(HealthDay News) — Reducing the high rate of obesity in the United States requires a comprehensive, population-based strategy, says a new American Heart Association (AHA) scientific statement.The AHA also recommends a wide range of approaches to help people adopt healthy behaviors, such as eating right and being physically active.

About 67 million Americans are obese, and an additional 75 million are overweight, according to the 2001-04 National Health and Nutrition Examination Survey.

“Almost all of our current eating or activity patterns are those that promote weight gain — using the least possible amount of energy or maximizing quantity rather than quality in terms of food,” Shiriki Kumanyika, chair of the statement working group, said in a prepared statement. “People haven’t just made the decision to eat more and move less; the social structure has played into people’s tendencies to go for convenience foods and labor-saving devices.”

Making policy and environmental changes at the local, state and federal levels could help boost healthy eating and physical activity without requiring deliberate action by individuals.

“We’re not talking about creating a dieting society, but looking at choices people make in day-to-day living that affect their ability to manage their weight and then trying to change the environment to facilitate healthier choices,” said Kumanyika, a professor of epidemiology at the University of Pennsylvania School of Medicine in Philadelphia.

The statement outlines the following areas to identify targets for change:

Locations of fast food restaurants. Restaurant portion sizes Availability of high-fat, low-fiber foods and sweetened drinks. Community design and infrastructure, which involves assessing land-use mix and walkability of neighborhoods, including: adequate sidewalks and areas for physical activity; accessibility of jobs, schools and recreation by walking or cycling; availability of public transportation.”The concept of population-level interventions to change contexts for individual behavior is well-known from the experience with tobacco regulations,” Kumanyika said. “Changes in these areas can eventually become ‘normal’ and displace the current ‘normal’ ways of doing things. Right now, you have to be pretty single-minded to make some of these choices, such as walking or riding a bike instead of driving. We advocate changes that will move the social norm to where physical activity is the custom.”

The statement was published in the current issue of Circulation.

More information

The U.S. Centers for Disease Control and Prevention has more about the importance of healthy eating and exercise.

by Steven Reinberg
HealthDay Reporter

More than 6 million children in the United States have a condition called nonalcoholic fatty liver disease (NAFLD), which can boost their odds for heart disease, researchers report.

NAFLD results from oily droplets of triglycerides forming in liver cells. In some children, this can lead to cirrhosis and liver failure and the need for liver transplant. In others, NAFLD can help cause diabetes, high blood pressure and high cholesterol, all of which are linked to cardiovascular trouble.

“NAFLD is now the most common chronic liver disease in children,” noted lead researcher Dr. Jeffrey Schwimmer, an associate professor of pediatrics at the University of California, San Diego. “We believe that children with NAFLD are at greatest risk for heart disease and diabetes,” he said.

The disease is now so common that between 9 percent and 10 percent of children in the United States have NAFLD, Schwimmer said. “About 80 percent of children with NAFLD are overweight,” he said.

Approximately 5 percent of these children will develop severe advanced liver disease, Schwimmer said. The majority of children with this condition are at risk for developing cardiovascular risk factors leading to what’s known as the metabolic syndrome, he added. Metabolic syndrome boosts heart risks and includes three of these symptoms: abdominal obesity, high blood triglyceride levels, lower levels of “good” HDL cholesterol, elevated blood pressure and elevated fasting blood glucose

The report is published in the July 8 issue of the journal Circulation.

In the study, Schwimmer’s team looked at 150 overweight children diagnosed with NAFLD, comparing them with 150 overweight children without the condition. Children ranged from five to 17 years of age with an average age of 12.7 years.

The team found that children with NAFLD had higher levels of blood sugar, insulin, total cholesterol, LDL cholesterol (the bad cholesterol), triglycerides and higher blood pressure compared with children without NAFLD.

In addition, children with NAFLD had lower levels of HDL cholesterol (the good cholesterol), Schwimmer’s group found.

“Overweight children with NAFLD were three times as likely to have metabolic syndrome as overweight children without NAFLD,” Schwimmer said. “Overweight children with metabolic syndrome, compared to overweight children without metabolic syndrome, have five times the odds of having NAFLD,” he said.

Schwimmer’s group noted that more Hispanic and Asian children had NAFLD compared with white and black children.

NAFLD is becoming more common among overweight children and is associated with type 2 diabetes and the metabolic syndrome, which puts children at risk for cardiovascular disease and type 2 diabetes.

“Since 2002, the numbers of children we are seeing with NAFLD and the severity of the disease we are seeing have both increased a great deal,” Schwimmer said.

Currently, there are no treatments for NAFLD, Schwimmer said. “Lifestyle therapy is the main method of treatment. Some people can have tremendous improvement in their disease with nutrition and physical activity, but that’s not true for everybody,” he said.

Overweight or obese children who should be screened for NAFLD include those with a family history of liver disease or cardiovascular disease or diabetes, Schwimmer said.

Most people with chronic liver disease will not have symptoms, Schwimmer said. “Approximately 25 percent of people with chronic liver disease have symptoms. These can be vague and include abdominal pain and fatigue,” he said.

“There is a sign that some children will have,” Schwimmer said. “There is a darkening and thickening of the skin around the neck called acanthosis nigricans. Many children with NAFLD will have at least some degree of acanthosis nigricans,” he said.

Dr. Sarah de Ferranti, director of the Preventive Cardiology Clinic at Children’s Hospital Boston, labeled NAFLD as yet another serious consequence of the obesity epidemic among children.

“The well-publicized pandemic of pediatric obesity has many consequences,” de Ferranti said. “Nonalcoholic fatty liver disease is a less well known, but increasingly appreciated, late complication of severe obesity that can lead to cirrhosis and liver failure,” she said.

“Pediatric practitioners should be aware of the need to look for a broad range of obesity complications, and families will need to understand that obesity is not purely a cosmetic issue but has important health consequences,” de Ferranti said. “Unless we address this pediatric obesity aggressively, we will be facing high rates in young adults of not only diabetes and heart attack, but also liver disease and the demand for liver transplant.”

More information

For more about NAFLD, visit the American Academy of Family Physicians.

By DAVID B. CARUSO, Associated Press

NEW YORK — Making cannoli is serious business in New York. It’s a dessert so tempting that even a hit man in the “Godfather” couldn’t leave a box behind.
But even the most respected chefs of this and other pastries are being ordered to make changes by Tuesday — the day New York’s trans fat ban takes full effect.

New York is the first American city to adopt such a stringent rule.

Starting this week, the ban extends to almost all prepared food in restaurants, bakeries, cafeterias, salad bars and food carts. There will be a three-month grace period before big fines are slapped on violators. The artery-clogging substance was first banned from cooking oils last year.

Chefs who relied on trans fats to make their pie crusts flaky, their crackers crispy and their muffins moist have worked overtime finding substitute ingredients. They have burned through hundreds of gallons of oil, shortening and margarine trying to retool old recipes without damaging flavor, texture or color.

Yet, with the deadline looming, it appears that few, if any foods, are getting whacked.

Fast-food giants from McDonald’s to Taco Bell say they have banished trans fats without having to drop a single item from their menu.

Baking supply companies have introduced a host of replacements for the partially hydrogenated vegetable oils that are the biggest source of trans fats. Not even Crisco is made of Crisco anymore. The company reformulated all of its products last year to have “zero grams of trans fat per serving.”

Even the cannoli has been spared.

New York’s biggest maker of fried dough shells for the classic Italian dessert reports that after four months of sometimes frustrating experimentation, cooks finally produced a trans-fat-free replacement that is just as crisp and delicious as the original.

“There is a little difference in taste,” acknowledged Mauricio Vasquez, general manager of Ariola Foods, which has been turning out pastries in Queens for 85 years. But, he added, “If you weren’t familiar with the shell beforehand, you’d never know the difference.”

by TARA PARKER-POPE

As my 9-year-old daughter began summer day camp last week, we talked about swimming rules, sunscreen and … cheese fries.

It was at summer camp a few years ago that she first experienced the culinary joy of cheese fries, which can pack 800 or more calories in a serving. Her camp is typical of those around the country: days packed with archery, swimming and adventure climbing; menus packed with soft drinks, burgers, chicken nuggets and, once a week, cheese fries.

Camp food is just one of the summertime nutrition challenges for parents these days. While childhood health advocates often blame schools for poor nutrition and a lack of physical activity, the problem often gets worse in the summer. Last year, The American Journal of Public Health published a provocative study showing that schools may be taking too much of the blame for the childhood obesity epidemic.

Data from kindergarteners and first graders found that body mass index increased two to three times as fast in summer as during the regular school year. Minority children were especially vulnerable, as were children who were already overweight.

Notably, even children who were too thin and needed to gain weight appeared to have better eating habits during the school year. They actually gained more weight while in school and less in the summer.

The data are far from conclusive; they are from 1998-99, the only time federal education officials gathered seasonal data on schoolchildren, said a co-author of the study, Douglas B. Downey, professor of sociology at Ohio State. Similar statistics were not collected for older children.

Even so, the findings suggest that while school nutrition may not always be ideal, children — whether overweight or underweight — may benefit from the structured nature of the school year, which includes scheduled meals, snacks and recess.

“Schools likely provide a more structured day for most children,” Dr. Downey said. “Kids’ access to food is limited to lunch and snack, and they usually receive at least some consistent exercise. When children are at home in the summer they have freer access to food, and while there’s warmer weather, there may be less consistent exercise.”

For parents, the data suggest a need to be extra vigilant about what their children eat during the summer. But that is easier said than done. While many school districts have nutritionists involved in lunch planning, relatively few summer camp programs do. Camps tend to focus on food safety — making sure the food doesn’t spoil in the hot sun. And parents who want to pack lunches struggle with the same problem, often resorting to packaged products that will hold up in the hot weather.

“Camp food is terrible,” said Susan B. Roberts, director of the energy metabolism laboratory at the Friedman School of Nutrition Science and Policy at Tufts University. “The problem is that they are doing what is easiest — the lowest common denominator for what kids like, and on top of that usually it has to be not something that goes bad and is no work to prepare.”

Despite the food, children who go to camp at least have the advantage of daily organized physical activity. Those who do not, particularly those in low-income families, often spend summers at home with little supervision or structure to their day. They end up watching television or playing video games and grazing on food all day.

“During the year, television viewing habits are more limited because of school and homework, but in summer, all bets are off,” said Dr. David Ludwig, director of the obesity program at Children’s Hospital Boston. “They are lying around all day long with little supervision, watching TV and playing video games. The mythical childhood of summer at the beach is becoming increasingly rare, certainly for children in the inner city.”

Weight gain aside, even brief exposure to certain foods can shape tastes and preferences for the rest of the year. Not only do children eat more when watching television, for instance, but they are also exposed to numerous commercials for sugar- and fat-laden foods and snacks.

“They’re being exposed to a huge number of food commercials for highest-calorie lowest-quality products,” Dr. Ludwig said. “Those effects have been demonstrated to alter food choice.”

Parents concerned about those choices can take a lesson from the schools. Ask baby sitters to create more structure in the summer day, schedule lunches and snacks at regular times when possible and encourage children to take a “recess” outdoors a few times a day. And parents of children in day camp still have control over breakfast and dinner and all meals on weekends.

“There’s not a lot of data on children’s summertime activities,” said Paul von Hippel, a former Ohio State researcher who was the lead author of last year’s study. “But I think what our data show is that it’s good to keep kids busy during the summer — just busy enough so they’re not eating all the time.”

By KELLEY HOLLAND

TAKE a look around your office tomorrow and see if you can identify a condition that’s quietly costing employers billions of dollars a year. Give up? Here’s a clue: waistlines.

Nearly two-thirds of American adults are overweight or obese, according to the Centers for Disease Control and Prevention, and the percentage of adults classified as obese doubled from 1980 to 2000 to 31 percent of the population. (To see how obesity has spread, take a look at some startling maps from the Centers for Disease Control and Prevention: on cdc.gov, search with “Obesity Trends 1985-2006.”)

In their capacity as health insurance providers, employers pay heavily for obesity’s spread. Obesity accounted for 27 percent of the rise in medical costs from 1987 to 2001, according to research by Kenneth Thorpe, a professor of public health at Emory University, and three colleagues. Obesity costs companies $45 billion a year, according to a report by the Conference Board and RTI International, a research institute.

Obese people tend to miss work more often and tend to be less mobile on the job than their thinner counterparts. Obesity is also a more powerful trigger for chronic health problems than either smoking or heavy drinking, according to research by Roland Sturm, a senior economist at the RAND Corporation.

And it is increasingly being treated as a disease in its own right, with therapy, bariatric surgery and drugs, all of which propel insurance costs higher.

But here is where the situation becomes confusing. Corporate leaders often speak out on issues that cost them tens of billions of dollars annually. Numerous executives have called for a plan for providing health insurance to the uninsured, for example. So why aren’t they making more noise about obesity?

“People in charge of benefits plans completely, 100 percent get it,” said LuAnn Heinen, director of the Institute on the Costs and Health Effects of Obesity, an offshoot of the National Business Group on Health. It is also clear, she said, that top executives are very interested in health benefit costs. But, she added, “their perception of obesity as a driver of costs — they may not understand that as well.”

Or maybe they are generally aware of obesity’s cost — almost 14 percent of United States chief executives counted it as a top health care benefits concern in the Conference Board-RTI report — but, as Ms. Heinen said, “It’s a sensitive issue to address head-on.” (It’s quite a contrast to Japan, where employers are actually measuring workers’ waists and doling out dieting guidance.)

American employers may also believe that obesity is not their problem to solve, particularly in industries with high employee turnover. After all, workers’ health care costs do not rise the minute they gain weight. And people tend to change jobs every four or five years, taking their health care costs with them.

“For most companies, it’s not a smart business move,” said Eric Finkelstein, director of the public health economics program at RTI. “Putting on a public health hat, you might say it’s unfortunate that companies don’t do more for employees. But it doesn’t make sense from an employer’s point of view.”

Still, companies can — and a few do — take cost-effective steps to encourage employees to lose weight and keep it off. Several studies indicate that simple cash incentives, like payments to employees for completing questionnaires assessing their health, discounts at health clubs, reduced health insurance premiums, can all help.

In addition, changing the habits of a few workers may affect the behavior of many more. Nicholas A. Christakis, a doctor and a sociology professor at Harvard, has studied the effects of social networks on obesity. When one friend gains or loses a lot of weight, he found, the odds improve that another will, as well. “You can take advantage of this multiplicative power of networks, so my behavior influences you, and you influence the next guy, and so on,” he said.

PSEG, the utility company based in Newark, recognizes in its wellness and weight-management programs the power of employees to influence one another. Several years ago, it began analyzing which illnesses and injuries were most common among employees. Not surprisingly for a company with workers who carry heavy equipment and operate jackhammers, musculoskeletal injuries were the most common cause of disabilities and absences. Digging deeper, the company found that obese employees were far more likely to get hurt.

One lineman who weighed 350 pounds could not ride in a bucket to elevated wires and other equipment, recalled Dr. Ronald Mack, PSEG’s medical director. Dr. Mack had long been generally aware that obesity was an issue for many workers, but “that was an aha moment,” he said.

Over the last few years, PSEG has revamped its wellness programs to emphasize weight and nutrition. It has also added some modest financial incentives for participation, like payments for filling out personal health evaluations.

The programs have not yet changed overall injury rates, but the employees who used all the services have 18 percent fewer missed days than their counterparts.

“Engagement, engagement, engagement,” Dr. Mack said. “That’s the goal.”

A study in the June issue of the American Journal of Epidemiology suggests that neighborhood environments influence the extent to which residents adopt and maintain healthy behaviors, Reuters Health reports. To assess the link between the physical and social environment and wellness, a team of researchers led by Dr. Mahasin Mujahid of Harvard University analyzed the body mass indices (BMIs) of over 2,800 adults living in New York City; Baltimore, Md.; and Forsyth County, N.C., between 2000 and 2002. They found that participants living in walkable neighborhoods with ample access to healthy foods were leaner than those living in less desirable physical environments. In addition, women living in neighborhoods with relatively high social environment scores in terms of aesthetic quality, safety, social cohesion and crime rate, were leaner than those living in less socially desirable areas. However, among men, the association was reversed, and men residing in highly rated social environments had higher BMIs than those from lower rated social environments. Noting that the results add to a growing body of evidence affirming that the physical environment influences residents’ health, Mujahid says that “even highly motivated individuals will find it very difficult to be more physically active and eat healthy foods if they live in environments that do not help support these lifestyles.” The researchers further recommend that “improvement in the neighborhood physical environment should be considered for its contribution to reducing obesity” (Hendry, Reuters Health, 6/11/08; Mujahid et al., American Journal of Epidemiology, June 2008 [subscription required]).

NY Times Editorial

It is a sad commentary on the health of American youngsters that we are cheering a leveling off of childhood obesity rates. Far too many children and teenagers are still overweight.

Tens of millions of young people will be at risk of illness and death unless this country commits to reversing, not just stabilizing, the epidemic.

The prevalence of obese and overweight children and teenagers has soared since 1980, and the heaviest children have added the most poundage. Now the upsurge appears to have paused, judging from some encouraging findings reported by federal health officials in The Journal of the American Medical Association.

Their analysis concluded that childhood obesity hit a plateau from 1999 to 2006. Even so, a dismaying 32 percent of young people aged 2 through 19 were still judged overweight or obese as measured by body mass index, with roughly half falling into each of those categories. Their excess weight increases their risk of developing diabetes, heart disease and other ailments.

Although one eminent researcher saw “a glimmer of hope” after two decades of extraordinarily bad news about weight gains, at this point no one knows whether the pause will become permanent or whether it is simply a temporary reprieve, perhaps a statistical aberration, before the rates start upward again.

Nor is there a ready explanation for why the upsurge has tapered off. Some think the epidemic may have hit a saturation point, where virtually all of the youngsters who are genetically inclined to become obese have gained excess weight and the remainder are less susceptible.

Others hope that public health programs to promote healthy diets, increase physical exercise and get junk foods out of the schools may be paying off.

Either way, it remains critical to help those who are already overweight shed health-hazardous pounds — and to reduce the number of overweight Americans. Researchers will need to look behind these latest numbers to determine what policies, if any, helped stabilize the epidemic and could, if pursued more energetically, help to reverse it.

By TARA PARKER-POPE, NY TIMES

Childhood obesity, rising for more than two decades, appears to have hit a plateau, a potentially significant milestone in the battle against excessive weight gain among children.

But the finding, based on survey data gathered from 1999 to 2006 by the federal Centers for Disease Control and Prevention and published in Wednesday’s issue of The Journal of the American Medical Association, was greeted with guarded optimism.

It is not clear if the lull in childhood weight gain is permanent or even if it is the result of public anti-obesity efforts to limit junk food and increase physical activity in schools. Doctors noted that even if the trend held up, 32 percent of American schoolchildren remained overweight or obese, representing an entire generation that will be saddled with weight-related health problems as it ages.

“After 25 years of extraordinarily bad news about childhood obesity, this study provides a glimmer of hope,” said Dr. David Ludwig, director of the childhood obesity program at Children’s Hospital in Boston. “But it’s much too soon to know whether this is a true plateau in prevalence or just a temporary lull.”

The data come from thousands of children who have taken part in the National Health and Nutrition Examination Surveys — compiled by the National Center for Health Statistics at the C.D.C. since the 1960s — and represent some of the most reliable statistics available on the health of American children.

The most recent data is based on two surveys — one in 2003 to 2004 and one in 2005 to 2006 — that included 8,165 children ages 2 to 19. In that group, about 16 percent of children and teenagers were obese, which is defined as having a body mass index at or above the 95th percentile on United States growth charts. For example, a 10-year-old girl who is 4-foot-7 would be considered obese if her weight reached 100 pounds. By comparison, about 5 percent of children and teenagers in the United States were obese in the 1960s and 1970s. As startling as those numbers are, the good news is that from a statistical standpoint, obesity rates have not increased since 1999. Estimates for the number of children who fall into the overweight or obese category also have remained stable at about 32 percent since 1999. Overweight is defined as at or above the 85th percentile.

In fact, the number of children who fall into the obese category decreased from 17.1 percent to 15.5 percent between the 2003 and 2006 surveys, but the decline was not statistically significant. So the researchers combined data from both surveys to enhance the statistical strength of the numbers.

The plateau follows years of excessive weight gain among American schoolchildren. For instance, in 1980, 6.5 percent of children age 6 to 11 were obese, but by 1994 that number had climbed to 11.3 percent. By 2002, the number had jumped to 16.3 percent, but it has now appeared to stabilize around 17 percent.

“It doesn’t mean we’ve solved it, but maybe there is some opportunity for some optimism here,” said Cynthia Ogden, the lead author of the journal report and an epidemiologist for the National Center for Health Statistics.

The researchers did not give reasons for the leveling off of childhood obesity rates. One concern is that the lull could represent a natural plateau that would have occurred regardless of public health efforts.

“It may be that we’ve reached some sort of saturation in terms of the proportion of the population who are genetically susceptible to obesity in this environment,” Dr. Ogden said. “A more optimistic view is that some things are working. We don’t really know.”

Data collected from a handful of obesity programs around the country suggest that the trends may be real.

In Somerville, Mass., a communitywide intervention led by nutrition researchers at Tufts University included doubling the amount of fruit served for school lunch, painting crosswalks to encourage walks to school and increasing physical activity in after-school programs.

Last year, the medical journal Obesity reported that during the 2003-2004 school year, Somerville schoolchildren gained less weight than children in nearby communities. The researchers are trying to replicate the program in rural areas in other parts of the country.

In Arkansas, a statewide obesity effort has eliminated vending machines in elementary schools, added a half-hour of daily physical activity to the school curriculum and sent home annual childhood health reports alerting parents about obesity risks. As part of the program, school officials in the past four years have tracked the weight and height of 475,000 children, and those numbers show that average body mass index rates in Arkansas have held steady.

“If the national data are now showing that as well, then probably we’re seeing the early effects of increased awareness and focus,” said Dr. Joe Thompson, a pediatrician and director of the Arkansas Center for Health Improvement, which collects the state’s student body mass index data. “But to achieve a long-term reversal is going to require a comprehensive and coordinated effort to make sure we’re reaching all kids across the U.S.”

One trend that has not changed in the new data are differences in obesity risk based on age and race. Children 2 to 5 were significantly less likely to be overweight compared with adolescents ages 12 to 19. While about 14.5 percent of white adolescent girls were obese, the numbers jumped to 20 percent for Mexican-American teenage girls and 28 percent for black teenage girls.

Among boys, Mexican-Americans were also more likely to have a high body mass index compared with white boys. Despite the differences, obesity rates have also appeared to stabilize among minority children.

One worry is that as obesity rates stabilize, financing for childhood health efforts will wane. In Arkansas, the program was a success but a financial crunch prompted the state legislature recently to cut physical activity programs in seventh through 12th grade.

While the latest data suggest the obesity epidemic may have been contained, researchers say the real question is whether it is possible to reverse the obesity trend among American schoolchildren.

“We still lack anything resembling a national strategy to take this problem seriously,” said Dr. Ludwig, co-author of an editorial accompanying the obesity report. “The rates of obesity in children are so hugely high that without any further increases, the impact of this epidemic will be felt with increasing severity for many years to come.”

By ALEX MINDLIN, NY TIMES

The average mother of a child under 15 spends more on fast food every year than on books, music, movies and video games combined, according to a report by the NPD Group, a market research firm. NPD surveyed 1,437 mothers through an online panel, asking them about discretionary spending for the youngest child, as well as spending on apparel and footwear.

The report found that the sex of a child accounted for very few differences in a mother’s spending, with two exceptions: video games, where boys’ mothers devoted more than double the share of their spending that girls’ mothers did; and clothing, where girls’ mothers allocated 26 percent of their spending, while boys’ mothers allocated 20 percent.

“Gender isn’t that big of a deal except for those two categories,” said Anita Frazier, an industry analyst with NPD.

NPD also reported, perhaps unsurprisingly, that mothers in poorer households spend a high percentage of their income on their children. Fifty-one percent of mothers with household incomes below $35,000 spend more than 5.5 percent of their household income on their youngest child, putting them in the top quintile of such spending. By contrast, only 9 percent of mothers with incomes over $75,000 do so.

Getting Kids to Think About Changing Exercise, Eating Habits Is One Thing; Keeping Them on Track Is Another
By Brigid Schulte
Washington Post staff writer

Marisol Quiroz watched in alarm as her overweight son ballooned 50 pounds in a year. She had taken him to doctors and nutritionists who told her to make him stop eating so much but never told her how.

David Quiroz, 12, weighed 215 pounds last fall. Half his body mass was fat. His cholesterol was elevated, his blood pressure was too high and the sugar in his blood was hitting dangerous levels. He was well on his way to diabetes and heart disease before reaching high school. His mother made an appointment to see David’s pediatrician alone. In tears, she told him she had no idea what to do.

She found out that the medical community does not really know, either. Doctors are great once a child becomes so obese that he or she develops diabetes or heart disease, critics said. But they have yet to figure out how to keep children from becoming obese or how to help them lose weight.

“We pediatricians do a fantastic job talking about food during a child’s first year of life. We know precisely how much formula a 6-month-old needs because we’ve been concerned about failure to thrive. But we’re not terribly good about what happens after that,” said Nazrat M. Mirza, a pediatric endocrinologist at Children’s National Medical Center in the District. “We pediatricians don’t even talk about obesity.”

Most in the medical community said they did not begin to recognize childhood obesity was a problem until it had become an epidemic. Now, researchers are predicting that one of every two children will develop Type 2 diabetes because of excess weight, which raises the probability that they will die as much as 20 years younger than their parents. And doctors are scrambling to catch up. The American Academy of Pediatrics only recently issued guidelines about what to do for an overweight child.

“There’s been a delayed response in the medical and health-care community because, in many ways, we weren’t prepared for it,” said Thomas N. Robinson, director of the Lucile Packard Children’s Hospital at Stanford University’s children’s hospital. The conventional wisdom was that children would outgrow the excess weight.

With so many young lives at stake, about the only thing the medical community knows for sure is that traditional weight-loss programs do not work. A success rate of 1 percent is the best medical professionals have seen.

“We know how to change people’s behavior, but we don’t know how to sustain those changes,” said Terry Huang, program director for pediatric obesity at the National Institute of Child Health and Human Development. It sounds so easy, he said. Eat less. Exercise more. If it were so easy, though, the majority of Americans would not be overweight.

Even when it comes to bariatric surgery, the most radical method of weight loss that physically shrinks the stomach, only 5 percent of patients return to what doctors consider a normal weight . In all weight-loss programs designed for adults and children, almost everyone initially loses, but within two years, patients have put the weight back on. “We have to change course,” Huang said.

That change is complicated by money. Obesity is not classified as a medical disease, which means few insurance companies will pay for weight-loss treatment. What they will pay for, however, are all the illnesses that arise from obesity.

Researchers are finding genes that contribute to obesity, and they are studying how foods affect hormones that contribute to appetite. Some researchers have found that people metabolize food differently, so no one diet will work for all types of people.

They are finding that the body is, evolutionally, still programmed to hunt for food and survive famine. If the body is not moving, as most aren’t in these sedentary times, the brain thinks the body is starving. So the body begins to cannibalize protein-rich muscle to feed the brain and conserve fat stores.

“We are living not as our genes intended. It’s not normal to play video games all day,” said Eric Hoffman, director of the Center for Genetic Medical Research at Children’s Hospital. “We have taught our children how to kill themselves. We have to reverse that.”

Mirza is one of the few pioneering pediatricians who is trying. Shocked at the rates of childhood obesity when she came to the United States from Kenya, Mirza has been working on a new kind of weight-loss program, one that involves changing the behavior of the whole family by reteaching everyone how to shop, cook, think about food. She is starting with the Latino community, where diabetes runs high. And, following up on genetic research, she is testing whether low-fat or low-glycemic diets work better for Latinos.

The need is acute, she said. In her practice, she has seen a 9-month-old weighing 30 pounds — twice the average size for a child that age. She works with an 11-year-old who weighs 420 pounds. And her associate, a psychologist who studies sleep apnea, is considering a tracheotomy for a 16-year-old so dangerously obese that he stops breathing 75 times an hour during the night.

It was to Mirza’s program that David Quiroz’s pediatrician told the boy’s mother to go.

David, a good-natured honor student at Julius West Middle School in Montgomery County, can matter-of-factly recite what he used to eat. School lunches of cheeseburgers, pizza, two or three servings of french fries or tater tots every day. A trip to the snack line for ice cream or cookies. Candy and soda from vending machines after school. Chips and soda at home while watching television or playing Halo on Xbox. “I think I overdid it,” he said.

He also can describe all the diets he has tried. He wanted to be healthy. He did not like that he got winded walking to class. He was not happy when he signed up for wrestling, but had to spend the semester on the bench because teachers could not find anyone in his weight class.

It’s just that he loves food. And he has always felt hungry, even after a big meal. “We’d go out to dinner at the Cheesecake Factory or Red Lobster and I’d eat all my dinner, then my brother’s, then everybody’s leftovers in the car on the way home,” he said.

His mother thought she was cooking healthy meals, but they were heavy on the white rice she liked from her childhood in the Dominican Republic. And she tried to help him. “I wanted him to join a soccer team or sports teams, but they have practices after school and I could never get him there,” she said. She works as a dental assistant in Bethesda and does not return home until late. His father works two jobs as a nursing assistant to pay for their house in Potomac. So she bought him a treadmill, an exercise bike and a punching bag. He never used them. She couldn’t get him interested in the equipment.

At his first weigh-in with Mirza’s Cool Kids program, David’s body mass index, which is the relationship between his height and weight, was 36 — more than twice the BMI for the average 12-year-old. His glucose tolerance was 177. Normal tolerance is 140; a diabetic’s is 200. And his insulin resistance was 13.2. Because insulin resistance has never been a problem for children before, doctors are not sure what a normal range is. Normal for adults is 2. “He really had the metabolic syndrome,” Mirza said, a new condition marked by a cluster of risk factors that lead to heart disease and diabetes.

That scared David. The summer before, he had found his father collapsed in the driveway, in the early stages of a heart attack.

For 13 weeks, David, his younger brother, William, and their parents went to Mirza’s clinic in Adams Morgan every week. They set goals and talked about overcoming barriers to healthy eating. They met with a psychologist to talk about self-image. The boys exercised, then learned about nutrition — they were shown test tubes filled with Crisco equaling the fat content of their favorite fast foods. Marisol Quiroz attended nutrition class with other parents and shopped with a nutritionist who taught her what to look for on food labels: no more than 3 grams of fat and 12 grams of sugar per serving, and high fiber — 5 grams plus the child’s age.

The family learned about proper portion size. If Quiroz serves white rice, she serves no more than a half-cup for each person. She began packing David’s lunch, substituting white bread and tortillas with whole-wheat tortillas and whole-grain white bread, because David does not like whole-wheat bread yet. She began cooking fish and baking chicken instead of eating out so often. If the family ate out, they chose Subway over McDonald’s, and ordered half-subs instead of foot-longs.

“The technique we use is not to make drastic changes, but small, permanent changes,” Mirza said.

It’s not about dieting; it’s about life choices. If a child watches six to eight hours of television a day, the first goal is to reduce the amount by an hour or two. If a child consumes several sugar-laced Gatorade drinks, juices, sodas and VitaminWaters, Mirza asks them to cut back.

She encourages families to eat meals together slowly and wait before reaching for seconds, as it takes 15 to 20 minutes for the stomach to signal to the brain that it is full. New research is showing that many overweight children who, like David, developed uncontrollable appetite habits very young, are often unable to recognize when they are full and need to relearn to listen to their internal hunger drive.

Mirza asks children to get a good night’s sleep, because when the body is sleep-deprived, it craves fatty, high-sugar foods. And she wants them to exercise. The children wear a pedometer and are asked to take at least 10,000 steps a day, or about five miles.

When David first put on the pedometer, he barely made it to 300 steps. His mother found a kid-friendly gym, FunFit, in Gaithersburg. She drives her sons there at least three times a week. They play around on mats and do a 30-minute circuit on a treadmill, stationary bike and kid-friendly machines. On days when the weather is good, she takes a walk with the boys and kicks a soccer ball in a park. Some days, David gets up to nearly 5,000 steps.

In February, David went again to Mirza’s clinic. He now goes once a month. At his weigh-in, he had lost nearly 30 pounds. His BMI was 30, and his insulin resistance has been reduced by half. “To lose six BMI is amazing. I am very proud of him,” Mirza said. “We’re not at a camp. He’s still living in the free world, and there’s so much temptation out there.”

David is proud, too. “I feel better about myself since losing weight,” he said. He is no longer the last to finish the mile run in PE. He is able to concentrate better in school. He still does not go to school dances, though he is thinking he might for the first time.

But he struggles. On days when there are class parties with cupcakes, his friends circle him and remind him how well he is doing.

On a recent day at lunch, David opened his small blue lunch box and ate a sandwich with low-fat turkey and provolone cheese spread with low-fat mayonnaise. He drank a 10-calorie juice and ate a banana. He was finished before his friends made it through the lunch line and took seats around him with their pepperoni pizzas, fried chicken patties on buns, chocolate milk and french fries. The snack line stretched nearly into the hall as students bought ice cream, candy, cookies and pretzels. Vending machines lined the hallways and one wall of the cafeteria.

David walked through the lunch line to see if there would be anything Mirza would approve of. He found a tray of bruised fruit and another of wilted iceberg lettuce and tomato slices. The low-fat yogurt had 40 grams of sugar. He looked wistfully at his friends’ meals. “Sometimes I miss it,” he said. “But then I think of my health.”

Change is hard. His mother said she sometimes finds french fry trays in his lunch box. And though he is eating healthier, he sometimes does not know when to stop. He still thinks the treadmill is boring. And his favorite thing on television remains the Food Network. He likes to watch the bakers on “Ace of Cakes” deliver confections like three-layer chocolate pound cakes.

“I’d love to do that,” he said wistfully. Then he smiled. “I just hope I don’t eat all the cake before I deliver it.”