The chubby boy considered his options in the Clarendon-Portsmouth cafeteria line, passing on the burrito or breaded chicken sandwich in favor of a sausage-studded slice of meat lover’s pizza.
On his way to sit down, he paused at a blue plastic cart laden with more food. He used tongs to pile lettuce on his plate, then grabbed a banana and several pieces of broccoli.

Kids were wary when the carts showed up a couple of years ago, but a stop at the fruit and veggie bar “is a part of the routine now,” said Antonio Lopez, principal of the North Portland school, which serves 470 students from kindergarten through grade eight. “Some kids, they just pile a lot of fruit on.”

The key to that new habit “is accessibility, really, and encouraging them,” Lopez said.

A group of Portsmouth parents and employees wants to give their entire community access to healthier food and encouragement to eat better and move more. They’re teaching students and parents how to cook healthy food and read nutrition labels, promoting walking and trying to increase the number of neighborhood stores selling produce.

Clarendon-Portsmouth is one of many U.S. schools that are making the fight against obesity a part of the curriculum, like math or English. If that sounds unrelated to education, Lopez says, just look around his school, which regularly has a few students who weigh more than 200 pounds.

“We know there is a crisis with childhood obesity, especially with the Latino population,” which makes up 60 percent of his students, Lopez said. “If you walk around the school you can see it. Really, from kindergarten on, you start seeing the patterns already developing.”

Those patterns of eating more and moving less are making 200-pound grade-schoolers common sights nationwide. Almost 17 percent of U.S. children are obese, defined as being above the 95th percentile on traditional body mass index growth charts. (Calculate your child’s BMI percentile here.)

While the child obesity rate hasn’t changed much in a decade, more kids who are obese are extraordinarily heavy. National surveys show a 50 percent increase between 1999 and 2008 in the chances a 6- to 19-year-old boy will be above the 97th percentile of BMI. And a new Kaiser Permanente Southern California study found almost 6 percent of children suffer “extreme obesity,” roughly equal to being above the 99th percentile on BMI-for-age charts. That rate tops 11 percent among African American teen girls and Latino males ages 6 to 19.

No one knows just what health problems those very obese children will face, but the future is not likely to be good. Obese kids are at much greater risk of being obese in adulthood, which can lead to heart disease, diabetes and some cancers. And some of those problems are already hitting in childhood, said Dr. Phil Wu, a Tualatin pediatrician who leads an effort to curb childhood obesity among Kaiser Permanente members.

“I already have a good handful of teenagers in my personal practice who have what we call nonalcoholic fatty liver,” Wu said. That condition can inflame and scar the liver, eventually leading to cirrhosis.

Some very obese children have high blood pressure and cholesterol. And Kaiser experts treat some teens with Type 2 diabetes, a weight-linked disease that normally hits adults older than 40. In fact, the group of U.S. residents at highest risk for diabetes is Latino girls: More than half the Latino girls born in 2000 will develop diabetes unless the nation’s eating and exercise patterns change, the U.S. Centers for Disease Control and Prevention estimates.

Clarendon-Portsmouth is battling obesity in many ways, helped by funding from health-promotion grants. The school bought some cooking equipment and offers weekly classes to teach sixth- through eighth-graders how to make healthy meals. The students get recipes to take home, encouraging the whole family to eat better.

On Thursdays and Fridays, the school holds classes for parents in both Spanish and English on health topics including how to read food labels for nutrition information and how to cut salt and saturated fat from cooking. The lessons, which draw about 25 families a week, are a good way to help families who have immigrated from Latin America fight obesity, Lopez said. Many immigrants have trouble finding familiar foods to cook and switch to cheap but calorie-laden restaurant food.

“I tried to eat the right food, but it’s very difficult in this country,” said Ingrid Hernandez, a mother of two Portsmouth students. “I work. It’s sometimes easier to buy fast food.”

Hernandez said the classes taught her how to cut sodium in her cooking and prepare fruits and vegetables she didn’t see in her native Guatemala. One of those, broccoli, is now a staple on her table, and she buys lots of canned and frozen vegetables to make in winter, as well as whipping up fruit smoothies for her kids. She has lost 17 pounds since changing her diet.

Santos Gutierrez, who has two kids at Clarendon-Portsmouth, started classes in October when he had to take over cooking for his family. He found he likes cooking and started making better foods, substituting healthier oils for lard and making more vegetables. Gutierrez said the new diet costs about the same, while his children are looking more fit and like the food.

“Now, my kids are really happy,” he said. “And we go walking a lot.”

School leaders are encouraging families to walk by asking parents to park a few blocks from school when they pick up or drop off students. Staffers organize “walk to school” days where families gather at the old Clarendon Elementary site and walk the nine blocks to Portsmouth (Clarendon and Portsmouth merged in 2008). Lopez hopes to make those “walking buses” more frequent and set up a second gathering point.

And a group has started working to increase the amount of healthy food sold around the school, which has no full-service groceries nearby. The school sits between two Fred Meyer stores, Lopez said, but the closest is more than two miles away. Last week, eight parents met with the owners of three small grocery and convenience stores near the school, urging them to stock more fresh and healthy food.

The owners “understood. They were very open to it for the community,” said Yolanda Morales, a full-time community adjunct who organizes the school’s health-promotion work.

Parents and school leaders may also start a nonprofit farmers market on the school’s grounds, Lopez said. Parents would form a co-op to buy produce wholesale, selling it at cost so others in the community could more easily buy fruits and vegetables.

With so much effort going into the Portsmouth obesity battle, it makes sense to ask whether school-based programs work to help children slim down. The answer, said Yale University expert Dr. David Katz, is “yes .¤.¤. and no.”

Many studies have shown that school-based programs can help kids lose weight or prevent obesity, Katz said, especially if the programs address both exercise and eating and include the family. But he said school programs alone can’t stop the obesity epidemic, which stems from “everything about modern living,” from the increase in sedentary TV and computer time among kids to the lack of parks and sidewalks that promote moving.

“Kids most deserve our protection, and schools gather them up for us in a place where we can reach them all,” Katz said. “But once established in schools, wellness programming needs to radiate out. .¤.¤. Let’s not expect too much from schools if we don’t also intervene in work sites, supermarkets, churches, neighborhoods, shopping malls and on the airwaves.”

Wu said schools and other community groups can do many things to fight youth obesity that he can’t do as a doctor. In his limited time with a child, Wu says, he checks for obesity and related health problems and tries to motivate families to eat better and move more. But that just tells people what they need to do. How to achieve those goals will differ among individuals, families and communities.

“The treatment part of it is going to have to, I think, increasingly fall to the community,” Wu said. “Obesity is based in very fundamental lifestyle and culture things: how we eat, how active we are. Those are things that aren’t happening in a physician’s office. They’re happening out in the community.”

No formal studies are going on to measure how much Clarendon-Portsmouth students are slimming down. But several parents said they and their children have lost weight and feel better. And, Lopez said, the lessons about eating and exercise should help students face life decisions tougher than whether to eat a burrito or a pear.

“It’s about how to make good choices and create good habits,” he said.

By Andy Dworkin, The Oregonian