Jeffrey Koplan, Chair of the IOM Standing Committee on Childhood Obesity Prevention, opened the workshop by providing background information on the IOM’s long-standing interest in childhood obesity prevention. Through its nutrition and health-promotion programs, the IOM has long been involved in advancing healthy eating and physical activity in the United States. These efforts include the two reports described in Chapter 1: Preventing Childhood Obesity: Health in the Balance (IOM, 2005) and Progress in Preventing Childhood Obesity: How Do We Measure Up? (IOM, 2007). The research documented in these reports made clear that childhood obesity is not a short-term problem but one that will challenge the nation for decades to come. Although these reports and the efforts of the IOM’s Standing Committee on Childhood Obesity Prevention have helped define the scope of the childhood obesity epidemic and various contributing factors, a set of effective, proven strategies for preventing and reversing the growing problem is lacking. The committee chose to hold this workshop in Texas because actions being taken by individuals, community groups, schools, legislators, and government at all levels to combat obesity make the state a valuable case study. Through the workshop, the committee sought to learn about the programs that have been implemented in Texas, their effectiveness, and the potential keys to their success, gathering useful information that could be disseminated to other communities and states.
David Lakey, Commissioner, Texas Department of State Health Services, highlighted the salience of the workshop by noting the point made in Chapter 1 that, according to a report by the Texas state demographer (issued just 1 week before the workshop), the number of obese Texans will
triple by 2040 if the state fails to strengthen preventive efforts in the near future. Lakey provided additional sobering statistics:
Over the last seven years, the obesity rate for young adults in Texas has increased from 10 to 20 percent.
As noted in Chapter 1, in 2007, two-thirds of Texas adults and one-third of Texas high school students were either overweight or obese.
In 2007, more than 20 percent of low-income children aged 25 who were enrolled in Texas’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were overweight or obese.
Given such statistics, Lakey stated that Texas leaders increasingly understand the severity of the childhood obesity crisis. He reinforced this point by quoting Governor Rick Perry’s recent state address:
If we do not tackle this problem, not only will this generation of children be the first to have a shorter average life span than their parents, but we will never get a handle on preventable diseases like diabetes, heart disease, and even some cancers. Let's address obesity where it makes the most difference, most quickly, with our school children.
Austin Mayor Will Wynn explained that when he assumed office in 2003, he learned that the city was ranked 19th or 20th among the fittest cities in the country. Although disappointed that Austin was not ranked higher, he was heartened by the fact that it was the only city south of the Mason-Dixon Line that had made the list. From that point forward, he endeavored to improve Austin’s fitness rating through a variety of means.
To reduce the $100 million the city spends each year on health care for its 12,000 employees—roughly half of which is accounted for by preventable illnesses—Wynn instituted the Mayor’s Fitness Council in 2004 to raise awareness of the costs of health care, promote better health and the prevention of chronic disease, and advance the city as a healthy place to live and work. Community stakeholders represented on the council included senior advocates, nutritionists, a behavioral psychologist, major employers, small employers, individuals from the public and private sectors, and children’s activity advocates. The council aims to support and inspire people to improve their fitness by encouraging physical activity and improved nutrition. Wynn advocates his own cause by running or walking to work every day.
The City of Austin also seeks to support the health and fitness of its employees by offering flex time, an active physical education program during business hours, showers at all city facilities, and bike racks. In addition,
Wynn has partnered with the medical community to develop the Austin Fitness Index, which establishes objective, scientific benchmarks for measuring improvements in physical activity, nutrition awareness, and wellness across the city. Using this index, Austin is seeing a positive trend in the cessation of tobacco use, due largely to its stringent antismoking ordinances.
Kenneth Shine, former President of the IOM, currently serves as Executive Vice Chancellor for Health Affairs for the University of Texas System. In this position, he has worked to raise the visibility of public health in the state. Shine began his presentation by referring to his own struggle with obesity and likened it to a chronic form of food addiction that, unlike other forms of addiction involving alcohol, drugs, or cigarettes, cannot be eliminated from daily life. Therefore, it is important to help children at very young ages develop internal control systems through which they can balance food intake and daily activity to maintain an ideal weight.
Shine commented that Texas is a particularly challenging state from a public health perspective given its substantial proportion of individuals with no health insurance. Code Red: The Critical Condition of Health in Texas, a survey of health insurance coverage in the state published in 2008, reports that Texas has the highest percentage of uninsured individuals in the United States. As a result, the state bears an especially high economic burden for the provision of health care. Medicare and Medicaid costs attributable to obese Texans total more than $5 billion annually, and future health care expenditures are predicted to skyrocket if the statewide surge in obesity is not brought under control. Said Shine, “The future … for the state is terrifying, because with our high rates of obesity, associated with diabetes, hypertension, and other chronic illnesses, we are looking at health care expenditures that are going to go through the roof…. The economics of access to [health] care in Texas, and the rest of the country, depend critically on whether we get control of obesity.” These health care costs threaten to negate the many economic advantages offered by Texas, including its lack of an income tax, its large concentration of Fortune 500 companies, and its popularity for business relocation.
With respect to children, the Code Red report concludes that promoting the health of children and their parents—whether insured or uninsured—requires health care systems built around patient-centered medical homes that provide coordinated, comprehensive care, including medical, dental, mental health, substance abuse, and preventive services. The report also recommends that Texas continue to strengthen efforts to offer integrated approaches to school health that emphasize nutrition, exercise, dental health, and disease management. Shine commented that since Texas is one of six states not facing a budget deficit in 2009, it is arguably well positioned to invest in these and other health care initiatives, which he believes will ultimately allow the state to prosper well into the future.