By Leticia Ibarra.
Of the 10 children in my family, I was the only one who was obese. I didn’t know it at the time, but my family mirrored obesity trends in Holtville, the small town in California where I grew up. In Imperial County, which borders Arizona and Mexico, 1 in 10 people were considered obese in the 1970s and ’80s. I hated being obese. I was teased and didn’t feel good about myself. I’d fantasize about a magical solution that could transform children like me overnight.
Fast forward to the present: I have a master’s degree in public health and my weight is under control. I’m the director of programs at Clinicas de Salud del Pueblo, a non-profit community clinic that provides health, dental, behavioral health, and education services to people in Imperial County.
Unfortunately, obesity is much more common here than when I was a kid. Today, 4 in 10 children in Imperial County are considered obese or at a weight that puts them at high risk for serious health problems like Type 2 diabetes, high blood pressure, and complications from asthma. Couple this with the county’s high poverty rate of 22 percent, and you have a recipe for an unhealthy community.
To determine if a child’s weight is a problem, a key measure is body mass index—measuring the child’s weight against a national standard of what’s considered healthy for their height, age, and gender. A child in the 85th percentile or more is considered overweight; at the 95th percentile and above, a child is obese.
One major problem in dealing with childhood obesity is that many parents see it as something their children will outgrow—not a major health concern that requires treatment. The clinic used to take this approach, too. We told parents and children to eat healthy and exercise, and to come back next year for a physical exam. This method didn’t work. Most kids don’t grow out of being overweight or obese and many parents don’t know how to help them make healthy choices around food and exercise.
In 2011, my community clinic saw an opportunity to expand our work and join forces with other agencies in the region to come up with a new strategy for controlling obesity. One focus of our work is to try to identify obesity problems much earlier in children’s lives, and monitor the problem more closely over time.
We desperately wanted an approach that would work. So our coalition included San Diego State University’s Institute for Behavioral and Community Health as the lead agency so that we’d have top researchers. My clinic and the Imperial County Public Health Department provided on-the-ground knowledge. And in order to get real money, we applied for a 4-year research grant from the Childhood Obesity Research Demonstration (or CORD) study of the Centers for Disease Control and Prevention.
The grant program is part of the Affordable Care Act and aims to tackle childhood obesity in impoverished communities. We were fortunate to be one of just three sites funded in the United States—the others are in Massachusetts and Texas. We aren’t scheduled to present the results of our project, which is called Our Choice/Nuestra Opción, until 2016 as CDC is working on a report to Congress first. We have already learned a few things we can share.
The study is focused on three Imperial County communities (Brawley, El Centro, and Calexico). When we launched Our Choice/Nuestra Opción last year, we invited about 600 children who had been diagnosed at our clinic as overweight or obese to participate—and we allow any family that comes through our doors to access the services.
The family wellness program engages the entire family in learning to make healthy choices. Three to four times a year, the overweight or obese child visits the clinic to see a clinician for a weight management and wellness exam. A patient care coordinator also works with the family to connect them with community resources—everything from recreation programs to food stamps.
Finally, community health workers (or promotoras) lead a series of 17 wellness and physical activity workshops over six weeks for both parents and kids. There are workshops just for adults focused on parenting skills like communication, setting rules, and the importance of being a good role model when it comes to healthy living. There are also workshops for the entire family where they set realistic goals and come up with a wellness plan. Finally, families learn to incorporate fun games into physical activities. For example, everyone pretends to be on a ship where a “captain” calls out commands like “drop the anchor” or “swab the deck,” which are different stretching exercises.
When we launched Our Choice/Nuestra Opción, we were not prepared for how challenging this was going to be. For example, only half of the families invited are taking advantage of the new family wellness program. For many families, it’s hard to find the time to participate in the workshops twice a week—or to make the follow-up visits so the child’s weight and wellness plan can be monitored.
One of the first families to participate in Clinicas’ new family wellness program was the Padillas. Their 11-year-old daughter had been struggling with her weight for a few years and her mother knew the family needed help. She was overweight herself.
Nevertheless, it was difficult for the Padillas to be a part of the program. The family doesn’t have a car and needed to find a ride or take the bus, which can be tricky after 8 p.m. when most workshops end. The mother said that she felt guilty when she didn’t follow the healthy life plan she worked on at the clinic. Like many families, she felt reluctant to visit the clinic if the family had lapsed. We stress that the important thing is to stay on track as much as possible.
The Padillas eventually started to figure out how to manage the plan and make changes to their lifestyle. They went out on walks (even when it was 105 degrees), watched less TV, gave up drinking sweet tea, and ate less of their favorite (fattening) Mexican foods.
This year, the 11-year-old girl’s body mass index went down from the 98th percentile to the 95th, a small step in the right direction. Major weight loss takes time, and the Padillas have made real progress by changing their behavior. The family now eats more fruits and vegetables, drinks more water, goes to sleep earlier, and includes more physical activities in their daily routine. The child’s weight is still monitored by a clinician and the family is welcome to attend any physical activity and wellness workshops.
But it’s not just families that need to commit to change. In many cases, social service agencies, including those of us working in the project, also need to model better behavior, like serving healthy food in public meetings. As part of Our Choice/Nuestra Opción, experts conducted training with the staff of clinics, childcare facilities, schools, recreation agencies, and restaurants. We also launched a public outreach campaign focused on healthy behaviors, like drinking water instead of sugary drinks, getting enough sleep and physical activity, and eating more fruits and vegetables. There are Our Choice/Nuestra Opción posters all over Imperial County with these messages.
The magical solution to childhood obesity that I wished for when I was a kid doesn’t exist. Tackling this problem means making a long-term commitment—and understanding that change won’t happen overnight. This is as true for families as it is for all of us.