A 10-year-old boy on medication for high blood pressure.
An 8-year-old treated for high cholesterol.
A 7-year-old girl diagnosed with Type 2 diabetes.
Southern Arizona children are suffering from adult afflictions – and doctors blame it on a troubling surge in childhood obesity.
In Arizona, 31 percent of children between 10 and 17 are overweight or obese, experts say.
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 prioritizes her budget to eat healthy now that she’s dealing with myriad health problems linked to being overweight since age 5. “Oyster mushrooms are expensive!
“I think the real weight problem we’ve got going on right now,” she says, “is called poverty.”
Small budgets, big barriers
Arizona in general has been behind the rest of the nation in its prevalence of obese and overweight residents, but over the past decade the problem here 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.
“Identify an at-risk population with high unemployment and a high number of people who are uninsured. Then look at where they get their food,” he says, noting a lack of grocery stores within walking distance coupled with a lack of transportation.
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.
“I never think it’s because families don’t want to participate,” she says. “There are single parents who work and they can’t commit. For those who do, there are transportation issues. But we do still believe the community need is there … so if we help two children, then we help two children. And that is important.”
The program was recently reduced to once a week from twice because parents were having trouble getting their children there.
“How about the mother who says, ‘I work eight hours, I come home and then clean, cook, etc. … How do I make time for my kids to exercise?’ ” says local internist Dr. Armando Gonzalez, who recently added weight-loss programs at his west-side Mesa Verde clinic. “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
Doctors at Southern Arizona’s only pediatric-surgery group will start offering lap-band surgery to adolescents once it’s approved by the U.S. Food and Drug Administration. Teens must be morbidly obese and have accompanying conditions such as arthritis, high blood pressure or diabetes to qualify.
“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. Dr. Ann O’Connor of Arizona Pediatric Surgery Ltd., in conjunction with Tucson Medical Center, expects to perform at least 10 of the surgeries per month.
“We’re seeing children with medical problems at age 15 that are like those of a 40-year-old,” O’Connor says. “They have gallbladder problems, severe reflux and a fair number with diabetes.
“The hope is that with the lap-band surgery you have a benefit of prevention. It’s much harder to treat diabetes over your lifetime than it is to prevent it.”
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.
“The most insulin-resistant sort of tissue you have is fat,” he says. “It increases whole body inflammation. There’s so much that’s bad about it.”
Diabetics are more susceptible to vascular problems and aggressive methicillin-resistant staphylococcal infections, Armstrong says.
“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. “If you get used to a salty flavor, you tend to want more salt.”
Rogers says reducing salt and sugar from a child’s diet can be difficult, requiring a retraining of one’s taste buds and adjusting to feeling satisfied with the flavor.
“The farther it’s gone from the farm to our mouths,” says Kurtzman, “the less healthy it’s going to be.”
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.
“Most of the time, because they have two jobs, there’s no time for cooking, so they do what is easier,” Dr. Gonzalez says. ” They go to Kentucky Fried Chicken, Burger King and McDonald’s. Everything is greasy.”
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. “Young men and women are failing to be retained on active duty in the military because of obesity.
“In 10 to 15 years who will be our soldiers, sailors, airmen?” the doctor wonders. “Who will take jobs as police officers, in fire departments, as emergency medical technicians?”
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.”