Taco Bell is more than full. Teenagers crowd into tiny booths like the clown car at a circus.
Down the street, a long line snakes through McDonald's as dozens, if not hundreds, of $1 food items pile onto trays and into sacks.
It's lunchtime at Merced High School, and the students have filed out to their choice eating establishments.
On one block of Olive Avenue, they have access to El Pollo Loco, Jack In The Box, Burger King, IHOP, Quiznos, Long John Silver's, Carl's Jr., Kentucky Fried Chicken and still others within walking distance of the 2,600-student campus.
Only upperclassmen get off-campus lunch privileges, but even among the students who stay on campus, healthy choices aren't the most popular. Last year, the high school district listed the most common purchases: assorted cereals, ranch dressing, chicken patties, sliced jalapenos, pickle chips, baked potato chips, cheese sauce, cream cheese and potato puffs.
The rate of obesity in the Central Valley is alarming at all age groups, but the number of overweight children is especially shocking.
And unlike Russian babushka dolls, which get smaller one inside the other, if a boy's body shape is too heavy, it's probable he'll be shaped that way as a grownup -- only bigger.
Twenty-two percent of Merced Union High School District students included in a 2006 UC 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.
These kids spend much of their lives in state-run schools. Many of them simply 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, said the high school 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, or CCROPP. "If you have $2 in your pocket, you're going to walk across the street and get three unhealthy items for that price."
Corchado and the obesity-prevention project focus efforts on "systems change," the concept that radical changes at a policy or fundamental level -- no more sugar in schools or free access to sports teams for every child, for example -- can dramatically alter the entire environmental health landscape of a place.
"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."
Overweight children often become overweight adults, both phases of their lives equally strewn with chronic illnesses. Obesity has been linked to high blood pressure, high cholesterol, type 2 diabetes and a laundry list of other ailments.
Children are now being diagnosed and treated for illnesses that once plagued mostly adults.
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 also 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."
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.
What he found was 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 on 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 -- still came in at a normal weight.)
The researchers' analysis showed that both gender and ethnicity had an effect on whether a person is overweight or obese. Girls were more likely to come in 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."
Nelson said the district's wellness committee has seen the results and are discussing ways to move forward. "Overweight is a concern, but obesity is what we really need to focus on," she said. "We have to work on this as a community."
School administrators also use the California Department of Education's yearly physical fitness test to monitor students' health. The last results available, from December 2009, showed that Merced County schoolchildren were less likely to perform in a healthy fitness zone in each of the six areas of the test than other students in the state.
Statewide, 29 percent of the students in grade five, 34.1 percent in grade seven and 38 percent in grade nine scored perfect on the exam. In Merced County, the showing was worse: 21 percent of fifth-graders, 29 percent of seventh-graders and 28 percent of high school freshmen scored perfect here.
Concern about what America's children are eating at school has grown in recent years, influencing popular culture and local, state and federal government.
"Jamie Oliver's Food Revolution," which aired in prime time and led ratings for a few weeks on ABC this spring, aimed to change the culture of one of America's unhealthiest cities, Huntington, W. Va. "The concept of what Jamie Oliver has done on that show is ideal. It's perfect systems change," Corchado said. "If that could be replicated in Merced, it could be done anywhere. It could trickle to the surrounding communities and ideally to all of California."
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 like fruits, vegetables and whole grains.
The 2009 Legislative Task Force on Diabetes and Obesity, which Ortiz served on, suggested that state lawmakers should 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 foods and beverages around schools.
Dr. David Simenson, associate medical director at Golden Valley Health Centers, listed the changes he'd like to see: no sodas in schools, low-fat foods only on campuses and an education program that would show parents the harm of eating fast food frequently.
Simenson said he treated a 15-year-old boy recently who'd 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," he said. "There's a lot of juicy, yummy food we shouldn't be eating."
The doctor said he was 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."
In their homes, in their schools and in their communities.
This story is the first in a series of three that will look at obesity during various stages of life in Merced County and the Central Valley. Danielle E. Gaines wrote this story while participating in California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication and Journalism.
Reporter Danielle E. Gaines can be reached at (209) 385-2477 or firstname.lastname@example.org.