TONY COX, host:

This is News & Notes, I'm Tony Cox. Type two diabetes, gall stones, cirrhosis. At what age do Americans tend to deal with these medical conditions? Sixty? Thirty? Maybe even 20 years old? How about 10 years old? With the rising number of overweight and obese children in America, more and more kids are facing medical conditions usually seen in older adults. How did we get to this point and what can we do to fight childhood obesity? Here to talk about this challenge is Dr. Sandra Moore. She is an assistant professor of clinical pediatrics at the Morehouse School of Medicine. Makani Themba Nixon, She is the executive director of the Praxis Project, a non-profit organization helping advance heath, equity and justice. And Alice Smith, program director of healthy lifestyles at Children's Health Care of Atlanta. Everyone, welcome to News & Notes.

Dr. SANDRA MOORE (Assistant Professor of Clinical Pediatrics, Morehouse School of Medicine): Hello, Tony.

COX: Dr. Moore, let's start with you.

Dr. MOORE: Yes.

COX: I'd like to ask about statistics, but before I even get in to that and how many children are overweight or are obese or are obese in this country, what is overweight exactly? How do you know if you're over weight?

Dr. MOORE: Well the medical community has a standard definition of being overweight, and it really is based on your child's age as well as their gender. And what we do is actually measure their weight and their height and we compare the two. And so if you weigh more than what is normal for your height, then you're considered overweight and certainly if you weigh even more, then you move into the obese category.

COX: How many children are overweight in America?

Dr. MOORE: Well, that's a very good question, because it really depends on who you are looking at. If you look at American children across the board from about two to 19, about 15 to 16 percent are actually overweight with an additional 16 percent being obese. But if you look at different ethnic groups or different genders, for example, Mexican-American boys, up to 25 percent of them are overweight as well as about 25 percent of all African-American girls.

COX: Overweight. Let me bring Makani in. Do you know why that is? Can you give us an explanation as to why there are those differences?

Ms. MAKANI THEMBA NIXON (Executive Director, Praxis Project): Well it's complicated, but I think a lot of it has to do with environmental and historical inequities that then become manifested in our bodies. So many kids of color do not have access to gym regularly, their schools are not equipped, they don't have gym teachers. I for one, my kid was in a gym class of 110 kids with one teacher before they could hire enough. So we have our families dealing with these issues. There are not enough safe places to play and also not enough healthy food that they can access. So part of the struggle is not only to make changes in individual behaviors, which must happen. But a lot of these differences can be explained by looking at the environment.

COX: Well Alice Smith, you're the program director of healthy lifestyles of Children's Healthcare in Atlanta. What concerns you most when you see the increased number of obese children, especially among African-Americans?

Ms. ALICE SMITH: (Program Director of Healthy Lifestyles, Children's Healthcare in Atlanta): Well, we're really concerned about the medical conditions that result in childhood, and especially because a lot of parents just don't understand the risk factors and what they mean in terms of developing chronic diseases really early on. We are seeing elementary school kids with high blood pressure, with sleep apnea, with joint and orthopedic problems. We're seeing young kids with type two diabetes who go on to have early onset of blindness and kidney problems. Some of them going on to kidney dialysis in their 20s. I think you mentioned earlier gallstones, non-alcoholic cirrhosis that can result in liver transplants. So this is really a serious concern, and 30 years ago we weren't seeing this. It just wasn't there in our children. So...

COX: Well, Makani, do you consider this an issue that is primarily laid at the feet of a lack of appropriate healthcare?

Ms. NIXON: Well healthcare is important once you have a problem. But the question is, how can we prevent this? Because much of this is preventable and especially when looking at childhood obesity, which so much of it has to do with access to food and access to play. One of the reasons why we're seeing the increase - there is a whole range of things - some of it has to do with being able to breastfeed, which also is a real important factor in reducing childhood obesity. How our neighborhoods are organized and the difference in the safety factor. Many of us grew up playing outside even if we lived in cities, where many kids, their parents are afraid and they're making choices between how much kids exercise and how safe they, you know, want to feel about where their kids are. And they shouldn't really have to make those choices.

I think the real key is, yes, we do need to have great access to child care - I mean to healthcare - when the problems manifest, but we also have to look at, what are the school systems? The school lunches, the places to play, all of the things so that parents can be supported in making good choices so they're not choosing between being afraid for their kids to play outside and allowing their kids to play and get the exercise that they need. And then also, you know, as we know that these things accelerate. If it runs in your family, then you're more like to have these problems. And so then we see this acceleration that we have to figure out how to stop the cycle.

COX: Well, Dr. Moore, as a physician, how much of this can be dealt with at the family level, let's say, in terms of either education or altering harmful practices, things of that sort?

Dr. MOORE: Well I do want to echo the sentiments of your other guest today in that, you know, it really is a three-pronged approach with policy, communities, families and even individuals. And so we do want to have a lot of prevention in place which means making sure that policies are in place so that kids have access to the different activities that will improve their health. In terms of the individual family, we have some programs here that actually work with families to really change the behaviors that had lead to overweight. And I was very pleased when you started your segment, you started with the health consequences of overweight. Because a lot of people may still believe that them being overweight we see the physical thing as a problem but really it's the medical complications that we are concerned about. And so if you can stress to individuals, stress to families, like mentioned, the consequences they're going to have primarily as young adults or when they're in their 30s. When they're pretty much in the prime of their life, we're very concerned about their quality of life at that point with those chronic diseases.

COX: What changed? You know, we've have obesity issues in the past. But why does it seem to be coming more of a, and I don't want to over state it, but seeming to become more endemic now than before? Dr. Moore.

Dr. MOORE: Well, there are several things that we've already mentioned. One being the environment. And so when you look at video game usage, when you look at computer time usage, when you look at TV viewing, if you look at African-Americans, we view more TV and have more what we call screen time than other children. And so if you're looking at TV, well you're not outside burning calories. You also want to look at the access to poor nutritional foods, so in other words, fast food. And so if you have bargain, quote unquote, fast food they're very high calories, you combine that with a sedentary lifestyle and then people can become overweight.

COX: Well Makani, I want to ask you this question because, I know that you have all heard the expression baby fat. Oh, she'll grow of it. He'll grow out of it when he gets to be a teenager, or when he starts growing or she starts getting taller, it will all just fall off. There is this sentiment, is there not, in the black community that we can and will grow out of baby fat when in fact maybe that's not the case?

Ms. NIXON: Well there are definitely cultural differences, and those things actually expand not only in the black community but also in some Latino communities and also some particularly Pacific islander communities, where we have different expanded ideas of beauty and body image, which in many ways is very healthy. I think the question - the issue is when if we cross those lines and they become unhealthy. You know, because there is a difference between someone that people say thick, right, versus being fat and not able to function. And I think that many folks now understand those differences. They're just not quite sure what to do. So programs like Dr. Moore's and other programs especially when they're in a school site can really make a difference to help kids figure out to back down from that cycle.

And so in terms of individual behaviors and support by your doctor, if you have a regular doctor, the centers are really important. But also being involved politically to help change those polices in going to like web sites like UnnaturalCauses.org and that whole PBS series that has really has helped people to understand better about how the environment works and how that plays out. And I would remised not to mention the fact that today is Juneteenth where around the country in many places, especially in African-American communities that have a large Texan population, folks are acknowledging and celebrating their information. They are getting the news around emancipation from slavery. And the Service Employees International Union has a project that's a Juneteenth project around health equity to try to engage families in being more involved in the environment and policy. Where too - so there's a lot of effort nationally to get more people involved, to be educated, to change their behavior but also change their environment.

COX: I want to follow up on that point with you, Allison, in a moment. But just in case you're just now tuning in, this is NPR's News & Notes. I'm Tony Cox sitting in for Farai Chideya. With us, Alice Smith, program director of healthy lifestyles at Children's Healthcare of Atlanta, Dr. Sandra Moore, assistant professor of clinical pediatrics at Morehouse's School of Medicine, and Makani Themba Nixon, executive director of the non-profit health advocacy group The Praxis Project. Alice, I want to come back to you because Makani was just talking about the cooperation that's required both politically, financially, socially, otherwise to sort of attack this issue of obesity on many fronts. But it would seem to me - and I would like you to respond to this - that that's a very difficult thing to do, to get all of these sometimes competing interests to work together for the good of our kids.

Ms. NIXON: Well, if you look at it as the whole thing it could be overwhelming. But if you take it one step at a time, there are many entry points into making a huge impact in the environment or the school. And one is for parents to get involved in their PTA, and the school wellness policies that are all over the country now and to become advocates. We have many examples in schools here of individual leadership, where parents and the principal or the school nurse have gotten together and they've built walking trails, they've gotten water in their vending machines instead of sodas, they - local people have gotten together with Georgette Organic (ph) and the local farmers so that they now have fresh produce from local-grown farmers in their schools. So there are many, many ways that people can get involved. Talking with their local restaurants about healthy - more healthy choices, restaurant chains are starting to put heart-healthy items on the menu. There are a lot of 10Ks and family walk/runs where families can get out together in support of different causes in their local communities. So I think that there is the growing awareness of people being willing to step forward, especially families with young children and get more involved.

COX: Well Dr. Moore, where should this begin? I know this may seem like a very simple question, but I would imagine that if you're talking about educating and re-educating people with regard to their diet and their healthy exercising and other kinds of practices, that this needs to start like at almost - I won't say the beginning of life - but really close to it, I would think.

Dr. MOORE: Well, you do want to start as early as possible. And you want to start with both the child as well as the family. And one thing in medicine we always say is, start with small steps at the beginning. And so sometimes families can feel overwhelmed or feel like they have to do so many different things. But the truth of the matter is, if you start out small, you really can make big changes. And so there are websites to support it, like www.MyPyramid.com. But it will list for you healthy foods. It will list suggested calories for children as well as adults. But one thing you want to do is things like eat a lot of fruits and vegetables. Very simple things. You want to drink water instead of drinking juice or regular sodas. You'll want to do family activities that require moving at least three to five times a week. And so simple things like that can really start and put you on a path to a healthier you.

COX: The things that you just mentioned, with maybe one exception, don't seem to involve a great deal of expense. Is that a formula for people who - you don't have to have money in order to do this correctly, is what I'm getting at. Is that right?

Dr. MOORE: You do not have to have a lot of money to do programs correctly, and I know many patients with limited resources who were able to get moving and to eat better. Now sometimes you may have some small financial challenges, but you have to think about in the context of your community and in your household, how can you overcome those?

COX: Well, Makani, do you find that there is resistance to that because of, let's say a stereotype that some of these foods don't taste as good as what people are accustomed to eating? Especially in black households.

Ms. NIXON: Well you know, I'm finding that people are becoming more and more open to experimenting. A lot of the folks we work with, you know, there's been a lot of great work and websites that have helped people to have healthier soul food. You know, I hear folks talking about new kinds of vegetables, you know. And so I'm actually very hopeful. I see people moving in a different direction, eating more fish. And one of the things my grandmother used to always say is that actually black folks eat healthy, you know, that that's our tradition. Our tradition is that the kinds of food that was unhealthy we really mostly only ate on Sundays. And that as people got more money they ate every day like it was Sunday. So if we can go back to those traditions of mostly vegetables, a little bit of meat, mostly fruit and simple foods during the week, and the richer foods if you have to them, have them once a week on Sunday. And get out and move and work. You know, as Dr. Moore said, those actually are our roots. And that's actually where we come from.

COX: Dr. Moore...

Ms. NIXON: So we can do that, and I think the - and the other thing, just again, is that a part of our tradition, too, is that we fight and we advocate for change, and that many of us are involved in our schools and trying to make change. And so as much as we advocate for the kind of teaching, we also have to remember that our kids' academic progress is also tied to their access to physical education as well.

COX: Absolutely. Unfortunately, our time has run out, and we'll have to end this conversation here. Hopefully, though, it will not be the last of these kinds of conversations that we offer to our audience, because the information that you are providing is so helpful and it is so very, very important. Makani Temba Nixon is the executive director of the Praxis Project. She spoke to us from NPR's headquarters in Washington, D.C. Alice Smith is the program director of child health promotion at Children's Healthcare of Atlanta. And Dr. Sandra Moore is assistant professor of clinical pediatrics at the Morehouse School of Medicine in Atlanta. She joined us from the studios of Georgia Public Radio.

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