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Introduction and Executive Summary

Everything’s Bigger in Texas

The phrase, “Everything’s bigger in Texas,” rings true when we consider the current state of Texans’ health. Nearly two-thirds (64.1 percent) of the state’s adult population is overweight or obese.

The majority of adult Texans, men and women alike, are overweight or obese. This is equally true for Whites, Blacks and Hispanic Texans, and for every category of income and educational attainment.

And obesity is on the rise. In 2005, there were nearly 3 million more obese adults in Texas than in 1990. Only 12.3 percent of Texas adults were obese in 1990; by 2005, that share had more than doubled, to 27.0 percent, well above the national average of 24.4 percent.

The Co-Morbidities and Costs of Obesity

The bottom line: Obesity cost Texas businesses an estimated $3.3 billion in 2005. This figure includes the cost of health care, absenteeism, decreased productivity and disability.

Most of the cost of private health insurance is borne by America’s employers. Since 2001, their health insurance premiums have risen by an average of 68.2 percent. The national epidemic of obesity is a major factor in rising health care costs and skyrocketing health insurance premiums, as well as lost productivity and absenteeism among Texas’ workforce.

Obesity generates more health care costs than either smoking or drinking. According to a 2002 study by Roland Sturm, a senior economist with RAND Corporation, obese people spend 36 percent more on health care services and 77 percent more on medications than their normally sized counterparts.1 The same study reported that smokers spend 21 percent more on health care services and 28 percent more on medications than nonsmokers. The corresponding numbers are even lower for problem drinkers.

Being overweight or obese increases one’s risk of acquiring costly, chronic illnesses, or co-morbidities, such as coronary heart disease, hypertension, stroke, congestive heart failure, high cholesterol, diabetes, osteoarthritis, gallbladder disease, asthma, sleep apnea and certain cancers. A prominent example of obesity’s effects is diabetes.

Eighty-two percent of type 2 diabetics in the U.S. are either overweight or obese. Various medical studies have explained how being overweight puts added pressure on the body’s ability to properly control blood sugar, and therefore makes diabetes more likely. In many of these cases, relatively small reductions in weight can delay or even reverse the effects of the diabetes.

The same is true with other obesity-related illnesses, as well as with obesity-related deaths. One study in the New England Journal of Medicine, for example, found that up to 20 percent of all cancer deaths are attributable to overweight and obesity.

Roland Sturm said it best:

Obesity has roughly the same association with chronic health conditions as does twenty years’ aging; this greatly exceeds the associations of smoking or problem drinking. (2002)2

These diseases cost employers—directly in higher health care costs and indirectly through lost productivity when workers are out sick, disabled or simply not functioning up to standard.

It Begins with Children

Sadly, the epidemic begins at an early age. In a Texas-specific study conducted from 2004 to 2005, researchers found that 42 percent of fourth graders were overweight or at-risk-of overweight, as were 39 percent of eighth graders and 36 percent of eleventh graders.

These children face lives filled with illness and limitations—and the prospect of early death. “If we don’t get this epidemic in check, for the first time in a century children will be looking forward to a shorter life expectancy than their parents,” said Dr. William J. Klish of Texas Children’s Hospital, in a 2002 Houston Chronicle article.

And children of obese parents face the additional risk of losing their parents to the debilitating and often fatal diseases that obesity can cause.

By 2025, many of today’s overweight children will be entering the work force as overweight or obese adults, at a considerable cost to their employers. If the prevalence of obesity continues rising as it did during the last decade, by 2025 46.8 percent of Texas adults will be obese.

If this trend continues, obesity could cost Texas businesses $15.8 billion annually by 2025.

Fixing the Problem

So what can be done to reverse the effects of the obesity epidemic and its associated costs to Texas employers?

Many private Texas employers already recognize the costs associated with workers who suffer from obesity and related illnesses. They realize something must be done to combat this problem.

The 2007 Texas Legislature has taken important steps to improve the lives of tomorrow’s workforce by introducing legislation aimed at instituting more physical education in public schools. Almost all school districts have removed foods with minimal nutritional value from cafeterias, and many districts are removing them from vending machines as well.

And many Texas companies are shifting their health care focus from disease treatment to prevention, in an effort to reduce future health care costs for preventable diseases.

The most successful of these programs offer financial incentives to employees, such as lower health insurance deductibles or company-paid gym fees, as well as other programs designed to encourage employees to choose healthy lifestyles.

Most such programs take from three to five years to show a return on investment, but those returns can be significant when they materialize.

Experts interviewed for this report agree that decreasing the prevalence of obesity, and thus slowing the rise in health care costs, will require a coordinated effort by the public sector, private enterprise and local communities. They must make a joint commitment to educate and to communicate the benefits of wellness activities and healthier behaviors.

Ultimately, of course, only the individual can be held accountable for the lifestyle choices he or she makes. But employers can promote wellness and provide their workers with incentives, knowledge and opportunities to make healthy choices in life.


  1. Roland Sturm, “The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs,” Health Affairs (March/April 2002).
  2. Roland Sturm, “The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs.”

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