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August 2009

A Plus-Sized Problem

Pilot program hopes to take bite out of childhood obesity.

by Mark Wangrin

Growing Enrollment

Obesity is generally defined through the Body Mass Index, which divides a person’s weight in kilograms by his or her height in meters squared. A BMI of 25 or more signifies being overweight; 30 or more is considered obese. A more complicated formula, which also factors in age and maturity, is used to determine obesity rates among children and adolescents.

As soon as he finished residency in 1982, Dr. Jose Gonzalez set about making his private practice in pediatric endocrinology grow. And grow it did – in ways he couldn’t imagine.

“The most alarming thing was seeing a 14-year-old who weighed 400 pounds,” Gonzalez says. “There are so many little faces like that you see and you say to yourself, ‘Oh my God.’”

Now Gonzalez is medical director of the Texas Health and Human Services Commission (HHSC). He’s in a position to do something substantial about runaway childhood obesity rates, which are looming as potentially devastating threats to Texans — and the state economy — in the next quarter-century.

“If it’s not the worst problem health care is facing today, it’s one of the worst,” Gonzalez says. “This has to be attacked. Health care is very good at [treating] complications from obesity, but not the prevention of it.”

Texas ranks 20th in the nation in childhood obesity, with 32.2 percent of children ages 10-17 considered obese, according to the 2007 National Survey of Children’s Health published by the National Center for Health Statistics. Though the state’s ranking dropped from sixth in the previous study, which covered 2003-04, its prevalence of obesity rose from 19.1 percent.

Over the next 16 years, the Comptroller’s office projects that Texas’ adult obesity rate could rise to 46.8 percent, driving the annual average health care cost per worker up by nearly 500 percent, to almost $1,300.

Tackling the Problem

The 2009 Texas Legislature sank its teeth into the problem, passing seven bills aimed primarily at improving nutrition, increasing physical activity and decreasing obesity rates among children. Among other measures, Gonzalez will help oversee a pilot program to tackle obesity and related health complications among Medicaid and Children’s Health Insurance Program recipients.

Paying by the Pound

If Texas cannot limit and reduce its obesity rates, the impact on the state’s economy could be significant. Based on current trends, the Comptroller’s office estimates that each obese worker’s health problems could cost his or her employer more than $1,600 annually.

Cost Per Worker (2005 dollars)
Year Obesity % Health Care Absenteeism Disability
2005 27% $480.23 $205.81 $40.29
2010 32.9% $597.82 $232.58 $45.53
2015 37.9% $773.48 $255.03 $49.92
2020 42.5% $987.18 $280.32 $58.87
2025 46.8% $1,259.92 $308.66 $60.42

Source: Texas Comptroller of Public Accounts, Counting Costs and Calories: Measuring the Cost of Obesity to Texas Employers

The pilot program legislation, sponsored by State Senator Jane Nelson of Flower Mound, aims to lower obesity rates by better educating children on making sound food and exercise choices. The wording of the bill was intentionally broad to allow latitude in developing an effective program, Nelson says.

“We wanted to give the agency as much flexibility as possible to collaborate with experts around the state in developing this pilot,” she says.  “Too many restrictions can sometimes stifle innovation.”

HHSC has just begun formulating the program.

Funding issues also need to be settled. The original bill containing the pilot program had a contingency rider that provided about $7.1 million in general revenue for its provisions, including the obesity pilot program. In the rush to pass legislation in the closing days of the regular session, however, the pilot program was rolled into Senate Bill 870, an act sponsored by State Senator Eddie Lucio of Brownsville, which also creates an Interagency Obesity Council to promote awareness of the condition and related illnesses. SB 870 was passed in the late-session flurry, but some details were left unsorted.

Obesity Report

For more information on obesity, see the Comptroller study Counting Costs and Calories: Measuring the Cost of Obesity to Texas Employers.

“We wanted to give the agency as much flexibility as possible… Too many restrictions can sometimes stifle innovation.”

– State Sen. Jane Nelson

The Legislative Budget Board is reviewing the rider to see how funding for the pilot program can be obtained, says Dave Nelson, spokesman for Sen. Nelson. HHSC estimates the program would cost about $2.2 million, about half of that to come from federal matching funds, he says.

“My hope is that this pilot will demonstrate the value of investing in prevention, both in promoting wellness and achieving cost savings in these programs,” Sen. Nelson says.

Exercise and better nutrition are only part of the equation. Gonzalez says that educational outreach designed to replace bad eating and activity habits with sound, healthy ones can take time.

“We have to be willing to be patient for the effect,” Gonzalez says. “Everybody wants a quick fix. That’s why people go to surgeons for bariatric [gastric band] solutions. But you cannot always do that.” FN

The Legislative Skinny

The 2009 regular session of the Texas Legislature passed seven pieces of legislation geared toward fighting growing childhood obesity rates.

  • SB 282 creates three Department of Agriculture grant programs to provide nutrition education to children in pre-school and child-care settings.
  • SB 283 strengthens the role of School Health Advisory Councils.
  • SB 292 requires schools to include goals and objectives for their Coordinated School Health Program in their annual Campus Improvement Plan.
  • SB 343 forms an advisory committee to study the availability and funding for fresh food retailers in underserved areas.
  • SB 395 authorizes the Early Childhood Health and Nutrition Interagency Council to create a six-year state plan to reduce obesity and improve nutrition and physical activity among children.
  • SB 870 requires the Health and Human Services Commission and the Department of State Health Services to establish a pilot program to fight obesity, improve nutrition and increase physical activity among Medicaid and CHIP recipients.
  • SB 891 defines physical education in the Education Code to ensure that students in P.E. classes receive a health benefit from them.

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