As the state’s health commissioner, I have occasion to fly more these days than when I practiced family medicine in Austin. As I fly over Texas, I often look out the window at the malls, houses, office buildings, highways and farms below.

In each of those countless places, millions of personal decisions are being made by millions of people millions of times a day that will affect their health and their lives.

It does not matter where I am, flying over El Paso, Lubbock, Midland, Fort Worth, Houston, San Antonio or the Rio Grande Valley, every minute of every day, individual decisions about what we eat, whether we exercise, smoke or drink and countless other decisions are determining the health status of every person.

Taken together, those millions of decisions represent our future in many ways.

Though still a board-certified family physician, I no longer see individual patients. I have only Texas as my patient. The public health policy issue that is most affected by those millions of decisions Texans make every day — and the one I would like to rally family physicians around — is obesity.

There is no need to repeat the numbers and statistics. Everyone in medicine is aware of the extent and depth of the problem. The new dimension of the problem involves the fiscal impact that obesity might have on how we support medical care in this country.

Obesity promises to overwhelm the entire medical care delivery system by loading on younger and younger patients at the same time that the number of our elderly increases. In no small way, the physical health of Texas might determine its fiscal health.

What is necessary now is not to repeat the tale of the tragic and costly toll that obesity takes but to begin to take the steps to solve it.

There are many players in the drama to stem the tide of obesity that is swamping us. But family physicians stand out among them because of our unique role as medical counselors.

We can pass as many laws and refine as many regulations as we want, but family physicians, perhaps only after parents and teachers, have a connection close enough to families to deliver, in frank and direct language, an assessment of the challenge at hand.

With no family untouched by the plague of obesity, there is no shortage of the role family physicians can play. And the role should revolve around common sense.

The first step is to make sure that everyone knows that a direct link between obesity and disease and illness exists. I am not sure that everyone understands the connection.

While effective public-awareness campaigns are critical, nothing should strike the right note more than for a patient or the parent of a patient to hear from a family physician directly that obesity can hurt, maim and kill.

Family physicians should be free to gauge the level with which they should deliver the anti-obesity message, but it is clear that the message should be delivered, along with the results of diagnostic tests that can reinforce the argument.

In that regard, family doctors should begin to measure the body mass index of their patients and aggressively seek to make patients appreciate the connection between obesity and their current or future health status.

We also have to be on guard that the state of our own physical selves can add or detract from the message we are trying to convey to our patients. Fit doctors make better messengers.

We family physicians are not attuned automatically to list an overweight condition or obesity as a primary cause for concern for our patients. But as obesity threatens, we as family physicians should respond. We should revamp our office procedures so that screening and counseling for overweight conditions are standard operating procedure.

Family physicians, too, should be more attuned to the efforts that are forming throughout the state to expose school-aged children to information and to routines by which they can develop positive life-long eating and exercise habits.

When they can, family physicians, who command respect in their communities, should encourage local school districts, parents, local officials and leaders to make sure that instruction on good nutrition and physical activity is incorporated into daily school curricula.

The threat of obesity started from the ground up, and it must be fought at ground zero.

Public policy makers in Austin can legislate, mandate and fulminate, but it is the individual child and parent and the individual head of household who will win the war against overweight and obesity.

Of the many millions of decisions that are made every day in Texas that constitute our health future, it might well be that the decisions by family physicians throughout the state to get actively and personally involved in the fight against obesity are the most important of all.