Patricia Verdugo got used to being the biggest kid in class, her round figure dwarfing her classmates even in kindergarten. She learned to take it when the other kids called her "fatso"--and other names she'd rather not repeat. She quietly sat out as scorekeeper during kickball at school, though she loves to play the game.
With 220 pounds on her 4-foot-10 frame, her knees couldn't take the punishment. She was gaining an average of 10 pounds a month when they broke--collapsed, really--under the burden of her body. Now, the third-grader sometimes leans on a cane. She winces when her 280-pound father merely mentions the daily doses of insulin he takes to control his diabetes, but she knows the needles she dreads may become a fixture in her own life. Doctors say she's poised on the edge of disease herself.
These extra pounds, often a source of shame and inconvenience, have become a serious--and scary--health problem.
"I don't want diabetes because I'll have to get shots," she said, her eyes filling with tears.
"It's hard" to watch, said Jerry Verdugo, 36, gazing tenderly at his daughter from across their Palmdale living room. "You go through it . . . you don't want your child to go through it."
American children face this ordeal in rising numbers. About 11% of 6- to 17-year-olds are obese, and twice that number are overweight. That's up from 5% who were obese and 15% who were overweight in the 1960s.
Far from just a cosmetic problem, obesity is considered by some experts to be one of the greatest medical risks faced by American children today. Besides diabetes, short- and long-term consequences may include orthopedic problems, premature puberty, respiratory complications, hypertension, heart disease and certain cancers--not to mention reduced self-esteem and socioeconomic achievement.
"It is an impending time bomb," said Naomi Neufeld, a UCLA pediatric endocrinologist. "It's not going to kill them tomorrow, but in terms of a threat to long-term health, it affects more children than any other disease."
For all its impact on young lives, childhood obesity is only beginning to be understood. Though weight gain among U.S. youngsters spans age categories, economic classes and ethnic groups, it may have different causes depending on each factor. And it eludes the standard "adult" solutions of crash diets and prescription pills--questionable even in grown-ups--because a child's growing body depends on balanced nutrition to thrive.
In general, however, experts believe that there are some common causes among the young: poor nutrition education, paltry opportunities for exercise, too much TV, the glorification and overconsumption of fast-food--health menaces to everyone, fat and thin, young and old. In addition, they cite psychological and cultural factors: the concept of food as love, for example, and the equation, particularly among disadvantaged groups, of fat with healthfulness.
Perhaps more than anything, these problems are rooted in the family, in entrenched food purchasing, eating and activity patterns. Many experts believe that they call for family solutions.
But parents may be poor role models. More than a third of adult Americans are overweight, and their children tend to take after them. Some parents are afraid even to broach the subject for fear of precipitating a lifelong eating disorder. Others mercilessly blame themselves or, at the opposite extreme, deny that it is a problem until a child's health suffers.
Many doctors, not well informed on the subject, offer bland, out-the-door advice such as, "Don't feed them so much." And while physical education has been dramatically curtailed in public schools, there are few outside programs geared to youngsters whose weight is soaring.
Still, some clinicians and researchers see attacking the complex problem of childhood obesity as an opportunity. In young people, they argue, there is still so much potential for change.
"I think there are things we can do," said Steven Gortmaker, co-author of a famous study linking obesity to television viewing. "The fact is, we haven't done them."
Sedentary Lifestyle
Why does fat run in families? And why, in particular, does it run in American families?
The deceptively simple answer is that children, and their elders, take in more calories--often fatty, sweet or nutritionally empty--than they burn off.
Most experts agree that weight gain is the product of some combination of genetic and environmental factors--with genes accounting for about 25% of the variation among individuals, according to one widely cited estimate.
But environment gets most of our attention because it counts more and it is, at least theoretically, under our control. Given the dramatic rise in childhood obesity in less than a generation, the American environment, clearly, is becoming more fattening.
"The very act of living in the United States puts you at great risk for obesity," writes Michael Fumento, author of a book that rails against the sedentary American lifestyle.
