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Reducing Childhood Obesity

Children have an especially hard time growing up in a society that seems to equate body image with personal value. And they are often incapable of changing the factors in their environment that contribute to obesity, such as poor food choices by caregivers, heredity, boredom, loneliness, family stress, untreated medical or psychological problems and feelings of shame, guilt and helplessness.

Over the past three decades, the childhood obesity rate has more than doubled for preschool children aged 2-5 years and adolescents aged 12-19 years, and it has more than tripled for children aged 6-11 years.

While many employers are trying to control obesity-related health care costs, the future work force — Texas children — is also involved in the battle of the bulge. Businesses may find that even their youngest new employees already suffer from chronic diseases, higher health risks or physical limitations stemming from excess weight and poor nutrition.

Because such a large part of childhood is spent in public school, governments and school districts are becoming increasingly involved with the issue of childhood obesity.

A National School Nutrition Policy

In 1946, the U.S. Congress enacted the Richard B. Russell National School Lunch Act. Underscoring the urgency of its actions, Congress declared that the act was “a measure of national security, to safeguard the health and well-being of the Nation’s children.”73

The National School Lunch Program later expanded to include the School Breakfast Program, the Special Milk Program and the Schools Commodity Program. These programs provide partial reimbursement to school districts for reduced-price meals and snacks they provide to low-income schoolchildren.

Congress gave the U.S. Department of Agriculture (USDA) administrative jurisdiction over these programs, but allowed state education agencies to run them. The Texas Education Agency (TEA) was Texas’ first program administrator; in 2003, the Texas Department of Agriculture (TDA) assumed this role.

In the 2008-09 school year, Texas children received 525 million reduced-price lunches, almost 247 million breakfasts and 20 million snacks at a total cost of $1.3 billion in both state and federal funds.74

“Competitive Foods”

Before the 1970s, school campuses rarely offered carbonated beverages, chewing gum or candy through school stores or vending machines. These foods acquired the name “competitive foods” because they are sold in competition with federally subsidized meals.

Since then, however, many school districts have not only allowed these foods to be sold on school grounds, but also entered into profitable — sometimes highly profitable — contracts with food and beverage vendors. In 2006, the U.S. Centers for Disease Control and Prevention (CDC) reported that 89 percent of senior high schools had vending machines or a school store selling competitive foods, as did 71 percent of middle schools and nearly 33 percent of elementary schools. The most popular beverages sold were sports drinks, carbonated drinks and fruit drinks with less than 100 percent juice; the most common foods were salty snacks.75

In the late 1970s, USDA developed a definition for “foods of minimal nutritional value” (FMNVs). These included many competitive foods as well as fried foods, ice cream, some types of candy and so forth. USDA rules developed at the time did not permit FMNVs in public schools until the last meal period.76 In 1983, the National Soft Drink Association successfully sued USDA to allow these foods to be made available throughout the school day, but the court also said that FMNVs could not be sold in food-service areas during meal periods.77

Congress approved relatively few childhood nutrition initiatives after the FMNV court ruling until 1994, when it passed The Healthy Meals for Healthy Americans Act. This act established improved meal and nutrition standards for subsidized school food programs, requiring that school lunches provide a third of a child’s recommended daily allowance of nutrients, and that breakfasts provide a fourth.78

Despite USDA’s efforts, the continuing expansion of FMNVs into schools and other lifestyle factors had a measurable effect on children. In 2004, the Institute of Medicine of the National Academies noted:

Over the past three decades, the childhood obesity rate has more than doubled for preschool children aged 2-5 years and adolescents aged 12-19 years, and it has more than tripled for children aged 6-11 years.79

A significant victory came in May 2006, however, when the American Beverage Association (ABA), the Coca-Cola Company, the Dr Pepper Snapple Group and PepsiCo promised to remove highly sweetened soft drinks from schools and provide lower-calorie options in age-appropriate portions within three years. Although the agreement was voluntary for schools, and existing contracts could continue, many bottlers and schools amended their contracts.

By March 2010, ABA reported “an 88 percent decrease in total beverage calories shipped to schools between the first half of the 2004-05 school year and the first half of the 2009-10 school year.”80

Texas Takes On Obesity

Texas state leaders also have taken action to combat childhood obesity. In July 2003, at the request of then-Texas Agriculture Commissioner Susan Combs and with the support of TEA, Governor Rick Perry requested USDA transfer responsibility for subsidized meal programs from TEA to TDA.

The state’s waiver application to USDA stated that TDA already had several ongoing child nutrition programs; had “an existing, excellent working relationship with the USDA” in other program areas; already employed the state nutritionist; and had a marketing division that could promote healthy agricultural products.81 USDA granted temporary approval for this transfer, which became effective almost at once for a three-year period.82

In June 2004, TDA issued a Texas Public School Nutrition Policy limiting fat, sugar, fried foods and portion sizes for all grades. Elementary schools could not allow any FMNV, candy or competitive foods on their premises, whether sold or given to schoolchildren, until the end of the last scheduled class. Middle schools could not allow the sale of FMNV or candy until the end of the last lunch period; competitive foods were allowed, but not during meal periods. High school students could purchase FMNV, candy and competitive foods on campus as long as they were sold outside of areas where meals are served or consumed. The policy also set a goal of ensuring that no more than 30 percent of the beverages sold in on-campus vending machines are sugared and carbonated.83

In fall 2006, TDA revised Texas’ policy, further reducing children’s on-campus access to fatty and sugared foods. Elementary school children now have on-campus access only to water, milk and pure juice, and no access to deep-fried foods, although foods partially fried by the manufacturer are acceptable if heated or baked without added fat. Middle school children likewise cannot have deep-fried foods, FMNV or any candy until after the last class and cannot have competitive foods within 30 minutes of meal periods. No more than 30 percent of vended beverage selections on high school campuses can be sweetened and carbonated, and no FMNVs or candy are allowed until after the last class.84

Other Texas Initiatives

The Texas Legislature continues to take an active role in addressing the issue of childhood obesity.

Physical Education

Play at recess and physical education (PE) are important parts of a child’s school day — or should be.

Before 2007, the State Board of Education had statutory authority to recommend but not require physical activity standards for Texas school districts.

The 2007 Texas Legislature changed this situation with Senate Bill 530, which obligated school districts to require children in kindergarten through fifth grade (K-5) to participate in “moderate or vigorous” physical activity at least 30 minutes each day. S.B. 530 also requires the same of schoolchildren in grades six through eight for at least four semesters. The law allows school districts some flexibility to set alternate standards, depending on how they schedule class time and extracurricular activities.

In what turned out to be a groundbreaking step, S.B. 530 also required each school district to annually measure the physical fitness of students in grades three through eight. The law’s provisions allow parents to see their child’s results, and require districts to report aggregated rather than individual student fitness information to TEA.85

Fitnessgram®

In 2008, Texas became the first state to employ a new physical fitness test, the Fitnessgram®, a tool developed by the Cooper Institute of Dallas. Fitnessgram is a software program that assesses physical fitness by measuring body composition, aerobic capacity, strength, endurance and flexibility, and compares the results to age-appropriate, research-based fitness standards.86 The Fitnessgram test was used to assess the physical fitness of more than 2.4 million Texas students representing 84 percent of school districts. The Cooper Institute and others raised $2.5 million in private funds to cover the costs of the first Fitnessgram study.

The 2008 assessment found that 33 percent of third-grade girls and 28 percent of third-grade boys were in what the Institute calls the “Healthy Fitness Zone,” a term that denotes that students have passed all six fitness tests. The older the students were, however, the worse their fitness levels. In seventh grade, just 21 percent of the girls and 17 percent of boys met the standard. Among high school seniors, only 8 percent of girls and 9 percent of boys fell into the “fit” category.87

In 2009, TEA and the Cooper Institute correlated Fitnessgram data with school district data on academic performance, disciplinary incidents and attendance. This Texas Youth Fitness Study, as it is known, found “significant associations” between physical fitness and high academic performance, low numbers of disciplinary incidents and low absenteeism. Students with high cardiovascular fitness or low BMIs also tended to do well on the Texas Assessment of Knowledge and Skills.88

Fitnessgram results for the 2009-10 school year were encouraging but mixed. Students in grades three through nine showed marked improvement compared to the 2008 results, but high school students showed a decline in fitness (Exhibit 13).89

Exhibit 13

Fitnessgram® Test Results (Share in the Healthy Fitness Zone on All Six Tests)

2007-2008 School Year
Grade Total Tested Girls (%) Boys (%)
3 102,342 33.3% 28.6%
4 80,539 28.5% 21.1%
5 66,798 23.8% 17.9%
6 60,663 23.1% 17.6%
7 55,441 21.3% 17.3%
8 48,971 19.0% 17.9%
9 39,456 13.9% 15.0%
10 28,650 12.4% 13.7%
11 21,152 10.7% 12.2%
12 13,040 8.2% 9.0%
2008-2009 School Year
Grade Total Tested Girls (%) Boys (%)
3 116,096 36.4% 30.9%
4 95,842 33.5% 24.6%
5 79,281 28.0% 20.9%
6 75,610 28.2% 20.6%
7 66,950 26.0% 19.6%
8 60,004 22.3% 19.8%
9 46,206 16.3% 16.1%
10 32,865 13.3% 13.9%
11 24,416 11.1% 12.2%
12 15,468 8.8% 9.3%
2009-2010 School Year
Grade Total Tested Girls (%) Boys (%)
3 119,401 37.3% 31.0%
4 102,709 34.2% 25.3%
5 87,389 30.1% 21.8%
6 83,982 30.2% 27.7%
7 76,555 28.1% 21.4%
8 67,218 24.2% 21.6%
9 48,278 17.0% 15.7%
10 32,069 13.2% 13.0%
11 23,431 10.6% 11.1%
12 15,214 8.1% 8.5%

Source: Texas Comptroller of Public Accounts.

Texas Fitness Now

The 2007 Legislature also appropriated $20 million for a new two-year Texas Fitness Now program led by Comptroller Susan Combs and TEA.90 Texas Fitness Now provides grants of at least $1,500 to middle schools with 75 percent or more of their students coming from economically disadvantaged backgrounds. Qualifying schools that apply for these grants can receive more aid based on enrollment.

To be eligible for the grants, schools must require their students to be physically active throughout the school year for at least 30 minutes each day or 225 minutes over a two-week period, in addition to other physical fitness and administrative requirements.

Texas Fitness Now grants allow schools to improve their PE programs, curricula and equipment (outside of any established team sports program). A quarter of each grant must support nutrition education.91

The 2009 Legislature extended the program, appropriating another $10 million annually for the 2010-11 and 2011-12 school years.92 Since its inception, Texas Fitness Now has provided grants to at least 379 school districts and charter schools. Houston ISD received the most aid in the program’s first three years, at $2.7 million.93

Beginning with the 2009-10 school year, Texas Fitness Now eligibility requirements were changed to allow schools with 60 percent or more economically disadvantaged students (rather than 75 percent) to qualify for the grants.94

PE Curricula

While Texas previously required schools to provide PE for kindergarteners through grade 12, the schools were responsible for designing their PE curricula. The 2009 Legislature changed that with the passage of S.B. 891, by Sen. Jane Nelson, which established a statewide definition of PE as well as standard student-teacher ratios for PE classes.

S.B. 891 adopted the standards of the National Association of State Boards of Education to ensure that public school PE programs, beginning with the 2009-10 school year, are:

…sequential, developmentally appropriate and designed, implemented and evaluated to enable students to develop the motor, self-management and other skills, knowledge, attitudes and confidence necessary to participate in physical activity throughout life.

School districts also must ensure that at least half of PE class time consists of moderate or vigorous physical activity in line with students’ ability, even those who have disabilities, chronic health issues or other special needs. The student-teacher ratio is capped at 45 to one, unless the district can ensure students’ safety at a higher ratio.95

Farm to School

In 2009, Texas became one of 24 states dedicating resources to direct locally grown, fresh food products into schools.

The Interagency Farm-to-School Coordination Task Force comprises representatives from TDA, TEA, the Texas Department of State Health Services (DSHS) and other groups; parents; school food services; agriculture, nutrition and health educators and researchers; and fruit and vegetable producers and distributors. Its responsibilities are to create a database of food producers by locale; assist farmers and ranchers with marketing their goods to schools; and design and update nutrition and food education resources.96

Early Childhood Health and Nutrition Interagency Council

While a number of programs address obesity in school-aged children, few reach children at earlier in life. The 2009 Legislature created the Early Childhood Health and Nutrition Interagency Council to coordinate state efforts to prevent obesity in younger children, particularly those in day care, foster care or early supplemental nutrition programs.97

The council, which comprises representatives from several state agencies involved with children and their health, is charged with reviewing current research and comparing Texas children’s health status and needs with those of other states; pursuing state and federal funding for health and nutrition promotion in childcare settings; reviewing member agencies’ programs for children; and identifying best practices and barriers to nutritional and physical improvement. The council sent its first report to the Legislature in late 2010.98

Academic Efforts

The University of Texas Southwestern Medical School in Dallas leads a consortium of research schools called the Taskforce for Obesity Research at Southwestern (TORS). With a $22.7 million grant from the National Institutes of Health and $9 million in annual state funding, TORS is studying obesity and human metabolism.99

Dr. Jay Horton, director of the task force and a professor of internal medicine and molecular genetics at UT Southwestern, says many exciting discoveries related to metabolism and diabetes control are receiving attention. For example, task force researchers discovered that the human hormone leptin appears to be useful in controlling Type 1 diabetes, a finding that could fundamentally change diabetes treatment.107

Another significant discovery concerns a protein called PCSK9 that interferes with the liver’s ability to remove heart-clogging cholesterol from the body. Dr. Horton says early tests indicate that a drug designed to counteract PCSK9 could lower blood cholesterol more than 50 percent.108

The University of Texas Health Science Center at Houston and the Michael and Susan Dell Foundation partnered in 2006 to create the Center for Healthy Living at the UT School of Public Health’s Austin campus. The center has created the Coordinated Approach To Child Health (CATCH) program “to promote physical activity, healthy food choices, and prevent tobacco use in elementary school aged children.”109

A cost-effectiveness study on CATCH indicated that the program returns $889.68 for every dollar invested, as measured by the extension of quality years of life and the avoidance of $68,125 in future health care costs for each participant.110 (See "CATCH Works to Reduce Childhood Obesity" for more information.)

End Notes

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