Monday, September 04, 2006

Spo-CAN! Part IV: This Is What Childhood Obesity Looks Like

I had a flippant title for this, but it didn’t seem appropriate given the material.

Last Sunday the Spokesman did a incredibly powerful article about a boy named Cody Harris, a 6 year old from Post Falls who has already been tipping the scales at 105 pounds. From the opening:

But Cody, the 6-year-old, is another story. Tall and stocky, with cheeks like soft pillows and a roll around his middle, Cody is easily mistaken for a hefty kid of 9 or 10. His shoulders are broad beneath his size 14 T-shirt; under the stretchy waistband of his shorts, his hips taper to legs like small tree trunks.

Cody was born big – two weeks early and 10½ pounds – and he's grown steadily bigger. At nine months, he weighed 30 pounds. By age 4, he was up to almost 80. At last year's checkup, Cody had gained 25 pounds, tipping the scale at 108.

We all see overweight kids every day. I can think of a couple in my school that are absolutely huge, and I can also identify several environmental factors in the school that don’t help.

  1. Our playground sucks. No big toy, no slide, only 8 swings to service all the kids from grades K through 3. We’ve got a couple of basketball hoops, some four-square areas, and tetherball, but that’s not enough. Hopefully they’ll get that fixed soon.
  2. I know that they’re supposed to consider nutrition when they do school lunches, but the policy in our kitchen is that they only have to have three things on their plate. That could well be the chocolate milk, the grilled cheese sandwich, and the ice cream cup, while they leave the cucumber slices and mixed fruit behind. I know I need to manage this better on my end as the classroom teacher, but there are so many other battles during the day that it’s hard to find the energy for this one.
  3. We’ve got two pop machines that the kids can get to. They’re not supposed to, but I’ve had first graders walk in the door in the morning with a 20-ounce Dr. Pepper who wonder why Mr. Rain is so mean when I take it away.
  4. I’ll freely admit that I could do better in the classroom. I have an M&M jar that I use to reward them for good behavior. It’s not healthy, but it sure does work. For snack I might serve fruit once a week, but that’s because I have to wash and cut fruit; single-serving crap in a bag is a lot easier to pass out.
  5. And yeah, I could do a better job of being a model for them. I start nearly every day with a Red Bull energy drink, and sometimes a Pepsi. I graze off of the M&M jar all day long. I also steal food off of their trays, and it’s never the broccoli that I go after.

On the positive side, my school does a great job of giving the kids time to move. Every child gets a recess every day, and in the lower grades it’s often two recesses. The kids also get 90 minutes of PE time every week, which maybe isn’t enough but it’s better than nothing. We also offer a great intramural program for the 5th and 6th graders, along with Bloomsday training for 1st through 6th grade in the spring.

It’s something every school can do better at. It’s important, and this is a great article towards that point.

I've put the full story below. If you're a Spokesman-Review subscriber, you can find it here.

A big boy

Celise Harris circles the parking lot of Coeur d'Alene Pediatrics, finally nosing her Yukon into a far space on the hot August asphalt.

The Post Falls mother is late for an appointment she's anxious to keep. It's a routine checkup for her children, Ciera and Cody, but for the Harris family, the meeting with pediatrician Duane Craddock feels much more than routine.

Ciera isn't the worry. At age 8, the blond girl with round glasses is growing normally, all thin arms and tan legs unfolding beneath her pink shorts and sparkly shirt.

But Cody, the 6-year-old, is another story. Tall and stocky, with cheeks like soft pillows and a roll around his middle, Cody is easily mistaken for a hefty kid of 9 or 10. His shoulders are broad beneath his size 14 T-shirt; under the stretchy waistband of his shorts, his hips taper to legs like small tree trunks.

Cody was born big – two weeks early and 10½ pounds – and he's grown steadily bigger. At nine months, he weighed 30 pounds. By age 4, he was up to almost 80. At last year's checkup, Cody had gained 25 pounds, tipping the scale at 108.

The surge alarmed Celise Harris, 36, and her husband, Wayne, a 44-year-old software engineer. Always a worry, Cody's weight became a primary focus for his family, setting off a year of monitored meals and accelerated exercise, all supervised by Celise.

So if today's checkup feels like a referendum on her effort, perhaps that's because it is.

Celise is quiet as Dr. Craddock steps into the tiny exam room and reaches for the yellow folder that tracks Cody's health since birth.

"Hey, Cody-man, how are you?" he calls to the boy, who's spinning in circles on a low stool.

Celise watches as the doctor reviews Cody's chart, sees his eyes grow wide as he confirms what she already knows.

Four pounds.

In a year.

That's all Cody has gained.

In the world of children's weight, where the average kindergartener gains five pounds between age 5 and 6, that's as good as a loss, his mother figures.

Dr. Craddock smiles.

"We had a good year, man!" the doctor says, high-fiving Celise first, then Cody. "We can celebrate!"

Cody jumps up on a chair to slap palms. Like any 6-year-old, he's happy at the attention, though he doesn't understand the worry about his weight.

But his mom, overwhelmed, reaches for a tissue.

"We had a good year," she echoes softly, wiping her eyes. "We had a good year."

American kids: obesity on the rise

It's not news that American children are growing alarmingly larger. Childhood obesity is an epidemic that encompasses nearly one in three U.S. kids, national health experts say.

In the last three decades, the percentage of 6- to 11-year-olds has tripled in the highest weight category reported by the national Centers for Disease Control and Prevention.

In 2004, about 19 percent of kids that age were in the 95th percentile for height and weight, which is defined as "overweight" by the CDC but as "obese" by organizations such as the American Obesity Association.

The AOA estimates that more than 30 percent of U.S. children ages 6 to 19 are overweight or obese, a number that shows no sign of declining. Newer studies indicate that the childhood obesity rate has doubled for preschoolers ages 2 to 5 in the past three decades and that increasing numbers of infants can be considered obese as well.

The Northwest seems to fare better than other parts of the country, but just slightly, studies show. About a quarter of 10- to 17-year-olds in Oregon, Washington and Idaho are overweight or obese, according to the most recent figures from the Kids Count survey conducted by the Annie E. Casey Foundation.

The flood of studies and surveys dismays doctors like Craddock, who says battling obesity is rapidly becoming a common problem in his North Idaho practice. Like other professionals, he blames too much TV, sedentary activities and an explosion of calorie-dense but nutritionally deficient foods.

"There's high-fructose corn syrup in everything," he says.

The obesity problem in the Inland Northwest isn't as dire as elsewhere, says Craddock, who estimates that 10 percent of the children he sees are overweight or obese. But he fears it's only a matter of time.

"It's frustrating. Everybody's struggling with obesity. It's an epidemic, and it's increasing," he says. "You feel like you're trying to go upstream in a river that's overrunning its banks."At 112 pounds on a 50½-inch frame, Cody Harris weighs as much as an average eighth-grader.

Despite the success of the past year, Cody's parents worry that they've got a shrinking window of time to save their boy from a lifetime of obesity.

"If we don't address it right now, he's going to be a 350-pound adult," says Wayne Harris.

The Harris family, who moved to North Idaho five years ago from Arizona, have struggled to control their son's diet and exercise habits, hoping to avoid the health and social problems that plague people who weigh too much.

That puts them on the front lines of America's ballooning childhood obesity problem. But the Harrises' experience shows that there's nothing easy about helping a heavy child lose – or even maintain – weight. It's a daily effort that requires unrelenting attention, constant patience and a determination to buck social pressures that conspire to keep kids fat.

"I think you need to realize our commitment to this," Wayne says.

Health risks – and more

If professionals are daunted by the problem of childhood obesity, parents are nearly paralyzed. In a society that simultaneously celebrates thin bodies and excessive consumption, even deciding when to worry is an issue.

For the Harrises, Cody's weight was a worry from the start. He was a big baby, they acknowledge, but daughter Ciera was born at 9 pounds and quickly grew into a petite child. Wayne and Celise felt sure Cody would do the same.

But the infant who nursed for four months and then began draining dry his bottles of formula grew more rapidly than anyone expected.

"When you think your baby is hungry, your instinct is to feed him," the mother says.

Craddock says he became worried when Cody reached 18 months with no signs of slowing. He broached the subject gently, as he does with all parents of overweight kids.

"You try to be articulate about how you talk about it," he says. "You don't use 'fat.' You don't use derogatory terms."

Wayne and Celise didn't need anyone to define the problem for them.

"When Cody was 2, we were concerned," recalls Wayne. "By the time he was 3, it was my number one priority."

A battery of medical tests showed no reason for Cody''s rapid gains, the pediatrician says. There's nothing wrong with Cody's endocrine or other systems, no apparent problem with his metabolic functions.

"There is not an identifiable medical illness for Cody," Craddock says. "His system is just really geared to making fat."

That scares the Harrises, who, like most parents of overweight children, worry about future health risks. High blood pressure, Type 2 diabetes, heart disease and liver disorders are among the most serious concerns associated with obesity in children and adults.

"The problem with obesity is not cosmetic," says Dr. Judith O'Connor, a pediatric gastroenterologist and hepatologist with the Feeding and Growth Clinic at Sacred Heart Children's Center in Spokane.

"We're not talking about weight reduction so they can be in a magazine or be socially acceptable … I tell parents, 'Your kids are at more risk than you are' " for health problems.

Health effects are the top worry, of course, but the Harrises don't deny that they're alarmed about the social effects of Cody's obesity as well.

"I always felt like I was overweight," says Wayne, a stocky, barrel-chested man who never approached Cody's relative mass.

"Obesity affects your quality of life. If you ever want to meet girls and want to get married, it's a huge issue."

A family dilemma

Defining a problem and knowing what to do about it are two different things, the Harrises say. They acknowledge that concerns about Cody's weight began to drive a wedge between them.

Wayne, an entrepreneur who runs his own business, Wayne Harris Enterprises, was frustrated at what he believed should have been a simple equation.

"You have to balance your caloric expenditure and your caloric intake," he says. "I felt he was eating way too much."

But Celise, the stay-at-home mom who monitors the children's activities and meals, knew it was more complicated than that. Like most women who've struggled with a few extra pounds, she knows food can be as much about emotion as nutrition.

"Even I have a hard time eating just fruit for a snack," says Celise, a ponytailed blond whose sessions with a personal trainer keep her weight under control.

Cody's attraction to food and his reaction to hunger always have been extreme, she says, a notion that Craddock confirms. From the time he was tiny, Cody has responded to hunger with tears and tantrums.

"When you're hungry, you want to eat," Craddock says. "Cody has a strong hunger drive."

Managing that drive has come to consume his mother's life. Celise's day is filled with meal plans and calorie counts. She monitors Cody's every morsel as if it were her own.

"Today for lunch he had half a sandwich, four strawberries, four carrots and pickles," she says. "I am certainly aware of everything that goes into his mouth."

Celise keeps meticulous track of his intake, aiming for five small meals of about 300 calories each.

"We do lots of salsa and vegetables. He's a raw veggie and ranch kind of guy," she says. "He's a dipper."

Even when Cody goes other places, his mom retains a tether.

"He'll call me on the cell phone and say, 'Mom, can I have a brownie?' "

Sometimes – though not often – Celise says yes.

She doesn't ban snacks from her house; a peek into the pantry reveals floor-to-ceiling shelves stocked with Wheat Thins, Cheetos and Quaker Chewy Granola Bars, along with peanut butter, soups and cereal.

"I'm realistic," explains Celise. "Kids watch TV, they hear about these things. I try to do carrots and fruits for snacks, but sometimes kids need something else. My kids don't by any means live on Cheetos."

There's a basket on the floor of the pantry filled with 100-calorie packages of crackers, cookies and other snacks. When Cody is hungry, Celise allows him to select one or two treats.

"Cody does not live on air," she says.

Celise knows there are people who might criticize her choices. She knows families where snack foods are not allowed at all and families where children eat nothing but junk foods.

"I'm trying to find the happy medium," she says.

Similarly, it's Celise's job to make sure both kids, but especially Cody, stay active. She acknowledges that he enjoys video games and computers, but she says his time spent with them is limited.

"The key to Cody is keeping him active," she says.

"I've got him signed up for five sports just between now and Christmas. He's signed up for flag football, golf, basketball, karate and swimming."

Adds Wayne: "He is not a passive couch potato."

Emotions charge family mealtime

The sun is sinking in the August sky as Cody dashes onto the deck of the family's riverfront home. He shrieks and giggles as Mitzi, the family's bichon frise, chases the boy down the steps to the elaborate play structure in the backyard. Cody jumps tummy-first onto a swing, pumps a couple of times, then leaps off. He heads down the dock, past the family's twin jet skis, past the covered speed boat, down to the full-size waterslide his dad installed this summer.

Wayne doesn't want to say what it cost to put in the slide, an impressive structure that hooks to a hose and curls into the river. He knows he's fortunate to have the resources to keep his children entertained and active. Whatever the cost – for the slide, for the swing set, for the child-sized rock-climbing wall – he figures it's worth it.

"He'll burn 1,000 calories climbing up and down those stairs," says Wayne. "If he goes up and down that slide 30 times, that's a lot of extra effort."

And climb Cody does, shrieking with delight as he splashes, over and over, into the chilly river.

That extra effort, however, generates a huge appetite in the boy, whose trouble coping with hunger quickly becomes apparent.

"I want dinner," he says, as he enters the kitchen. His voice rises quickly from a whine to a wail. "I'm ready for dinner! I'm hungry."

With little warning, he throws himself on the floor. A few feet away, his mother and grandmother toss salad and wrap ears of corn in aluminum foil.

"He sees us getting it ready, and he thinks it's time to eat," says Peg Pytko, Cody's Arizona grandma.

With practiced calm, Celise ignores the boy thrashing on the floor. She's purposefully low-key as she slices peppers, lays out broccoli and squirts low-fat ranch dressing into a tiny cup.

She keeps her voice low, her tone neutral, even in front of visitors, even as her youngest child launches into a full-scale tantrum. Tension fills the air as Wayne walks in, sizes up the situation, and suggests a game. Distraction, they've learned, works better than confrontation with Cody.

Checkers, maybe?

"Battleship" is even better.

Diverted, Cody immediately improves his mood. He pulls up a chair at the kitchen table and goes to war with his dad.

"E-8" says Cody.

"Miss!" says Wayne.

"J-4," says Cody.

"Hit!" says Wayne, sending his son into gleeful giggles, thoughts of food momentarily forgotten.

But when Celise brings over the tray of vegetables and dip, "Battleship" is over. Cody's eyes light up at the sight of food.

"Do you want to take a veggie break?" his dad asks.

But Cody already has dunked one piece of broccoli, then another, into the dressing. The pepper strips are soon gone, followed by the carrots.

"Celise, he's gonna polish this whole plate," Wayne warns.

"Let's take it away, then," says Cody's grandmother.

Celise folds her lips together and shakes her head.

"No, Mom," she says in that same calm voice. "I'm not going to take a veggie plate away."

"Can I have more dip?" pipes up Ciera, goading her brother. "Cody, why did you polish off the plate so that no one else can eat?"

Cody, occupied with another stalk of broccoli, seems not to notice.

'A big, strong boy'

Staying calm and using distractions to divert children from food are vital techniques in the struggle with obesity, medical experts say. Parents like Celise and Wayne must master a delicate balance between addressing the child's eating habits and not making food the focus of their life.

"You get into battles over eating or pooping and it's a big problem," says O'Connor, the feeding clinic specialist. "Those are the only things that they can control and kids learn that pretty fast."

Children like Cody, who is "very, very bright," are especially challenging, says Craddock.

"Very bright kids are good at manipulating to get what they want," he says. "You've got to stand your ground and be persistent. They do a very good job, but (Celise) wears down."

The challenges do mount, the Harrises say. In addition to diet and exercise, they worry about the emotional effects being overweight might have on Cody. Aside from Cody's intense reactions to food, his parents believe he's a well-adjusted boy.

"It has been suggested to see a psychologist, but I don't think it's necessary," Wayne says. "He doesn't have anything wrong physically or mentally. He just likes food."

Because Cody is still so young, he hasn't confronted many social problems because of his weight, they say.

At home, they're careful to describe Cody's size in positive terms.

"We've never used the word 'fat.' We say, 'Man, Cody, you're a big, strong boy,'" she says.

Occasionally, Ciera pesters her brother about his size or complains about his eating habits. But her parents quickly quash any signs of sibling rivalry.

"Stay out of it, Sweet Pea," says Wayne, when Ciera starts to tease.

The Harrises believe that sending both kids to Holy Family Catholic School in Coeur d'Alene fosters a similarly protected environment where name-calling, for instance, is not allowed.

"When I was a kid, I would get teased (for being overweight)," Wayne says. "Kids don't need that kind of trauma."

Cody's gregarious personality is probably the reason he's popular with his peers, his parents say. He's a funny boy, quick with a silly joke or action. He nibbles corn on the cob like a typewriter, ending with a "ding!" and a wild wiggle of his eyebrows that cracks up his parents and sister.

"When Cody laughs, we all laugh," Ciera says.

For now, Celise says attention on Cody's weight doesn't affect him.

"He's so confident," she says. "He's really, really outgoing."

But Wayne and Celise are acutely aware that they won't be able to protect Cody from society's harsh judgment forever.

"I don't want to know how much he weighs because it stresses me out," says Wayne. "I didn't weigh that until I was in the eighth grade, and I thought I was fat."

The Harrises take some comfort in the notion that society is kinder to overweight men than women.

"The only thing that would be worse would be if it were Ciera who was obese," says Wayne. "It would be a heartbreaker if the problem was reversed and it was Ciera."

As it stands now, coaches are already sizing up Cody as a future linebacker, his father says.

Adopting a realistic attitude about Cody's future is essential, says Craddock, the pediatrician. He was encouraged by Cody's recent visit and by the determination exhibited by his parents, especially his mom. But he also believes that Cody's combination of genetics and temperament could easily lead to lifelong obesity.

"I'm guardedly optimistic that we're going to slow his weight gain down," the doctor says. "It's a tribute to them as a family. The hard part is, this is such a long road."

But the Harrises say it's a road they have no choice but to take.

"We only have a window of opportunity here to get results," Wayne says. "We're going to fix this. I'd never forgive myself for not taking care of it while I had the opportunity."


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