The AOA aggressively lobbied to make obesity an LHI, beginning in October, 1998, with a presentation of oral comments at a public hearing in Philadelphia. AOA representatives also appeared at public hearings in Chicago (November, 1998) and Sacramento (December, 1998) as well as at a November meeting of the Healthy People Consortium in Washington, DC. In June, 1998, the AOA joined the consortium, which encompasses national membership organizations and government agencies.

The AOA’s 75 pages of written comments, titled Obesity: Increasing the Understanding of a Neglected Public Health Hazard, sparked interest in the public health community and influenced federal policy. The comments were submitted to the DHHS in December, 1998.

A Flawed Design

Healthy People 2010 contains 467 national health objectives, grouped into 28 "focus areas." Except for Overweight and Obesity, each LHI is assigned a distinct focus area with numerous objectives. For example, Physical Activity has 15 objectives and Tobacco Use has 21.

In contrast, the Overweight and Obesity LHI is subsumed by the Nutrition and Overweight focus area and is given only three objectives:

• Healthy weight in adults,


• Obesity in adults, and


• Overweight or obesity in children and adolescents.

The remaining 15 objectives in the focus area are mainly nutrition-oriented. Overweight and Obesity is further minimized by its placement in the sub-category of Weight Status and Growth, which contains an objective unrelated to obesity: Growth Retardation in Children.

The DHHS defines the development of obesity as "a complex result of a variety of social, behavioral, cultural, environmental, physiological, and genetic factors." Yet the department insists on treating obesity as an objective related only to nutrition.

According to the DHHS, LHIs "serve as a link" to the objectives in Healthy People 2010 and "can become the basic building blocks for community health initiatives." The AOA applauds the department for defining Overweight and Obesity as a basic building block. The structural integrity of the design is compromised, however, by the absence of a separate focus area for obesity.

"Healthy People 2010 is described as a road map to improve health for all people, but with obesity, the Department of Health and Human Services has forgotten the compass," said Morgan Downey, AOA’s executive director. "The DHHS has in essence said, 'You Are Here' on the map, and now it’s up to you to get to your destination. Reducing the prevalence of overweight and obesity are destinations that require detailed directions. Waiting until the year 2020 could lead Americans to a dead-end, continuing to search aimlessly for ways to prevent and treat obesity."

"Healthy People 2010 is an important document that addresses various health issues, several of which are associated with obesity," continued Downey. "To complement Healthy People 2010, the AOA developed Healthy Weight 2010 that health professionals, public health officials, managed care organizations and policy makers can use for guidance. The AOA looks forward to partnering with these groups."

Healthy People 2010 can be found on the Internet at www.health.gov/healthypeople

Leading Health Indicators

The LHIs, which represent a snapshot of the nation’s health, were chosen for their relevance, their ability to motivate action and the availability of data to measure progress. For each LHI, progress will be monitored at national and state levels. The 10 LHIs are:

• Physical Activity


• Overweight and Obesity


• Tobacco Use


• Substance Abuse


• Responsible Sexual Behavior


• Mental Health


• Injury and Violence


• Environmental Quality


• Immunization


• Access to Health Care