Somehow, Texas Is Still Getting Fatter

In 2012, after two decades of steadily marching skyward, Texas' obesity rate dropped, from 30.4 percent to 29.2 percent. That hardly made Texas thin, to be sure; the state was still the 19th fattest state in the chubbiest country in human history, but the drop theoretically meant that there were something like 230,000 fewer Texans who were alarmingly fat. 

This was a blip. In 2013, obesity in Texas had hopped up to a record 30.9 percent. In 2014, the most recent year data's available, it increased another percentage point. Texans are now officially three times as fat as they were in 1990, when the obesity rate was 10.7 percent. The continued expansion of Texas' collective waist lines is a big reason why Texas slipped three spots in annual health rankings released this week by the United Health Foundation.

The natural assumption is that Texans are fat because they're lazy and eat too much. And the natural assumption is basically right. "Calorie intake-calorie expenditure — that is the formula," says Steven Kelder, co-director of the Michael & Susan Dell Center for Healthy Living at the University of Texas Health Science Center's School of Public Health in Austin. For a variety of reasons — fewer pedestrians than New York, fewer outdoor enthusiasts than Colorado, a native cuisine drenched in fry oil — this formula is particularly unbalanced along the so-called "southern obesity belt," which encompasses Texas.

But humans have known for eons that eating a lot and laying around makes them get fat, and it's been apparent for several generations that there are way more fat people now than there used to be. From there, calculating the devastating public-health consequences is basically a matter of arithmetic. So why is it so hard to keep people from doing the things that make them fat?

"Here's the bottom line truth of it: Scientists and physicians need to be a little more humble and recognize the solutions aren't always so obvious," says Marc Hamilton, director of the University of Houston's Texas Obesity Research Center. "Meaning, we think we've figured it out but we haven't." Preaching about eating better and exercising more hasn't moved the needle. "That advice is what I would consider unfortunate. It's been out there for a long time, but it hasn't changed the health of Americans from a public health standpoint at all."

Hamilton's research focuses heavily on the negative health effects of a sedentary lifestyle. (He credits himself with coining and spreading the phrase "Is sitting the new smoking?") His main argument is that the traditional notion of exercise — half-hour bursts of intense activity — isn't enough to offset the damage caused by sitting for huge chunks of the day. He's not necessarily saying everyone should get a treadmill desk, just that it would help reduce the prevalence of obesity and related problems like diabetes and heart disease if people could incorporate physical activity throughout their day. "Every minute counts."

Kelder, who sometimes hops on the elliptical machine in his office's hallway, agrees that physical activity needs to be incorporated into the day, but that's only part of the puzzle. "We don't have a strong way to educate the population about nutrition," he says. Consuming an extra 200 or 300 calories per day without a commensurate increase in physical activity can lead to obesity over time, Kelder says, a narrow margin of error that makes it particularly vital that people make well-informed decisions when it comes to diet and exercise.

For Kelder, the obvious place to start is schools, where there is a captive population whose habits are still malleable. He expects the Healthy, Hunger-Free Kids Act of 2010, which was signed into law five years ago this month and required healthier school lunches, to have a positive impact on childhood obesity, never mind the partisan grousing that it represented a nanny-state intrusion into school lunchrooms. School-nutrition advocates have lobbied Congress to tweak the law, mainly by adding additional funding, but lawmakers missed a deadline to do so in September. The failure to reauthorize the law does not affect the school-lunch provisions.

Beyond lunches, Kelder thinks schools also need to be better about providing opportunities for physical activity and nutrition education. Kids need at least 60 minutes of physical activity per day — closer to 90 if they're chunky — opportunity for which Kelder thinks should be provided by schools, through some combination of recess, physical education classes, and programs before and after school. "The question then is, how much nutrition education do you need to have a nutritious population." The answer, according to his research, is 10 minutes every day. This could take the form of standalone lessons on nutrition, or else nutrition could be incorporated into other lessons, like math.  That may help prevent some kids from becoming fat adults. To tackle the problem of adult obesity, Kelder thinks employers should adopt policies along the same lines and thinks the government should continue working to expand access to healthy food.

All of which are great, sensible ideas that could eventually lead to a healthier Texas. Myriad factors have contributed to the obesity epidemic, and there will need to be myriad solutions. Either that or we all start booking tickets on a dystopian, Wall-E-style space cruise.
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Eric Nicholson
Contact: Eric Nicholson

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