and rigid need for reform in our food environment, a reform i would say the ordinance before you this afternoon would be a critical improvement. citizens. i think the toy ordinance is a great example of the effectiveness of marketing. you would be the second jurisdiction in the state of california. it would incentivize healthy males. -- healthy meals. some data i have -- this individual spends $1,400 a year more. and that is 42% more than a non- obese one would spend. could you talked little about the cost? >> the study released last year looked at the cost in terms of health care costs and lost productivity for the state as of hold. the price tag is $4 billion. it is costing this community over $900 million a year. >> perfect courier -- perfect. >> this is a critical step in the fight against childhood obesity. while heightened awareness have helped, problems are increasing. here in california, the prevalence of obesity is declining for some groups but increasing for others. disparities are increasing and are deeply troubling. we see patients every week who are severely obese, yet despite our best efforts, once they walk through the doors it is too late. the environment for so many children, particularly low- income children and children of color, is on healthy. children who walk to and from school may be more fit than their peers who do not walk, but they may be fatter because they stopped to buy food. we need to enact legislation if we truly want to decrease childhood obesity and eliminate health disparities. >> it does been really helpful with developing the legislation. youwe have a paid lobbyist who s allegedly speaking on behalf of the nutritionist community. you have these credentials. you think it is an established fan of that has access to the types of -- established tenants that has access to the types of fast-food the volunteer childhood obesity? >> i am not a dietitian, but i would say that. >> you think that is a common belief? >> yes. >> i am of pediatrician and a faculty member. i would like to echo the comments said we do not think fast food is only reason. why i am concerned about the health of my patients. we see diseases on a regular basis. some are high blood pressure, even children with knee and back problems secondary to obesity these are basically diseases taught us adult onset diseases. the most concern is the scourge of pre-diabetes. there is a skin care of -- as skin condition you can see. this is something i see a on a daily basis. often these children are four or five years old. this is a very concerning. i think we have strong data of the links fast-food consumption to obesity dave. -- obesity hearing and we see parents for perhaps 30 minutes every few months, and we cannot fight against the massive amount of marketing dollars the food industry has we can try to educate, but i think we need more systematic approaches, and i think this is a wonderful start. >> can you give me an idea. at one way to we considered obese? is it 20 pounds, 30 pounds, 10? >> for children there is not a precise number, because it depends on that age. we look at the bmi. that is a body mass index. we have come to a designation looking at percentiles. if you're in that 85th percentile, you are considered overweight. greater than 90 is dobie's. a 3-year-old who weighs 60 or 70 pounds would be obese. >> the 9-year-old? can you give me her -- >> it depends on the heights of the child. they could ways significantly more but not be obse. >> i am going to read a couple of names. >> i am a resident pediatrician at uc san francisco. thanks for your time i think we all agree we want kids to eat healthier. if it is hard to expect even the most diligent parents can compete for the money is spent every year on toys for roughly marketed to kids, and there is no doubt the marketing works. it has been shown the marketing efforts strongly affect children's preferences and ultimate consumption of these foods as early as age 2 and into the teenaged years. it often comes as news to parents that the high fat foods are harmful to children and that many of them do not need the recently it -- do not meet their recent standards, which recommends 500 calories for breakfast, 650 for lunch. you find many of these meals have of boards of 900 calories, sometimes more, so parents must wonder if it is so clearly marketed to kids, how on earth could these meals ever be anything other than appropriate for healthy kids? many of them are not, and we know this. it should not be the parents have to wonder like this. chain restaurants should support these parents, and they should only use their marketing skills to promote those mills fed are appropriate for healthy kids. we're looking to shift things -- to promote those meals that are appropriate for healthy kids. >> thank you. >> my name is matt richardson, and i live-in districts to very good -- district two. >> you have to speak directly into the microphone. >> i live in district two, and i have a clinical agreed. i am here to speak because i am happy to talk to patients on a weekly basis about weight management. oi am talking about people who are too heavy to perform moderately vigorous activity. obesity is a risk factor such conditions at of to a low quality of life and increase health care bills. i believe it addresses of population that is at risk in addition, when children leave their house, there have with our already is set. the organization for economic cooperation and development says the united states is leading the charge. three of the four americans will be obese by 2020. this is a perfect example. one of the steps is important. >> i did see this, and i noted america has the highest risk of childhood obesity in developed nations. is that one of the conclusions from the report? a lot of chinese officials were saying they are seeing obesity and overweight going up in direct connection with the introduction of fast food places, but i think they were noting that on a global level the mediterranean diet is great, but all that goes away when they moved to america of. >> i am going to read several more cards. >> i believe these are fun house see kids, coming from the parents. the parents do not do their job could. if they are busy working. then they bring their kids to macdonald or buy food for their kids for the toy is. my nephew lights the kids. -- likes the kids. the toy also gives them a chance to tell the story. i believe the legislation should be how to educate the parents. the selection is by the parents. the money isn't their pockets. -- is in their pockets. they have the choice to choose healthy food, not mcdonald's. >> i come to you with three hats. our goal is to improve nutrition low income children received. i was old enough to be aware of the difference it made to me and my ability to socialize and do well in school. it is tied to malnutrition for many kids. one thing i heard today was that as parents, your legislation will undermine the mi5 authorities -- my authority. yei have never heard of any my friends do that with their children at home. why are they enticing my children with a choice? we set them, and they work to get to the point where they can achieve the goals. we are doing a program where people get an extra $10 worth of produce. that is the kind of thing we should do. we mean multifaceted solutions. i encourage you to help san francisco where we take bold steps. >> i just wanted to give crops -- props for pretty much demanding to make major changes. >> i am on that committee, though i am not speaking on behalf of the committee today. >> i am going to read a few more. >> my name is albert staying -- chang. i am the director. we urge you to drop this recommendation. if you add one more, it is very tough. secondly, i read another expert testimony today. i do not blame the legislature because of my problem. you said more regulation does not help. i wish she would concentrate -- you would concentrate on legislation. they can expand overseas. we know the mcdonald house did provide free room and board for the parents, and they provide a lot of scholarships for the asian students the reagan -- for the asian students. >> thank you yhuri go -- thank you. >> he is just adding to the line. >> as your name is called, when you can speak, please do so very dead -- please do so. >> i think mcdonald's has improved the formula calls for many years of rock. a good -- for many years a lot. they are changed to french fries and meals a change to soda. many years they care about the trial with many results. have been to china, hong kong, macao, and taiwan, and many restaurants where the children have not so many problems about healthy of syria -- about healthy. why only the usa or send francisco the children get on how of it, -- unhealthy. i think education is the problem, not made donald syria and -- not make donald. -- mcdonald's. mcdonald's is not the problem. the parents get their food from mcdonald's and not from their -- sorry about that. it is not the problem how. also the problem is education. >> thank you spirited -- thank you. >> i wanted him to respond to some of the marks being made. thank you so much for being here. i think it is a fact that americans are not eating as many vegetables as they should. but does not mean we should not be taking many more efforts to try to move in that direction. she said few of the males would meet those standards. i would assume it is much greater at this point. it is an apples and oranges comparison. >> to explain what you mean by that. >> the survey that the doctor did? >> it is a survey of dietary histories and not what was in the play. a number of comments relayed to the feasibility. this is something the department really wants to hear about. so far the major concern seems to be about the vegetables. i think we would like to know what the barrier is. we know we can take vegetables for school children. we know school children are eating vegetables
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