Obesity: The Texas Medical Association recognizes obesity as a serious public health problem. Approximately 66 percent of Texans are either overweight or obese, and nearly one-quarter of adolescents and children are overweight or obese. Obesity is a risk factor for heart disease, stroke, hypertension, diabetes, and some cancers. Obesity and the associated medical complications increase health care spending and patient morbidity and mortality.
Texas children now are in a health crisis, with the highest percentage of students with type 2 diabetes, obesity, and heart disease in the history of our state. Obesity in childhood increases the risk of obesity in adulthood. Obesity is the second most preventable cause of disease behind tobacco use.
TMA encourages physicians to become educated and empowered to conduct appropriate assessment and treatment of overweight patients and obesity in their practices and to serve as leaders in their communities and in the policymaking process to improve healthy eating and increased physical activity among our state's children. The crisis results from a multitude of factors, including lack of physical activity, poor nutritional habits, and personal and societal responsibility. These issues require a multipronged response. TMA will monitor and encourages research on the medical, psychological, and social issues related to obesity to be best informed when making recommendations on prevention and treatment.
TMA supports the need to educate Texas adults and children on the importance of proper diet, nutrition, and physical activity in the prevention and management of obesity. Specifically, TMA makes the following recommendations:
A Healthy School Environment
(1) TMA supports the development of a coordinated, comprehensive approach to child health through the schools. This includes integration of nutrition education into the K-12 school curriculum. TMA recommends school-aged children to receive at least 60 minutes of daily physical activity (30 minutes of which should be structured activity in a school setting). The program must provide for coordinating (a) health education, (b) physical education and physical activity, (c) nutrition services, and (d) parental involvement.
(2) TMA supports strong nutritional standards for all foods and beverages available at schools with emphasis on increasing the availability of fruits, vegetables, and whole grains and reducing the amount of sodium, fat, and calories. TMA supports the U.S. Department of Agriculture (USDA) nutritional standards and meal patterns for the National School Lunch and the School Breakfast programs. TMA also supports a strong Texas Public School Nutrition Policy that is aligned with guidance on optimal nutrition.
(3) TMA supports educating the general public on the benefits of maintaining a proper diet and adopting a schedule of daily physical activity. This includes targeted messages to specific audiences including pregnant women, parents, and preschool and day-care employees, and mid-life and older adults.
(4) TMA supports public education on the clinical definition (body mass index - BMI) and the adverse consequences of obesity.
(5) TMA supports the use of evidence-based resources that provide guidance on nutrition and physical activity. These may include tools to inform the public on nutrition resources such as the Dietary Guidelines for Americans as implemented in USDA's "ChooseMyPlate."
(6) Child care regulatory agencies should require child care providers and early childhood educators to practice responsive feeding and provide infants, toddlers, and preschool children with opportunities to be physically active throughout the day. Child care facilities should allow infants, toddlers, and preschoolers to move freely with limited use of equipment that restricts their movement. Toddlers and preschoolers should spend limited time sitting or standing still.
(7) TMA supports educational and other public health efforts to address obesity. These activities should focus on the need for people to consume smaller portions of food. Marketplace food portions have increased in size and now exceed federal standards. Portion sizes began to grow in the 1970s, rose sharply in the 1980s, and have continued in parallel with increasing body weights. TMA supports family meals at home.
(8) TMA advises against having a television in the bedroom and supports limiting screen time (computer, television, and digital media including electronic games) both at home and in the child care settings, to fewer than two hours a day for children age 2 and older and recommends no screen time for children younger than age 2.
(9) TMA supports breastfeeding infants for at least six months, but encourages up to 12 months as infants who breastfed longer have lower incidences of obesity.
Public Policy Initiatives
(10) TMA supports making physical activity an integral part of life and local community initiatives that promote a built environment that encourages safe physical activity for all, such as lighting parks and sports fields, promoting walking in the mall, cycling lanes, and so forth.
(11) TMA encourages physicians to participate in broad-based coalitions that are engaged in obesity prevention and fitness interventions through community health improvement processes and evidence-based programs and policies that reflect the recommendations of the U.S. Community Preventive Services Task Force.
(12) TMA should work to support physicians by providing information on potential public state and federal funding for obesity awareness, education and technology, and preventive obesity care.
a) TMA should actively seek to collaborate with the food and restaurant industry to increase menu labeling in Texas, and work to advance this initiative nationally through the American Medical Association.
(13) TMA supports an increased role for health plans, policy makers, and employers when it comes to obesity prevention and intervention. TMA should work with health plans to recognize obesity as a primary diagnosis and develop payment codes for physicians for prevention and treatment of obesity.
(14) Physicians should actively participate in their local school health advisory committees (SHACs). SHACs provide an opportunity to promote nutrition and other health standards as well as guide health policy for school districts.
Physician and Patient Assessment/Education
(15) Physicians should assess their patients for overweight and obesity (using the body mass index and nutritional status) during routine medical examinations and discuss with at-risk patients the health consequences of further weight gain; if treatment or counseling is indicated, physicians should encourage and facilitate weight maintenance or reduction efforts in their patients or refer them to a physician with expertise in the clinical management of obesity.
(16) Physicians should consider a child's (a) attained weight-for-length or body mass index at or above the 85th percentile, (b) rate of weight gain, and (c) parental weight status to assess which young children are at highest risk of later obesity and its adverse consequences.
(17) Physicians should consider each office visit an opportunity to educate and council on physical activity and healthy nutrition.
(18) TMA supports cultural, ethnic, and language sensitivities when educating and counseling patients and families.
(19) Medical schools should be encouraged to teach medical students the etiologies of obesity including nutritional choices and social circumstances, and the pathophysiology of the possible sequelae of obesity such as diabetes and metabolic syndrome, and be encouraged to teach students the prevention and management of obesity, including the value of healthy nutrition and the importance of maintaining an ideal body weight through proper dietary intake and regular physical activity. Physicians should be the model of appropriate weight and health.
(20) Physicians should be trained in the proper assessment techniques for using the body mass index during routine medical examinations and "best practices" for facilitating weight maintenance or reduction efforts in their patients.
(21) Physicians should be up to date on current therapies such as, but not limited to, counseling, reinforcement, medication, and surgical options. (Res. 28J, p 156, A-91; substitute CPH Rep. 4-A-03; amended CM-CAH Rep. 5-A-10; amended CSPH Rep. 4-A-13).