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.



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