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June 4, 2009 – Vol. 3 • No. 10
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Childhood obesity:
An avoidable problem

Michelle Botus-Foster admits that it took some doing to break the cycle of overeating.

”Growing up,” the state social worker recalled, “we used to pile the food on. There would be a peak on your plate.”

It was little surprise, then, that her 12-year-old daughter, Khalima, was having difficulty managing her weight.

“I used to be skinny when I was in the fifth grade,” Khalima now in seventh grade, said ruefully.

But pressures at school took their toll and the pounds began to mount. Khalima says that she likes to eat; junk food and Chinese food are her favorites. Watching too much television and playing video games didn’t help matters.

Within one year, she had gained 10 pounds.

“Khalima started eating too much,” her mother said bluntly.

But it wasn’t a scale that tipped off Khalima that it was time to pay attention, nor was it the warnings from her mother. The wake-up call came from Khalima’s closet — most of her clothes had grown too small.

“We became complacent,” Botus-Foster said, quickly pointing out that she too had gained extra pounds. “We started to eat too much fast food and not exercise enough.”

Those days are long gone.

Nowadays, she, Khalima and other family members take walks through the Arnold Arboretum or around Castle Island. To make sure they are eating right, the whole family makes a weekly expedition to Haymarket Square for Saturday food shopping. Fortunately, the children have a penchant for vegetables. Baby carrots are one favorite, and Khalima would make Popeye proud — she loves spinach.

And in this age of super-sizes, Botus-Foster pays particular attention to the sizes of portions.

“I cook less food now,” she explained. “I used to cook a lot in case friends dropped by. But that only made us eat more.”

Botus-Foster takes her role very personally: “It’s my responsibility to encourage healthy choices. It’s not about being a size 0 or 2. It’s about good health and lifestyle.”

Fortunately, Botus-Foster has help in a slew of new state regulations and local policies. Last January, the Commonwealth of Massachusetts enacted “Mass in Motion,” a comprehensive initiative that targets obesity with particular focus on school-aged children.

The state went even further by endorsing the Physical Examination of School Children, a new law that requires public schools across the state to obtain the body mass index (BMI) of first-, fourth-, seventh- and 10th-graders with their parents’ consent.

Under the new law, effective this upcoming school year, the BMIs will be sent to parents along with recommendations for children who are obese or at risk for obesity.

The Massachusetts Department of Public Health (DPH) will receive the analysis as well in order to monitor progress over the years.

The state has taken other measures. Under the Calorie Posting Amendments, which goes into effect on Nov. 1, 2010, food establishments must publicly display calorie information — even at the drive-through window, where up to 60 percent of meals are sold.

The new regulation applies to fast food and chain restaurants that offer the same menus in at least 20 sites across the state. A similar ruling has been in effect in New York since 2008.

The Boston Public Schools are also taking direct aim at the obesity problem by targeting low-nutrition foods sold on their premises. For instance, total fat in snacks is limited to 30 percent of calories per serving size and added sugar to 35 percent. Milks cannot exceed 14 ounces in size and must be reduced, low-fat or skim.

Size matters — no more super-sized cookies or big bags of regular chips. Soft drinks and fruit drinks with minimal nutritional value are gone.

And with good reason. In the 2007 report on health and risk behaviors of Massachusetts youth, it was found that 11 percent of high school students were obese and another 15 percent were at risk.

The numbers were worse for middle school students — 18 percent were at risk of obesity.

The study went on to detail some of the factors contributing to the problem. Only 60 percent of high school students had attended physical education classes weekly or played on a sports team in the past year. No more than 15 percent of all students ate the recommended number of fruits and vegetables per day, and just over one-third of high school students reported that they ate breakfast everyday.

Hardest hit are students of color. The Mass in Action report by the DPH noted that in 2007, obesity was more common in black and Hispanic high school students at 22 and 15 percent, respectively, than white students, at 9 percent.

“It’s a constant battle,” said Ayla Gavins, principal of Mission Hill K-8 School in Roxbury. “We might require healthy eating in the school, but the students can buy unhealthy snacks at a nearby convenience store.”

As a result, the staff keeps a close eye on what their students eat at lunch.

“If we notice that they are eating only potato chips and cookies,” Gavins explained, “we advise them that that’s not enough and direct them to healthier choices.”

The state and local initiatives come on the heel of some well-publicized national efforts. For one, the Robert Wood Johnson Foundation has devoted $500 million to childhood obesity.

For another, the Alliance for a Healthier Generation, a partnership between the American Heart Association and the William J. Clinton Foundation, was developed to “eliminate childhood obesity and to inspire all young people in the United States to develop lifelong, healthy habits.”

Despite those efforts, Botus-Foster says the solutions lie within each family. It was family genetics that prompted her to make a real effort.

“My daughter is predisposed to diabetes,” she said. “My grandmother was overweight and had high blood pressure and diabetes. My father is diabetic as well and a sister had gestational diabetes.”

That family history contributed significantly to Botus-Foster’s decision to enroll Khalima in Race Around Roxbury (RAR), a community-based program that uses exercise, nutrition education, art and counseling to address weight management in children and adolescents.

In addition, participants receive regular screenings, BMI tracking and risk assessments for obesity-related illnesses.

Khalima joined a couple of months ago and says it has helped a lot. She takes full advantage of all the offerings, including art and dance classes. She likes the kickboxing, but admits that she’s a little clumsy.

She also has a favorite.

“I’m learning how to cook healthy meals,” she said. “I made baked fried chicken.”

Excited, she ticked off the ingredients — boneless chicken breasts, egg and corn flakes for breading. She was surprised at how good it tasted.

“I couldn’t believe it,” she said. “It really was good.”

Khalima goes the extra mile. “I walk home from school every day,” she boasted. “It’s about a 30-minute walk.” Then she works out at Body by Brandy, a fitness center affiliated with RAR.

It’s paid off. According to her case manager, Khalima lost five pounds after one month of membership.

“Now I’m back on track,” she said.

Jonathan Baez (front) leads Dante White (rear, second from left) and Khalima Botus-Foster (rear, middle) and other youth in a kickboxing class to help manage their weight. (click here to enlarge photo)

Dr. Shakhia Anand (right), the director of pediatrics at Whittier Street Health Center, runs a weight management program for children and teens.

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