Credit: Kavitha Cardoza

A student at Beers Elementary in Southeast enjoys Salad and Strawberry day.

First lady Michelle Obama started her “Let’s Move” campaign in part because people under the age of 25 are the first generation of Americans who are expected to live shorter lives than their parents, due to diet-related health issues. Last week, in a five-part series called, “The Heavy Burden Of Childhood Obesity” WAMU’s Kavitha Cardoza and Ginger Moored interviewed overweight children, their families and the doctors who are trying to help. I spoke to Kavitha to find out more about how race and class complicate the already challenging task of addressing obesity in some of D.C.’s youngest citizens.

Kavitha, you mentioned a clinic where the patients include a child who can’t bite a carrot because her teeth have rotted from her diet.

That’s an issue. One of the doctors told us they keep telling kids to eat more fruits and vegetables, yet this girl can’t eat carrots because her teeth have rotted and it hurts her. So some of these kids just can’t. It’s really hard for families. There was a 3-year waiting period for one obesity clinic. Meanwhile, a boy is putting on 4 lbs a month, can you imagine what a three year waiting period would mean? Three years x 4 lbs a month, think of how bad his problems will be.

Tell me about the family that did have access to a clinic; they saw a doctor who spent an unusual amount of time with them, right?

The doctor patiently spent 90 minutes with that family, trying to teach them about nutrition…they hadn’t even left her office and they were opening up and eating food. They’re just little children, of course if they see an Oreo, they want to eat it. And there was so much going on during that appointment…the Mom was braiding her kids hair, two little boys were playing, there were babies. After, the Doctor said, “You know, I have relatives who are obese. In my practice, I see single-parent, low-income families like the one I came from. A lot of people give up on families like that and I never want these families to feel like I’ve given up on them.”

What was the purpose of that visit, specifically?

At that appointment, the doctor was trying to explain nutrition labels. She told them not to worry about saturated and unsaturated fats at this point, because it’s too complicated. She said during the last visit, she explained calories. This time it was grams of sugar. She thinks they will get to a point where they do talk about fat. But it’s not just them–many of us are unaware of how unhealthy what we eat can be…5 grams is one spoon of sugar? I certainly didn’t know that. I grew up in an urban city, in Bangalore. Ginger, my producer, grew up on a farm in Virginia, and our connections to food are very different. She eats fruit and I eat chips and chocolate. I felt like a living test case. I’m not overweight, so it didn’t occur to me, how bad some foods can be.

In one story, you met a child who often has to be excused from class to go to the bathroom because his weight is putting pressure on his bladder– so obesity is now affecting that child’s school work, too. I thought, “What is he missing when he’s out of the room?”

He’s definitely missing things. Also, of all the things to be mocked for at that age…going to the bathroom? Anything related to bodily functions is hilarious to these children and this kid is going to the bathroom multiple times during the day.

And that same child isn’t even allowed to go to the bathroom unless he has a new Doctor’s note confirming his needs every few months, right?

It has to be an official note on letterhead. His school is not thinking, “Let’s connect the dots, this is an ongoing problem, so let’s keep this note on file.” His Mom was telling us about how his school was not at all sensitive to her child’s situation. The doctor said it was a reflection of how society is judgmental of these kids and how they “lack self-control”. This boy has trouble walking up stairs to the third floor and adults at his school make comments, “Oh, he should just stop eating.” If he doesn’t like school, what happens to him then? There was a 7-year old who said she wants to die because of obesity. How can you concentrate on academics if that’s how you feel?

What else does obesity affect?

One doctor said that cognitive functions are delayed in obese kids as well, so there are many different ways this is affecting them. I knew kids would get teased, but I didn’t realize how that intersected with other things. There was a teen whose girlfriend dumped him because of his weight and he was so sad. Imagine that, when you’re a teen experiencing first love. These kids are dying to do what all the other kids are doing. One said, “I love football but now I’m too big to be on the team.” It’s overwhelming.

So there are many factors that complicate their attempts to get healthy?

Every facet of these kids’ lives is complicated…one boy didn’t own a scale or a pedometer. He had never been on a treadmill. All of the advantages we might enjoy– we may be able to afford a gym or we may live in a neighborhood where it is safe to go for a walk. They don’t have any of that. So even if you tell them to lose weight, what does that mean in terms of class if they don’t have access to what they need?

I read that Councilmember Mary Cheh became a proponent of school gardens after she heard a student ask if they could grow McNuggets.

That’s a larger issue of how disconnected we are from the process of growing food, especially in urban areas. There is a total disconnect that these kids are not well-served by…they eat junk and don’t realize why they need to eat healthy or what that even means. A lot of people ask why the government should be involved, but on a policy level whose responsibility is it? Childhood obesity is a huge problem, but is it a family issue? A school issue? There’s no consensus even on that. Why do we even need policies like the Healthy Schools act? It’s an uphill battle. And yet gardens are wonderful, kids go outdoors, they see food grow, they learn colors.

Did anything surprise you?

One thing that shocked me is that kids may be picky eaters, but they are curious and interested. Imagine not ever being exposed to strawberries. I remember when a little girl told me that…I asked her to clarify what she meant. Had she never tasted one? She said, “No. I’ve never seen one.” To me that was so shocking. Some kids saw cauliflower and would say, “Can I have white broccoli?”

What about “personal responsibility”?

I’d always see articles that said people don’t care about nutrition, well it’s not that—they don’t understand what it means. I asked one teen how long it takes to burn 100 calories and he had no idea. The parents have no idea. It’s so abstract to them. There are two different issues here: not having the information to understand what eating healthy means and having that information and then choosing to eat unhealthy. That’s not what we encountered. We found that on a basic level, people didn’t have adequate information. They don’t know how many grams of sugar a teaspoon holds.

And what about food deserts?

Food options are limited in certain wards, so kids turn to whatever they can get, like high-sodium cup o’ noodle soups. That used to be my staple when I was a student in the U.S. I did not realize until I talked to this kid and I looked at the package–it’s a half-serving, not even a full one. So automatically you’ve got to double that amount, and you’ve got to be good enough at math to do that calculation! He certainly didn’t think to consider it. It was not on my radar, either. And that cup was just a few mouthfuls. He’s going to be hungry again in a few hours after a 400-calorie snack.

It’s almost like there are exercise-deserts, too.

There aren’t many convenient options. One child was interested in martial arts, but he would need two buses and a train to get to a class. Then he picked football, but he couldn’t do that because of his weight. Playing outside isn’t possible because of gun violence. Even a walk around his house is dangerous. There was a shooting right outside this kid’s window. His dad died from being shot so that was on his mind. We don’t think of all these situations because they don’t exist for us. I can walk to work and even if it’s dark I don’t feel scared to walk home.

What does that child do?

It’s really sad, he’s scared to go outside so he plays video games in a really small apartment, where there is no space to do a sit-up or a push-up.

So there’s little he can do, safely.

He needs someone to help him and talk to him about this. We asked, “If you could have any help, what would you want?” He said, “Someone to tell me what to eat. Someone to play with me on the weekend.” He was so sweet, he said, “I think it’s a really good idea to be healthy, but I want to tell people you don’t have to bring it up with me every time.” This has become his identity; he’s obese. For a lot of these interviews, I felt really bad for the kids. It was so unfair.

If they don’t know how to change, how can they change? How possible is change?

The doctor said “baby steps”. Now her patient is going to McDonald’s once a week, whereas before it was three times. The doctor told me that the parents of these kids have consumed food a certain way for 30-40 years, and for the kids it’s been that way all their life. Suddenly, we are asking them to eat totally differently. It’s like asking someone to speak a different language.

What about the proliferation of fast food in the neighborhoods these kids live in?

We have to realize that a child who walks home from school goes to McDonald’s because that’s what he passes. He gets the biggest thing on the menu because it fills him up until his mom comes home–and she works long hours. There are multiple fast food and takeout places within walking distance of these homes. Research shows three things influence our choice of what to eat: price, taste and convenience. We compared wards and the inequality was really striking in terms of how many grocery stores there are, so it’s not enough to say, “Eat healthy.” One advocate mentioned there really isn’t a choice if there’s nowhere to go, close by.

How feasible is it to travel elsewhere for food?

A parent may have to take two buses to buy groceries, and then arrange to get a lift home by paying someone $20 for a ride. That’s less money going towards food. And they have to coordinate such plans and that’s even more work. On a bus, you can only take what you can carry. There are so many steps and processes we just don’t think about. There’s a huge structural inequality these people have to contend with, as they try and change their lives.

Trygve.u/Armenian Red Cross Youth

In case you missed it, here’s a must-read interview from WAMU about how powerful the stigma attached to HIV and AIDS is. This story is heartbreaking:

Dr. Sohail Rana is a member of Howard University’s Department of Pediatrics. As Washington, D.C., tries to reduce the incidence of HIV, Rana asks, “Is the stigma associated with HIV now worse than the disease itself?”:

Angel died last Saturday. She was 18. I was her doctor since she was four.

She used to call me Dad.

Technically, Angel died of an AIDS-related illness. The truth is, Angel died from the stigma related to HIV.

Angel contracted the disease at birth from her mother. With today’s medicine, she could have lived a long, productive life.

But many people, including her family members, made her feel dirty because of HIV. She felt rejected.

In shame, she refused to take her medication. Consequently, her HIV progressed to AIDS. The untreated AIDS led to her death.

ChepeNicoli

I’m reading NBC4, where I learned that the District Department of Health has created a special website called “Rubber Revolution” to encourage safe sex. Available in seven languages, the site prominently offers free condoms and displays condom trivia, too. That’s how I newly know that an average condom can hold four quarts of liquid.

In a city with a 3.2 percent HIV rate — higher than that of West Africa — any effort to promote safe sex is worthwhile. The “Rubber Revolution” website offers useful information on obtaining and using condoms, and on practicing safe sex in general…

By far the weirdest thing on the site is the “What Kind of Condom Are You?” quiz, which like all those loathed but pervasive Facebook quizzes, uses a few superficial questions to lead to an ostensibly whimsical result. Do you like cheeseburgers and fries? You might be a latex condom. Reality TV fans could be flavored condoms. If you like being in charge at work, you’re a magnum.

Despite this misfire, the site has its uses. Free condoms can be obtained from the city through a discreet web form — “mailed in a plain envelope” — or, if you’re less shy, you can just “call 311 and tell the customer service representative that you want to order free condoms.”

NBC’s P.J. Orvetti reports that even if you “are” a flavored or latex condom because of your quiz result, the Department will send you free Magnum-sized prophylactics, which was the only aspect of the program which gave me pause. Poorly-fitting condoms don’t stay on, and that would defeat the noble purpose of a site which is trying to protect D.C. residents from sexually-transmitted diseases.