CHOC Children's

From OC Family

Published September 1, 2012

Individuals, families, communities and our country will face health- and weight-related issues lasting far into the future if we don’t address this problem now. 
By Tori Richards
 
She was only 10 years old, but Ciera Barragan of Orange didn’t care about living. Filled with despair, hopelessness and indifference over the void that her father’s death left, Ciera used food as a comfort and withdrew from the world.
   
“She didn’t care if she got a good grade or passed a test, she didn’t care about herself or how she looked – and how you look is how you feel,” says Ciera’s mother, Delania Grijalva. “She wasn’t even motivated to get up and take a shower; it was a really deep depression.”
   
Ciera gained close to 50 pounds – which for a 10-year-old is significant – while eating a staple of fast food, Hamburger Helper, pizza, sugary cereals and ice cream, quick-fix meals that were easy for her single working mom to provide.
   
“Back then, it was kind of a downfall; it was hard to be motivated or to be helped out,” Ciera recalls. “It was depressing, just like I was in a funk. I had no way to get out of it. Instead of doing exercises like some people do to cope, I went to eating. I ate everything you could think of that was unhealthy for someone my age.”
   
The severity of the situation crashed down on Grijalva when she found letters that Ciera had been writing to her dead father, saying she wished he could take her outside to play.
   
Grijalva enrolled her daughter in a summer health camp and then followed up with a school program sponsored by St. Joseph Health in Orange that educates and counsels children about fitness.
   
Fast-forward four years: Ciera lost those 50 pounds. Her 5’7” frame fits into a tall size 13 (when she started, she was a 17/18), and she is a health ambassador of sorts to friends and family. Not only does she have a strict whole-foods diet, she is also a marathon runner, volleyball player and overall athlete with a tons of friends and boys who ask her out on dates. She exercises about three hours a day.
   
“I try to make this my life, to eat healthy,” Ciera says. “I look at the past and my ?pictures, and I don’t like who I see. Now I look in the mirror and absolutely love who I am. Everyone else loves who I am, and I’m helping them change as well. I hope my story helps someone; so many kids don’t have the opportunity I that I did.”

A national epidemic
No doubt about it, childhood obesity is a problem that is gripping our nation and touching every socioeconomic class, race and denomination. It’s a scourge that has immediate mental and physical repercussions and can also bring with it lifelong health problems.
   
The data from the California Center for Public Health Advocacy is nothing short of shocking:

• 38 percent of fifth, seventh and ninth graders in California are overweight or obese.
• 75 percent of overweight teens are likely to be obese adults.
• 80 percent of children diagnosed with type 2 diabetes are overweight.
• California ranks first in the nation in health expenditures due to diabetes.
• The health and lost-productivity cost of obesity for all ages in California is $21 billion a year.

In addition to diabetes, other related health issues include fatty liver disease, high cholesterol, bone and joint problems, high blood pressure, stroke, cancer, sleep apnea, seizures – and sudden death.
   
It’s such an epidemic that fitness has become a platform for First Lady Michelle Obama, who founded the Let’s Move! organization to educate and aid Americans in making healthy choices.
   
And for the first time in the modern era, children now face a shorter lifespan than their parents did, due largely to obesity. A 2005 study by the New England Journal of Medicine revealed that the next several generations may live about five fewer years.
   
“The fact that children aren’t going to live as long as their parents breaks my heart,” says Dr. Patricia Riba, a pediatrician who founded Dr. Riba’s Fit Club (drribashealthclub.org), a Santa Ana-based fitness program for children. “If you look at the needs of these children, they are not getting proper nutrition. If they are eating pizza, soda, chips, hot pretzels, Cheetos and fries, they are not getting calcium and minerals.
   
“We need to get back to the basics and feed children what the cavemen ate: water, fruit, vegetables, whole grains and grilled meat,” Riba says.
   
While obesity can be genetic, the propensity for this cannot be blamed on that alone because statistics don’t lie: Obesity has increased by three-fourths in the past 30 years, says Dr. Azhar Qureshi, senior vice president of Community Health at St. Joseph’s.
   
“Portion sizes have doubled in fast food, such as a 32-ounce soda instead of an 8-ounce soda,” he says. “Gallons of soda leads to obesity. PE classes are not mandatory in schools. Parents don’t send their kids out to play, so instead they are inside watching TV. You find this more in the poorer neighborhoods because of the crime.”
   
Nowhere is obesity more prevalent than in low-income neighborhoods and among African-Americans, Hispanics and American Indians, studies have found. One reason is the lack of access to many of the fitness opportunities enjoyed in the more affluent communities.
   
Orange County mirrors this reality. According to a study by the California Center for Public Health Advocacy, the top five cities with the lowest obesity rating for children have the highest average household incomes. They are also communities with a culture that encourages and celebrates outdoor activity. For instance, only 14.3 percent of children are overweight in Laguna Beach, followed by Newport Beach (18.3), Laguna Niguel (19.4), Aliso Viejo (20.8) and San Clemente (21.1). Conversely, more than half of the children in Stanton are considered overweight (51.8 percent) followed by Santa Ana (46.8 percent) and Anaheim (43.5 percent).
   
But the overriding issue pertains to the high cost of quality whole foods and the time element involved in preparing them if parents are working.
   
“Because so many kids are overweight and obese and look like their peers; so many parents don’t realize there is a problem,” says Caroline Steele, a nutritionist and dietician with CHOC Children’s, which is in the process of building an obesity treatment program. “If everyone in the family is overweight, it looks normal.

“What we do know is that it’s tied to socioeconomic levels because cheap foods may not be the healthiest foods,” Steele continues. “If you are trying to stretch your dollars, things like ramen noodles aren’t the healthiest.”

Steele offers some simple solutions for parents who are in a time crunch and must buy fast food or if the family dines in a restaurant: 

• Ask for an item without cheese, which saves 100 calories.
• Skip the bacon on burgers, which should be turkey or veggie instead of beef.
• Have a salad instead of fries.
• Do not super-size anything.
• Ask for salad dressing on the side; vinaigrette is better than anything creamy.
• Ask servers to forego bringing bread or chips to the table.
• Consider ordering appetizers instead of a full entrée.
• Use mustard instead of mayonnaise, ketchup or sauces.
• Eat half an entrée and take the other to go.

Healthy solutions
The experts all agree: Battling obesity involves a total lifestyle change, not just dieting. The emotional toll carried by being overweight cannot be overstated, and children need tools to understand how they got that way and set the stage for a lifetime of success.

To that end, Orange County health providers and the government have created a myriad of options to help.

Kaiser Permanente has a vast campaign geared toward eradicating obesity. Called Healthy Eating, Active Living (HEAL), it involves working with both the government and corporations to promote exercise and proper nutrition.
   
On the local side, Kaiser Permanente sponsors health fairs to educate the public; hosts farmers markets at its medical centers in Irvine and Anaheim; and has worked with the city of Anaheim to develop community gardens at three locations where families can grow their own food.
   
Additionally, Kaiser Permanente has provided grants to bring food to low-income families; co-sponsored an HBO documentary titled “The Weight of the Nation”; and conducted training seminars at businesses geared toward wellness.
   
St. Joseph’s Healthy For Life program – the one that Ciera attended – serves 3,703 students in Southern and Northern California. There, children at low-income Title 1 schools can receive free breakfasts and lunches, along with classes that are part of their school curriculum. There, students participate in exercises such as kickboxing, are coached on fitness and nutrition, and work on raising their self-esteem.
   
The Network for a Healthy California is a state organization that partners with dozens of government agencies, nonprofits and school districts to help prevent obesity. Like the St. Joseph’s program, it brings healthy food and nutrition education into low-income schools. It currently reaches 140,000 students attending 14 Orange County school districts.
   
Another part of the program involves bringing a different fruit or vegetable into 350 Newport Mesa Unified District classrooms each month to educate the children on its benefits. The Network also runs parent nutrition classes taught by dieticians.
   
Ten years ago, the Children and Family Commission of Orange County gave Dr. Patricia Riba a grant to start Dr. Riba’s Health Club to treat childhood obesity for at-risk children.
   
In 2009, Riba’s organization grew to include exercise-based facilities in several hospitals and other locales, and a number of foundations donated funds. Fit Clubs operate several days a week in Santa Ana, Costa Mesa and at the Orangewood Children’s Home. They provide healthy snacks, conduct fun group exercises and educate families about proper nutrition. Unlike school programs, Fit Clubs enroll children through referrals from pediatricians and schools.
   
“Most of them don’t have a way to pay and we find it,” Riba says. “We don’t turn anyone away based on money.”

Success stories
One afternoon at Dr. Riba’s Fit Club, two women stood side-by-side chatting. Their two young girls had become friends while attending the group, and the women found a small support group for each other.
   
Both had a similar story to tell: Their daughters’ obesity was brought about by junk food and little exercise.
   
“We would eat McDonald’s, Taco Bell and pizza for lunch and dinner,” says Melissa Alcantar, 28, of Garden Grove. “It was just faster and easier to get something when I was out.”
   
Her daughter, Hazel, was 4 years old and 17 pounds overweight. After a year and a half, she lost most of the weight, and her family eats fast food just once a week.
   
“It’s really hard,” Alcantar admits. “But now everything is baked. Lots of fruits and vegetables.”
   
Amelia Sandoval, 28, of Santa Ana, started attending a Fit Club when a doctor told her that her 6-year-old, Nallely, was overweight.
   
“I was shocked, I actually thought she was fine,” Sandoval says. “He told me about the health risks, and I got scared and came here.”
   
Nallely lost 7 pounds in a year. Sandoval started cooking a variety of healthy meals instead of just shopping for TV dinners, frozen entrees and fast food.
   
“I would take her to the grocery store and just let her pick out what she wanted because she was happy,” Sandoval says. “I came here and realized I wasn’t helping her. I was being lazy.”
   
Now vegetables and grilled chicken – both without sauce – are staples. The only beverages in the house are water or low-fat milk. And if Nallely looks at a meal and says “ick,” Sandoval will tell her: “This is what is served.” The girl has actually learned to love broccoli and cauliflower.
   
“Now, we just have a treat every 22 days,” Sandoval says. “It’s funny. I look at junk food now, and it really isn’t that appetizing. We will see it on TV and look at it like it’s gross.”
   
But Nallely is still a young girl, so Sandoval lets her attend parties and eat what she likes there.
   
“She will go and eat sugar or junk and say, ‘Mommy, this tastes funny’ then go home and be sick because she ate something bad.”

Get moving
Proper nutrition is great, but it needs to be done in conjunction with regular physical activity.
   
“Many studies make the point clear that inactivity leads not only to obesity but also to poorer academic performance,” says Riba. “Encouraging children to be more active is a healthy and long-term tool to relieve stress, prevent many diseases and maintain a healthy weight.”
   
But how much is the proper amount?
   
“Ideally, children should get about 60 minutes of physical activity every day, but one of the biggest barriers of children getting the recommended amount is the drastic increase in screen time over the last few years – up to 7.5 hours per day between computers, TV, cellphones or other electronic devices,” says Tracy Bryars, program manager for St. Joseph Health’s Healthy for Life.
    
Physical activity is a crucial element to the overall health and wellness of a child because it not only aids in a child’s physical health, it also boosts self esteem and confidence – and children that are physically active tend to perform much better academically.
   
When you look at the next generation, that’s what we want to strive for, contends Bryars.

WHAT IS BODY MASS INDEX?
The World Heath Organization (WHO) uses body mass index (BMI) as a simple weight-to-height calculation that is commonly used to determine if adults are overweight or obese. It is found by dividing a person’s weight in kilograms by the square of his height in meters. A Google search reveals many BMI calculators that convert figures into standard (not metric) measurements.

• A BMI greater than or equal to 25 is overweight.
• A BMI greater than or equal to 30 is obese.

10 STRATEGIES TO HELP BEAT OBESITY
Childhood obesity doesn’t happen overnight, and lifestyle changes are difficult and challenging. The experts interviewed for this article offer some insights that will make a difference.

1. Increase the amount of physical activity. This means parking the car farther from your destination, initiating games and turning off the TV and computer. Michelle Obama had it right: Let’s Move
2. Increase fruit and vegetable intake. It can be canned, frozen or fresh. The important thing is to include this at every dinner and at lunch if possible.
3. Reduce the amount of fast foods and fried foods. Try eating at home more to control nutrition quality.
4. Make half the portions fruits and vegetables. If you add some protein, you may be too full to eat starchy foods.
5. Eat regular meals. Skipping breakfast and lunch makes for unhealthy choices later.
6. Provide healthy snacks like carrot sticks or almonds throughout the day. This will keep your child’s metabolism revved up and stave off sugar binges.
7. Reduce the amount of sugary drinks and juices. Instead, opt for water or something unsweetened such as iced tea with lemon.
8. Eat smaller portions. Ciera Barragan’s mom bought smaller-sized plates and bowls so they didn’t feel too deprived.
9. Get the family involved. It’s easier to stick with healthy choices if the whole family is united. That way, everyone can lose weight.
10. Children should not be on diets. They are still growing, and it leads to deprivation. Instead, change eating habits and portion sizes. Do not force them to eat everything on a plate.

THESE NUMBERS DON'T LIE
In California, schoolchildren in fifth, seventh and ninth grades must undergo state-mandated fitness tests. The California Center for Public Health Advocacy, together with the UCLA Center for Health Policy, broke down these results and determined which cities have the highest obesity rates. This 2010 test included only cities with a population of more than 20,000 that had a 100-percent student-participation rate.
   
The Orange County cities represented in the test show the percentage of overweight and obese children. Note the wide disparity between the wealthier cities and the low-income communities:

Laguna Beach ... 14.3%
Newport Beach ... 18.3%
Laguna Niguel ... 19.4%
Aliso Viejo ... 20.8%
Dana Point ... 20.8%
San Clemente ... 21.1%
Irvine ... 21.4%
Rancho Santa Margarita ... 22.9%
Mission Viejo ... 25.1%
Huntington Beach ... 26.4%
Lake Forest ... 26.9%
La Habra ... 27.2%
Cypress ... 27.6%
Brea ... 28.0%
Seal Beach ... 28.8%
Fullerton ... 30.9%
Fountain Valley ... 31.4%
Westminster ... 33.0%
San Juan Capistrano ... 33.7%
Tustin ... 35.9%
La Habra ... 36.9%
Garden Grove ... 38.0%
Buena Park ... 41.8%
Orange ... 43.4%
Anaheim ... 43.5%
Santa Ana ... 46.5%
Stanton ... 51.8%