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Exercise in prevention

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Aug. 8--It has all the trappings of a carefree summer camp -- hopscotch, jump-rope and arts and crafts -- but the agenda is deadly serious. This camp teaches kids about diet and exercise that can help them live longer and healthier lives.

Nationwide, 9 million children are obese -- 16 percent of kids, compared to 4 percent in 1960. The total medical costs of obesity for American children and adults is well over $100 billion a year.

To keep those costs in check and to stop overweight kids from growing into dangerously obese adults, an insurance company, a hospital chain, a dental firm and a nursing school joined forces with others to launch a series of free obesity prevention summer camps.

"This is about investing money now so these kids as adults will be healthier people," said Dr. Jennifer Nuovo, regional medical director for Health Net of California, the insurer that organized three camps in the Sacramento area this summer. If the Project Healthy Kids camps are deemed a success, the company will plan similar programs around the state for next summer.

Most of the kids at the free camps were poor and at risk of developing lifelong health problems that accompany obesity, such as asthma and diabetes. Many were overweight, as were their parents.

Despite all that, "fat" was a forbidden word at camp.

"As a medical community, we are still struggling with how to talk to kids about their weight," Nuovo said. "You say nothing and risk a child becoming obese, but if you tell a kid they are overweight you risk taking a happy kid and making them insecure or maybe anorexic or bulimic."

The Monday camp session at the Robertson Community Center in Del Paso Heights began with a talk about healthy hearts.

"If you have too much weight, your heart works too hard," said one of the nursing students who worked as counselors.

Kids marched in place, once holding feathers and again holding half gallon milk jugs filled with sand. Each time, they stopped after one minute to take their pulses -- nursing students patiently bending to place children's fingers over their pulse points on wrists and necks.

Linda Boyce, 9, sat on the sideline during the marching demonstration, saying she didn't feel well. Her sister, Tavina, 10, stood in the cluster of foot-stomping kids, swaying slowly from side to side without actually lifting her feet.

The following day, when the kids jump rope, Tavina confesses she's never done it before. That lesson, too, begins with a smattering of scary facts, such as, for example, every 33 seconds someone dies of a heart attack because we are eating once-in-a-while foods every single day.

Wednesday, it's martial arts, and Linda sits to the side in a chair with her feet up, holding ice to her temple for headache relief. Tavina joins the other kids in enthusiastic kicking and self-defense routines. Tavina smiles broadly each time she rushes, braids flying, to test a new move on one of the instructors.

Over the weeklong camp, the girls also learned about portion sizes, a revelation to many of the kids and to the parents in attendance for nutrition classes. One serving of meat, just three ounces, is as big as a deck of cards, not a paperback novel. A half-cup portion of ice cream is the size of a tennis ball, not a softball.

The sisters, the youngest of five kids, don't have much to say about what they eat at home. Oatmeal is a common dinner, they say, because it's one of the few things an older sister knows how to make. Mom is overweight. Dad is obese and has dialysis treatments three times a week, his kidneys compromised by hypertension. That gets in the way of regular family dinners at home, the girls said.

If they don't show immediate signs of changing what they eat, the sisters do show growing enthusiasm for sports as the week of camp continues.

For Linda, daily exercise before camp consisted mostly of walking around the house. She likes watching "Tom and Jerry" more than sports. But she wants to change.

A week is not always long enough for diet and exercise resolutions to take hold, but it can be a good start, said Ken Thorpe, a health economics professor at Emory University who has researched obesity costs.

"Anything that gets people engaged is worth trying. The problem is too costly to ignore," Thorpe said.

The price of the obesity epidemic can be seen in higher premiums for health insurance. According to Thorpe's research, the cost of treating medical conditions linked to obesity increased tenfold to $36.5 billion from 1987 to 2002. And it keeps rising.

The medical costs are one reason camp sponsors included health insurer Health Net as well as Catholic Healthcare West, Access Dental and the Sacramento State University Division of Nursing. Other sponsors: Subway, Community Resource Project, Flip 2 It Sports, the Dairy Council of California, KCRA-TV and Club Fresh.

Individual patients and their families pay a price for obesity, too, beyond the difficulty of living with chronic health problems brought on by being overweight. Gaining 20 pounds can add $500 a year on average to patients' medical bills, studies show.

And more financially devastating, the net worth of the obese is typically about half that of people with normal body sizes, according to recent research by health economist Jay Zagorsky at Ohio State University.

Each one-unit gain in an average young person's Body Mass Index, a measure of healthy weight by height, leads to a loss of about 8 percent in wealth, or about $1,300.

"People have always been looking at how your health is impacted by your weight, but now we know that your wealth is also compromised by excess weight," Zagorsky said.

But for many families, life gets in the way of good intentions.

Nikeisha Levingston finished a Healthy Kids program at the Oak Park Community Center the week before the Boyce sisters began camp in Del Paso Heights.

The quiet 10-year-old said she doesn't eat much junk, and she likes fruits and vegetables. Trouble is, her mom has difficulty coming up with the time and money for that luxury every week.

Patricia Young juggles sporadic part-time jobs as a home health aide and a school cafeteria worker. She makes grocery runs on days when the paychecks come.

"I have a good girl. It's easy to get her to eat fruits and vegetables," Young said. But no produce was in the fridge of her Florin area home. "Next week, maybe I'll get some when the check comes," Young said.

By end of the camp at the Robertson Community Center, the Boyce sisters are wearing pedometers and checking constantly to see who has more steps counted. They head home certain they will now exercise more as a family, a vow their mom says she will help them keep.

"I want to be healthier," Linda said resolutely. Sister Tavina nodded in agreement.

Linda and Tavina said they will swim each day in the pool at their apartment complex, which mom said she would do, too. The girls also said they would jump rope. And eat more vegetables. And try to remember to carefully check portions before meals.

Like many other parents who attended nutrition classes while the kids were in camp, Ivona Boyce came away both determined to change some things and resigned to the way life is.

"I have five kids who just want to eat and go," she said. "It's hard to feed them all these different things when they want hamburgers and hot dogs all the time. I will try. I just don't know about all this. But I can give it a try."

OBESITY COSTS: Obesity costs the state of California more than $28 billion a year, in direct medical expenses for children and adults and in indirect economic costs for lost productivity and workers' compensation claims. Some of the costs:

--$9.2 billion: Medical bills statewide caused by physical inactivity.

--$4.1 billion: Medical expenses related to obesity each year.

--$47 million: Added annual cost of cancer treatments for obese patients.

--$22 million: Total additional annual cost of diabetes care for obese patients.

--$28 million: Extra annual cost of kidney and digestive disease treatments caused by obesity.

Source: California Department of Health Services


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