3, 2022. The suit charged TTB with failing to act on a citizen petition, submitted to the Treasury Department in 2003 to mandate alcohol labeling. CSPI, CFA, and NCL filed the petition along with a coalition of 66 other organizations and eight individuals, including four deans of schools of public health.

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

Americans now have an Obesity Bill of Rights

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January 31, 2024

Media contact: Nancy Glick, 202-320-5579, nancyg@nclnet.org; Simona Combi, 571-527-3982, simona.combi@ncoa.org

Washington, DC – Because obesity – the most prevalent and costly chronic disease in the United States –remains largely undiagnosed and untreated a decade after the American Medical Association (AMA) classified it as a serious disease requiring comprehensive care,[1] the National Consumers League (NCL) and National Council on Aging (NCOA) today introduced the nation’s first Obesity Bill of Rights and launched a grassroots movement – Right2ObesityCare – to advance changes in federal, state, and employer policies that will ensure these rights are incorporated into medical practice.

Developed in consultation with leading obesity specialists and endorsed by nearly 40 national obesity and chronic disease organizations, the Obesity Bill of Rights establishes eight essential rights, so people with obesity will be screened, diagnosed, counseled, and treated according to medical guidelines and no longer face widespread weight bias and ageism within the health care system or exclusionary coverage policies by insurers and government agencies.

“Our goal with the Obesity Bill of Rights is to define quality obesity care as the right of all adults and empower those with the disease to ask questions and demand treatment without discrimination or bias regardless of their size or weight” said Sally Greenberg, Chief Executive Officer of the National Consumers League. “For too long, adults with obesity have encountered a health care system that is working against them. They have been stigmatized, discriminated against, not treated with respect by their health providers, and have faced significant hurdles and burdensome requirements to receive obesity care.”

As described by Patricia Nece, J.D., Immediate Past Chair of the Obesity Action Coalition, “For my entire life, I’ve been a target of ridicule simply because of my weight. People rarely take time to look beyond my weight to see me.”

Currently, only 30 million[2] of the estimated 108 million adults living with obesity[3] have been diagnosed with the condition, and only about 2% of those eligible for anti-obesity medications have been prescribed these treatments.[4] The consequence of untreated obesity for the nation is worsening outcomes for over 230 obesity-related chronic diseases,[5] approximately 400,000 premature deaths a year,[6] and an estimated $1.72 trillion in direct and indirect costs to the U.S. economy.[7]

Defining Quality Obesity Care for All
The Obesity Bill of Rights establishes and promotes eight essential rights to drive transformational change and define the core requirements for people with obesity to receive person-centered, quality care:

  1. The Right to Accurate, Clear, Trusted, and Accessible Information on obesity as a treatable chronic disease
  2. The Right to Respect by all members of the integrated care team when screening, counseling, and providing treatment
  3. The Right to Make Treatment Decisions about one’s health goals and obesity care in consultation with the individual’s health providers
  4. The Right to Treatment from Qualified Health Providers including counseling and ongoing care from health providers with expertise in obesity care
  5. The Right to Person-Centered Care that is personalized, respects the individual’s cultural beliefs, meets their specific health goals, and considers the person’s whole health and not just their weight status
  6. The Right to Accessible Obesity Treatment from Health Systems, so those with severe obesity receive care in settings that allow for privacy, using size and weight-accessible equipment and diagnostic scans
  7. The Right for Older Adults to Receive Quality Obesity Care that comprises a respectful, comprehensive care approach consistent with their personalized medical needs
  8. The Right to Coverage for Treatment with access to the full range of treatment options for the person’s disease as prescribed by the individual’s health provider

“Collectively, these rights will ensure that adults with obesity have trusted, accurate information about their disease, respectful and nondiscriminatory care from medical professionals, and insurance that provides access to all treatments deemed appropriate by their health providers,” said Ramsey Alwin, NCOA President and CEO. “In town halls across the country, older adults told us they often feel invisible when seeking obesity care. The Obesity Bill of Rights recognizes and aims to address their unique challenges.”

Putting the Bill of Rights into practice

With the goal of reversing the trajectory of the nation’s obesity epidemic, NCL and NCOA will spearhead Right2ObesityCare, a new grassroots movement to engage people with obesity, their caregivers, health professionals, community leaders, employers, and a network of obesity and chronic disease organizations to drive adoption of the Obesity Bill of Rights in clinical settings.

Using the online hub www.right2obesitycare.org to mobilize stakeholders, Right2ObesityCare will focus on national and state policy efforts, including developing a set of national “obesity goals” for full implementation of the Obesity Bill of Rights by December 31, 2029. Plans include hosting regional town halls, workshops, and advocacy forums across the country; scheduling meetings with federal and state legislators and regulators; and arming interested citizens and advocacy leaders with materials and tools to advocate for implementation of the Obesity Bill of Rights in their communities and workplaces. NCL and NCOA also will pursue development of a model law that stakeholders can use to incorporate the Obesity Bill of Rights into state law.

“The Obesity Bill of Rights brings us a step closer to creating a society where all individuals are treated with respect and without discrimination or bias regardless of their size or weight. Establishing eight essential rights for people living with obesity strengthens efforts to end such blame, shame and discrimination and give individuals who want and need it, access to safe and effective options to improve their health,” added Joe Nadglowski, President and CEO of the Obesity Action Coalition.

Advocacy on implementing the Obesity Bill of Rights also gives policymakers new impetus to pass legislation that will remove the regulatory and insurance obstacles that keep many people with obesity from getting the care prescribed by their health providers.

According to Rep. Brad Wenstrup, DPM (R-OH), “By tackling obesity head on, we can better prevent numerous additional diseases like type 2 diabetes, high blood pressure, and heart disease. My bill, the Treat and Reduce Obesity Act (TROA), expands Medicare beneficiaries’ access to treatment options to include FDA-approved medications, clinical psychologists, registered dieticians, and nutrition professionals. Not only would this legislation help Americans live healthier and longer lives, but it can also save taxpayer dollars over the long run.”

Added Rep. Gwen Moore (D-WI), “Obesity is a chronic condition – not a personal or moral failing. We need to ensure our health care system treats it as a disease, so that Americans with obesity can access holistic, high-quality care that meets the full spectrum of their needs. I am proud to be a co-lead of the Treat and Reduce Obesity Act, which puts us on a path toward effectively treating obesity, helping create healthier outcomes for Americans and supporting enhanced quality of life for Medicare beneficiaries who need comprehensive care.”

Development of the Obesity Bill of Rights

A year in development, the Obesity Bill of Rights is the product of extensive research combined with four town hall meetings hosted in senior centers and churches in California, Delaware, Mississippi, and Oklahoma between June and August 2023. At these town halls, more than 250 older adults, community leaders, and local clinicians described a health care system that is inhospitable to delivering quality obesity care, and physicians described having limited time for counseling, not enough training in obesity management, and inadequate coverage and reimbursement for obesity care.

After turning this knowledge and the lived experiences of older adults into a first draft, NCL and NCOA hosted a roundtable at The Obesity Society annual meeting in October 2023 where leading obesity experts reviewed the preliminary document and made recommendations. NCL and NCOA then sought feedback from specialists in minority health, aging, and rural health, as well as health professionals and other stakeholders who provided additional guidance. The final step was to circulate the updated Obesity Bill of Rights to a wide group of stakeholder organizations, resulting in initial endorsements from 36 obesity, public health, and chronic disease organizations and medical societies.

Nearly 40 consumer, aging, and public health organizations endorse the Obesity Bill of Rights

To date, the following organizations have endorsed the first-ever Obesity Bill of Rights: 1) the Academy of Nutrition and Dietetics; 2) Alliance for Aging Research; 3) Alliance for Women’s Health & Prevention; 4) American College of Occupational and Environmental Medicine; 5) American Medical Women’s Association; 6) American Nurses Association; 7) American Society on Aging;  8) American Society for Nutrition; 9) Association of Black Cardiologists; 10) Association of Diabetes Care & Education Specialists; 11) Bias180; 12) Black Women’s Health Imperative; 13) Choose Healthy Life; 14) ConscienHealth; 15) Council on Black Health; 16) Defeat Malnutrition Today; 17)  Gerontological Society of America; 18) Global Liver Institute; 19) Health Equity Coalition for Chronic Disease; 20) HealthyWomen; 21) Lupus Foundation of America; 22) MANA; 23) National Asian Pacific Center on Aging; 24) National Black Nurses Association; 25) National Hispanic Council on Aging; 26) National Hispanic Health Foundation; 27) National Kidney Foundation; 28) Noom, Inc.; 29) Nurses Obesity Network; 30) Obesity Action Coalition; 31) Obesity Medicine Society;  32) Patients Rising;  33) Partnership to Advance Cardiovascular Health; 34) Preventive Cardiovascular Nurses Association; 35) The Obesity Society; and 36) WeightWatchers.

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About NCL

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. The organization’s mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

About NCOA

The National Council on Aging is the national voice for every person’s right to age well. We believe that how we age should not be determined by gender, color, sexuality, income, or ZIP code. Working with thousands of national and local partners, we provide resources, tools, best practices, and advocacy to ensure every person can age with health and financial security. Founded in 1950, we are the oldest national organization focused on older adults. Learn more at www.ncoa.org.

 

[1] Obesity Medicine Association. June 19, 2013. “AMA House of Delegates Adopts Policy to Recognize Obesity as a Disease. Accessible at https://obesitymedicine.org/blog/ama-adopts-policy-recognize-obesity-disease/:

[2] PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.

[3] Hales CM, et al. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018. Centers for Disease Control and Prevention. NCHS Data Brief. No. 360. February 2020.

[4] PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.

[5] Obesity Care Advocacy Network. Fact Sheet: Obesity Care Beyond Weight Loss

[6] Hurt Rt, et al. Obesity epidemic: overview, pathophysiology, and the intensive care unit conundrum. J Parenter Enteral Nutr. 2011 Sep;35(5 Suppl):45-135

[7] Milken Institute (October 2018), “America’s Obesity Crisis: The Health and Economic Costs of Excess Weight.”

NCL comments on Proposed Rule – Fish and Shellfish; Canned Tuna Standard of Identity and Standard of Fill of Container

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November 21, 2023

Media contact: National Consumers League – Melody Merin, melodym@nclnet.org, 202-207-2831

The National Consumers League recently submitted comments regarding the Proposed Rule, “Fish and Shellfish; Canned Tuna Standard of Identity and Standard of Fill of Container.” We believe that the Proposed Rule, when implemented, will modernize the standard of identity for “canned tuna,” 21 C.F.R. § 161.190 (“canned tuna SOI”), to require an accurate measure and declaration of weight, and to allow for “safe and suitable” ingredients to provide manufacturers with the flexibility to keep up with changing consumer tastes.

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

Obesity medicine specialists, health providers, insurers and employers urged to make obesity treatment a right of all Americans

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October 13, 2023

Media contact: National Consumers League – Nancy Glick, nancyg@nclnet.org, 202-823-8442 NCOA –Simona Combi, Simona.combi@ncoa.org, 571-527-3982

Washington, D.C. – With growing evidence that U.S. adults with obesity feel stigmatized and ignored by their health care providers, the National Consumers League (NCL) and National Council on Aging (NCOA) today urged health professionals, insurers and employers to join a national movement to define quality obesity care as a right for every American.

Taking the case directly to health professionals on the front lines in delivering obesity care, NCL and NCOA used The Obesity Society’s annual meeting in Dallas October 14-17 to announce plans to provide Americans with an Obesity Bill of Rights.  Today, over 100 million adults are living with obesity[1] (42 percent of the public), yet only 10 percent get help from medical professionals.[2] An Obesity Bill of Rights has the potential to transform obesity care by empowering Americans to demand the respect of their health providers and to be screened, diagnosed, and effectively treated for their obesity based on medical treatment guidelines.

“For too long, adults with obesity have encountered a healthcare system that works against them. They are stigmatized, discriminated against, not treated with respect by their health providers, and confront significant obstacles in receiving the care they deserve. ” said Sally Greenberg, Chief Executive Officer of the National Consumers League. “This must change; we need an overhaul of the health system, and we believe an Obesity Bill of Rights can drive this transformation.”

Because this change will only happen if there is agreement on a set of basic rights that ensure adults with obesity receive respectful, timely, and effective obesity care, NCL and NCOA unveiled www.Right2ObesityCare.org, a new online engagement platform, so the nation’s health providers, insurers and employers can play a role in developing the Obesity Bill of Rights.  Right2ObesityCare.org explains the purpose and research-driven process and encourages a wide range of health professionals – from obesity medicine specialists and physicians to dietitians, nutritionists, exercise physiologists, health educators, and mental health professionals – to contribute their ideas.

Town Halls Chart the Obstacles for Adults with Obesity and Their Providers

Along with hearing from health professionals, the Obesity Bill of Rights will be informed by the insights of both adults with obesity and their health providers who participated in four town hall meetings that NCL and NCOA hosted across the country. Held in senior centers and churches in

California, Delaware, Mississippi, and Oklahoma between June and August 2023, the town halls involved more than 250 older adults, community leaders, and local clinicians who laid bare a healthcare system that is inhospitable to delivering quality obesity care.                                                        

When asked to share their experiences, older adults attending the town halls spoke of feeling invisible when seeing a health provider, not being listened to, and being treated with disdain when they initiated conversations about their obesity. At the same time, physicians described feeling inadequate to provide obesity care due to the limited time for counseling, not enough training in obesity management, inadequate coverage and reimbursement for obesity care, and needing better tools to help patients recognize obesity risks. This confirms research that finds adults with excess weight often feel unwelcome in the doctor’s office or believe that seeking help for obesity signifies moral failure. [3]

“This is a chronic condition that no one wants to talk about,” said Ramsey Alwin, NCOA President and CEO. “For several decades, NCOA has worked to empower older adults to better manage their chronic conditions. To break down barriers related to obesity, we held town halls that allowed both older adults and their health providers to relay their lived experiences. What we learned is that encouraging more people to seek obesity care requires an investment in science-based, easy-to-understand, accessible information about obesity; a healthcare system that encourages informed decision-making and patient-centered care; and effective public policy that requires health plans to provide access to the treatments deemed appropriate by the health provider, including lifestyle interventions, FDA-approved weight loss medications, and bariatric surgery.”

Mobilizing for Change
With the townhalls as a guidepost, NCL and NCOA are now leading a rigorous process to finalize and release the Obesity Bill of Rights to the medical community and public before the end of 2023. The process includes hosting a meeting of top experts to review a preliminary draft with recommendations for refinement. NCL and NCOA will also seek feedback from specialists in minority health, aging, and rural health, as well as health professionals and other stakeholders who offer advice through the online engagement platform.

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About NCL

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. The organization’s mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

About NCOA

The National Council on Aging (NCOA) is the national voice for every person’s right to age well. We believe that how we age should not be determined by gender, color, sexuality, income, or ZIP code. Working with thousands of national and local partners, we provide resources, tools, best practices, and advocacy to ensure every person can age with health and financial security. Founded in 1950, we are the oldest national organization focused on older adults. Learn more at www.ncoa.org.

[1] Hales CM,, et al. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018. Centers for Disease Control and Prevention. NCHS Data Brief. No. 360. February 2020.

[2] Stokes A, et al. Prevalence and Determinants of Engagement with Obesity Care in the United States. Obesity. Vol. 26, Issue 5; May 2018, 814-818

[3] Gunther S, et al. Barriers and enablers to managing obesity in general practice: a practical approach for use in implementation activities. Qual Prim Care. 2012; 20: 93-103

Guest Blog: Standardizing portions could help stem the obesity epidemic

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By Deborah A. Cohen, MD, MPH

The past few decades have seen dramatic changes in the food environment and food behaviors, all resulting in the epidemics of obesity and diet-related chronic diseases.  About 72% of American adults are overweight or obese and more than half have diet-related chronic diseases. Our research shows that the food environment actually encourages people to eat impulsively and markets twice as much food as people need to maintain a healthy weight.  Our diets are largely influenced by the relative supply and availability of different food products, by marketing, and by other factors we aren’t even aware of.1-3  Restaurants are among the largest risk factors for a poor diet.

Here’s a rather shocking statistic: most Americans dine out between 4-5x per week and, on average, spend 55% of all their food dollars on meals and snacks away from home.4,5  The problem is that away-from-home meals are often inferior in nutritional quality to meals prepared at home – they tend to be higher in salt, fat, and calories, and lower in fruit, vegetables, and whole grains; they also typically include 2-3 times more calories than we need to maintain a healthy weight.6,7  Indeed, portion sizes have been increasing substantially over the past three decades.8

When people dine away from home, their ability to control portion sizes, and thus caloric intake, is limited. Studies demonstrate that we all eat more when we are served more. 9,10   As portion size increases, calories go up. The results are stunning:  Laboratory based studies in both adults,11,12 and children13,14 show that when larger portion sizes are served, calories go up as much as 30% with no differences in self-reported hunger.  So eating out – which we do a lot more than we used to – is a major contributor to weight gain and increases the risk of obesity and chronic diseases.6 Multiple studies support the association between frequency of meals consumed in restaurants and the risk for overweight.15-18

My research looks at how portion sizes can be made transparent and predictable with the hope that this would have an enormous benefit for America’s obesity crisis. Smaller, standardized portions are a practical and feasible solution to help stem the obesity epidemic.

Portion control has also proven to be an effective measure to reduce the amount – and therefore the harm – of alcohol consumption.19,20 Alcoholic beverages are classified by the percentage of alcohol content and the U.S. government defines a standard drink as containing 0.6 oz. of alcohol. Standard drink sizes are 12 ounces for a standard beer, 5 ounces for a glass of wine, and 1.5 ounce shot of 80 proof spirits.  These standard portion sizes allow us to measure a standard drink and to limit the risk of inebriation. Many states mandate that alcohol be served in standard portions; twelve states also require that larger portions of alcohol carry a higher price.21  Applying these principles to food could be an enormous aid, since people are not reliably able to judge what constitutes an appropriate individual portion just by looks.22-24 Standard portions are also a necessity for medications.  Many consider food as “medicine”, so applying portion standards to food is a natural extension that could improve health outcomes. That was our goal.

Piloting the Solution: Standardized Portions

Under a National Institutes of Health funded planning grant, my colleagues and I  developed guidelines for standard portions .  With input and guidance from an advisory board composed of nationally recognized nutrition researchers, we set calorie limits for meals at 700 calories each for lunch and dinner, 500 calories for breakfast and 200 calories for snacks.  We separated meal components into appetizers (150 calories), soups (150 calories), dressings and salads (150 calories), plain entrees (200 calories) for breakfast, lunch and dinner, mixed entrees (350 calories), non-starchy sides (100 calories), starchy sides (150 calories), beverages and desserts (100 calories).25

We conducted a pilot study with three local restaurants in Southern California. We incentivized these establishments to create an alternative menu to their usual offerings, providing meals in quantities that met the above caloric guidelines. We offered restaurants a $2000 participation fee as well as paying for all the costs of the menu development and printing, and purchasing gift cards to offer customers as part of the evaluation. The restaurants created new “Balanced Portions” menus, which included 6-8 items from their regular menu. The meals were not intended for weight loss purposes, but are only designed to prevent unintended overconsumption.

We began our pilot project by  asking restaurant managers to identify which menu items were the most popular. The project did not change any preparation or recipes. Not surprisingly, even though we would be reducing the quantity of some items served and increasing the quantity of others, none of the restaurants were interested in reducing the price of any item for offering less.

One restaurant did not want to change the price or the quantity, we plated the calorically set portions and then had them pack the remaining food for carry out.   (see Figure 1, top menu.) When we measured the original food quantities, in most cases the amounts served were double the guidelines for a single meal, so leftovers were sufficient for a second meal. The meal was marketed as “Dinner today, Lunch tomorrow”.

The other two pilot restaurants were not interested in packing up extra food, so they created an alternative menu by selecting menu items that already met the guidelines. The owners came up with new prices comparable to other selections on the menu. At yet another restaurant, the regular menu only included entrees and sides, so to get variety, people needed to order several large dishes. The new menu allowed people to get variety with one order. In all cases we requested that each meal contain at least one cup of vegetables. We piloted this with 3 restaurants: First Szechuan Wok, Dave’s Deli & Catering, and Delhi Belly. (Figure 1)

Once we verified the quantity of food to be plated as a serving size, we sent the meals out for calorimetry (measures calories) to verify that the calories would be <700.  All the meals met the criteria. We then held a training session for restaurant staff and provided written guidelines on food to be plated for each menu item. We provided restaurants with measuring cups and kitchen scales so they could meet the guidelines. The plates were full, as we generally increased the quantity of vegetables and reduced the quantity of meats and starchy sides. The restaurants all passed the training session.

Feedback from Customers. Once the menus were launched and made accessible to patrons, we invited customers to provide feedback on the menus and their experience and offered them gift cards from the restaurant for their participation, whether or not they ordered from the Balanced Portions Menu.

Overall, the feedback on the alternative Balanced Portions menus from customers was positive. We conducted in-person and phone interviews with 33 customers (56% ordered from the Balanced Portions menu) who dined at one of the three restaurants. Findings from the one-on-one interviews revealed that 16 of the 18 customers who ordered from the Balanced Portions expressed satisfaction with their meals and shared that they “would love” to see Balanced Portion menus offered at other restaurants. In addition, the availability of Balanced Portions menu may help them reduce food waste, maintain healthy eating habits, and meet recommended dietary guidelines. Interestingly, among those who ordered from the regular menu, one participant described the portions as “very generous” and more than half reported going home with leftovers.

However, some of the interviewees expressed concerns regarding cost and thought lowering the prices and offering more Balanced Portion menu options may encourage more people to opt for standardized portions. Some participants thought eliminating to-go options and offering smaller portions at lower prices would be most  appealing.

Adherence to Portion Sizes. We also assigned a research assistant (RA) to be a “secret shopper.” The RA ordered Balanced Portions meals to-go and then carefully measured each component with measuring cups and kitchen scales to determine adherence to the guidelines previously issued. In all but one case, the restaurants were adherent to the guidelines. At Delhi Belly they did give a little extra rice, and we advised the owner to be serve a bit less rice.

Conclusion: Our results were very promising.  We concluded that it is highly feasible for restaurants to offer meals with standard portions that reduce the risk of overconsumption, overweight and obesity associated with dining out. We also concluded that we will need more attention to the issue of Balanced Portions menus over time to inform future rollouts at a national level.  Furthermore, understanding the impact on customer attitudes and behavior will provide critical insights into how to scale this in the future. This research is a rewarding and promising first step, full of opportunities to effectively address the obesity crisis and its connection to eating food outside of home.

  1. Milliman RE. Using background music to affect the behavior of supermarket shoppers. Journal of Marketing. 1982;46(3):86-91.
  2. Milliman RE. The influence of background music on the behavior of restaurant patrons. Journal of Consumer Research. 1986;13(2):286-289.
  3. Curhan RC. The relationship between shelf space and unit sales in supermarkets. Journal of Marketing Research. 1972;9:406-412.
  4. Kant AK, Whitley MI, Graubard BI. Away from home meals: associations with biomarkers of chronic disease and dietary intake in American adults, NHANES 2005-2010. Int J Obes (Lond). 2015;39(5):820-827.10.1038/ijo.2014.183
  5. Saksena MJ, Okrent AM, Anekwe TD, et al. America’s Eating Habits: Food Away From Home. In. Wash, DC: USDA; 2018:*https://www.ers.usda.gov/webdocs/publications/90228/eib-90196_summary.pdf?v=98073.90222*
  6. Lin BH, Frazao E. Away-from-home foods increasingly important to quality of American diet. ERS/USDA. 1999;*http://www.ers.usda.gov/Publications/AIB749/.*
  7. Rosenheck R. A systematic review of a trajectory towards weight gain and obesity risk. Obes Rev. 2008;9(6):535-547.
  8. Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977-1998. JAMA. 2003;289(4):450-453.
  9. Rolls BJ, Roe LS, Meengs JS. Larger portion sizes lead to a sustained increase in energy intake over 2 days. J Am Diet Assoc. 2006;106(4):543-549. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16567150
  10. Diliberti N, Bordi PL, Conklin MT, Roe LS, Rolls BJ. Increased portion size leads to increased energy intake in a restaurant meal. Obes Res. 2004;12(3):562-568. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15044675
  11. Rolls BJ, Morris EL, Roe LS. Portion size of food affects energy intake in normal-weight and overweight men and women. Am J Clin Nutr. 2002;76(6):1207-1213. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12450884
  12. Kral TV, Roe LS, Rolls BJ. Combined effects of energy density and portion size on energy intake in women. Am J Clin Nutr. 2004;79(6):962-968. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15159224
  13. Rolls BJ, Engell D, Birch LL. Serving portion size influences 5-year-old but not 3-year-old children’s food intakes. Journal of American Dietetic Association. 2000;100:232-234.
  14. McConahy KL, Smiciklas-Wright H, Birch LL, Mitchell DC, Picciano MF. Food portions are positively related to energy intake and body weight in early childhood. . Journal of Pediatrics. 2002;140:340-347.
  15. Ayala GX, Rogers M, Arredondo EM, Campbell NR, Baquero B, Duerksen SC, Elder JP. Away-from-home food intake and risk for obesity: examining the influence of context. Obesity (Silver Spring, Md). 2008;16(5):1002-1008. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=18309297&site=ehost-live
  16. McCrory MA, Fuss PJ, Hays NP, Vinken AG, Greenberg AS, Roberts SB. Overeating in America: association between restaurant food consumption and body fatness in healthy adult men and women ages 19 to 80. Obes Res. 1999;7(6):564-571.
  17. Jeffery RW, French SA. Epidemic obesity in the United States: are fast foods and television viewing contributing? Am J Public Health. 1998;88(2):277-280.
  18. Hornick BA, Krester AJ, Nicklas TA. Menu modeling with MyPyramid food patterns: incremental dietary changes lead to dramatic improvements in diet quality of menus. J Am Diet Assoc. 2008;108(12):2077-2083. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=19027412&site=ehost-live
  19. Voas RB, Fell JC. Preventing alcohol-related problems through health policy research. Alcohol Research & Health. 2010;33(1-2):18-28. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2010-23622-003&site=ehost-live
  20. Anderson P, Chisholm D, Fuhr DC. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet. 2009;373(9682):2234-2246. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=19560605&site=ehost-live
  21. NHTSA. Preventing Over-consumption of Alcohol – Sales to the Intoxicated and “Happy Hour” (Drink Special) Laws *http://www.nhtsa.dot.gov/people/injury/alcohol/PIREWeb/images/2240PIERFINAL.pdf*. 2005.
  22. Levitsky DA, Obarzanek E, Mrdjenovic G, Strupp BJ. Imprecise control of energy intake: absence of a reduction in food intake following overfeeding in young adults. Physiol Behav. 2005;84(5):669-675. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15885242
  23. Levitsky DA, Youn T. The more food young adults are served, the more they overeat. J Nutr. 2004;134(10):2546-2549. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15465745
  24. Wansink B, Painter JE, North J. Bottomless bowls: why visual cues of portion size may influence intake. Obes Res. 2005;13(1):93-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15761167
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*Links are no longer active as the original sources have removed the content, sometimes due to federal website changes or restructurings.

The National Consumers League applauds the reintroduction of bipartisan legislation to give millions of Medicare beneficiaries access to safe and effective obesity treatments

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July 21, 2023

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, 202-823-8442

Washington, D.C. – The National Consumers League (NCL) welcomes the reintroduction  of the Treat and Reduce Obesity Act (TROA) as a needed step to end outdated Medicare rules that leave millions of seniors with diagnosed obesity – particularly members of Black and Latino communities – vulnerable to disability, disease and premature death due to lack of access to the full range of treatment options.

Introduced by Senators Tom Carper (D-DE) and Bill Cassidy (R-LA) and Representatives Brad Wenstrup (R-OH), Raul Ruiz (D-CA), Mariannette Miller-Meeks (R-IA) and Gwen Moore (D-WI), TROA will end this regulatory logjam by expanding coverage under Medicare Part D to new FDA-approved anti-obesity medications, which are currently excluded under a policy dating back to 2003. TROA will also end Medicare Part B restrictions on intensive behavioral therapy (IBT) that limit the delivery of IBT to primary care providers and restrict the physical locations where this care can occur. Through TROA, clinical psychologists, registered dietitians and nutrition professionals will be able to provide IBT if an individual with obesity is referred by a physician.

At a time when the obesity rate among adult Americans exceeds 40 percent and is even higher among communities of color – virtually half of African Americans (49.6 percent) and 44.8 percent of Hispanics are living with obesity – passage of TROA could be a critical step in changing the trajectory of a disease that for too long has been overlooked and undertreated. The National Consumers League applauds TROA’s reintroduction in the 118th Congress and pledges our support to gain passage of this important legislation on an expedited basis.

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About the National Consumers League (NCL)
The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.