Cover Story : Big Kids : The Not-So-Small Task of Teaching Children Better Ways to Eat and Exercise

David Bayer, a Calabasas sixth-grader, and Joan De Vito-Agins, a Tarzana registered dietitian, sit across from each other, separated by a desk heaped with pizza, bran muffins, baked potatoes, yogurt, orange juice, watermelon and a bread basket. The bountiful feast is made entirely of plastic.

DeVito-Agins sets a plate of plastic spaghetti in front of David. “I don’t like meat sauce,” he announces.

The spaghetti disappears and is replaced by a plastic open-face hamburger, imitation corn on the cob and unnaturally green broccoli stalks.

“I hate broccoli,” David complains. “I never eat broccoli.”

“Carrots,” DeVito-Agins says. “You like carrots?” She whisks the broccoli away and arranges a few orange sticks on the plate.

David balks. More food is passed back and forth. After a few minutes of negotiation, DeVito-Agins and the boy agree on fake watermelon chunks in place of a vegetable.

“This is like a Woody Allen movie,” says David’s father, Mike Bayer, with a sigh.

David, 11, has been visiting DeVito-Agins ever since he was a chubby 9-year-old with a fondness for french fries and “chocolate, chocolate, chocolate ice cream.” With the help of DeVito-Agins and her plastic food stash, David has learned proper portion sizes, and he knows how to put a healthy, well-balanced meal together--even if he won’t touch broccoli.

David has slimmed down and added several inches to his height over the past two years. But at 5 feet and 130 pounds, he would still like to look thinner. His aim is to not gain any weight until he grows a few more inches, allowing his height to catch up.

To reach his goal, he limits junk food to three times a week. He eats more fresh fruit. He carefully records his meals. He eats baked potatoes instead of fries, and he snacks on frozen yogurt instead of ice cream.

And he has amassed an impressive collection of baseball cards, for DeVito-Agins offers her young clients a non-food reward at each visit.

David has lots of young company in his battle with fat.

Almost a third of the nation’s children are obese. The medical definition of obesity is weight that is 20% or more above a person’s ideal weight. The number of obese children has increased by more than 50% since the 1960s, according to a study by the Harvard University School of Public Health.

“In the last six or seven years, I have definitely seen more kids in the Valley who are above the ideal body weight for their age and height,” DeVito-Agins says. “The Valley doesn’t seem to be quite geared up for fitness.” She says there are not enough safe areas for children to play outside or ride their bikes.

Tarzana registered dietitian Ellen Bauersfeld agrees. “I see a tremendous number of overweight kids in the Valley. It is rampant, it really is.”

It’s not easy being a big kid. Overweight children often have high blood pressure and cholesterol levels, and they are at risk of developing respiratory problems, heart disease and diabetes. Many obese children and most obese teens become obese adults, according to the Center for Child and Adolescent Obesity at UC San Francisco.

And the problems aren’t just physical, said Canoga Park clinical psychologist Paulette K. Penton. “Overweight children have a poor self-image, low self-esteem and low sense of self-worth,” she says. “They have trouble with relationships at school. They are not accepted by their peers. They feel excluded and left out. They are really hurting.”

Experts say weight problems may appear as early as infancy. “Plenty of kids really balloon out to 18, 19, 20 pounds at 4 months old,” says Dr. Richard Feuille, a pediatrician at St. Joseph Medical Center in Burbank. “They usually begin to slow down by 5 or 6 months, and by the time they are a year old they are usually right on track with everyone else. But if the baby is off the growth chart and not gradually becoming thinner, I want to do something about it.”

Feuille suggests diluting formula 15% to 20% more than usual and offering babies more water or diluted juice. “Apple juice has as much sugar as Coca Cola and more calories than beer. It has to be watered down,” he says.

Babies on solid foods should be fed more fruits and vegetables instead of meat. “We don’t want them to lose weight, but to slow down,” he says, noting that a daily reduction of just 50 to 100 calories is sufficient.

DeVito-Agins says a variety of factors contribute to the increased incidence of childhood obesity.

“Physical activity isn’t reinforced as a positive family lifestyle,” she says. “Very rarely do you see families biking or hiking together. Instead they go to dinner or the movies, or kids stay home with Nintendo or the TV.

“Also, many kids don’t eat breakfast because it’s not part of the household morning routine, and they skip lunch because brown bags are not cool. Then they come home starving at 3 p.m., and they eat chips, Pop Tarts, Wheat Thins--three times what they would have eaten if they had had lunch.”

Parents’ eating habits and attitudes about food usually contribute to children’s weight problems, according to Dr. Marilyn Lange, a pediatrician specializing in child development and genetics at St. Joseph Medical Center. “Almost all overweight children are the products of what their parents are doing, and not what the children are doing to themselves,” she says. “Many parents use food as a reward. I tell my patients, ‘Hugs, not cookies,’ ”

But parents are advised to stay away from strict diets for their chubby children.

A 13-member National Institutes of Health panel of physicians, nutritionists and psychologists recently concluded what many people already know only too well: Diets don’t work. In fact, very low-calorie diets can harm children. According to the American Dietetic Assn., severe food restriction can interfere with bone, muscle and brain development.

“I see overzealous parents who put their kids on such restrictive diets that the kids actually suffered growth failure,” Feuille says.

“Some mothers put their kids on 800- or 1,000-calorie diets, and that’s not what they should be doing at all,” DeVito-Agins adds. “They are cutting back too drastically. Diets that don’t allow room for treats do psychological damage. Kids feel deprived and get into sneak eating, and they are labeled as ‘bad’ or ‘cheating.’ We shouldn’t even use the word diet with kids.”

Instead, DeVito-Agins says the answer is healthy eating--not just for the heavy child, but for the whole family. “Take the spotlight away from the child,” she says. “Parents are the primary providers of a child’s meals. They should encourage healthy snacks, know correct portion sizes and change the food environment in the house.”

That’s just what Sherry and Michael Loewenstein are doing in their Northridge household. When their daughter, 13-year-old Ariella, decided she wanted to lose 20 pounds, the family banded together. They still watch sitcoms together as a family but no longer polish off a box of crackers. Sherry stopped buying crackers because they are high in fat and salt. Michael bought a hot-air popcorn popper so the family could enjoy a healthy snack. Sherry removes the skin from chicken before cooking it. She serves less starchy foods and more salads topped with fat-free salad dressing.

Ariella lost 10 pounds in one month.

“It’s not a diet,” Sherry says. “It’s a way of life. It’s an awareness program, an awareness of what goes into the mouth.”

But food isn’t the only reason kids are too fat. They also don’t get enough exercise. A National Children and Youth Fitness study found that one-third of the youngsters ages 10 to 18 do not exercise enough to receive any aerobic or endurance benefit. Only half the children get the minimum exercise they need--at least 20 minutes of vigorous physical activity three times a week.

Instead of running or playing, they are sprawled out in front of the tube. According to a 1989 Nielsen survey, children watch television an average of 24 hours a week--and that doesn’t include the time spent watching videotapes or playing Nintendo.

Parents can help get their kids moving, according to Debby Norden, a Tarzana psychologist and registered nurse. “The key to a physically fit child is a healthy family environment,” she says. “There are so many ways parents can focus even very young children into activities. I have seen parents put infants in the bicycle seat and ride with them in the fresh air. Play ball with them. Get out and take a family walk every night.”

Family exercise programs reap additional rewards as well, says Margie Chadburn. When her 14-year-old daughter, Alissa, decided she wanted to lose weight, the two of them began to take regular evening walks through their Valencia neighborhood.

“It’s not only beneficial for your body, but you have extra time with your child,” she says. “During an hour walk, you talk about a lot of things. You really get to know your kid.”

Together, the Chadburns pack salads to take to work and school, and they eat more fruits and vegetables. “We hardly have any dessert,” Chadburn says. “If I buy anything that is sweet, I make sure it is fat-free.”

Alissa lost 10 pounds, and she hopes to shed 10 more. “I know a lot of people starve themselves, and that is totally stupid,” she says. “Exercise and nutrition: It sounds so basic, but it really works.”

What doesn’t work are most commercial weight-loss programs and “fat camps” that promise quick results. Because the programs do not change the family’s diet and exercise habits, the children will probably regain any weight they lose.

“Sure, the kid will lose the weight,” Norden says. “But as soon as they come back to the family environment, the weight comes back on. And again, their self-esteem goes ‘Boom.’ That is so destructive. That’s why weight loss has to start in the home. You have to work with the family dynamics and develop a healthy lifestyle.”

Shapedown, a 12-week, family based program for overweight children and adolescents, is recommended by the American Medical Assn. and the Food and Drug Administration. In addition to teaching nutrition and exercise, Shapedown works on improving attitudes and behavior toward food.

“We make them comfortable talking about how they feel--for example, when they are in the dressing rooms getting ready for P. E. class,” says registered dietitian Sherry Gordon, who leads the Shapedown program offered by Kaiser Permanente in Granada Hills. “We try to build their self-esteem so they feel good about themselves and are able to make positive changes.”

Developed in 1979 at UC San Francisco, Shapedown is offered at 450 hospitals and clinics nationwide. Cost is $200 ($150 for Kaiser members).

At one recent Shapedown meeting, five boys and three girls, ages 10 to 15, spent 30 minutes exercising. An aerobics videotape flashes on the television in front of the room, and the kids collapse in giggles as they attempt to mimic the steps of the dancers on the screen. They flail rounded arms and sturdy legs about, sometimes kicking or crashing into each other, which sets off a new round of hysterics.

“I would like to check my pulse,” announces Eli Mann, a round-faced 10-year-old in a long baggy T-shirt and shorts. “It’s probably one thousand and somethin’. The sweat’s falling off my face.”

Parents meet separately. They learn to strengthen family relationships, improve communication and understand and support their children’s goals. They discuss the practical aspects of losing weight, wondering what foods to buy and what to make for dinner. They want to help their kids, they say, but they admit to occasionally ordering pizza because it’s easier.

“Going shopping for clothes is the worst thing in the world,” says one mother of a 12-year-old girl. “I hurt for her.”

Children enrolled in Shapedown set goals for themselves, such as playing outside instead of watching television. They vow to not let cruel comments get them down. “My mother always criticizes me,” says a girl in a voice no louder than a whisper. “She points to my cousin or thin friends, and she says, ‘Why can’t you be like her?’ ”

“People are prejudiced against people who are fat,” adds Karen Barkham. The 13-year-old Tarzana honor student lost 14 pounds while enrolled in Shapedown--more than anyone else in her class. She hopes to lose 50 more.

“It is hard, but it will be worth it,” she says. “I will feel better and be healthier. I want to look in the mirror and say, ‘Wow, I look so good.’ ”