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Childhood obesity

Tucson doctors, teachers, parents fight childhood obesity

Hispanic, American Indian kids face the highest risk

At Miller Elementary School on Tucson’s southwest side, first-graders are learning about nutrition and health.

They talk about the food pyramid, and the importance of eating five servings of fruits and vegetables every day.

They’re also learning to make healthy snacks. Monday’s recipe was “ants on a log,” a nutritious treat made by stuffing a piece of celery with peanut butter, then sticking raisins on top.

“You can put as much or as little peanut butter on as you want. It’s your snack,” says nutrition teacher Tina Anderson, who also is Miller’s cafeteria manager. “And this, ladies and gentlemen, is a snack you can make yourselves, at home.”

Anderson’s teaching style is fun and upbeat, but her purpose is completely serious. It’s about fighting the increasing epidemic of childhood obesity.

The problem was listed as a public health priority in January 2000, when the federal government set its health goals for the coming decade. At that time, 11 percent of all children were overweight or obese. The goal was 5 percent by this year.

Instead, childhood obesity rates in the United States have continued to climb. Today, 33 percent of children in this country are overweight or obese.

“It’s an incredibly difficult problem to solve,” says Dr. Tracey Kurtzman,
a University of Arizona pediatrician who has been studying the problem for seven years, starting while she was at the University of Texas Health Sciences Center.

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Kurtzman is one of the creators of “Ready, Set, Smart Start,” a program to provide parents with simple strategies for keeping their baby’s weight where it belongs.

Refrigerator magnets, for example, remind parents that breastfeeding reduces their newborn’s chance of becoming overweight, and that taking a 4-month-old for a ride in her stroller is great for parent and child.

“We don’t know yet how effective this is. It needs further study,” Kurtzman says. “Our thinking is we need to prevent childhood obesity from happening to begin with. And we need a comprehensive program for not only the kids, but to help the whole family become more healthy.”

Tucson Medical Center nutritionist Jenna Fu agrees wholeheartedly. She directs the hospital’s Fit Kids program, teaching overweight children and teens about good nutrition and exercise to help them get in shape.

“We try to educate the parents, teach them about healthy snacks,” Fu says. “It has to be a partnership between the adults and the kids. Parents want their kids to be healthy, they just don’t always know how.”

Dr. Andrew Arthur, a pediatrician with El Rio Community Health Center, said childhood obesity is one of the most common, and most challenging, issues he deals with.

“There is no current accepted model for treating childhood obesity. It doesn’t exist,” Arthur says. “Many programs have been tried, and a few of them have shown minimal results . . . But when you check up six months later, the improvements go away.”

Arthur says he doesn’t believe in diets. He prefers instead to teach his young patients to make choices that are good for them.

“With older kids,” Arthur says, “I like to focus on ‘What are your strengths, what do you hope to accomplish in your life, and how can we help you achieve your goals?’

“What’s sustainable is when someone chooses to take care of their body because they see some positive things happening in the future as a result. And if they cut back from five sodas a day to one soda a day that’s a positive step.”

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Childhood obesity is a nationwide problem, but southern Arizona is in a particularly high-risk zone. Hispanic and American Indian children are far more likely to be overweight than children in other ethnic groups, according to the Centers for Disease Control and Prevention.

In a 2008 study of low-income preschool children, the CDC found more than 21 percent of Indian children, and 18.5 percent of Hispanic children met the definition of obese – their weight ranked them in the 95th percentile for children their age.

In contrast, the study found 12.6 percent of white children were obese, and even fewer Asian and black children.

Those kinds of statistics convey that genetics are at least part of the problem. But increasingly, public health experts are pointing to poverty.

The recession, job layoffs, escalating food costs – they all amount to a huge struggle for single parents and even married couples, experts realize.

“I sympathize,” Kurtzman says. “There are just so many barriers to healthy living right now. When you’re a single parent working two jobs, fast food is easier and less expensive than healthy food. I’m a busy parent, and I understand.”

So does First Lady Michelle Obama, who launched a nationwide campaign against childhood obesity last month. Her “Let’s Move” campaign emphasizes more physical activity, more healthy foods at school and teaching children to make good choices.

“It wasn’t long ago that I was a working mom, struggling to balance meetings and deadlines with soccer and ballet,” Obama said at her Feb. 9 press conference NY TIMES . “And there were some nights when everyone was tired and hungry, and we just went to the drive-through because it was quick and cheap, or went with one of the less healthy microwave options, because it was easy.”

Two days after Obama’s campaign launch, The New England Journal of Medicine reported on a study that analyzed decades of data on almost 4,900 Tohono O’odham and Pima Indian children. Those who were the most overweight as children were more than twice as likely to die before age 55 than those who were thin.

Childhood obesity out-ranked childhood pre-diabetes and high blood pressure as risks for early death.

Miller Elementary School Principal Mary Anderson (no relation to Tina) is well aware of such data. Ninety percent of her students are from low-income families, and qualify for free or reduced-price lunches – for many of them, their main meal of their day. Ninety percent of Miller’s students are Hispanic, and 4 percent are Indian. Those children face twice the usual risk of developing diabetes, and are at risk for obesity and other chronic illnesses.

“We have a lot of kids who are overweight,” Anderson says, “and we have a couple of kids who have diabetes.”

Since arriving at the school three years ago, she has implemented several programs to keep her students healthy.

Anderson limits school parties to two a year; the last was for Valentine’s Day. “We did have a lot of cupcakes, but we saw a lot of vegetable trays,” she says. “We’ve seen a shift in the kinds of foods that come in.”

Funding cuts have left no money for physical education classes, so this school year Anderson began using tax-credit donations to pay the salary of parent Brett Dusz to be the school’s P.E. teacher. On Monday afternoon, he was outside supervising fourth-graders in a game of kickball.

“It’s really fun. We get to have fun just playing and running,” said Claritza Campoy, a 10-year-old with the school’s track team. And she agrees with Anderson’s assessment that the P.E. classes have shown another benefit.

“There’s like no fighting” when the kids are outside playing, she says.

But obesity prevention may need to start before kids are old enough for school. One in seven low-income, preschool-aged children is obese, the Centers for Disease Control and Prevention reported in November.

Obesity prevalence in low-income 2- to 4-year-olds increased from 12.4 percent in 1998 to 14.6 percent in 2008. Again, Hispanic and Indian pre-schoolers were more likely to be obese than white, Asian and black children.

Earlier this month, The New York Times reported on a Harvard Medical School study that makes a case for preventing childhood obesity even before a child is born.

Babies whose mothers smoke during pregnancy are typically underweight at birth, but face an increased risk of becoming obese afterward, the study found. Babies who sleep less than 12 hours are also at increased risk.

The Institute of Medicine has been asked to develop obesity prevention recommendations covering children pre-birth to 5 years.

For children who are overweight or obese, learning new habits may be the best approach, experts advise.

“Soda is not poison,” Arthur says. “Neither is McDonald’s. Neither are Hot Cheetos. Neither is birthday cake. But those things should only be occasional treats.”

Jane Erikson, a former health care writer for The Arizona Daily Star, is very glad to be writing for TucsonSentinel.com.

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Val Cañez/TucsonSentinel.com

Miller Elementary School fourth-grader Daniel Estrada, 9, stretches. All of these fourth-graders are in Matthew Morondos' class.

Teacher losing weight too

  •    To win the battle against childhood obesity, experts say, adults need to model healthy behavior for kids.
  •    Tina Anderson is doing just that.
  •    Anderson, Miller Elementary School’s cafeteria manager and nutrition teacher, helped organize a “Biggest Loser” program last year for about 20 of the school’s employees – herself included.
  •    So far, Anderson has lost 49 pounds. She would like to lose another 50.
  •    “When the kids see that my body and health have changed because I eat healthy, it helps them make healthy choices. And it helps their parents,” Anderson says.
  •    A photo in her office shows the children what Anderson looked like 49 pounds ago. One boy asked her recently, “Is that you, Ms. Anderson? You look different.”
  •    Every Monday, Anderson asks the children what kinds of healthy foods they ate, and what kind of exercise they enjoyed over the weekend.
  •    “They tell me ‘I ate a banana,’ or ‘I went on a walk with my family.’ It’s fun.
  •    “And when we’re in the cafeteria, I tell them, ‘I eat my fruits and vegetables, you do too.’ But I also tell them, ‘I don’t like okra, so I don’t eat okra. But there are lots of vegetables to choose from.’”

On the Web

Centers for Disease Control and Prevention: cdc.gov/obesity/childhood

Healthy People 2010 report: healthypeople.gov

New England Journal of Medicine: nejm.org/cgi/content