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MIAMI - Kevin Zapata stares at a plate piled with brown rice.
Is it one portion or two?
"It's two," says the 7-year-old, who at 85 pounds, is 20 pounds overweight.
Kevin is lucky. Through a program at the University of Miami, he's learning early the importance of portion size in keeping your weight down.
Doctors are alarmed about the nation's obesity epidemic, particularly among children. More than 1 million teens - an estimated three out of 10 overweight adolescents - are on their way to diabetes, high blood pressure and early heart attacks. If unchecked, thousands of kids could face early death, some as young as their 20s.
"We have children 6 or 7 years old who have the manifestations of all of these diseases together," said Dr. Sonia Caprio, an associate professor of pediatric endocrinology at the Yale University School of Medicine and one of several experts last week at an obesity conference in Fort Lauderdale.
The cluster of these conditions - known as metabolic syndrome - at such an early age concerns physicians, who are screening some children as early as 2 for cholesterol.
"If we don't catch it then, it's going to be a disaster later," said Dr. Grace Wolff, director of pediatric cardiology at the University of Miami/Jackson Memorial Medical Center. "If you have high cholesterol as a child it follows you into adulthood."
Metabolic syndrome is most common among overweight kids, said Dr. Stephen Cook, a University of Rochester researcher and co-author of a study on the syndrome published in the August issue of the Archives of Pediatrics and Adolescent Medicine.
Children who have at least three of the following likely have metabolic problems:
-Excessive abdominal fat (above the 90th percentile.)
-Blood sugar levels above 110.
-High blood pressure (above 130/85).
-Triglycerides above 110.
-High Density Lipoprotein ("good" cholesterol), which decreases the risk of heart disease, below 40.
While total cholesterol of 200 is acceptable for adults, children should be no higher than 170, even lower for young children.
The syndrome starts with excessive insulin in the blood - caused by overeating, fatty foods and lack of exercise.
"If you become overweight, it will make that insulin resistance worse, then you see blood pressure climb and cholesterol levels go up," Cook said.
Combating such problems in the early years - when children's brains and bones are still growing - is problematic. In adults, high cholesterol is treated with drugs. But doctors are reluctant to prescribe powerful drugs to small children, out of fear of long-term effects. And limiting fat from the diet to ward off pounds seems like the right choice, but fat is an essential element for brain growth in early years.
"It's such an important time," said Yale's Caprio. "We need to understand it fast. If we don't intervene, we're going to have a nation full of problems."
Dr. Mary Mehta, a pediatric cardiologist at Broward (Fla.) General Medical Center's Chris Evert Children's Hospital, recently treated a 256-pound 12-year-old. These youth typically have problems with asthma, shortness of breath and sleep apnea because of their excessive weight. She does routine EKGs, heart stress tests and ultrasounds on obese children and often finds enlarged organs.
"The heart is bigger than it should be. It's having to work harder to keep up with what the body needs," Mehta said.
WHAT TO DO
How to reverse the trend? Start teaching kids early about healthier food choices, smaller portion sizes and exercise.
UM's Mailman Center for Child Development sponsors the Better Eating and Activity for Children's Health (or BEACH) clinic. A kids' fitness training gym at Baptist Hospital in Kendall recently expanded and Coral Springs Medical Center is opening a program targeting overweight teens.
Sisters Shawntay Mercer, 16, and Nicole Sawyer, 13, signed up recently ago for the BEACH program. The siblings, who weigh 268 and 272 pounds respectively, are at a high risk for a number of cardiovascular diseases.
Dr. Robert Kramer, a pediatric gastroenterologist at the clinic, tells them: "We know this is cutting years off your life. You have to change the way you live. And that may be the hardest thing you have to do. But it's going to be easier to do it now than waiting until you're 30."
The girls will start bi-weekly nutritional counseling sessions at the clinic, where there's a six-month waiting list. The classes, which last for 12 weeks, are led by UM dietitian Sheah Rarback and a psychologist. At each meeting they set goals for better health.
"My goal was not to watch TV and go to the park and run laps," Kevin said during a recent session. The topic of the day: portion sizes.
Lessons, too, have to start at home.
"Our whole idea is to work slowly with these parents and help them help their children unlearn bad habits and learn new good habits," said UM psychologist Dr. Alan Delamater who counsels the BEACH children. "Parents are models for their children. Do they ride bikes on the weekends or do they sit on a couch eating potato chips?"
Kevin's dad, Walter, said even though his insurance doesn't cover the $35 session fee or $65 doctor's visits, it's worth it.
Since July, Kevin's triglycerides have gone from 119 to 53 (below 104 is considered good). His cholesterol went from 184 to 170 and his good cholesterol (HDL) shot up from 43 to 52.
Father and son exercise and eat together now. Kevin has karate three days a week. Both go to the park twice a week; Kevin runs two laps; dad walks one.
"He has helped me a lot," said Walter, 40, who weighs 320. "I have a problem. I don't want Kevin to have the same problem."
(c) 2003, The Miami Herald. Distributed by Knight Ridder/Tribune News Service.