Maria CRUZ bustles around her kitchen preparing dinner, keeping one eye on a simmering pot of salsa verde and the other on her 8-year-old son, Abel. He's an energetic kid prone to bursts of song and dance -- and to occasionally sneaking food when his mother's back is turned.
"Ay, junior!" cries Maria as she spies him slinking off with a just-cooked chicken leg. Any mother would be annoyed, but Cruz's concern goes deeper. At 4 feet 7, Abel weighs just under 200 pounds, making him morbidly obese. Concerned about a family history of diabetes and fearing his weight will continue to rise, Cruz recently enrolled her son in an eight-week nutrition and exercise program that involves the entire family, not just the child.
After a couple of weeks, Abel already has lost 5 pounds, an accomplishment that makes Cruz beam. She stands in the kitchen smoothing her son's T-shirt over his stomach and smiles. "See?" she says. "It used to stick out."
Cruz and her husband, Abel Sr., are among millions of parents of overweight or obese children who are trying to help their children lose weight safely. Some, like Cruz, have been lucky enough to enroll their children in special programs that, while temporary, offer useful information. But there are far too few programs to fill the need, and many families have no idea where to turn. Some struggle to devise a nutrition and workout plan with little or no guidance. The process -- however it's done -- is seldom easy and can take years of commitment.
Experts agree that parents are a crucial element in their children's weight loss. Kids need strong role models and a support system to provide proper nutrition, exercise and motivation to stick to a plan. That may mean that parents, many of whom are themselves battling weight problems along with their kids, can no longer live in denial about their own health.
Obesity rates in the U.S. continue to rise: More than 15% of kids between ages 6 and 19 are considered obese, according to the federal Centers for Disease Control and Prevention. And those extra pounds put these children at heightened risk of diabetes, high cholesterol and high blood pressure. Obesity in youth is also a strong predictor of obesity in adulthood.
While the obesity problem touches every demographic, ethnicity and culture, health experts cite the same culprits for all: television, computers and video games; junk food and unhealthful school lunches; inadequate school physical education programs and a scarcity of safe playgrounds and parks; busy moms and dads who don't emphasize the importance of physical activity to their children. Doctors may diagnose the condition, but might lack the time or knowledge to counsel families on nutrition, exercise and the psychological aspects of weight loss.
Considering the mighty flow of information -- much of it conflicting -- about issues as varied as portion size and protein, it's not surprising that parents need help getting their kids started. Parents willing to make changes find the process both rewarding and frustrating. Cruz has been successful in changing some of her son's eating habits -- he now eats more vegetables and fruit -- but it can be a tug of war weaning him off the soda and sweets he loves.
But Cruz, 27, is determined to help her son. She's trying to rearrange her work schedule at the downtown Los Angeles McDonald's restaurant where she's employed so she can take Abel to more exercise classes. Abel Sr., 34, works as a roofer, and the parents' busy work schedules make it difficult to keep tabs on whether their son is getting daily exercise. The family has taken long walks in their neighborhood.
Cruz's parents and husband are diabetic, so meals are generally healthy and include a good mix of protein and healthy carbs such as vegetables. Since Abel started his program, however, she cooks with far more prudence. "I add only a tiny bit of this," she says, carefully measuring the vegetable oil she's putting into a pot. Lean meats are usually boiled or roasted without any added fat. Abel turns his nose up at numerous vegetables, but broccoli, cabbage and spinach are still offered.
Adapting meals and exercising more have been good for her too, says Cruz. Having battled a weight problem most of her life, she doesn't want her only child to go through what she has.
But there's another fear that hovers in Cruz's mind. She recalls hearing of an incident in New Mexico four years ago when a 3-year-old girl who weighed 120 pounds was temporarily removed from her family by authorities because of feared health risks. "I don't want that to happen to us," she says, "because we love Abel so much."
However unfounded her worries might be, it's partly what motivated the family to heed the suggestion of Abel's pediatrician to enroll him in PowerPlay MD, a privately funded weight-loss program started by Los Angeles pediatrician Lydia Hazan that provides instruction in nutrition and offers exercise and some counseling on how to modify behavior and deal with such issues as teasing. The program, which follows up with families after the eight weeks, is held at a few health centers in the Los Angeles area.
"They kept telling me I needed to do something, but I didn't pay attention," she says, when her son, who weighed 7 pounds, 12 ounces at birth, began to gain a great deal of weight around age 5. Abel underwent a battery of tests at Childrens Hospital Los Angeles to see if there was an underlying medical cause, but results were negative.
Some families welcome an intervention, says Abel's pediatrician, Dr. Luis Lopez, while others ignore repeated warnings until the situation becomes critical. In the Latino community, he adds, there is often the belief that a chubby baby is a healthy baby. "It's hard to break through that wall," he says.
"You cannot wait for these kids to be above the 95th percentile of BMI," Lopez says, referring to the body mass index charts that use height and weight to determine overweight and obesity. "Once they're obese, it's extremely difficult to get them to lose weight and maintain it."
At a recent PowerPlay session, Cruz and Abel join a group of other moms and their young kids in a room at the downtown Eisner Pediatric & Family Medical Center. Today there is good news: Abel has lost almost 2 pounds, his weight dipping just below 200.
Abel gets a high-five from Judith Mercado, who leads the hourlong nutrition session. "How many calories do we look for in a snack?" she asks the group, which chimes back, "One hundred!" She offers tips such as perusing school lunch menus to pick out healthy foods, and she encourages the kids to try new fruits and vegetables.
For parents, having overweight children isn't "a sign of ill will -- parents are just confused," says PowerPlay's Hazan. "I'm bringing it back to basics and common sense. Kids want to discuss diet; they want to learn. Why not be open about it?"
Habits about food and diet are formed by the family, says Dr. Naomi Neufeld, founder and medical director of KidShape, a 17-year-old program with some 30 locations that, like PowerPlay, educates families about nutrition and provides exercise. "In the beginning," says Neufeld, "it's hard to convince someone that simply reducing the amount of soda or juice the child drinks can make an effective change, but even after two weeks they see changes. The family's even fighting less, so we're addressing the family dynamic. They're seeing results, and that's quite powerful."
Cruz gives PowerPlay high marks for helping her and Abel understand things such as portion size, food groups and the importance of daily exercise. When he wants a snack before meals, she takes a cue from the program's workbook and, instead of giving him food, asks him first if he's tired, bored or thirsty -- usually it's one of the three. "I'm going to start doing that with myself too," she says.
After dinner she sits at the dining room table while Abel clears the dishes, then sits down next to his mother. "Look, Mom," he says, "my eyes are bigger."
She laughs and strokes his cheek. "Yeah, when he was fatter his eyes were closed more," she says. "But now he's losing weight."
"My mom was happy that I lost weight," Abel says. But was he?
"Yes, because I'm a little fat and I need to lose weight," he says, adding that he feels tired after exercising, but more energetic during the day. "I want all the kids to see that I'm losing weight."
In second grade a classmate called him fat, but otherwise teasing, Cruz says, hasn't been a big issue since Abel started school. Cruz, who recalls being teased in school about her own weight, told her son not to be ashamed of his size, that "if we can do something about it, we'll fix it. You're overweight, but you care for other people, and you have parents who love you." After a talk with the boy and Abel's teacher, the teasing stopped, and the boys are now friends.
One research study found that the stigmatization of overweight children may be getting worse. In 1960 children were shown illustrations of a healthy child, an obese child and of kids with various disabilities, such as being in a wheelchair or on crutches, and were asked with whom they'd most want to be friends. The obese child was chosen least. When that study was duplicated in 2003, the number of children who put the obese kid at the bottom of the list increased by 40%.
It was difficult for Elsa Sweasey to hear about the teasing her 10-year-old daughter, Jacqueline, endured at school.
"A lot of kids would call her names like 'Miss Piggy' and 'jack-o'-lantern,' " says Sweasey, as tears well up in her eyes. "She didn't tell me, another child did. She said that Jacqueline was crying. I told Jacqueline that I don't want people hurting her. I told her we were going to do something about it, that being chubby doesn't mean you're dumb or ugly."
Sweasey, 45, sits on a bench behind Our Mother of Good Counsel, a Roman Catholic church and school in L.A., while Jacqueline plays volleyball just yards away. Over the shouts and laughter of the children, Sweasey talks about the changes the family has made since a visit to the pediatrician a few months ago. The doctor told Jacqueline that if she didn't start paying attention to her weight now, the situation could be far worse by the time she was a teenager.
Since then the family has kicked into high gear. Jacqueline has stopped drinking soda and eating chips, and she no longer snacks after dinner while watching TV -- habits that, Sweasey says, pushed Jacqueline's weight up to 140, despite the fact that she was fairly active.
Sweasey takes her daughter to the Hollywood YMCA several days a week for karate, swimming or hip-hop dance classes, or to work out on the cardio equipment, which they do side by side. She works a night shift job in maintenance at Cal State L.A. and is attending school to get her high school equivalency diploma. After picking up Jacqueline and brother Eric, 8, after school, she sits through volleyball practice or takes the kids to the Y. On weekends, Sweasey, her husband, John, 47, and their kids all trek to the Y. Sleep these days is minimal, but her determination to help her daughter is far stronger than her desire to nap.
Jacqueline has already lost about 11 pounds, and her delight shows. At home she reaches into her closet and retrieves a pretty floral dress that used to be too tight. It's still a little snug, but she can get into it.
"When I see my mom work out, I want to do it," she says.
But can Jacqueline keep such a hectic schedule for long? "She has her own mind and her own will, which is pretty strong for a 10-year-old," says her father, adding that he doesn't believe Jacqueline will burn out on exercise. "I don't worry about that," he says. "She loves a lot of different sports."
Not every child is as motivated as Jacqueline, says her pediatrician, Dr. Ameeta Ganju. "She was very honest with me, saying she often ate in front of the TV. The family gets full credit for being receptive to the discussion and helping me brainstorm ideas, and making those changes happen."
Sweasey and Cruz, like other parents, want the simplest things for their kids -- being able to shop in the children's department instead of the adult's, or running the length of the schoolyard. Cruz would like to get Abel started in soccer; the exercise and camaraderie would be good for him, she thinks.
"There's nothing that's impossible," she says. "Sometimes it's a little hard and you get tired, but we can make it. We want our son to be healthy. So it's worth it."