Kids Suffering from Adult Illnesses

By Mariana Alvarado and Stephanie Innes

Lifestyle, diet and genetics play a role, but the biggest common denominator among them is socioeconomic.

"It's an amazingly paradoxical problem," says Dr. Tracey Kurtzman, an assistant professor of clinical pediatrics at the University of Arizona's College of Medicine. "If you think about poor people in the rest of the world, they are emaciated and skinny and impoverished and malnourished. Here, our poor population is malnourished with too much."

Cheap food is often unhealthy. There's no Arizona law mandating physical education in schools. High-crime neighborhoods mean running and playing outdoors is discouraged. Gym memberships or club sports are not feasible for families challenged to provide basic necessities.

"It's costly to eat a healthy diet," says Tucson writer Reva Mariah S. Gover-Shield Chief, 41, who is dealing with myriad health problems linked to being overweight since age 5.

"I think the real weight problem we've got going on right now," she says, "is called poverty."

Small budgets, big barriers

Over the past decade the problem of obesity in Arizona increased at a faster rate than in most other states, says Scott Going, a professor in the UA's Department of Nutritional Sciences who has researched childhood obesity for more than 20 years.

Contributing factors include population growth among Hispanics, an at-risk group. And there's an overrepresentation of minorities among lower-income residents.

Also, Arizona is a transient state, and people are moving here from parts of the country with high obesity rates, he says.

With an estimated 20 percent of U.S. children living in poverty, the health risks are immense.

"Poor people can't afford to buy good fruits, vegetables, good cuts of beef. Basically they eat whatever they get their hands on," says former U.S. Surgeon General Dr. Richard Carmona, who is president of the nonprofit Canyon Ranch Institute in Tucson.

One of the biggest problems for leaders of the FitKids program at Tucson Medical Center is attendance. More than 30 students are invited to participate in each session of FitKids, an hourlong weekly exercise-and-nutrition class for physician-referred at-risk kids. About a dozen show up and maybe two finish the program, says Mary Lou Fragomeni, who manages outpatient therapies at TMC.

"There are single parents who work and they can't commit. For those who do, there are transportation issues."

The program was recently reduced to once a week from twice because parents were having trouble getting their children there.

Internist Dr. Armando Gonzalez, who recently added weight-loss programs at his west-side Mesa Verde clinic, says, "The father says, 'I get up at 5 a.m., go to work, then I have a part-time job and don't get back home until 9 or 10 p.m. What do you want me to do?' "

Just three public schools in Pima County have daily physical education. Some charter schools don't offer it at all.

Young kids, grown-up illness

"Morbidly obese" typically refers to a body mass index of 40 or more, which for many teens would mean 100 pounds or more over their ideal weight.

University Medical Center researcher and podiatric surgeon Dr. David G. Armstrong directs the Southern Arizona Limb Salvage Alliance and routinely sees diabetic patients with amputated feet and legs, vision and cardiovascular problems. He sees patients in their 30s who have suffered strokes.

"It used to be the average age of our patients was mid-50s. Now it has skewed 10 years younger," says Armstrong. "It's like a demographic tsunami."

Broaching the subject with young children can be delicate.

"A lot of times they are embarrassed and teased," pediatrician Kurtzman, says. "The hardest thing to recognize is that it's not about what you look like. I always tell these kids: 'You are a beautiful person. You don't have an ugly body, but it's not as healthy as it could be.' "

A question of taste and time

Parents who rely on dollar-menu items at fast-food restaurants to nourish children usually have a hard time changing eating habits later.

"The problem with children is if they get an idea, a taste of food being high in fat, high in salt, high in sugar, then that becomes what is expected and the norm," says registered dietitian Nancy Rogers, coordinator of the Worksite Wellness Program at UA Life & Work Connections.

Reducing salt and sugar from a child's diet can be difficult, adds Rogers. But with its low cost and long shelf life, processed food may be the only choice for many families. A bag of white rice or pasta can produce several quick and filling meals for a fraction of the cost of a recommended meal of lean protein with fresh vegetables.

Big Ramifications

As surgeon general, Carmona declared the current generation of children could be the first to live shorter lives than their parents because of the obesity epidemic. He stands by that comment.

"Seventy-five cents of every health-care dollar spent in the U.S. is for chronic diseases, and most of those are being driven by obesity," Carmona says.

A recent study published by the New England Journal of Medicine found that the heaviest children were more than twice as likely as the thinnest to die before age 55.

Carmona speaks with urgency about addressing the problem, while warning that inaction carries a "huge cost to society."

"The number of obese and overweight children right now is not acceptable and it's a future national security issue," Carmona says. "I can't think of any other topic in contemporary health that is more important."

Contact reporters Stephanie Innes at sinnes@azstarnet.com or 573-4134 or Mariana Alvarado at malvarado@azstarnet.com or 573-4597.

Most federal guidelines consider children overweight if their BMI is at the 85th percentile or higher for their age, sex and height. A child is considered obese at higher than the 95th percentile for BMI for children.

Este reporte especial fue producido como un proyecto del California Endowment Health Journalism Fellowships, un programa del Annenberg School for Communication & Journalism de University of Southern California.

This special report was produced as a project for the California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication & Journalism. MARIANA and STEPHNIE did reporting and writing for the section.