Skip to comments.Heavy Questions (obesity)
Posted on 01/02/2005 12:04:52 AM PST by neverdem
The road changes just past the Starr County sign. The shoulder disappears, the grass is left uncut and the black-eyed Susans and big pink Texas sage have to compete with the orange traffic cones set out by the border patrol. Just two counties up from the Texas tip, where the flood plains along the Rio Grande change to rolling hills and eroding cliffs, Starr County, largely Mexican-American, is one of the poorest counties in the nation. Fifty-nine percent of its children live below the poverty level, and in the strange new arithmetic of want, in which poverty means not starvation but its opposite, it is also one of the fattest.
In the colonias on the edge of Rio Grande City -- jerry-rigged neighborhoods that are home to many illegal immigrants and lack adequate municipal services -- houses that look as if they might fall down neighbor houses that look like fortresses, a result of the boom-and-bust drug economy. Little gorditos run around in juice-stained diapers, and as the kids get older, they only get fatter. By the time they are 4 years old, 24 percent of the children are overweight or obese; by kindergarten, 28 percent; and by elementary school, 50 percent of the boys are overweight or obese, along with 35 percent of the girls. The concern is not just cosmetic. Overweight children are at significantly greater risk for developing Type 2 diabetes, and by early adulthood, hypertension, heart disease, stroke, colon cancer, breast cancer, gallbladder disease, arthritis and sleep apnea. ''Stop by any time,'' said the local school district superintendent, Roel Gonzalez, inviting me to visit. The child of migrant farm workers, Gonzalez is perhaps the children's greatest advocate and the community's greatest critic. ''I will take you down the hall in any one of my schools, and you will see most of the children aren't slim anymore; they're all beefy. Kids are 30, 40 pounds overweight already, and they're only in high school. We're basically walking time bombs.''
The burden of childhood obesity is one created by adults and borne by children, and while the problem is widespread in America, there are few places where the children are lumbering under the load the way they are in Starr County, the point on the U.S. map where all the vectors that lead to obesity form a tidy asterisk. Some reasons are clear and well documented, but others are less transparent. According to the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey, rates of childhood obesity are among the worst in the Mexican-American population, and Starr County is 98 percent Mexican-American. The U.S. Department of Health and Human Services, among other sources, also shows that as socioeconomic status falls, rates of childhood obesity rise, and Starr County is desperately poor. Not only is Starr County in Texas -- one of the fattest states in the Union -- but it is also on the U.S.-Mexico border, the fattest part of Texas. The overall effect is devastating: almost half the adults in Starr County have Type 2 diabetes. A child is considered at risk if a close family member -- mother, father, sibling, aunt, uncle -- has diabetes, meaning virtually every child in Starr County is at risk of contracting the disease.
Complicating matters, self-discipline is typically not a hallmark of the school-age years. When you talk to children about losing weight, ''you see a blank stare,'' Gonzalez said. ''They hear you, but there's really not anything they can do.'' Vans of well-meaning doctors regularly barrel down from San Antonio and Houston, feeling the smooth blacktop change to bumpy gravel as they near their destination and knowing that if nothing changes soon, if the children continue to put on ever more pounds, they will be responsible for having watched over the first generation of American children to have shorter expected life spans than their parents.
During the 2003-2004 school year, Peggy Visio, special projects coordinator for the University of Texas Health Science Center in San Antonio, made 13 trips to Rio Grande City, the largest town in Starr County. Visio, who specializes in diabetes prevention, worked previously with Sioux Indians in South Dakota, and her university recently received a grant from a private donor enabling her to start a program in the Rio Grande Valley. Beginning last January, Visio screened 2,931 elementary-school children, assuming she'd find about 600 at high risk for diabetes. Instead she found 1,172. Forty-five families volunteered to enroll a child in her program, a combination of weekly nutrition and exercise classes, plus two sessions of lab work to measure each child's height, weight, blood pressure and blood sugar and to examine each child for signs of diabetes. As part of the project's design, half of the families met with Visio and her staff in person, and half met via video link in order to test the efficiency of telemedicine -- that is, seeing a doctor, nurse or nutritionist remotely. (All participants came to the lab in person.) Starr County has 15 physicians; the ratio of residents to doctors is 3,412 to 1. (The statewide ratio is 661 to 1.) There are no behavioral therapists or pediatric dietitians in Starr County. The nearest pediatric endocrinologist lives about 70 miles from Rio Grande City.
One of the first things Visio did when she started the Diabetes Risk Reduction via Community-Based Telemedicine program, or Dirrect, in Starr County was to analyze the food served in the Rio Grande City Consolidated Independent School District, where all children receive both free breakfast and free lunch; so many qualified that it was easier just to serve everybody. The food service is run by Edna Ramon, who is 80 years old and began her job nearly two generations ago when malnutrition, not obesity, was the district's main problem. Ramon still talks about her memories of the dry hair and bony hands she saw on the children in the district in those early days. Visio analyzed Ramon's menus and quickly established that with breakfasts containing as many as 600 calories and lunches with 800, every child was on track to gain at least nine pounds during the school year. In addition, children were drinking huge quantities of sugary drinks -- sodas, fruit drinks and sports drinks -- which they bought from vending machines and at convenience stores and also drank at home. In the two months between her first two visits -- between initially screening the children and starting the program itself -- the children gained an average of two pounds.
Visio also found at the outset that 13 percent of the prekindergarten and 18 percent of the kindergarten students she screened had acanthosis nigricans, a disorder characterized by dark, thick patches on the skin. Acanthosis nigricans can signal insulin resistance, warning of diabetes, a disease in which the body does not produce or properly use insulin. Insulin, a hormone produced by the pancreas, controls the level of sugar in the body and helps the body use glucose as fuel. Excess fat tissue and insufficient muscle, which come from a lack of exercise, predispose a person to diabetes. Left untreated, diabetes can lead to blindness and loss of limbs; many of the children she found with acanthosis nigricans had never been to a doctor.
Visio -- an intensely organized and practical 47-year-old woman who makes spreadsheets of her own children's after-school activities and who cooks meals on Sunday for the entire week -- was deeply worried and deeply frustrated. ''People who were supposed to be helping these children'' -- school nurses, school food-service officials, even parents -- ''were teaching them the wrong things. They wanted to make the children happy by giving them what they wanted. It was making the children sick.''
ccording to Nancy Butte, director of the Viva la Familia Project at Baylor College of Medicine in Houston, 40 to 60 percent of the prevalence of childhood obesity in the Hispanic population can be attributed to genetic factors. ''Much has been written about children who are overweight,'' said Butte, explaining her study, ''but little is known about why Hispanic children in particular tend to be more at risk for obesity.'' Many believe that there is, most likely, a set of genes that makes some people more susceptible than others. Butte suggests that at least part of the genetic component may be related to ''the thrifty-gene hypothesis,'' the theory that some combinations of chromosomes create a situation in which cells are more inclined to store calories efficiently for times of scarcity. Some researchers have speculated that because many Mexican-Americans are descendants of American Indian hunter-gatherers, who evolved to store fat more easily for times of famine, those living a sedentary life in modern westernized societies with access to fast food may be more prone to gain weight.
Butte has embarked on a five-year program of intensive metabolic and physiological testing, taking blood samples from Hispanic children and their parents, scrutinizing how children metabolize calories and analyzing body composition. She explained that the self-reported data she collected did not show great differences in calorie intake between children who were obese and children who weren't. But as Butte notes, ''We know they have to be eating more,'' and everyone tends to underestimate how many calories they eat. In order to assess how individuals actually metabolize what they consume, Butte is also gathering data in a ''room calorimeter,'' an extreme measure that involves a sealed chamber equipped with a bed, toilet, sink, desk, TV, CD player and telephone, where children spend up to 24 hours. Here, caloric intake, as well as how much oxygen a child breathes and how much carbon dioxide she exhales, can be precisely recorded.
Outside factors are not helping, either. Throughout America, high-calorie fast food is cheaper than food that's good for you. Starr County has its share of franchises, including McDonald's, Dairy Queen, Jack in the Box and Burger King. What's more, in the Rio Grande Valley, as elsewhere, children are not getting enough exercise, a fact linked by some to the general indifference to exercise along with the misapprehension of risk: the risk of, say, letting your kid run around the neighborhood versus the risk of encouraging a sedentary life by keeping her home.
''If you look at the probability of something that's in the headlines -- that your kid is abducted -- the probability of that happening to your child is very low, though certainly it's a terrible thing,'' said Deanna Hoelscher, director of the Human Nutrition Center at the University of Texas's School of Public Health at Houston. ''But if it happens, everybody hears about it, so the perception is that the risk is very high. However, the probability of your kid being overweight right now is very high, because a lot of kids are overweight. So you have to balance things out. Though of course, providing safe places for children to play would alleviate parents' fears.''
While to date few have studied them, the sociological underpinnings of childhood obesity in Hispanic communities seem to operate on three levels: inside Hispanic -- and American -- culture as a whole, inside specific communities like Starr County and inside families. Visio's most rewarding work has been inside individual families; as she puts it, ''I've got to get to that home, that mom, that family, that grandmother. Get inside that child's world. The child doesn't have the money to buy groceries.''
One afternoon she met with Cristen Gonzalez, who was 9 years old, and Cristen's mother, Gracie, a schoolteacher in Rio Grande City, to discuss the situation at home. Two months before, Christen started Visio's program. At that time, Cristen, the oldest of three children, was well into the overweight range. Cristen has a small, sweet voice, is on the elementary-school drill team and wants to rescue animals when she grows up. She also wants to be a good girl, and in the context of Visio's program, with its focus on healthful food and weekly nutrition and exercise classes, her mother was concerned. ''She's been obsessing about the program,'' whispered Gracie, who was also hoping to lose weight. Cristen drew quietly at a folding table. ''This week especially, she's been so self-conscious. I can't have it anymore.''
Guilt is a major problem in dealing with childhood obesity -- the guilt parents feel in denying their children food or inadvertently making them self-conscious about their weight, the guilt children try to instill in their parents in order to get what they want. Gracie, by all rights, has a lot to feel proud about. The Gonzalez family is strong, loving, disciplined and intact. Gracie and her husband both have good jobs in the school district; they don't eat much fast food, going out for only one meal a week, lunch after church on Sunday; and they are still married -- and that puts them way ahead of most families in the county, where jobs and structured families are scarce. Once, a few years ago, when a friend of Cristen's came to sleep over, the little girl saw Gracie in the kitchen and begged her to make her spaghetti; people rarely cooked in her house. The girl also found it exotic that Cristen had a bedtime; she was used to falling asleep around midnight from sheer exhaustion.
Still, life for the Gonzalezes was not so easy. Three kids plus two working parents did not leave Gracie time each week to plan menus and shop carefully for groceries, which Visio explained she should do. So harried was Gracie that she sometimes caught up on paperwork while her children ate dinner. This meant, to Visio's eyes at least, that Cristen was more or less having to tackle her weight problem alone.
Visio asked Gracie what her past week was like.
''Crazy,'' she replied. ''So crazy. My husband had to take care of his parents, and my little Anthony'' -- who is 5 -- ''lost his two front teeth running into his best friend's head. I walked out of a staff meeting to get here. I've barely had time to eat.''
Visio pressed her, ''Have you been sitting down for meals together at night?'' The Journal of Adolescent Health has reported that families that eat together consume healthier food.
Gracie smiled and shook her head. ''Haven't had time.''
''Do you think this weekend you can make menus again, go shopping?''
''Cristen needs you -- you just told me, she's obsessing on the program.''
''Don't make me feel worse,'' Gracie said. ''I already feel bad enough.''
Cristen looked up from her drawing again.
''Twenty minutes, just 20 minutes,'' Visio said. ''Everyone has 20 minutes. I'm sorry to tell you this, Gracie, but if you're not sitting down to meals together and showing her you eat just like you're telling her to, you're putting it all on her.''
Across town at the John and Olive Hinojosa Elementary School, on an unpaved road beside one of the colonias, 50 second and third graders in red-and-white uniforms spent phys-ed class having a dance party under a big gazebo. It's rare to see children in Rio Grande City being so active outside. The average high temperature is above 87 degrees for nine months of the year, and even in the cooler months, the north wind blows fiercely across the Rio Grande plain. Despite the day's heat, the dance party was a grand success, the kids jumping and shaking and feeling confident and comfortable. But paradoxically, that confidence can create its own problems. Sometimes, explained Olga Smedley, the principal, that self-certainty gives the children the upper hand in dealings with their parents. Starr County has three bridges to Mexico, and countless places for unofficial crossings. Some women who live in the area arrived from Mexico pregnant in order to have American-born children. As a result, many parents are trying to raise children in a country where they aren't supposed to be.
''A lot of these parents give in to their kids too much,'' said Smedley, a pretty and trim mother of three who grew up in the Rio Grande City area and does her best to resist her chubby 6-year-old's relentless requests for shrimp scampi. The upended power dynamics can lead parents to cede authority to children and lead children to bully their parents. ''These children threaten their parents,'' Smedley said. ''They say: 'If you spank me, or if you do this, I'm going to call child protective services. I'm going to call the police.' '' Smedley explained that the kids are just being kids, but the parents, perhaps feeling vulnerable, capitulate. ''Who's in control?'' Smedley asked, her eyes widening and her frustration apparent. ''I told the parents -- it's because you're allowing it.''
The odd power dynamic affects food choices as well. After Visio trimmed back the fat and sugar from the school lunch and breakfast menus -- no more breakfasts of sugar-coated cereals and a bag of cookies; in fact, cookies are no longer served, and cereals are low in sugar -- many teachers were pleased. But the children, not surprisingly, were not happy, a feeling they expressed by staging lunchroom protests and hanging signs outside some cafeterias that read ''No more diet'' and ''We want to eat cool stuff -- pizza, nachos, burritos, cheese fries.'' Visio expected as much from the kids, but what caught her short was how much the children's hounding got to their parents, and how often those parents caved to their children's shortsighted, unhealthful wishes. ''We have one morbidly obese girl, and since we changed the menus, her mother has been stuffing her backpack with three bags of chips and three candy bars, every day,'' Visio said. ''This is in addition to a full breakfast and lunch. Some of these parents are just afraid to say no. They love their children, but their children have them convinced that if they eat a healthy diet, they will starve.''
he issues affecting the Hispanic child-obesity epidemic have been the hardest to talk about, and Roel Gonzalez, the school superintendent, has appointed himself the man for the job. ''I know we always hear sad stories about different groups of people, but this is one group that's very sad,'' Gonzalez said over breakfast one morning.
Many of the concerns he described are true of American culture as a whole and crystallized in Starr County. ''The attitude here is hoard as much as you can right now, because there might not be tomorrow.'' Some health care researchers who are studying obesity and diabetes among Hispanics talk about an undercurrent called fatalismo -- the belief that there's little you can do to alter your own destiny, so why not live for today? ''But we have to change,'' Gonzalez said. ''We don't have more time. This is something we need to get on now, but we're going to go slowly. Like my dad says, if you're in a hurry, go slow, and I'm in an awful hurry.''
Gonzalez grew up in Starr County, left for a time to work in upstate New York and Washington and now every morning puts on a suit and heads to Che's, the restaurant downstairs in Rio Grande City's one elegant old border hotel, where we met one day. Gonzalez sees himself as the children's advocate in the ''Lean on Me'' tradition, the stalwart authority figure, the local boy made good. ''The kids are not negotiable,'' he said in his husky, urgent voice, stopping often to greet every customer who walked in by name. ''You can have my parking space, my office, I don't care, but I will never negotiate the kids. Those children's lives are my responsibility. Not only academically -- their lives physically are in my hands.''
Gonzalez has decided that the children deserve not only positive change -- when Visio approached Gonzalez about revising the breakfast and lunch menus for the kids in her diabetes program, he instructed her to alter menus for the entire district -- but also to hear adults speak the truth about the particular problems in their community. In the past year, he set up salad bars for all the teachers (''the teachers have to model it, because kids idolize their teachers, and if they don't, they're bad teachers''). He also hired Rey Ramirez, a local Hispanic athlete -- a Texas track and field champion -- to try to get his town physically active again. As a farmhand, Gonzalez's father never had to seek out exercise, but Gonzalez himself, like a lot of his neighbors, is packing a few extra pounds. He understands what the children are up against. ''Out here it's 110 degrees at 6 in the afternoon, and not very many people want to go outside and play. Myself, I get up every morning and walk. I get up at 4:45 a.m. or 5, and it's hard. Some mornings, I just want to stay in bed. If it's so hard for me, I can only imagine what it's like for a child.''
Gonzalez also talked about how attitudes toward self-reliance have changed significantly in the course of a single generation. He told a story I heard several times from people over 40 in Rio Grande City. ''When I went to school they gave you colored coupons,'' he said. ''The blue one meant you paid for your lunch. The white one was a reduced price. The pink one was free, and you didn't want to be seen with the pink one. People would tear you apart.'' Now government assistance is a major part of the fabric of society. In addition to free meals for their children in school, many adults in Starr County receive food stamps, health care and utility and housing subsidies. Much of this is beneficial, of course, but Gonzalez also explained that it has contributed to eroding the old norms. A while back, for instance, Gonzalez caught a girl smoking marijuana. ''I told her that's not what I would call normal behavior for a girl of 12, and she said, 'It's normal in my house.' It's normal in my house. We've got to change what's normal.''
The parents in Gonzalez's community are as loving as you'll find anywhere, but, as Gonzalez explained, there is an inclination to overempathize or overcompensate with their children. This is happening across cultures and classes throughout the country. Children are indulged and are obese everywhere, but the conditions in Starr County aggravate the problem. His term to describe this is ''pobrecito syndrome,'' an affliction of parents and other adults, passed down to youngsters, part fatalismo and part a communal throwing up of the hands. Pobrecito means ''poor little thing,'' and ''the pobrecito syndrome,'' Gonzalez said, occurs when parents ''feel sorry for their child and they're doing the best they can but -- they're just so sorry and they really do nothing. All they do without intending to is perpetuate the problem, and so it continues.'' Or to put it another way, some parents can have bad habits -- regarding food, drugs, exercise, financial responsibility -- that they want to change, or say they want to change, but can't. ''Basically, it's an addiction. We just can't get the parents off the TV, and we can't get them to stop eating fast food. We can't get them to do anything. And the kids aren't going to get off the TV if the parents don't get off the TV. It's going to be a long, hard battle, because it's very hard to reach the child if the parent is entrenched.''
Several years ago, Gonzalez and his wife started a Subway franchise in Rio Grande City in order to provide a quick, affordable option to greasy fast food. It was one small step -- like his current efforts to secure financing to build an indoor pool and nice walking paths in town -- but Gonzalez realizes the problems run much deeper. ''We have drugs everywhere,'' he said. ''The cemeteries are full of people who OD'ed. We have kids coming to school who've seen a father or a brother shot, kids who are dealing with a parent in prison.''
Still, when Gonzalez says he's been up all night thinking about a kindergartner who weighs 90 pounds -- the average for an American kindergartner is about half that -- it's easy to believe him. ''We have to catch them between kindergarten and second grade, because after that it gets real hard,'' he told me. ''The ones that are slightly obese, what we call 'chubbies,' at that stage they can change. But once they get too big, it's next to impossible.'' With so many children and parents overweight or obese, there's little stigma attached to being fat. Teasing about extra heft or gentle nudging to eat more healthfully doesn't begin until the problem is quite dire. ''They think, I look good. They don't already see that they're in the danger zone.'' Gonzalez slipped his suit jacket back on to rush off to the high school for the day. ''These kids mean the world to me. We've got to make the first move. If we ask the kids to make the first move, we're going to lose the battle.''
In her pink terry tank top and shorts, Cristen stopped by the Rio Grande health center to be weighed and measured by Visio's team before heading to a pool party for the drill team. By 9 a.m., the morning was scorchingly hot already, and in line at the health center in front of Cristen stood a boy in a dark blue T-shirt and dark blue pants named Alfredo. Daniel Hale, a pediatric endocrinologist at the University of Texas Health Science Center in San Antonio, and one of the nation's leading experts on childhood diabetes, looked at the blood pressure cuff and said to Alfredo, ''I bet we need a little bit bigger one for you.'' Then he said to the boy, ''So, what have you been doing?''
Alfredo said, ''The kids all went to the pool on Friday, but I didn't want to go, so I just stayed home.''
Hale measured him at 4 feet 11 inches, then he put him on the body-composition analyzer scale, where Alfredo registered 171 pounds and 46 percent body fat.
''The problem is,'' Hale said after the boy left, ''most of the potential solutions rest either on very large changes in public policy or very small changes that individuals and families must make in the context of their own home. There's very little we in the public-health community can do. We don't have very much control over what children eat, we don't have much control over safety, which affects where children play, and we're not in people's homes, where kids are taking part in the major sedentary behavior, known as television watching. And here in South Texas, where you can get an Extreme Gulp, which is 52 ounces of soda, and a bag of chips for a dollar, and there aren't many outlets for physical activity, the kids are at great risk. The biggest problem is not that that kid doesn't feel comfortable swimming. The biggest problem is that the long-term consequences of an unhealthy lifestyle begin to accumulate 15 to 20 years after those lifestyles are initiated. When these kids are in their 20's, the consequences are really going to come home to roost.''
When it came to Cristen's turn, she weighed in at 10 pounds less than two months before, when she started the program. Her mother, Gracie, two younger lean children in tow, said proudly: ''It wasn't until she started school that you couldn't see her neck. Now you can see more of her neck.''
Cristen smiled and stood up for herself. ''I have to say, I have a neck, and it's right here.''
Elizabeth Weil is an author of ''Crib Notes: A Random Reference for the Modern Parent,'' published by Chronicle Books.
I think brick laying, roofing and landscaping must all be fattening.
I don't think that's the case in this article --- which isn't about working women --- the women in these regions (Starr Co, Rio Grande) are welfare mothers. It's about obesity in the poverty class --- too many food stamps, too many meals at Head Start centers and cultural differences regarding food.
The best thing would be to cut off many or all of the welfare programs, get them off their behinds and out working for a living. Taxpayers get hit twice --- we have to pay for their food and living expenses so they can lay around filling their faces --- then after their obesity has caused them health problems we have to provide free health care too.
Proclaim the GOOD NEWS! The biggest problem for poor people in America is obesity! Only 70 years ago, (1935) some people were going hungry.
I believe real the "root" cause of increasing childhood obesity, as well as much of adult obesity, is the result of the high rate of women in the workplace.
Phooey. More like it's the result of sedentary lifestyles--computers, television, video games.
Amen to that-yank their snouts out of the trough and they get off their butts. We moved to this rural community from SA about 1 1/2 ago, and the only fat kids we see any more are the ones we see on our way to work in the city. There aren't many fat adults out here, either, but the welfare queens can't afford to live here-there are no "projects", no section 8 housing and even a trashy trailer or an old converted feed barn on a ranch carries an outrageous pricetag, because no one wants the widespread crime, drugs and prostitution associated with those people. Kids out here are involved in sports, FFA, etc and families still sit down to a home cooked meal at night.
My question is, why does an educated school teacher no know how to take care of her children?
Seems to me that she should know how to monitor the little girls food intake without the help of the government.
But then what do I know?
I'm five to eight pounds underweight due to a demanding physical job and some stress in my life. I keep hearing how terrible I look from my son's mother-in-law. She looks like a bowling ball with legs.
OK, but pancakes and gravy?
The skinny, which I'm not BTW, will inherit the earth :)
Isn't shrimp very low in calories? Scampi isn't fried, either. And isn't it expensive for a town supposedly suffering from dire poverty?
One could only hope that the family eating habits will come full circle, and we will get back to the Ozzie and Harriets days. Don't tell me that it cannot be done. It is called prior planning.
Inquiring minds would like to know why a 6 year old needs shrimp scampi?
Depending on how close to the Gulf they are shrimp could be fairly inexpensive there. Asking for shrimp scampi is healthier than asking for the typical junk food kids ask for.
I think a lot of the problem with the obesity factor in general is High Fructose Corn Syrup and partially hydrogenated fats that is in everything processed, even foods that shouldn't have HFCS have it. Kids diets today are nothing but highly refined shots of sugar all day long which keeps the pancreas pumping out insulin to handle the loads.
A bag of salad shrimp ($2.99), a little butter, garlic and parsley. Bingo. Serve it on a bed of greens and you have a nice healthy cheap meal for an adult and a kid.
Cheaper then fast food and ready in about the same amount of time.
lol That guy won't be seeing 55!
bump and save
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