Whether on campus or off, teenagers are surrounded by unhealthy food options.
These include all kinds of inexpensive fast food choices offered before, after and during school to poor-quality meals prepared at home by parents who are just trying to feed their kids.
The rate of obesity in the Northern San Joaquin Valley is alarming for all age groups, but health care officials say the number of overweight children is especially troubling.
Although the problem is valleywide, it is particularly acute in Merced County.
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Twenty-two percent of Merced Union High School District students included in a 2006 University of California at Merced study were found to be obese based on their body mass index, a measure of body fat based on height and weight. There's little reason to suspect that rate hasn't risen in four years.
In Stanislaus County, one in four children age 5 to 18 are overweight, according to the California Department of Health, and the county in 2006 ranked 34th out of the 58 counties for overweight children age 5 and younger.
California's physical fitness testing recently showed that almost 42 percent of ninth-graders in Stanislaus County had an unhealthy body composition.
Valley kids spend much of their lives in state-run schools. Many of the schools can't enforce well-intentioned state nutrition programs in a world of fast food chains and nutritionally deficient but cheap sack lunches packed by poor parents.
Marie Nelson, director of student support services at the Merced high school district, said the district is keenly aware of health issues at its campuses. Merced High is the district's only school that releases students at lunchtime.
"The health issue is one of the priorities we have in our district. We know students lose the opportunity for education because they are at home ill," Nelson said. "But just controlling whether students go on or off campus for lunch does not control what their choices are. Students also bring foods to campus, which is their right, that are not exactly healthy."
Others said they'd like to see the fast food temptations removed, at least during the school day.
"It obviously doesn't help when you have such easy access to unhealthy food," said Claudia Corchado, Merced County coordinator for the Central California Regional Obesity Prevention Program.
"Obesity is not just the result of individual choices. It's the environment we live in and the environment that we're raised in," Corchado said. "Particularly in low-income neighborhoods here, it is not safe to let your child play in the front yard anymore. You can't walk to school anymore. Easy, close access to healthy food is virtually nonexistent."
Problems in adulthood
Overweight children often become overweight adults with chronic illnesses. Obesity has been linked to high blood pressure, high cholesterol, type 2 diabetes and other ailments.
Children are being diagnosed and treated for illnesses that once plagued mostly adults.
The spectre of obesity has prodded Stanislaus County health agencies and schools to launch programs promoting better nutrition and more activity among children.
Officials can only hope that the walk-to-school exercises, school gardens, a renewed focus on physical education and other awareness programs can start to make a difference.
"Healthy students lead to healthy adults, so this is a critical issue to address," said Jane Johnston, assistant superintendent of administrative services for the Stanislaus County Office of Education.
The agency just completed the two-year Fit for the Future campaign, which localized the governor's fitness challenge of four or five years ago. Officials found that 1 percent of schools were participating in the challenge, but that changed when coordinators developed fitness campaigns at their schools.
The state recognized the effort by awarding $100,000 in gym equipment, which will be installed at Tuolumne Elementary School in Modesto, and the county education office expects to receive another $100,000 in equipment this year.
The county Health Services Agency has urged schools to put more emphasis on physical education and review the food served in their cafeterias.
But school-based efforts are only part of the solution. Many teens live in neighborhoods with little access to healthy food or opportunity for physical activity.
According to the county's Community Health Assessment for 2008, Stanislaus County has 5.3 fast food restaurants for every 10,000 residents, compared with 5 per 10,000 in San Joaquin County and 3.8 per 10,000 in Merced County.
Modesto City Schools' closed campus policies discourage fast food runs by students.
"It is the built environment that influences the ability of teens to buy affordable, healthy food and have more physical activity," said Esmeralda Gonzalez, a health promotions manager for the county Health Services Agency.
"If we emphasize policy and system change, it might take a while to see the progress, but we are definitely going in the right direction."
In 2004, former U.S. Surgeon General Richard Carmona announced that this generation of children would be the first to live a shorter life than their parents. His sentiment has been the subject of praise and scorn in the years since, but has spurred many a conversation.
"It's a very powerful statement," Corchado said. "Because no parent wants to live longer than their child -- particularly if the cause of death is a preventable disease."
Data proves the point
In Merced, the issue has reached critical mass.
Data on Merced's overweight, obese, unhealthy and unfit kids have been captured in a growing body of local research.
In 2005, UC Merced researcher Rudy Ortiz started an ambitious project to measure the height, weight, waist circumference and systolic blood pressure of more than 2,000 students in the Merced Union High School District.
He found that 41.2 percent of all students in the study were overweight or obese. Boys in the study were nearly two times more likely to be obese than overweight.
"What's scary is that we're dealing with 14- to 17-year-olds, and we've already missed the time in which they were 'just overweight,' " said Simon Weffer, a UC Merced professor and co-author of the study.
"So that also suggests that the high school looking at obesity is too late and interventions -- somewhere down the road -- need to happen earlier than in health class at the age of 14." (The majority of boys -- 53 percent -- were of a normal weight.)
The researchers' analysis showed that gender and ethnicity had an effect on whether a person was overweight or obese. Girls were more likely to be at a healthy weight, with 65 percent recording a normal body mass index. Black and Latino boys were more likely to be overweight or obese than their white counterparts. In girls, there wasn't a difference in the prevalence of being overweight and obese along racial lines.
"We've visually been able to see the change in student sizes, Nelson said. "This is confirming what we had expected -- not only in our district, but also in our nation."
Recommendations for stemming childhood obesity have emerged from many quarters:
In a September report, the UCLA Center for Health Policy Research called for a state industry fee on soda and other sugary drinks; the report is called "Bubbling Over: Soda Consumption and its Link to Obesity in California." Proceeds from the fee would go back to communities in proportion to consumption levels. Sixty-two percent of the city of Merced's 2- to 11-year-olds consumed at least one soda a day, the highest consumption rate in the state.
The White House Childhood Obesity Task Force proposed federal regulations that would create front-label nutrition information standards for food; increase resources for the school lunch program; and provide economic incentives to increase production of healthy foods such as fruits, vegetables and whole grains.
The 2009 Legislative Task Force on Diabetes and Obesity, on which Ortiz served, suggested that state lawmakers create health education curriculum standards for California; increase funding and accountability for physical education; pay more to schools that provide fresh fruits and vegetables; and, among other suggestions, ban mobile carts from selling junk food and beverages around schools.
Trouble seen at younger ages
Dr. David Simenson, associate medical director at Golden Valley Health Centers, listed the changes he'd like to see: no sodas in schools, only low-fat foods on campuses and an education program that would show parents the harm of eating fast food frequently.
Simenson said he recently treated a 15-year-old boy who had gained 55 pounds after eating a cheeseburger and milkshake every day for lunch.
"People don't know healthy eating habits anymore. There's too much fast food, too much fat and too much sugar," Simenson said. "There's a lot of juicy, yummy food we shouldn't be eating."
The doctor said he is troubled by the progression of obesity from adults to teens to toddlers.
"I see 3- and 4- and 5-year-olds with weight problems. These are not kids that wake up, crawl out of bed and say, 'I'm going to make poor food choices today,' " Simenson said. "So they are suffering from poor food choices made by the adults in their lives."
Modesto Bee staff writer Ken Carlson contributed to this report.