Childhood Obesity: a Lurking Health Risk

Patricia Verdugo got used to being the biggest kid in class, her round figure dwarfing her classmates even in kindergarten. She learned to take it when the other kids called her “fatso”--and other names she’d rather not repeat. She quietly sat out as scorekeeper during kickball at school, though she loves to play the game.

With 220 pounds on her 4-foot-10 frame, her knees couldn’t take the punishment. She was gaining an average of 10 pounds a month when they broke--collapsed, really--under the burden of her body. Now, the third-grader sometimes leans on a cane. She winces when her 280-pound father merely mentions the daily doses of insulin he takes to control his diabetes, but she knows the needles she dreads may become a fixture in her own life. Doctors say she’s poised on the edge of disease herself.

These extra pounds, often a source of shame and inconvenience, have become a serious--and scary--health problem.

“I don’t want diabetes because I’ll have to get shots,” she said, her eyes filling with tears.

“It’s hard” to watch, said Jerry Verdugo, 36, gazing tenderly at his daughter from across their Palmdale living room. “You go through it . . . you don’t want your child to go through it.”

American children face this ordeal in rising numbers. About 11% of 6- to 17-year-olds are obese, and twice that number are overweight. That’s up from 5% who were obese and 15% who were overweight in the 1960s.

Far from just a cosmetic problem, obesity is considered by some experts to be one of the greatest medical risks faced by American children today. Besides diabetes, short- and long-term consequences may include orthopedic problems, premature puberty, respiratory complications, hypertension, heart disease and certain cancers--not to mention reduced self-esteem and socioeconomic achievement.

“It is an impending time bomb,” said Naomi Neufeld, a UCLA pediatric endocrinologist. “It’s not going to kill them tomorrow, but in terms of a threat to long-term health, it affects more children than any other disease.”

For all its impact on young lives, childhood obesity is only beginning to be understood. Though weight gain among U.S. youngsters spans age categories, economic classes and ethnic groups, it may have different causes depending on each factor. And it eludes the standard “adult” solutions of crash diets and prescription pills--questionable even in grown-ups--because a child’s growing body depends on balanced nutrition to thrive.

In general, however, experts believe that there are some common causes among the young: poor nutrition education, paltry opportunities for exercise, too much TV, the glorification and overconsumption of fast-food--health menaces to everyone, fat and thin, young and old. In addition, they cite psychological and cultural factors: the concept of food as love, for example, and the equation, particularly among disadvantaged groups, of fat with healthfulness.

Perhaps more than anything, these problems are rooted in the family, in entrenched food purchasing, eating and activity patterns. Many experts believe that they call for family solutions.

But parents may be poor role models. More than a third of adult Americans are overweight, and their children tend to take after them. Some parents are afraid even to broach the subject for fear of precipitating a lifelong eating disorder. Others mercilessly blame themselves or, at the opposite extreme, deny that it is a problem until a child’s health suffers.

Many doctors, not well informed on the subject, offer bland, out-the-door advice such as, “Don’t feed them so much.” And while physical education has been dramatically curtailed in public schools, there are few outside programs geared to youngsters whose weight is soaring.

Still, some clinicians and researchers see attacking the complex problem of childhood obesity as an opportunity. In young people, they argue, there is still so much potential for change.

“I think there are things we can do,” said Steven Gortmaker, co-author of a famous study linking obesity to television viewing. “The fact is, we haven’t done them.”

Sedentary Lifestyle

Why does fat run in families? And why, in particular, does it run in American families?

The deceptively simple answer is that children, and their elders, take in more calories--often fatty, sweet or nutritionally empty--than they burn off.

Most experts agree that weight gain is the product of some combination of genetic and environmental factors--with genes accounting for about 25% of the variation among individuals, according to one widely cited estimate.

But environment gets most of our attention because it counts more and it is, at least theoretically, under our control. Given the dramatic rise in childhood obesity in less than a generation, the American environment, clearly, is becoming more fattening.

“The very act of living in the United States puts you at great risk for obesity,” writes Michael Fumento, author of a book that rails against the sedentary American lifestyle.

In fact, becoming “acculturated” in the United States is considered a risk factor for immigrant families, says UC Davis nutrition educator Marilyn Townsend.

The Verdugos know all about that.

“The first thing you do here is get yourself a car and drive everywhere,” said Patricia’s mother, Joy, a medical receptionist whose family emigrated from Mexico when she was a year old. “Whatever color you are, you get lazy. . . . You sit down or stand for eight hours, go home and drive through a burger joint. . . .

“Me, I grew up on fast foods and frozen dinners. Unfortunately, I have [transferred] that to my children.”

In Mexico, where Jerry spent most of his youth, “if we wanted meat, we had to go chase it,” he said. “Here . . . you go spend your paycheck at the store.” Research has shown that certain minority groups, especially African American and Mexican American women, are at greater risk for obesity as adults. Though the differences are not as pronounced in children, the pattern emerges as early as preschool.

Fat-Storing Differences

One theory holds that people who come from plant-based societies, like Mexico, where high-calorie food is scarce, are more adept at storing fat, says David Heber, director of UCLA’s Center for Human Nutrition. That becomes a liability when rich food is plentiful and relatively cheap, as in the United States.

An extreme example is the Pima Indians in the Southwest, who are considerably fatter and more prone to diabetes than their relatives south of the border.

But genetics vary more among individuals than they do among populations--and the fact is that all types of children are getting fatter in this country.

The environmental reasons vary by family, location, ethnic group and economic status. One large-scale study of 9- and 10-year-old girls in Oakland showed that white girls from unemployed and less well-educated families were more prone to be overweight than other whites.

For black girls, socioeconomic status was not an issue, but obesity--as with white girls--was associated with having an older mother, being physically more mature and living in a smaller family. Researchers speculated that parental overindulgence might be a factor.

“The mechanisms I think are still unclear,” said Pat Crawford, a UC Berkeley researcher who is working on the ongoing study. “If we had the answer, we would be quite famous.”

It is a paradox that in a country obsessed with slimness, an obesity epidemic is raging. But Kate Moss is not for everyone.

To some minorities, immigrants, families in poverty and others, such skeletal supermodels are not icons of beauty--and they are wildly unrealistic.

“The American ideal is being thin, 105 pounds, white and blond,” said Sauti Glenn, a middle-class African American mother from Carson. “We’ll never be that. . . . We are a big people; we are usually bigger [than whites]. It’s more accepted for black people. [We] don’t think it’s unattractive.”

What concerns Glenn and her 15-year-old daughter, Kylah, is not the fashion trends of well-off whites, but their own health. By that measure, Kylah, in whom diabetes was recently diagnosed, is in the danger zone. Now their entire family of four--all of whom are large--struggle together to eat fewer fried burgers and more broccoli.

“You’d have to be one of the strongest people in the world to do it by yourself,” Kylah sighed.

Different ideals of body size grow out of culture and experience.

In Mexico, where food can be scarce, and in some African American households, where low birth weight historically has been a problem, a fat child is often seen as a healthy child. Even as the child matures and enters adulthood, excess padding tends to be more tolerated.

For families living in poverty, piling on pounds--in another paradox--may be a function of a deprived environment. Poor children have fewer safe places to burn off energy, and their parents have more limited shopping options.

Nutritionist Christiane Wert, who works with UCLA endocrinologist Neufeld, said she is struck by the variation in market goods in well-to-do and low-income neighborhoods.

Stores in downtown Los Angeles, catering to minorities and recent immigrants, tend to offer more sugar-laden drinks, limited green vegetables of variable quality, and a paltry selection of low-fat frozen dinners, snacks and dairy products, she said. A few miles away, at stores in Beverly Hills, the produce is bountiful and vibrant, the low-fat and low-sugar goods abundant.

“For low-income families, it’s a lot more difficult” to find healthy food, Wert said. “It has to be a committed mother or father that’s willing to take time when they go to the grocery store.”

Effects of TV Cited

Despite the differences within the American environment, the escalation of childhood obesity has some common culprits that keep children on the couch and off the blacktop.

The greatest of these may be TV. Not far behind, experts say, are television’s technological cousins, computers and video games.

In a 1996 study, Harvard’s Gortmaker and his colleagues found that youths who watched more than five hours of television per day were nearly five times as likely to be overweight as those watching less than two hours. The relationship held true despite adjustments for ethnicity, economic status and other factors.

To Gortmaker, the world of cheap, vicarious thrills, “the video life” perpetuated by “the inactivity industry,” is the fat child’s nemesis. The consequences worsen as the channels expand and more adults rely on television as a bargain baby-sitter. Compounding the effects of numbing passivity, researchers say, are the snacks children tend to eat while watching and the alluring TV advertisements for additional treats.

The hours of television are most harmful for what they replace: Tag, jump rope, neighborhood ball games--the general physical activities of youth.

Kids aren’t burning as much fat in school either. Public schools, in a cost-cutting mode, have slashed physical education requirements. In California, teachers may sandwich PE haphazardly between “real” subjects. The high school requirement is two years, cut from four two decades ago.

Innovative fitness programs have blossomed here and there and the state has a comprehensive PE plan, but critics complain that the plan is not enforced and that coordinated leadership is lacking from education administrators in Sacramento and Washington.

“I think a lot of teachers are aware that kids need to get out and run,” but there is far more focus on teaching and testing academic skills, said school nurse Kit Dreyfuss of the Santa Monica-Malibu Unified School District. “Society needs to get with the program and realize that we are both body and mind.”

The problem extends beyond schools--to American communities that often are hostile to fitness seekers, says Walter Willett, a Harvard public health professor and bicycle commuter. “We spend hundreds of billions of dollars making it difficult to ride bikes safely. The redesign of the urban and suburban environment has got to start sometime.”

Dwindling physical outlets are most distressing, say some experts, because exercise is a far more desirable means of weight control than calorie cutting. Some argue that systematic dieting is dangerous for growing youngsters.

“I think you’re on a slippery slope, taking a 10- or 12-year-old and telling them to restrict calories. If you can get them physically active, you can put it in a positive vein, and you avoid getting them into bulimia” and other nutrition problems, said Charles Kuntzleman, a professor of kinesiology at the University of Michigan.

Others say the real problem is not food intake or inactivity, per se, but the psychological troubles they represent.

Laurel Mellin, an associate professor at UC San Francisco, argues that obesity is rooted in “weak nurturing” and ineffective limit-setting within the family.

“Instead of thinking about it as how much fat is on the body, think about it as an indicator of distress in our children,” said Mellin, who has developed a treatment program called Shapedown based on these ideas. “The underpinnings are permissiveness and deprivation in the family environment. They cause the same effect: The child does not develop the skills to be responsible for themselves. They are at risk of seeking an external solution.”

Food as an Enemy

It seems, to some overweight kids, that the world is against them.

“Have you seen that movie, ‘Omega Man?’ ” asks Eric Radulovic, 12, who at 5 foot 6 weighs 186 pounds. “A neutron bomb hits--some people die and a lot turn into mutants. [The hero] has to destroy them. That’s the way I feel. It’s one guy against the army. . . . The army is food and the [other] kids.”

Last year, Eric was in so many fights at school he had to transfer to another campus. He said groups of bullies--three or more boys all smaller than he--attacked him because he was fat.

“I had to defend myself,” he said.

At home in his Hollywood apartment, he fights his other enemy: food. His mother, an Egyptian immigrant who dotes on the boy she is rearing by herself, shows her love by cooking, feeding and offering more. In the same way, she shows hospitality to a dinner guest, pushing seconds and thirds, and complaining, “You don’t like!” when rebuffed.

Eric knows this routine well.

“Mom forces food on me,” he says, shooting his mother a reassuring smile.

“I am scared he will be faint,” she responds.

Back in Cairo, Fawzia Radulovic’s mother doted in the same way, never allowing her daughter to leave home without a care package. But Fawzeh has another explanation for her son’s weight problem--depression. The boy was devastated four years ago after the Northridge earthquake, which destroyed their previous home and killed his dog. That’s when the pounds really piled on.

Whatever the reasons Eric eats--and they are probably complex--he is slowly taking the pounds off. A doctor referred him to one of the few family-oriented programs in the Los Angeles area--called Kidshape--designed especially for children who are overweight. So far, he says, he’s dropped 38 pounds.

Kidshape represents one doctor’s hope for a solution. Like several other programs for children in California and the country, it is founded on the notion that change comes in tiny increments, that family involvement is key, and that children respond best to positive incentives.

“You can’t give up on kids,” said Kidshape founder Neufeld, echoing a sentiment of many adults studying and treating child obesity.

“Children have the greatest potential for learning and change! If you provide them with the tools, the amazing thing is how well they respond. . . . This is the ideal time [in their lives], before bad habits are formed.”

The idea is moderation--slow, steady and ideally lasting transformation. One of the eight-week Saturday morning sessions for parents and children, for example, is devoted to portion sizes. Dietitian Shannon Duffy drew gasps from her class last month when she revealed that the recommended intake of fruit juice, daily, is a mere splash--half a cup. She awed them with the recommended portion size for meat, as well: It’s no bigger than a deck of cards.

Joy Verdugo and her daughter drive to the two-hour classes every week, 120 miles round-trip from Palmdale to Westwood. When Joy runs late, Patricia urges her on.

“I want to lose weight,” her 9-year-old daughter says.

Neufeld just wants the kids, many of whom either have or border on diabetes, to get healthy. “They are not going to be Kate Moss,” and Neufeld doesn’t want them to be. She sees such waif-like models as the flip side of the obesity problem, the opposite--and equally undesirable--extreme.

The classes aren’t for everyone. One 7-year-old boy, who weighs 110, was blunt. “I don’t like it. It’s a little bit of a waste of my Saturday.” But his mother, who lives in Beverly Hills, is an eager student, learning to relax her anxiety about “policing” her son’s food intake.

Neufeld knows her program is just a start, serving maybe two dozen families a session.

But she sees promise in starting here, in a UCLA basement on Saturday mornings, bringing parents and children together to hear messages about healthy living.

“We are a tenth of a drop in a huge ocean,” she said. “But our families are making better choices.”

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Help for Slimming Down

Programs for overweight youngsters and their families

Academy of Health and Fitness--Juniors and seniors at Redondo Union High School and elsewhere prepare for health careers and educate other students about health, nutrition and fitness. Contact: Les Congelliere, (310) 798-8665, Ext. 2049.

California Project Lean-Food on the Run--Program promotes healthful food choices, physical activity for high school students and families. Operates at 10 lower-income schools statewide, including Colton and San Fernando. Contact: Cyndi Guerra-Walter, (916) 322-1555.

Health Champions--Santa Monica-Malibu Unified School District program promotes good diet, exercise and lifestyle. Includes health screening. Contact: Kit Dreyfuss, (310) 450-8338, Ext. 205.

KidShape--UCLA-based classes promote healthy lifestyles. Costs about $60 per week; financial aid available. Contact: Naomi Neufeld, 1-888-600-6444.

Shapedown--Family-based program developed at UC San Francisco develops parents’ nurturing and limit-setting skills; helps children accept responsibility for diet and activity. Group and individual sessions statewide. Cost varies. Contact: Balboa Publishing, (415) 453-8886.

Shapers--Workshops in nutrition, activity and behavior modification for adults, teenagers and children in San Francisco Bay Area, offered through hospitals and medical groups. Full workshops run $50 to $100. Contact: Laura Wallace, 1-888-7SHAPER.

Sparthenian program--Unique Clovis High program requires four years of physical education (state requires two). First two years introduce physical activities and wellness instruction; last two offer electives, from competitive sports to snorkeling. Contact: Cliff Wetzel, (209) 299-7211.