Childhood Obesity Prevention in Texas: Workshop Summary (2009)

Texas State Senator Jane Nelson, Chair of the Senate’s Health and Human Services Committee, and Comptroller Susan Combs each spoke about their successful efforts to pass school-based health initiatives in Texas. Both explained that these successes were hard won, and described the challenges they faced and the strategies they used to overcome them.

Nelson believes that “prevention is the solution.” Her involvement in childhood obesity prevention in Texas began several years ago when a concerned parent notified her that schoolchildren were sitting most of the day at their desks except for a short lunch period. Upon investigating the issue, Nelson found that in the prior legislative session, the Texas Education Code had been rewritten to omit physical education requirements. As a result, most schools had eliminated physical education and devoted the time instead to academic instruction. Nelson assumed it would be easy to reinstitute the physical education requirements but found that the process was incredibly difficult. The initial bill put forth mandated physical education instruction for all children in grades K–12. School administrators and educators balked at the bill, arguing that this time was essential for academic achievement. The bill had to be cut back twice—first covering only kindergarten through middle school and then covering only kindergarten through elementary school—before it finally passed the Senate in 2001. Since this early win, Nelson has continued her efforts to increase physical education activities in schools; she succeeded in expanding the requirements in 2005 and 2007.

Nelson noted that incorporating physical education requirements into law is sometimes not enough. Some schools failed to implement physical

education programs after the laws were passed, illustrating the need to ensure that such laws are enforced.

Nelson identified helping the public and policy makers understand the significance of the obesity problem as the greatest challenge. A major concern is the cost of physical education programs. One way to address this concern is to present data comparing the cost of such programs with the costs that will be incurred if the childhood obesity trend is not reversed. Nelson and Combs worked together to publish a report on the cost of obesity to Texas businesses. This report, Counting Costs and Calories (Combs, 2007), showed that the current direct and indirect costs of obesity to state businesses due to decreased productivity, disability, and absenteeism total $3.3 billion annually. This number is predicted to surge to $15.8 billion by 2025 without intervention.

Nelson also stressed the importance of obtaining public support. Some individuals do not understand the threat of childhood obesity, nor do they feel that government should be involved in what their children eat and whether they exercise. Nelson believes government intervention is warranted if it reduces governmental exposure to high health care costs in the future and if it helps enhance academic achievement. Educating the public about the childhood obesity issue and the potential academic, fiscal, and social consequences is an essential element of passing health-promoting legislation. To this end, Nelson and her colleagues are working to link Fitnessgram data to report card marks and test scores, discipline problems, and absenteeism to demonstrate the connection between physical fitness and academic achievement.

Combs has been instrumental in mobilizing schools to eliminate vending machines and improve the quality of food they offer. She explained that before 2003, schools controlled their own nutritional environment, and the Texas Education Agency oversaw the school meals programs. Many schools had exclusive beverage contracts with soft drink companies under which they received higher revenues for selling soft drinks than water. Despite unassailable data showing the negative effects of food of poor nutritional quality and despite testimony to that effect by Combs (then elected as Commissioner of the Texas Department of Agriculture) and Eduardo Sanchez (then Commissioner of the Texas Department of Health), in 2003 the Texas Senate failed to vote out of committee a bill that would have curbed the sale of junk food in schools. “We found it shocking that the facts did not matter. The facts were inconsequential. And so we had to do it by fiat,” said Combs.

Undeterred, Combs devised another strategy for tackling the problem, previously used in New Jersey. The Texas Department of Agriculture gained jurisdiction over the nutritional environment within public schools by becoming the designated state agency for federal monies granted by the U.S.

Department of Agriculture (USDA) for school meals—funds totaling roughly $1 billion, as Texas is the largest consumer of school food in the country. This allowed the state in 2003 to issue the Texas Public School Nutrition Policy, which banned foods of minimal nutritional value in elementary schools—a policy that exceeds the standards required by USDA. Combs noted that this is a replicable strategy for other states, particularly those in which the agricultural commissioner is elected rather than appointed.

When Combs became comptroller, she leveraged her position of controlling Texas finances to institute physical education in middle schools attended by at least 75 percent educationally and economically disadvantaged students. To this end, Combs, working with Nelson and the Texas Education Agency, was able to zero out the cost of physical education for schools that applied for grant monies. As a result, 577 schools attended by approximately 250,000 Texas middle school students participated in the program, which provided 30 minutes of physical activity a day or 225 minutes over 2 weeks. Combs noted that 25 percent of the funds were earmarked for nutrition education.

Having made such significant strides in the school setting, Combs is now turning her attention to the adult employment community. She noted that the state cannot afford an unhealthy population of employees, many of whom serve as role models for their children. Several workplace wellness programs have been initiated at various Texas companies; many of these companies are realizing financial savings due to reduced health care expenditures (Table 4-1). “All of these employers are understanding that if

you have a healthy workforce that is ready to work, it makes good sense to your bottom line,” she said.

Like these Texas businesses, state government offices, including Combs’s department of 2,800 employees, have instituted wellness policies. These policies include up to 16 hours of time off per year for physical activity, Weight Watchers programs, pedometer contests, and delivery of fresh farm food to the workplace, among other strategies. Combs and Nelson are currently discussing ways to incentivize other businesses in Texas to follow models of worksite wellness.

Combs, S. 2007 Counting Costs and Calories: Measuring the Cost of Obesity to Texas Employers. Texas Comptroller of Public Accounts. http://www.window.state.tx.us/specialrpt/obesitycost/96-1245costs calories.pdf (accessed October 5, 2009).