NEWS

Growing up too fat/Kids suffer adult ailments as more become dangerously obese
Kim Severson, Meredith May, Chronicle Staff Writers
Sunday, May 12, 2002 (SF Chronicle)

Shirleisa Rogers is 10 years old and weighs more than 200 pounds. Every morning, she slips a needle full of insulin into the fat on the back of her right arm. At lunch, she finds a spot on her left arm. Before she goes to bed, she pumps the syringe into her stomach.

The San Leandro girl has a kind of diabetes once so rare in children that doctors call it "adult-onset." A decade ago, the pediatricians treating Shirleisa would have been surprised to see such a case in a child. Now, they see two to five youngsters a day with it.

California public health experts say children like Shirleisa are ailing canaries in a coal mine -- the early signs of a deeper problem. The state's kids are the fattest they have ever been.

Specialists at Children's Hospital Oakland, where severely obese Northern California children go for treatment, see teenage boys whose hip bones have popped from their sockets. They treat girls whose hormones have gone so haywire they're growing beards. They prescribe high blood pressure pills for 12-year-olds and worry that high school patients might have heart attacks or strokes.

"I'm looking 9-year-olds in the eye and talking to them about their bodies as if they are 50- or 60 year-olds," said Barbara King-Hooper, a nurse educator at the children's hospital.

More than a quarter of the state's children ages 9 to 17 are overweight, some by only 10 or 20 pounds, some by 100 pounds or more. Certain groups, such as African Americans, Latinos and poor whites, are even heavier. And the fattest kids are getting fatter.

After decades of holding steady, the number of severely overweight children in the United States has doubled since 1980. The situation is so bad, the surgeon general in January declared childhood obesity a national epidemic.

Health experts and government leaders are only beginning to coordinate a plan of attack for the problem and to calculate the long-term costs. Earlier this month, the Centers for Disease Control and Prevention reported that national hospital costs related to childhood obesity had more than tripled in the past 20 years to $127 million.

So what's going on?

-- The state cut physical education classes about the time children began spending record time in front of television and computer screens.
-- More than half of California high schools look like food courts, selling lunch from chains like Taco Bell and Pizza Hut.
-- Children simply don't play outside as much, sometimes because parents don't trust the neighborhood or can't afford sports fees or equipment.
-- Families have less time to cook and eat together. As a result, fast-food suppers have replaced the home-cooked meal.

In other words, almost everything about modern life contributes to
childhood obesity.

"We're looking at the diseases of a civilization imploding on itself," says Dr. Catherine Egli, who is treating Shirleisa.

ON THE BENCH

When senior Rachel Willis thinks back on her career at Oakland's Fremont High School, gym time won't be among her memories. That's because like most California high school students, she didn't have much of it. "I did P.E. when I was a freshman, and the only thing they made us do was run a mile," she said. "Other than that, it was like free time. They gave us some basketballs and footballs to play with, but about 20 percent just hung out on the benches and talked."

The state has required just two years of high school P.E. since the late '70s. Today, many high schools offer even less than what's required, or allow students to replace P.E. with cheerleading or marching band. In some cases, a student can get out of P.E. if a parent sends a note that states the child works out at a gym.

Most elementary kids in California get only about 15 minutes of organized exercise a week, even though the state requires 100 minutes a week for children in first through sixth grade and 200 minutes for seventh- through 10th-graders.

"Most schools have cut P.E. programs to save money, so regular teachers now have to lead P.E. and many don't know what to do. So they count recess as P.E., " explained Ron Wilkins, head of the YMCA of the East Bay.

Every year kids take the California Physical Fitness Test. The exam, given in March, sends 1.2 million fifth-, seventh- and ninth-graders through a host of aerobic, strength and body fat tests.

This school year, 77 percent flunked.

SITTING AND EATING

Krystina Garcia, 16, of Hayward is hooked. Sending instant computer messages to her friends after school is a four-hour-a-day habit. She doesn't take P.E. at Tennyson High School. Her mother works two jobs and comes home exhausted between 8 and 9 p.m., with just enough energy to swing by the drive-through on her way home.

An adult with a body mass index of 30 or more is considered obese. Krystina's is 51. Her health landed her in the office of Children's Hospital clinical dietitian Kathy Love. She was lucky to get in. Pediatricians refer overweight children so regularly that patients now wait six months for an appointment.

The diagnosis? A case of Type 2, or adult-onset, diabetes and high blood pressure. "It's good that I found out, so I can do something about it rather than sitting here getting bigger and bigger," Krystina said. With Love's help, she spends more time dancing in her room and walking her Chinese Foo dog, Precious. She's cutting her Internet time in half and helping her mother out with dinner.

"Last night," Krystina said, "I made chicken Parmesan." The key to Krystina's success is curbing what doctors now call "screen time. " The average American child between the ages of 8 and 18 spends more than three hours daily watching television and another three or four hours with the Internet and video games, according to a Nielsen Media Research report. The American Academy of Pediatrics recommends limiting children to no more than two hours a day of TV.

GENERATION FLAB

If we are what we eat, California kids are microwave burritos, super-size fries and 52-ounce Extreme Gulps. That's in part because almost half of all food is eaten out, according to U.S. Department of Labor statistics. Another federal study shows that teenage boys eat 70 percent of their meals away from home.

This spring, a reporter asked a class of 23 media students at Oakland's Fremont High School how many sat down with any family member the night before to have dinner. Only two raised a hand. Money and time are the reasons, the students said. Either one or both parents was working, the student was working or no one was around. "We are all on different schedules and we are hungry at different times," said Tharey Sen, 17.

Today's teenagers were raised on Happy Meals, introduced by McDonald's in 1979 -- just one year before childhood obesity rates began to climb. Today, about 90 percent of America's children between 3 and 9 visit a McDonald's every month, reports Eric Schlosser in "Fast Food Nation" (Houghton Mifflin, 2001).

Nutritionists point out that as young people's appetites for fast food has increased, so has portion size. The original McDonald's order of fries weighed in at about two ounces and provided 200 calories. In 1972, the large order of fries was introduced, which had 320 calories. In the '80s, that size was renamed medium. A decade later, the term "super-size" was coined and the size of an order grew to 540 calories and 25 grams of fat, according to the Center for Science in the Public Interest.

In 1998, McDonald's spent just over $1 billion on advertising. Fast food and candy advertising is tightly woven into movie and TV promotions, sporting events -- and even education. Reese's Pieces offers a promotional book that encourages children to use pieces of candy to learn to count. "It's really hard to resist fast food, especially when your kids really like it," said Lucille Beltran of San Leandro, whose whole family is on a diet, including the littlest boy, who came homw from elementary school one day asking her who Jenny Craig was.

Last fall, her 16-year-old daughter, Shante, discovered during a frightening four-day hospital stay that she, like half of her family, has Type 2 diabetes.

Shante cut back on fast food. She started going to the gym every other night and joined a softball team.

"It's hard sometimes for me, like I have meetings with my friends who are planning a quinceanera and they all decide to go to McDonald's together," Shante said. "I stay behind."

SCHOOL FOOD LOADED WITH FAT

Don't think there's refuge inside the school cafeteria. The lunch lady serving a government approved hot lunch is but a dusty icon. The most popular school lunch is a small pepperoni pizza, nachos, a peanut butter cookie and a diet soda -- all items sold in California school cafeterias without having to meet federal nutrition standards. Such a la carte items make up 70 percent of lunch sales in California high schools, according to a 2000 survey of 345 California high school cafeterias.

That particular lunch is a dietary bomb, containing 1,116 calories and 51 grams of fat. By comparison, a federally regulated school meal can't be more than 825 calories and 28 grams of fat.

School food has become so unhealthy that Love counsels her obese patients at Children's Hospital to avoid the cafeteria. Some lawmakers and state experts say the fight against childhood obesity has to start in the schools. A pioneering bill introduced last year by state Sen. Martha Escutia (D Montebello) called for a statewide school ban on junk foods.

It's a much tougher task than it seems. Nationally, school districts reap $750 million a year from vending machine sales. And PTAs and athletic groups regularly sell pizza and candy on campus to raise money. Escutia's bill was watered down after a strong lobbying effort from companies like Pepsi and Hershey Foods, as well as from vending companies and school officials who rely on the money from junk-food sales.

In the end, the new law bans certain junk foods only in elementary schools and restricts their sale in middle schools. High schools are virtually untouched. Oakland is ahead of the pack. In February, the district became the first in California, and possibly the nation, to ban candy and soda in vending machines.

And other, smaller efforts are happening. At several Berkeley schools, for example, gardens called "edible schoolyards" are being built. Last year, Berkeley High School dumped its standard-issue cafeteria food for organic fare, which five local restaurants deliver to campus daily. But not all educators think schools are the place to fight the obesity battle. "If you only serve what you want them to eat with no choices, then the child won't eat," said Bill Caldwell, who was the first food service director in California to welcome fast food into a school cafeteria and now helps manage school menus for the California Department of Education. In the early '90s, he opened a food court with Taco Bell, Kentucky Fried Chicken and Pizza Hut at Capistrano Unified. Caldwell limited the menu to the healthiest items that the fast food chains offered, like a bean-and-cheese burrito without sour cream. "If there is an obesity problem," Caldwell says, "it happens before they come to the school cafeteria."

FAT LIKE ME

Although medical experts worry that a generation of obese children could cost millions in future health costs, others don't see being overweight as such a big deal -- including some teenagers. Certainly, the pressure to be thin is still acute, especially for certain groups of teenage girls. But for a growing number of kids, "the large are in charge."

"It's not embarrassing to be fat, especially with the boys. They love to be big and get praised for it at school," said Rachel Willis of Fremont High School. "Maybe it's because of the people we see in the media, like Jill Scott and Missy Elliott and Biggie Smalls. There are a lot of big kids at school, so most people say it's what's on the inside that matters," she said.

RACE, CLASS PLAY ROLE

Joanne Ikeda, co-director of the Center for Weight and Health at UC Berkeley, cautions that the issue is about health and not size. And, she says, race and class are factors. Including teenagers, a full third of the state's African American and Latino children are overweight, according to recent research from the University of California. For white children, research shows, the poorer a child is, the more likely he or she will be overweight, Ikeda said. Class has less to do with whether kids from other races are overweight.

So far, California offers only a handful of programs aimed at fighting childhood obesity. Much hope is pinned on the California Department of Health's Obesity Prevention Initiative. Funded in part with money from the Centers for Disease Control, health officials are two years into a three-year effort to evaluate the problem and make suggestions on what might work.

"This is not a problem that one agency, one organization, one entity can own and do something about. We're trying to get all the agencies, all of the community groups on board," Ikeda says. "This is calling for a revolution in the way people live. They can't spend four hours in front of the television and eat at fast food every night and expect this to go away."

HOPE FOR THE FUTURE

Shirleisa, the diabetic 10-year-old, first came to Egli's attention last summer, after an unquenchable thirst led the girl to drink 12 sodas on the Fourth of July. A few days later, she was nearly in a diabetic coma. Her sugar levels, which should be under 200, were topping 800. She spent nine days in the hospital.

The reasons for her poor health are complex. People on both sides of her family have diabetes. And her mother, Elwanda Rogers, is heavy. Half of the children who are obese after the age of 6 will remain that way their entire lives, the New England Journal of Medicine has reported. Obese teenagers have it even worse. They have only a 20 percent to 30 percent chance of slimming down.

Then there are emotional factors. Just before Shirleisa was diagnosed, a series of relatives died. Her father lost his job, forcing the family to move from Hayward to the two-bedroom apartment Shirleisa now shares with her parents, two brothers and her great-grandmother.
The doctors think Shirleisa was depressed.

"I think that's probably right," says her mom. "She took to eating in secret."

Mom would come home and find loaves of bread gone, or Shirleisa's room filled with food wrappers. And Rogers admits that her own home-style cooking, including fried chicken and big portions, didn't help her daughter.

So the pair started working with nutritionist Love and Barbara King-Hooper, the registered nurse at the diabetes clinic. They helped Shirleisa and her mother change some of the family eating habits. Portions are smaller. Crystal Light has replaced fruit juice. Shirleisa counts the carbohydrates she eats and tests her own blood sugar.

She gave up some of her TV time to do more dancing. And she rides her bike.

On her April visit to the clinic, she got news that her blood sugar had stabilized. Egli was willing to let her stop the insulin shots for a while. Shirleisa ran to the waiting room to find her little brother, her arms raised over her head in victory.

"Guess what? I don't have to take my shots anymore," she said. But the long-term prognosis for today's obese children is murky. Doctors haven't had enough time to study the impact all that extra weight will have on a generation of young bodies. Often, adults with type 2 diabetes face heart disease, stroke, blindness and possible amputation of one or both feet. Does that mean children diagnosed at 10 or 15 will be blind by the time they are 25? What happens to high school boys with clogged arteries? What are the effects of a whole generation of girls hitting puberty in elementary school?

Doctors just don't know. It's too new. "The bottom line on these kids," says Egli, "is that no one has really seen them into adulthood."

Health resources

-- The Center for Weight and Health at the University of California at Berkeley is a clearinghouse for research and programs. It offers packages for neighborhoods and for health professionals who want to address childhood obesity through community action. Contact (510) 642-1599 or visit www.cnr.berkeley.edu/cwh/.

-- Project LEAN (Leaders Encouraging Activity and Nutrition) is a state effort to get Californians to eat healthier. Among the programs is Food on the Run, which educates high school students about healthy eating and helps them push for healthy food and more physical activity at school. Visit www.californiaprojectlean.org/.

-- The California Adolescent Nutrition and Fitness state-run program focuses on Latinos, African American, Asian/Pacific Islander and American Indian children and features a weight-loss and health program for black youth called Promoting Physical Activities Together, or PHAT. The first PHAT hip-hop event is June 1 in Oakland. Call (510) 644-1533 or visit www.canfit.org.

-- The Centers for Disease Control and Prevention maintains a Web site with information about children and weight. Visit www.cdc.gov/growthcharts.

-- The U.S. Surgeon General has declared obesity a national epidemic. For research and information about childhood obesity, visit www.surgeongeneral.gov/topics/obesity/.

Complications from childhood obesity

-- Emotional problems
Teens with weight problems tend to have much lower self-esteem and be less popular with their peers. Depression, anxiety and obsessive-compulsive disorder can also occur.

-- Breathing problems
Can aggravate asthma and cause sleeping problems, like sleep apnea. Overweight children have had their tonsils and adenoids removed to help them breathe.

-- Adult-onset diabetes
The body becomes resistant to the action of insulin, which means the body can't process sugar. Sugar build-up in the body can damage blood vessels. That's why places with small blood vessels, like the eyes, and blood vessel at a distance from the heart, like in the feet, can stop working.
Kidney function can stop. Diabetes can damage the heart, lead to a stroke and damage the nervous system.

-- Acanthosis
The neck, elbows and joints might develop thick, velvety skin folds that become dark with pigment. It's a consequence of insulin resistance associated with obesity.

-- Bones and joints
Extra weight can cause bowed legs, joint problems and back pain. Bones and joints mature more quickly, which could lead to problems later in life.

-- Excess fat
Can make the body produce excess estrogen, which can lead early puberty in girls. Obese girls can also develop a condition called "polycystic ovary disease," which means the body makes extra testosterone. Obese girls sometimes grow beards and excessive hair on other parts of their bodies. Their periods and normal sexual development stop and they can become infertile.

Fighting obesity

Several state lawmakers are working on bills to fight childhood obesity:

-- Sen. Tom Torlakson (D-Martinez) has introduced SB1868, which would force ninth-graders who flunk the state fitness test to take more than two years of high school physical education. The bill also would require that schools send home each child's fitness score.

-- Sen. Deborah Ortiz (D-Sacramento) introduced a bill to remove soda from all schools within five years. According to SB1520, soft drinks now comprise the leading source of added sugar in a child's diet.

-- Assemblywoman Carole Migden (D-San Francisco) wants the California Department of Education to simply enforce the existing P.E. requirements. Her proposal, AB1793, would better monitor the amount of physical education students actually get and impose deadlines on schools that fail to meet the state's minimum.

E-mail the writers at kseverson@sfchronicle.com and mmay@sfchronicle.com
----------------------------------------------------------------------
Copyright 2002 SF Chronicle