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Consumers League (NCL) welcomes the reintroduction  of the Treat and Reduce Obesity Act (TROA) as a needed step to end outdated Medicare rules that leave millions of seniors with diagnosed obesity – particularly members of Black and Latino communities – vulnerable to disability, disease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.

I’m going for the kids’ portion!

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With overweight and obesity stats in an upward trajectory, the National Consumers League and the Georgetown School of Business are partnering up for a survey on a simple topic: what do Americans know about portion sizes, calories of average foods, and how many calories we can eat each day without packing on the pounds? 

We have a health crisis in America. From 2015-2016, 39.8 percent of American adults were considered obese–which means the body mass index (BMI) measurements of more than 129 million of us are considered obese. The annual medical cost of obesity is estimated at $147 billion because heart disease, stroke, type 2 diabetes, and cancers are tied to obesity. What is particularly concerning is that more than a third of younger people, ages 20-39, are obese.  

In fact, the New York Times reported that roughly a fifth of our soldiers are obese! The military is trying to combat this problem by replacing sweet drinks with water and cutting out fried foods, but it’s not working. 

The United States Department of Agriculture’s Dietary Guidelines recommend that the average person should consume about 2,000 calories a day. Do most of us know that if you exceed 2,000 calories day regularly, you pack on the pounds? (That’s unless, of course, you’re getting a lot of calorie–burning exercise or have a great metabolism.) Is that number too high for many of us? (It is for me. If I eat more than 1,650 calories, I know I’m going to put on weight.) That’s what we want to find out with our research: what do Americans really know about this guideline? 

We will also be asking whether most Americans know how many calories are in average serving of common foods such as yogurt (150), hamburgers with bun (350), pizza (350 per slice), bagels (325), muffins (425), a 4-piece fried chicken dinner with all the fixings (850-1,200), a 30–oz. steak (1,400), a piece of cheesecake (650), a big chocolate chip cookie (450), and an ice cream cone (300-400.) 

Also, do Americans know what an average serving is? A Cheesecake Factory salad is not an average serving! Each of their salads have more than 1,300 calories. That’s too much for one meal. Unfortunately, restaurant serving sizes have increased a lot over the last several decades. 

Which brings me back to my headline–kids’ portions! I’ve begun sampling my local downtown DC upscale food spots popular with millennials like Roti, CAVA, Chopt. The custom is that you order a bowl of lettuce or spinach as a base and put lots of pretty healthy but also pretty caloric toppings, add a protein for a few bucks extra, and crowned with shredded cheese and salad dressing. When you’re done, you have a big portion and lots of good food but also lots of calories–albeit not from hamburger and fries but still, calories! 

So try the kids’ portion! They are cheaper by a third, a lot less food, a lot fewer calories, and completely filling. My CAVA kids meal had a small white bread (unfortunately) pita, yogurt spread, two small spicy meatballs, cucumber salad, tomato salad, three pieces of fried bread, and scoop of brown rice. In other words, a lot of food! I figured it was about 550 calories. Voila! A third of my 1,650 allowable daily intake of food. And I was stuffed. I’ll be trying other food outlets to check out the kids’ portions. And we recommend that other consumers do the same–helps to limit calories and prevent food waste when you’re eating out!

NCL to USDA: Portion control must be key strategy for fighting America’s highest-ever obesity rates

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July 11, 2019

Media contact: National Consumers League – Shaunice Wall, MS, RD, shaunicew@nclnet.org, (202) 835-0331, Carol McKay, carolm@nclnet.org, (412) 945-3242, or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC—The National Consumers League (NCL) presented oral comments to the USDA’s Dietary Guidelines Advisory Committee today in Washington, DC, urging the committee to focus on portion control as a key strategy to address the rise of obesity.

“Unfortunately, while the current version of the Dietary Guidelines mentions portion size – it appears to be mostly an afterthought among the various strategies to improve diets and fight obesity,” said NCL Executive Director Sally Greenberg. “Portion balance is not mentioned in the guidelines’ executive summary; this is despite the fact that larger portion sizes have greatly contributed to the problem of overweight and obesity.”

Nationally, 39.6 percent of adults and 18.5 percent of children were considered obese in 2015-2016, the most recent period for which NHANES data were available. These figures represent the highest percentages ever documented and obesity rates are projected to affect half of all adults, or 115 million adults, by the year 2030. There are also substantial economic losses associated with obesity. The estimated annual medical cost of obesity in the United States was $147 billion in 2008 U.S. dollars; the medical cost for people who have obesity was $1,429 higher than those of normal weight. 

“One promising, and we think underutilized, strategy for tackling the obesity epidemic is helping consumers understand and implement appropriate portion control,” said Greenberg. “This simple step to improving public health should not be marginalized in the forthcoming edition of the Guidelines; rather it should be one of the key points stressed by the Dietary Guidelines Advisory Committee and form a cornerstone of the Dietary Guidelines.”

NCL’s full testimony is available here (PDF).

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About the National Consumers League

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.

Three reasons scientists believe bugs are the next beef

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Shaunice Wall is NCL’s Linda Golodner Food Safety and Nutrition Fellow

There’s a thin line between hunger and disgust when deep-fried tarantulas and smoked barbeque crickets are on the menu. Many scientists argue that animal protein is not environmentally sustainable, so alternatives–like bugs–may be the answer to the perils of global warming. Recent research supports eating bugs as a way to maintain a protein-rich diet while benefiting the environment.

Infographic comparing the water, feed, and land needs of cattle against the same needs for bugs farming

Why bugs are slowly crawling into our everyday diets

As the world population continues to grow, so will demand for animal protein. By 2050, we’ll be eating more than two-thirds the animal protein we do today, causing a strain to our planet’s resources. The surge in demand for animal protein has also contributed to an increase in greenhouse gases (carbon dioxide, methane and nitrous oxide). These gases lead to extreme weather conditions, ozone depletion, increased danger of wildland fires, loss of biodiversity, stresses to food-producing systems and the global spread of infectious diseases. Even today, climate changes are estimated to cause over 150,000 deaths annually.

Most westerners prefer beef over bugs

While many of us westerners may gag at the thought of maggots in our sausage, more than 2 billion people throughout the world have been eating bugs as a regular part of their diets for millennia. But historically, for westerners, livestock not only yields meat, but also milk and milk products, their hides or skins provide warmth, they are suitable for plough traction, and act as a means of transport. Because of the use of these animals, the benefits of eating insects in many societies has failed to gain much interest. Also, certain insects are transmitters of disease and are virtually a nuisance.

So, why should we eat bugs?

In 2013, a report by the Food and Agriculture Organization (FAO) of the United Nations, urged global citizens to eat more bugs for three reasons:

  1. They’re healthier for you…and tasty too!
    • Bugs are a healthy, nutritious alternative to mainstream staples such as chicken, pork, beef, and fish (from ocean catch).
    • Many insects are rich in protein, good fats, and high in calcium, iron, and zinc.
    • Insects already form a traditional part of many regional and national diets.
    • Bugs can be used as an ingredient substitute for almost any recipe. Here’s a link with ideas on how to make some delicious bug treats!
  2. They’re safer for the environment
    • Bugs promoted as food emit 75 percent fewer greenhouse gases (GHGs) than most livestock.
    • Insect rearing is not necessarily a land-based activity and does not require as much land as livestock.
    • Because they are cold-blooded, insects are efficient at converting feed into protein (crickets, for example, need 12 times less feed than cattle, four times less feed than sheep, and half as much feed as pigs and broiler chickens to produce the same amount of protein).
    • According to the Harvard Political Review, producing one pound of beef requires 10 pounds of feed, 1,000 gallons of water, and 200 square feet of pasture. In contrast, producing one pound of insects only requires two pounds of feed, one gallon of water, and two cubic feet of land space.
  3. They’re lower in cost
    • Bug harvesting/rearing is a low-tech, low-capital investment option that offers economic opportunities to all levels of society.
    • Insect rearing can be low-tech or very sophisticated, depending on the level of investment.

Recent advances in research and development show edible bugs to be a promising alternative to meat for both human consumption and as feedstock. But to make this a reality, regulatory frameworks for safety and nutrition will need to be developed and government, industry, and academia will need to work together.

In the meanwhile, knowing the benefits can help turn disgust to hunger when tarantulas or crickets appear on the menu… Something to think about!

Amazon and other retailers launch program allowing SNAP beneficiaries to order food online

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Shaunice Wall is NCL’s Linda Golodner Food Safety and Nutrition Fellow

On April 18, 2018, Amazon and other retailers launched a two-year test (pilot) program to boost food access to some of New York’s 2.7 million Supplemental Nutrition Assistance Program (SNAP) participants. Beneficiaries will be able to use their SNAP benefits to order groceries online and have them delivered directly to their door.

photo of supermarket produce“SNAP is one of the most efficient and important public benefit programs,” said Shaunice Wall, NCL’s Linda Golodner Food Safety and Nutrition Fellow. “SNAP helps reduce food insecurity and improves the nutrition of millions, especially among the most vulnerable Americans. For many Americans living in food deserts, online food retailers are sometimes the only way to stock refrigerators,” NCL supports this collaboration between USDA and Amazon.

“People who receive SNAP benefits should have the opportunity to shop for food the same way more and more Americans shop for food–by ordering and paying for groceries online,” said U.S. Secretary of Agriculture Sonny Perdue. “As technology advances, it is important for SNAP to advance too, so we can ensure the same shopping options are available for both non-SNAP and SNAP recipients.”

Stats on the rise of e-commerce sales in America in 2017

The pilot will test both online ordering and payment. It will also work to ensure that orders are processed safely and securely, according to the United States Department of Agriculture (USDA). SNAP participants will be able to use their benefits to purchase eligible food items, but not pay for service or delivery charges. 

The program will also add a new SNAP redemption option, with broad selection, low prices, and the convenience of home delivery without requiring a membership fee. As Amazon expands participating areas throughout the life of the pilot, they believe the program will dramatically increase access to food for customers living in rural and remote locations.

The USDA defines food deserts as communities where one-third of the population lives at least one mile away from a supermarket in an urban area and 10 miles away in a rural area. For SNAP beneficiaries, it is often the simplest – or sometimes the only – option to use their electronic benefit transfer (EBT) card at convenience stores or gas stations, which often have only a sparse supply of produce and fresh protein.

The pilot will start with SNAP households with EBT cards issued by New York. Online retailers will only be able to deliver in New York. The plan is for the pilot to eventually expand to other areas of New York as well as Alabama, Iowa, Maryland, Nebraska, New Jersey, Oregon, and Washington. Lessons learned will then allow expansion of online purchasing in SNAP.

“The ultimate goal of this pilot is to pave the way for a national rollout once the USDA identifies the best path to large-scale implementation,” says Amazon. NCL recognizes that the advancement of SNAP takes on a larger significance because of the argument by conservatives that the program “costs too much, has grown too quickly, encourages government dependency and discourages work.” NCL supports SNAP and this exciting online system, if it works, well, will address the dearth of healthy food options for millions of Americans in food desserts or who cannot, for lack of transportation, health or disability reasons, get to a supermarket and choose from healthier options.

For more information, please visit the SNAP Online Purchasing pilot webpage.

Consumer groups, food industry jointly call on USDA/HHS to emphasize portion control in next Dietary Guidelines – National Consumers League

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February 6, 2019

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC–Three national consumer advocacy organizations and six leading food industry trade associations joined together to call on the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) to emphasize portion control in the development of the official 2020-2015 U.S. Dietary Guidelines for Americans.

“One promising, and we think underutilized, strategy for tackling the obesity epidemic is helping consumers understand and implement appropriate portion control,” wrote the National Consumers League, the Consumer Federation of America, and Consumer Action. The consumer groups’ letter to USDA and HHS was cosigned by The Grocery Manufacturers of America, the Sustainable Food Policy Alliance (SFPA), the American Beverage Association, the Sugar Association, the National Confectioners Association, and the American Frozen Food Institute.

A copy of the letter can be accessed here.

The consumer groups and trade associations reminded the government that, “The current version of the Dietary Guidelines merely discusses portion size as an afterthought in strategies to improve diets and fight obesity, with the concept not even mentioned in the guidelines’ executive summary.”

Despite an array of consumer education efforts, including mandatory nutrition labeling on food packages and, more recently, on restaurant menus, obesity is still a dire problem. More than two out of three Americans remain overweight or obese, despite such efforts.

The consumer and industry groups noted that, “Larger portion sizes clearly contribute to increases in the rates of overweight and obesity . . . [we] therefore urge the Dietary Guidelines Advisory Committee, once they are appointed and convened, to focus on portion control as a key strategy to address the rise of obesity and related dietary diseases.”

The National Confectioners Association has launched the Always A Treat Initiative. A central aspect of this voluntary industry effort is providing consumers with more choices in smaller portion sized packages. The founding members of the SFPA have taken similar steps.

The Grocery Manufacturers Association has long supported the need for portion recommendations when developing achievable and practical dietary guidance.

The American Beverage Association has committed to offering a wider variety of smaller portion sizes. Members of the American Frozen Food Institute offer a large variety of portion-controlled meal options, and the Sugar Association has publicized that sugar is best enjoyed in moderation.

The consumer advocacy groups and trade associations concluded, “These programs represent cost-effective measures to combatting obesity, but this is only a start. . . . [We] look forward to participating in the deliberations that will lead to the new Dietary Guidelines.”

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About the National Consumers League

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.

A lesson in sautéing up nutrition: the coconut oil debacle – National Consumers League

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Last week, a Harvard professor made headlines after calling coconut oil “pure poison.” I can’t help shaking my head at such an outlandish statement. The idea that foods can cause cancer—or the opposite, that one superfood can cure disease—is a false claim we see time and again in news. We see it particularly in headlines, serving as “clickbait.” Food is neither a pure poison nor a panacea.

Like the many food “scandals” before (remember 2015’s bacon-gate?), the coconut oil debacle does reflect substantial data on its potential dietary fat harms. Before describing the data on coconut oil, it’s necessary to describe changes in the study of dietary fat over the last few years. In June, the British Medical Journal published a consensus statement on dietary fats. The image below from BMJ captures the evolution of the relationship between nutrition science, dietary fat intake, and heart disease. Essentially, eating foods high in saturated fats is not what causes high LDL (the “bad” blood cholesterol) or coronary heart disease—what most people had thought for decades. Instead, it’s a combination of nutrients, dietary intake, and other health conditions that lead to heart disease.

Amid these developments, consumers gained unprecedented access to new cooking oils in the food marketplace. It is now commonplace to see avocado, cottonseed, groundnut, and other vegetable oils alongside canola and olive oils in the grocery store; and the growth in demand is even stronger in Asian countries. Globally, the market is expected to grow by 5.5 percent from 2017 to 2026, representing $65 million annually.

As the market boomed, researchers began testing the differences in the nutritional profiles between the many new varieties of cooking oils available for mass consumption. Coconut oil stood out, high in saturated fat content and, coincidentally, touted by many media influencers as a cure all to everything from skin and hair care and as an alternative to canola oil for frying foods.

Several longitudinal studies found that coconut oil raised LDL to levels similar to those found in butter, beef fat, and palm oil. In 2017, the American Heart Association awarded coconut oil a presidential advisory warning against its consumption. Alternatively, coconut oil also has the lowest polyunsaturated fat among the many varieties of cooking oil—a mere 2 percent, as compared with the 78 percent of safflower oil.

But authors reporting on the coconut-oil-is-poison story seemed surprised at the notion that the popular item could be detrimental to health. This makes sense, given that we—broadly as consumers—generally think coconut oil is … healthy. According to Cargill’s annual FATitudes survey (see table below), perception of coconut oil healthfulness grew from 44 percent in 2015 to 52 percent in 2017. At the same time, canola oil—tying with olive oil for first place in monounsaturated fat levels, which is linked to HDL (the “good” cholesterol in the bloodstream)—hovered around 35 percent.

The good news is that any consumption of vegetable oils seems to be preferable to animal cooking sources (e.g., lard, butter, or red meat). As the cooking oils market continues to grow, we must do a better job at reducing the power of clickbait. Flashy headlines should not take the place of facts.

Dietary Guidelines 2020: Back to the future for portion sizes – National Consumers League

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Sally GreenbergWith 47 percent of the U.S. population projected to be obese by 2030 – and more than 2.1 billion people expected to weigh in as overweight or obese – it’s no surprise that governments worldwide have waged war on a health crisis which not only causes 5 percent of all deaths every year, but also has a $2.0 trillion economic impact annually. So what new measures can be taken that haven’t already been tried?

Is the solution based in advanced technology or medicine? Or do we need to take a step back and take a look at the bigger picture, and tackle a complex problem with simpler solutions by going back to basics? Research seems to indicate that portion control is one of the most promising strategies.

Advances in technology and entertainment over the past 40 years mean we are moving less. At the same time, our meals and snacks have been supersized. In its latest revision of the nutrition facts panel, the Food and Drug Administration (FDA) has increased some of the standard serving sizes for various food and beverage products to better reflect the total calories people are actually consuming. This could, however, send the wrong message about proper portions of food. And while there are some great nutrition tools and fact sheets available (see for example the National Institute of Health’s page on Portion Distortion), this puts responsibility on the individual to make the right choices. There are also initiatives about portion control from the American Heart Association and the American Cancer Society.

The 2015 Dietary Guidelines for Americans discussed adapting portion sizes to help individuals make choices that align with the Dietary Guidelines´ other recommendations. But this was more of a passing comment without further guidance, and simply not actionable by consumers, health and wellness professionals, or even policy makers.

If real change is going to happen, it not only has to start at an individual level but also via policy based intervention and through corporate action. And there’s compelling evidence to show that portion size reduction, as a collective movement, could be the single most effective solution to an expanding problem.

The food industry’s own research – from the International Food Information Council’s 2017 Health and Wellness Survey – highlights this unmet opportunity, showing that consumers want to consume smaller portions as one of the steps to be healthier, however they are not acting on it, and are instead prioritizing value.

An interesting comprehensive analysis conducted by the McKinsey Global Institute (MGI) is worthy of consideration. The paper found that while education and personal responsibility are critical elements of any program to reduce obesity, they are not the only solutions. Interventions that rely less on conscious choices by individuals and more on changes to the environment and societal norms are what’s needed—an example of this includes reducing portion sizes of packaged foods and fast food.

According to MGI’s research, portion control, as opposed to other obesity intervention methods such as product reformulations, labeling, weight-management programs, surgery, etc., is the single highest-impact intervention for reducing obesity; and the most cost-effective strategy.

Has it been tried? Not really—there was a previous attempt that was never implemented when in 2012, NYC Mayor Bloomberg tried to regulate portions by proposing the “Sugary Drinks Portion Cap Rule” prohibiting certain places from selling sugar-sweetened beverages that exceeded 16-fluid ounces. While the intention of the regulation was not to ban sugar-sweetened beverages, but to assist consumers with portion control, industry succeeded in defeating this initiative – apparently the rule exceeded NYC Board of Health’s regulatory authority.

Since 2012, and despite the supportive research of reducing portion sizes, little has been done to execute an effective policy that would seek to ‘re-size’ all of our packaged foods and beverages to take them back to healthier portion sizes. With the 2020-2025 Dietary Guidelines around the corner, there is no better time than now for policy makers to make a difference. Consumers need and deserve a clear, authoritative voice to provide impactful and easy to implement guidance on portion sizes and portion control for all foods and beverages.

Collaboration to educate consumers: ‘Always a treat’ – National Consumers League

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As conversation hearts and boxes of chocolates start to appear across America this week, we’re reminded that candy plays a very special role in our celebration of Valentine’s Day.

We found some recent developments in the confectioner industry worthy of note this Valentine’s Day.

The National Confectioners Association (NCA) has joined with the Partnership for a Healthier America to provide consumers with more information about their favorite treats. Known as the Always A Treat Initiative, this is a 5-year collaboration to focus on transparency, portion guidance and choice, and consumer education.

NCA says that, over the next few years, consumers will begin to see more chocolate and candy options in smaller pack sizes, along with new products and more front-of-pack calorie labels. And, they tell us, many of those choices will be 200 calories or less. That’s a positive development. 

The data show that consumers enjoy candy about two or three times per week and average around 40 calories per day from chocolate and candy items. Sounds about right. I’m an “everything-in-moderation” believer myself, and as someone with a serious sweet tooth, a little candy goes a long way in satisfying my craving for sweets.

Providing more information and adaption to consumer demand makes sense for the industry. 

NCL likes the confectioner industry’s collaboration with PHA and the investment they are making in programs to help consumers to make better and healthier choices for themselves and their families. So enjoy the sweet treats that come with this holiday, and Happy Valentine’s Day!

Obesity doesn’t discriminate, but should preventive care be more personalized? – National Consumers League

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obesity.jpgBy Ali Schklair, Linda Golodner Food Safety & Nutrition Fellow 

It isn’t news that obesity is an urgent problem in our country. According to a recent study by the CDC, over one third of US adults are obese. Education and health professionals have presented numerous strategies to combat this growing epidemic. Still, in order to enact real change, there needs to be a greater focus on how overweight and obesity affects specific populations.

Growing up with a brother with disabilities, I was exposed to the many challenges my family faced trying to help him develop healthy habits. Nutrition and weight were always difficult issues to manage. As a kid, my brother was very skinny. He was taking a medication that sped up his metabolism and suppressed his appetite. My parents would beg him to eat anything, even if the food was mostly fat and sugar. But as he got older, changed medications, and moved out of the house, he began to gain weight. Traditional weight loss methods have not worked for him. My brother faces a unique set of challenges, but he certainly isn’t alone. 

Obesity rates for adults with disabilities are 58 percent higher than they are for adults without disabilities. Additionally, obesity rates for children with disabilities are 38 percent higher than they are for children without disabilities. These numbers put adults and children with disabilities at a much higher risk of developing weight-related diseases such as heart disease, stroke, type 2 diabetes, high blood pressure, and certain types of cancers.

So why are these rates so high? As is the case with my brother, many people with disabilities are prescribed medications that cause sluggishness or weight gain. Also, any physical disability affecting motor or balance issues, sight, or stamina can make getting enough exercise challenging. Many people with disabilities are sensitive to the taste, color, texture, and smell of certain foods, which can lead to limited food repertoires.

Along with physical or medical challenges, there are lifestyle differences that make weight loss for adults with disabilities especially difficult.  Adults with disabilities often rely on support staff, family members, job coaches, and nurses to help them through their day. Many adults with disabilities also have little control over their finances. This means food is often chosen and cooked for them, usually the quickest and easiest options.

The disability population faces a range of obstacles when it comes to addressing the obesity epidemic. But it is not just people with disabilities that face unique challenges. In its polling, the CDC has outlined how socioeconomic status, sex, and ethnicity can all contribute to the prevalence of obesity. Once we are better able to understand the barriers to eating healthy and getting adequate physical exercise, we can tailor strategies to address the unique needs of differing populations.