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Poor diet and inactivity hurt children and state's future
Trimming the Fat

Empty calories and empty playgrounds could lead to empty coffers in Texas. More than a third of the kids in Texas schools are overweight, according to Texas Health Commissioner Eduardo Sanchez, and that means future health hazards for children and fiscal hardships for the state.

In April, Sanchez told the Joint Interim Study Committee on Nutrition and Health in Public Schools that the number of overweight Texans will double by 2040. Their health care costs are also expected to double.

Obesity not only causes serious illnesses, such as diabetes, heart disease and gallbladder disease, but it is also draining state resources, he said.

Bulges cost billions
In 2001, overweight or obese adults cost Texas $10.5 billion. That includes the direct costs of health care and the value of lost productivity, illness, disability and premature death, according to Dr. Margaret McCusker, a Centers for Disease Control and Prevention (CDC) representative assigned to the Texas Department of Health (TDH).

Moreover, Texas' children are more overweight than the national average, McCusker said. Thirty-five percent of Texas' school-age children are overweight, compared with an average of 15 percent nationwide, she said.

"The number of children in the U.S. who are defined as overweight doubled in the past 30 years, and we assume the same trend applies in Texas," she said. "And as the number of children who are obese or are at risk of becoming obese increases, the cost of obesity also will increase."

The CDC reported overall public and private spending of more than $5.3 billion in Texas for obesity-related illnesses in 2003. That figure does not include lost work time, decreased productivity or other indirect costs.

The CDC estimates that in 2003, the Texas Medicaid program--sponsored by the federal and state government to provide health care for the poor--spent $1.2 billion on obesity-related illnesses. State and federal Medicaid spending for elderly Texans topped $1.2 billion for obesity in 2003, according to the CDC.

Number-two killer
The CDC announced in March 2004 that a combination of poor diet and physical inactivity is the second-highest cause of preventable death in the country after tobacco, claiming 400,000 lives in 2000, a 33 percent increase over 1990. The CDC also predicted that poor diet and physical inactivity will be the top killers by 2005.

Children do not get enough physical activity because they watch too much television, play too many video games and spend too much time on the Internet, according to the TDH's Statewide Obesity Task Force's February 2003 Strategic Plan for the Prevention of Obesity in Texas.

A 12-year-old child who is overweight has a 75 percent chance of being overweight as an adult. Moreover, an obese 30-year-old has roughly the same medical costs as a 50-year-old of normal weight, the task force reported.

The treatment of obesity in children is just as ineffective as in adults, the task force concluded. The group said prevention is a much more logical approach to weight control.

The Texas Legislature and state agencies are trying to help children develop healthy eating habits and routines of physical exercise that could help them stay fit.

On the playground
Recognizing the danger children face, the 2001 Legislature passed Senate Bill 19, requiring physical activity in public kindergarten and elementary schools. In March 2002, the State Board of Education mandated a minimum of either 30 minutes of physical activity each day for children in these grades or 135 minutes per week.

Middle and high school students don't have a minimum weekly requirement. To graduate from high school, students must have 1.5 credits of physical education and one semester of health education.

While the requirement for elementary school is a great start, more is needed in middle school and high school, said Michelle McComb, manager of TDH's Adolescent and School Health program.

"For children to learn, they must first be healthy," she said. "The school districts, however, are between a rock and a hard place. They have limited funding and pressure to improve test scores and a limited number of hours."

The Legislature also ordered school districts to provide coordinated school health programs in elementary schools aimed at reducing the risk of obesity, cardiovascular disease and Type 2 diabetes by 2007. The Texas Education Agency (TEA) approved two programs before the 2003 Legislature required the agency to adopt rules for evaluating these programs. The rules, effective on May 2, are at rules/home/coeadopt.html.

Some districts offer programs, such as Coordinated Approach to Child Health (CATCH), to help kids learn to adopt a healthier lifestyle. More than 1,400 Texas elementary schools have adopted the CATCH curriculum, said Peter Cribb, CATCH project director. The program has trained school personnel at more than 500 schools to meet the requirements of the bill, he said.

"CATCH staff train, at a minimum, a food service manager, a classroom teacher and a physical education teacher from each school because it's essential they know what each other is doing so they can work together and provide a coordinated effort that will positively change the school environment and, subsequently, children's physical activity and health behaviors," Cribb said.

The program helps more students, and not just athletes, become more active, said Lisa Bunting, a physical education teacher at Gene and Betty Schmalz Elementary School in Katy, Texas.

"I have kids coming up to me and telling me, 'Hey, I ate my green beans today,' and that didn't happen before," she said. "The kids are seeing the connections and telling their parents what they're eating and what they shouldn't be eating. I heard from one parent who said their family could no longer super-size their meals. Their child said regular portions were enough."

In the cafeteria
Texas public schools serve 400 million lunches and nearly 200 million breakfasts each year, according to the Texas Department of Agriculture (TDA). The meals the state's 4.2 million public school children eat at school affect their eating habits and their health.

"Children may not survive their parents because of obesity," Texas Agriculture Commissioner Susan Combs warned. In March 2004, Combs revised TDA policy for all public schools participating in the National School Lunch Program, School Breakfast Program and the After School Snack Program.

The new policy, effective August 1, 2004, will limit the number of grams of fat and sugar schoolchildren may have each week. The policy will also eliminate deep-fat frying after a phase-in period. TDA not only will reduce the portion sizes for foods such as chips, cookies and frozen desserts, but also will restrict the sale of foods that compete with school meals, such as food from vending machines or bake sales.

In addition, new limits will be set on the sale of sugared, carbonated beverages. Servings of French fries may not exceed three ounces, may only be served once a week and students may only buy one serving at a time. And schools that serve milk must offer 2 percent, 1 percent or skim milk.

The new policy also requires districts to offer fruits and vegetables daily, and by the 2006-07 school year, all juices sold should be 100 percent real fruit or vegetable juices.

In the community
S.B. 19 also authorized the creation of local school health advisory councils (SHACs) to provide community input on health-related issues. The 2003 Legislature expanded SHACs' duties to include making recommendations on obesity prevention curriculum in schools.

Only 10 percent of the public school districts, however, have active SHACs, according to State Sen. Eddie Lucio Jr., who serves on the Joint Interim Study Committee on Nutrition and Health in Public Schools.

Lucio says every school should have a SHAC or Wellness Program that addresses nutrition, physical activity and other health components.

"The thought of so many young children developing life-threatening illnesses like diabetes compelled me to file the bill that [created the study committee] to help us work together as nutrition and medical experts, families and communities, to improve nutrition and health in our public schools," Lucio said.

Pam Wagner