Childhood Obesity Off the Scale in California

September 09, 2005|Carla Rivera | Times Staff Writer

A new study says that 28% of the state's children are overweight -- a health crisis poised to explode into higher rates of serious illness.

In California, renowned for lean bodies and active lifestyles, childhood obesity has reached epidemic levels, with more than 40% of the schoolchildren in some communities overweight, according to a new study.

Children in Southern California fare particularly badly: Of the state's 10 largest cities, Los Angeles, Santa Ana, and Anaheim top the scales, with 36%, 35% and 32% of their children overweight, respectively. By comparison, 24% of San Francisco's children are overweight and 26% of San Diego's are.

Statewide, 28% of children are overweight, a 6% increase since 2001, according to the study by the California Center for Public Health Advocacy, a nonprofit organization in Davis.

The report, based on public school fitness test scores for fifth-, seventh- and ninth-graders, is the first to look at the percentage of overweight children in specific communities.

Those extra pounds are a public health crisis poised to explode into increased rates of debilitating illnesses, the report warns.

"We were shocked by the findings, especially when we looked at specific communities," said Harold Goldstein, the center's executive director. "We see regions with more than one-third of kids overweight. It really is scary when you look at the long-term costs in human suffering and the economy. Three-quarters of overweight teens will become obese adults. One-third of children born in 2000 can expect to develop diabetes."

The Central Valley town of Wasco has the highest percentage of overweight children: 42%. In nearby Delano, more than 40% are. And 41% of the children in the Los Angeles community of Wilmington are overweight.

In Pacoima, El Monte, Huntington Park and North Hollywood, well more than one-third of schoolchildren are overweight, the study found.

The rates were far lower in some areas, including the foothill community of El Dorado Hills near Sacramento, with 9% of children overweight, and Manhattan Beach, with 8%.

The report's authors determined whether children were overweight by looking at their body fat.

Experts say that whether a community's children tend to be fat or fit depends on demographics and socioeconomics.

"What is required to explain this in more detail is further study of what is going on in different communities," Goldstein said. "Latinos, Pacific Islanders and blacks are more overweight than other groups. Low-income communities have a higher density of fast-food outlets, and it takes more effort for people to buy healthy foods. Los Angeles is designed for cars, and it doesn't help that schools often don't have physical education anymore. But the point is: The trend is worsening for everyone."

Researchers are most concerned with the growing threat to public health.

Francine R. Kaufman, director of the Center for Endocrinology, Diabetes and Metabolism at Childrens Hospital Los Angeles, said the diabetes program there is overflowing and can't meet the needs of the numbers of children referred to it.

"We are seeing kids who are morbidly obese," Kaufman said. "These kids have apnea when they go to sleep at night; they have to go on breathing devices just like adults. They have problems with their livers that we had never seen before in kids that eventually may lead to cirrhosis and the need for a transplant. We're seeing irregular periods and hormone imbalances that may impact fertility."

The growing levels of overweight children "reflect conditions in schools and communities that encourage children to eat and drink unhealthy foods and beverages and that limit their physical activity," the study asserted. Children and parents are enticed by supermarket displays, the convenience of fast food and mouth-watering television ads proffering fatty, sugary goodies. "We're looking at what could be an unending cycle of morbidity and disease," Kaufman said.

Families like that of Rafael and Maria Navarez and their four children are fighting to combat such harmful influences. Rafael, 55, said the family was stunned when oldest son Rafael, 14, was diagnosed with Type 2 diabetes, which is tied to being overweight. Neither he nor his wife has a family history of obesity, Navarez said.

But they knew the kids were exposed to poor food choices at school and got little exercise. They were reluctant to let them go out in their Boyle Heights neighborhood to play by themselves. The senior Rafael's part-time job as a grocery clerk did not allow for extravagances like fresh fruit and vegetables every day.

After doctors expressed concern about 8-year-old Sergio's weight and referred the family to the Childrens Hospital program, they got serious about improving their health.

"I don't want to blame the schools," Rafael said. "It's up to us as parents to stop letting kids eat bad food at school or outside school, and now we make their lunch."

The whole family supports the younger Rafael and attends clinic sessions in which they get weighed and have their blood sugar tested. They walk together several times a week and are learning to kick bad habits.

California policymakers have begun to combat obesity, giving final approval Tuesday to legislation written by Sen. Martha Escutia (D-Whittier) that bans the sale of sodas and sets requirements for food sold on school campuses during school hours.

Gov. Arnold Schwarzenegger, who is sponsoring a Sept. 15 summit in Sacramento to address childhood health and nutrition, has vowed to sign the measure.

Local school officials were among the first to react, with the Los Angeles and San Francisco public schools setting restrictions on vending machine sales.

"At LAUSD, we've adopted a centralized contract for healthy beverages with Pepsi, and we're looking to them to help us re-brand the way children eat," said school board President Marlene Canter.

"Some kids have been raised on fast food since they were little, and they don't know any difference between what's healthy and unhealthy."

Canter said the district is developing programs to promote healthful eating, including health fairs, cooking classes aimed at different cultures and farmers markets on high school campuses.

"Everybody says: 'You are going to be taking choice away from kids,' but it's not that. They will learn, if they eat a bag of potato chips, it's like eating a vat of fat," Canter said.

"We want children at an early age to become knowledgeable so that when they're in their 50s and 60s they're not at risk for chronic disease."

Although many experts agree that more children are overweight, there is debate over the reasons and the best ways to tackle the problem.

Dan Mindus, a senior analyst at the Center for Consumer Freedom in Washington, said he had no quarrel with the report's findings, but he cited other recent studies that show tremendous drops in the level of children's physical activity and no evidence of higher caloric intake.

"Kids aren't running around outside with their friends like they used to. They're spending all their time with computer games and on the Internet," he said. "And meanwhile, recess and gym class are withering on the vine with only 25% of high school students enrolled in PE at any time."

He acknowledged that his group receives some funding from food and beverage companies, but said the organization is nonprofit, nonpartisan and independent.

"In case after case, we see evidence kids aren't eating any more than they used to, but exercising less," he said. "It's almost too easy to blame snacks in school when it's more difficult to try to get kids moving again."

Other experts said that reversing the obesity trend would require not only removing sodas from school campuses, but changing societal norms.

"It's about a huge increase in calories and an extremely sedentary lifestyle," said Marion Nestle, a professor of nutrition, food studies and public health at New York University.

"It's now acceptable to eat more times during the day, acceptable to eat publicly, acceptable to sell soft drinks to kids in school and to eat huge quantities, and it didn't used to be that way. There's a very large complex of social trends going on that affect kids, and we're really going to have to change society."

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Too heavy

Percentages of California children in grades 5, 7 and 9 who were found to be overweight when tested in 2004:

Percent overweight, statewide

All: 28.1%

Boys: 33.9%

Girls: 22.0

Pacific Islanders: 35.9%

Latinos: 35.4

American Indians: 31.7

Blacks: 28.7

Filipinos: 24.7

Whites: 20.6

Asians: 17.9

Others: 24.4

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Percent overweight, 10 largest cities

Los Angeles: 36.3%

Santa Ana: 34.8

Anaheim: 32.3

Oakland: 30.7

Fresno: 30.5

Long Beach: 29.1

Sacramento: 28.7

San Jose: 27.4

San Diego: 26.4

San Francisco: 24.4

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Source: California Center for Public Health Advocacy

Bullies Target Obese Kids

MONDAY, March (HealthDay News) -- For kids, a few extra pounds may invite trouble from the schoolyard bully.

New research suggests that just being overweight increases the risk of being bullied. And factors that usually play a role in the risk of being bullied, such as gender, race and family income levels, don't seem to matter if you're overweight -- being overweight or obese trumps all those other factors when it comes to aggressive behavior from other children.

The study found that being overweight increased the risk of being the target of bullying by 63 percent.

"One of the reasons we started this study is that obesity is so much more common today. Now that about half of kids are overweight or obese, it doesn't make you such an outlier anymore, so we thought maybe kids wouldn't be bullied for being overweight anymore," said study author Dr. Julie Lumeng, an assistant research scientist at the Center for Human Growth and Development at the University of Michigan in Ann Arbor. She added that the researchers also hoped they might be able to find some protective factors against being bullied, such as doing well in school.

"What we found, much to our dismay, was that nothing seemed to matter. If you were obese, you were more likely to be bullied, no matter what," she said.

Results of the study will be published in the June issue of Pediatrics, but were released online May 3.

The study included 821 boys and girls from a nationally representative sample of children selected from 10 sites around the United States. Bullying behaviors were assessed in third, fifth and sixth grades. The youngsters were mostly white, half of them were male and 15 percent were overweight in the third grade.

By sixth grade, teachers reported that 34 percent of the study children had been bullied, and mothers reported that 45 percent of the children had been bullied, while 25 percent of the children themselves said they had been bullied.

Previous research has shown that boys, minorities and children from low-income groups are more likely to be bullied, so the researchers took these factors into account to see if they made a difference. The study authors also considered a child's social skills and academic achievement in their analysis.

"No matter how much we retested, the findings were very robust. Obese kids are more likely to be bullied," said Lumeng.

She said that one of the reasons she believes the findings were so consistent is that prejudice against overweight or obese people is "so pervasive that it's acceptable." But, she added, "Obesity is really complex. It's not all about willpower. It's a brain-based disorder, and I hope that message becomes clearer."

Dana Rofey, an assistant professor with the Weight Management and Wellness Center at Children's Hospital of Pittsburgh, said she wasn't surprised by the findings. "Bullying is the most common psychosocial complaint that our patients present with," she said.

"For parents and pediatricians, one of the issues our study raises is that if you're caring for a child who's overweight, you need to be alert to this and you might want to gently bring it up with the child. Ask, 'How are things at school going?' or 'Does anyone ever say something that makes you feel bad?' because this may be an issue that's difficult for kids to bring up," said Lumeng.

If your child lets you know that he or she is being bullied, Lumeng said your first response should be to validate your child's feelings and let them know that it's not OK for someone to treat them like that.

What to do next can be tricky, agreed both experts.

"Be supportive, and let your child know that you'll help them. Consult with your child and ask how he or she would like you to get involved," advised Rofey. Many youngsters may ask their parents to take a hands-off approach, she said. But she recommends setting some guidelines. "Say something like, 'It seems you have this under control right now, but let's keep talking and checking in about it.'"

Rofey also recommends teaching your child how to avoid situations that might lead to teasing or bullying, and talking with your child about how to reach out to adults if they need to. Depending on the situation, she said that parents may need to step in and advocate for their children at the school. But, she advised always letting your children know what steps you'll be taking.

Type 2 diabetes threatens more and more children

By Rachel Uranga, Staff Writer

Sweat trickling down his neck, baby-faced Delvin Arroyo struggled to hold a 15-pound weight high over his head.

It was no small achievement.

Last year, the 153-pound 12-year-old couldn't run a city block. He had high blood pressure, and his doctor diagnosed him with borderline type 2 diabetes. Linked to obesity, the chronic life-altering disease can lead to blindness, heart disease and limb loss.

Delvin was scared and depressed, so his mother placed him in a weight-loss program that has him engaging in more strenuous physical activity. He has since shed 20 pounds, cutting his chance at developing type 2 diabetes -- a disease once only found in adults.

"This is saving my life," Delvin said recently, as he was getting his exercise clothes ready for class. "I am doing this for my health."

His journey is one that thousands of children will have to take if health officials are to stave off the rising tide of type 2 diabetes.

Linked to obesity, the chronic and costly condition has been expanding along with American waistlines. Though the number of children with the disease appears statistically small, experts consider its presence ominous.

"We are at a devastating point in our history," said Dr. Francine Kaufman, former president of the American Diabetes Association and author of "Diabesity," a look at the speed with which diabetes, hypertension and other obesity-related diseases are afflicting children. "One in three children born in 2000 will have diabesity in their lifetime."

Nationally, one in five deaths is caused by diabetes -- most related to type 2 diabetes. And it costs the nation billions -- $132 billion in 2002 -- in direct and indirect medical costs, not to mention loss of productivity and higher levels of depression among diabetics.

It disproportionately affects Latinos, African-Americans, American Indians and Pacific Islanders. And the numbers are expected to surge -- changing the everyday habits of millions.

Type 2 occurs when the body fails to produce enough insulin -- the hormone that helps the body's cells use and burn sugar-- or the cells ignore insulin. Unlike type 1 -- which occurs when the body fails to produce insulin -- type 2 is often preventable in children.

It can be curbed through diet, medication and daily blood sugar checks. But it can also worsen with catastrophic consequences, including kidney failure.

Up until the 1990s, type 2 diabetes was thought to occur only in adults. But that changed as clinicians started noticing a wave of overweight adolescents coming to emergency rooms in diabetic-like comas.

"There was a great deal of disbelief," said Dr. David Geffner, a clinical professor of medicine at UCLA. "My pediatric colleagues were shocked that children had the adult form of diabetes and that it could happen in kids."

In response, doctors loaded these children up on insulin as they did with children with type 1 diabetes. Some children were injecting themselves several times a day because of the high dosages they were prescribed. But their bodies couldn't process the insulin in the same way as type 1 children do. Instead, the type 2 diabetics gained more weight, compounding the problem.

A group of physicians finally convinced the scientific community that the hormones in children as young as 10 could be altered due to their lifestyle -- much like their adult counterparts.

"It has become a silent epidemic," Geffner said. "If we don't do something now, these children are going to die younger than their parents."

Though there are no current statistics on the number of kids with type 2 diabetes, experts tracking the phenomenon estimate at least 40 percent of the new patients diagnosed every year have type 2 diabetes. That's about one in 1,000 children. And many more overweight kids, like Delvin, are considered pre-diabetic.

Delvin, like most pre-diabetic children and type 2 diabetics, never thought he was at risk until a doctor observed the tell-tale darkened skin around his neck.

Also known as black neck or "Acanthosis nigricans" -- a common symptom of diabetes -- the dark skin signals the body's resistance to insulin. It's often the first inkling parents get their child either has or may be at risk to developing diabetes.

"When I first heard I was really surprised," said Delvin's mother, Senobia Arroyo, a Van Nuys housekeeper. "For me, his health is the most important thing."

The disease has altered their life. The single mother of two -- who has a family history of type 2 diabetes -- now cooks dinner every day, no matter how tired. She peels the skin of the chicken for Delvin and his 8-year-old sister and prepares lunches with salad and vegetables. And, despite sporadic pleas from Delvin, burgers from In-N-Out are out of the question.

Such a plan comes at a cost. Arroyo's grocery bills have doubled, and she struggles to stretch her paycheck. The $1 bag of potato chips she used to buy was half the price of a bag of Delvin's favorite Fiji apples. And the expensive fresh foods wilt or rot more quickly than canned foods she used to buy.

"At times, it's hard," she said. "We can't afford an amusement park anymore or things like that. It is worth it though."

Her gasoline bill has also spiked. Five times a week, she treks 30 miles across town to a Beverly Hills skyscraper, where her son attends Power Play, a Medi-Cal-covered weight-loss program for children.

Studies have shown that pre-diabetics who lose 5 to 10 pounds and exercise 30 minutes a day can reduce their chances of developing the disease by more than half.

Parents, school districts and private insurers, as well as federal and state governments sensitive to the disease's rising cost, are slowly beginning to pump millions of dollars into fitness programs like Power Play.

Inside a carpeted seventh-floor office overlooking Wilshire Boulevard, portly adolescents pedal exercise bicycles, catch weight balls and sweat away the pounds they have spent most of their childhood accumulating.

As Delvin holds the 15-pound weight over his head, trainer Thomas Martin, eggs the class of six on.

"Come on, all the way up," he says, as the children groan.

Dr. Lydia Hazan, founder of the program, estimates that six out of 10 of her clients are pre-diabetic.

Many regularly devour sodas and chips, weigh more than 200 pounds, rarely exercise and have diabetic parents.

"We have a crisis on our hand," Hazan said. "And we are behind the ball."

Delvin is one of the lucky ones. He got help early and is sticking to the program. Hazan said she has watched children 15 years old starting to go blind after failing to follow up with their diagnosis.

Clinic workers say it's not uncommon for patients to stray. Kiauni Martin, a 15-year-old sophomore at Fremont High School in South Los Angeles, never gave the idea a thought. Last year, a doctor diagnosed the 230-pound basketball player with type 2 diabetes.

She takes pills twice daily and must check her own blood level when she goes to bed and when she wakes. She has cut out Hot Cheetos and sour Gummy Bears and become an sort of informal ambassador of the disease at her school.

"I am doing this knowing that I will live another day," she said. "I want everyone to know it can be prevented, but if you have it you will be OK."

Rachel Uranga, (818) 713-3741   rachel.uranga@dailynews.com