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Today’s Children
Tomorrow’s Work Force

 Prevalence of Overweight in U.S. Children: Exhibit 23

The future trend of our obesity crisis depends on today’s children and their ability to learn healthy lifestyles.

The National Health and Nutrition Examination Survey (NHANES), a study of U.S. adults and children conducted by the U.S. Centers for Disease Control and Prevention, has documented a dramatic increase in the prevalence of overweight American children. According to NHANES data, 6.1 percent of U.S. children aged 12 to 19 were overweight during the period of 1971 through 1974; in 2003 and 2004, by contrast, 17.4 percent of children were overweight in this age range (Exhibit 23).1

Overweight children are likely to remain overweight or become obese adults. The U.S. Surgeon General has reported that 70 percent of overweight children will become overweight or obese adults.2

In a Texas-specific study conducted from 2004–2005, researchers found high rates of overweight and at-risk-of overweight among children; 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.3

In a 2002 Houston Chronicle article, Dr. William J. Klish, of Texas Children’s Hospital was quoted as saying:

“If we don’t get this epidemic [of childhood obesity] in check, for the first time in a century children will be looking forward to a shorter life expectancy than their parents.” (2002)4

These children, as obese adults, will contribute more than their normal weight counterparts to the higher costs of health care and losses in productivity.

The Future of Obesity

By the year 2025, many of today’s overweight children will be entering the work force—at a considerable cost to their employers. Using logistic modeling the Comptroller estimates that 46.8 percent of Texas adults will be obese and 14.4 percent will be normal weight by 2025 (Exhibit 24). In that year, the Comptroller estimates that there will be a total of 10.6 million cases of adult obesity in Texas, more than 9.1 million new cases since 1990.5

 Projected Adult Obesity Trends in Texas 1990-2025: Exhibit 24

In the exhibit below, the dashed lines project obesity versus normal weight prevalence. At this rate, the number of obese Texas adults will surpass the number of normal-weight Texas adults after 2008.6

Future Costs

The Comptroller estimates that obesity cost Texas businesses and private insurers $3.3 billion in 2005. This cost includes health care costs and those due to absenteeism, presenteeism and disability.

If we project these costs out to 2025, and account for the increase in the prevalence of obesity estimated earlier and the increase in the working population, obesity and obesity-related illnesses could cost Texas businesses $15.8 billion in 2025. Health care costs will comprise more than 55 percent of the total cost, at $8.8 billion; absenteeism will account for $2.1 billion; presenteeism will account for $4.5 billion; and disability will account for $420 million (Exhibits 25 and 26).

For more detail on future cost projections, see Appendix 3.


Every Texan should be concerned about the growing obesity epidemic. Today, nearly two-thirds of Texas adults are overweight or obese, putting them at risk for heart disease, stroke, diabetes, cancer and hypertension. If current trends continue, the number of overweight and obese citizens will grow so rapidly that many Texas businesses may not be able to survive. What some observers fear is that health care costs will outpace profits and make many businesses uncompetitive.

“Employers are not choosing to become involved in waging the war on obesity—they are already involved. Employers today are paying a high price in health care costs, lost productivity and absenteeism due to disability and even death connected to obesity.”7

—LuAnn Heinen, director, Institute on the Costs and Health Effects of Obesity, National Business Group on Health (2005)

One major company representative who spoke with the Comptroller’s review team found that its health care costs were increasing by 27 percent per year. At this rate, the company estimated its health care costs would overcome its profits within five years. To stop this trend, the employer instituted a wellness program that has slowed this growth to less than 3 percent per year.

Costs to Private Businesses and Insurers Attributable to Obesity: Exhibit 25

Businesses have long recognized that goals are rarely met unless they are measured and tracked. With obesity, not much is tracked. All stakeholders will need a better means to document the costs and health effects of overweight and obesity in children and adults.

Today BMI and obesity as a co-morbidity are not tracked in insurance claim records nor are they readily available in medical records. Costs incurred from obesity are difficult to assess, and virtually no research has been done to define the costs associated with overweight children. Unless stakeholders can track and measure costs and related health issues for obesity, it will be difficult to effectively control the epidemic.

The Comptroller applauds the bold initiatives the Texas Legislature is taking to improve the health of our children, the work force of tomorrow. Legislation has been filed that would institute more physical education in our public schools. Already, foods of minimal nutritional value have been removed from almost all school cafeterias and many vending machines. These measures are a huge step in the right direction, and should slow the growth of overweight Texas children.

But to stem the tide of the obesity epidemic, all stakeholders—employers, parents, schools, the medical community and government must work together, to do whatever they can to both reduce the current obese population and to prevent healthy and overweight people from becoming obese. Ultimately, we must become a society focused on preventing obesity, rather than treating the diseases it causes.

Dr. Paul Handel, vice president and chief medical officer for Blue Cross/Blue Shield of Texas has articulated a hopeful vision for our future:

“By refocusing our health care system on preventing illness, managing chronic conditions and encouraging healthy lifestyles instead of treating people only when they’re sick, businesses can reduce health care costs and improve worker health and productivity.” (2006)8

 Costs to Private Businesses and Insurers Attributable to Obesity (in billions): Exhibit 26


  1. U.S. Centers for Disease Control and Prevention, “Overweight and Obesity: Childhood Overweight—Overweight Prevalence,” (Last visited March 6, 2007.)
  2. U. S. Surgeon General, “Overweight and Obesity: Health Consequences,” (Last visited March 6, 2007.)
  3. Deanna M. Hoelscher, et al., School Physical Activity are Nutrition (SPAN) III Survey, 2004-2005. UT School of Public Health, Houston.
  4. Todd Ackerman, “Study Shows Houston Kids Getting Fatter,” The Houston Chronicle (January 23, 2002), p. A-19.
  5. Estimates made using projected adult population data from the Texas State Demographer and a 0.5 migration scenario.
  6. Estimates are from the Comptroller of Public Accounts, based on logistic functional modeling from 1990-2005 BRFSS observations.
  7. LuAnn Heinen, “The Big Picture: U.S. Employers Combat Weight-related Health Costs,” Health & Productivity Management, Special Edition Vol. 1, No. 2 (February 2005)
  8. Texas Coalition for Worksite Wellness, “Statewide Summit Urges Innovative Solutions to Employee Health,” Austin, Texas, November 20, 2006. (Press release.)

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