Second of Three Parts
And yet, there they were, walking around in classic zombie pose - ambling along on stiff legs, arms poised straight ahead - in the South Toledo YMCA gymnasium one recent weeknight.
"Show me your best zombie," encouraged Michelle Tilton, the session's leader. "Zombies actually exercise because they've got to run around to scare people."
The youths, about a half-dozen of them, were running around and having fun. Just as important, they were learning about health, nutrition, and exercise as part of a free program called "Kids in Motion." Along with a companion program involving parents called "Families in Motion," the initiative is one of a few that have sprung up locally to tackle the dangers of child obesity.
Much has been made of the need for major changes in public policy to improve what America's children eat and how much they exercise, given that 15 percent of them are seriously overweight, according to the most recent data from the Centers for Disease Control and Prevention. But programs like those at the YMCA take on the problem one child at a time.
Marlene Schwartz, co-director of Yale University's Center for Eating and Weight Disorders, is a big believer in taking on the bigger problems - getting snack and soda vending machines out of schools and everyday gym class back in - but she also understands that there are children who need help now.
"While we're waiting for the environment to change, you have a child whose personal risk is going up every day," she said.
There's a host of medical or psychological problems associated with obesity ranging from sleep apnea to depression to asthma. Those who are overweight have a greater risk of high blood pressure, arthritis, and even Type 2 diabetes. It is this last complication that often grabs people's attention, particularly because it used to be known as adult-onset diabetes.
"Here's a disease that was virtually nonexistent in children a generation ago," Ms. Schwartz said. "The reason that's really frightening is, the earlier you have diabetes, the earlier you're going to have the serious consequences. This generation of children now may not live as long as the previous generation."
Mary Jean Ohns, a pediatric nurse practitioner who coordinates "Way to Go Kids," a program for overweight children run by Toledo Children's Hospital, said it's no surprise that local hospitals have seen an increase in health problems related to child obesity. It makes sense, for example, that it often would be paired with high blood pressure and heart disease.
"The stress the weight puts on the heart, their bodies weren't meant to handle that," she said.
Once a child is having health problems related to being overweight, it may be possible to reverse them in some circumstances, Ms. Ohns said.
"If you're talking about things like joint problems and back problems, that can improve when the kids have less stress on their back," she said. Cholesterol and high blood pressure may also improve if the cause was being overweight, though there can be several factors behind those, she said. With diabetes, however, it's more a matter of trying to manage it better.
Concerned about student fitness levels, Nathan Hale and McKinley elementary schools in Toledo have instituted a program called HeartWalk with the help of a grant from Toledo Children's Hospital. Teachers take children out in groups and walk around the building after lunch, and for each mile a student walks, he gets a plastic foot to wear on a necklace.
"It's become quite the rage," said Michelle Tuite, principal of Hale Elementary.
"Way to Go Kids" is a national eight-week program that the hospital adopted over the summer. Its fall session began Wednesday with a group of 20 students between the ages of 9 and 12, each of whom were examined by a registered dietician before the first session and deemed to be overweight or at-risk.
The YMCA's program, which has more than 175 participants spread throughout its branches and the Jewish Community Center, is open to anyone. It was developed by the Toledo-Lucas County Health Department.
In general, the programs have similar structure and goals. Each splits sessions between talking about nutrition and health issues and having fun exercising.
So when the kids at the South Toledo YMCA aren't running around like zombies, they're learning to measure their heart rate and talking about what good foods they ate over the last week.
"I had bananas," said one girl. "Then I had cookies."
"Well, one's OK," Ms. Tilton said.
"I had two."
Participants at "Way to Go Kids" work on their endurance and flexibility before hearing that it's never good to supersize their meals - "unless it's broccoli," Ms. Ohns said. And there's homework too, such as keeping a log of what they - and their parents - eat or what physical activity they do.
The goal is to keep things fun so that kids leave with a more active lifestyle.
"Physical activity isn't just sitting on a couch playing Sega Genesis," said Josh Little, program director at the South Toledo YMCA. He said its sister institutions in Detroit are looking at its initiatives here.
"There's a lot of programs out there in the United States, but a lot of them don't work. They don't offer a solution. A child wouldn't want to do the activities," he continued. "Kids need to have fun and come back and stay physically active."
Another model exists in southern Ohio, where Cincinnati Children's Hospital Medical Center has a comprehensive weight management center. Its program called HealthWorks! provides individual attention for children between the ages of 5 and 21, who must qualify as overweight, and their families.
The program brings together a physician, two dieticians, two psychologists, a nurse, and an exercise physiologist to create an individualized treatment plan and then monitor the progress over the first phase of four to six months. HealthWorks! has about 200 patients a year, though about half drop out, said Dr. Stephen Daniels, program director. The cost of this individualized attention is hefty, between $4,500 and $5,000, and isn't always covered by insurance.
In the end, handling child obesity is as simple as eating and exercise, he said, but that's the hardest part, too. For the most extreme cases, there are some medical options available.
Two drugs are approved for treating obesity in adults - orlistat, which blocks absorption of fat in the intestine, and sibutramine, which reduces appetite. Neither has been studied extensively in children and would be considered experimental for that age group, Dr. Daniels said.
There also is bariatric surgery, which reduces the size of the stomach. "We're talking about kids who are in the 300, 350, 400 [pounds] and above range in terms of weight," Dr. Daniels said.
The Cincinnati hospital has performed 42 of the procedures on adolescents in the last year. The hospital systems in Toledo have not performed any, hospital officials said.
For local parents Madelyn Rawson and Kim Stokes, their concern these days is prevention. They both have daughters participating in "Kids in Motion."
Mrs. Rawson said her pediatrician raised flags about her 7-year-old daughter Maretta during a doctor's visit in February, stating that she should not gain any weight for two years. While her brothers are always outside playing, Maretta tends to stay inside, her mother said.
"She likes to draw, read, play school. She's up in her room doing quiet things," Mrs. Rawson said.
Now, she's put Maretta on a modified South Beach Diet and tried to get her in more activities, including "Kids in Motion."
"I know the teacher. It's lots of fun," Maretta said after a recent session.
Mrs. Stokes wants her daughter Ricki Fowlkes to learn about eating and exercising and, above all, having fun.
"I want her to get to meet other kids, meet and relax," she said. "She realizes that she's a big girl. I don't want her to think that her weight will keep her from doing things."
Tomorrow: Healthy eating for your family.
Contact Ryan E. Smith at: firstname.lastname@example.org or 419-724-6103.