An earlier version of this article incorrectly identified Nazrat M. Mirza as a pediatric endocrinologist. She is a general pediatrician whose research focus is obesity at Children's National Medical Center in Washington.
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The Search for Solutions
"We are living not as our genes intended. It's not normal to play video games all day," said Eric Hoffman, director of the Center for Genetic Medical Research at Children's Hospital. "We have taught our children how to kill themselves. We have to reverse that."
Mirza is one of the few pioneering pediatricians who is trying. Shocked at the rates of childhood obesity when she came to the United States from Kenya, Mirza has been working on a new kind of weight-loss program, one that involves changing the behavior of the whole family by reteaching everyone how to shop, cook, think about food. She is starting with the Latino community, where diabetes runs high. And, following up on genetic research, she is testing whether low-fat or low-glycemic diets work better for Latinos.
The need is acute, she said. In her practice, she has seen a 9-month-old weighing 30 pounds -- twice the average size for a child that age. She works with an 11-year-old who weighs 420 pounds. And her associate, a psychologist who studies sleep apnea, is considering a tracheotomy for a 16-year-old so dangerously obese that he stops breathing 75 times an hour during the night.
It was to Mirza's program that David Quiroz's pediatrician told the boy's mother to go.
David, a good-natured honor student at Julius West Middle School in Montgomery County, can matter-of-factly recite what he used to eat. School lunches of cheeseburgers, pizza, two or three servings of french fries or tater tots every day. A trip to the snack line for ice cream or cookies. Candy and soda from vending machines after school. Chips and soda at home while watching television or playing Halo on Xbox. "I think I overdid it," he said.
He also can describe all the diets he has tried. He wanted to be healthy. He did not like that he got winded walking to class. He was not happy when he signed up for wrestling, but had to spend the semester on the bench because teachers could not find anyone in his weight class.
It's just that he loves food. And he has always felt hungry, even after a big meal. "We'd go out to dinner at the Cheesecake Factory or Red Lobster and I'd eat all my dinner, then my brother's, then everybody's leftovers in the car on the way home," he said.
His mother thought she was cooking healthy meals, but they were heavy on the white rice she liked from her childhood in the Dominican Republic. And she tried to help him. "I wanted him to join a soccer team or sports teams, but they have practices after school and I could never get him there," she said. She works as a dental assistant in Bethesda and does not return home until late. His father works two jobs as a nursing assistant to pay for their house in Potomac. So she bought him a treadmill, an exercise bike and a punching bag. He never used them. She couldn't get him interested in the equipment.
At his first weigh-in with Mirza's Cool Kids program, David's body mass index, which is the relationship between his height and weight, was 36 -- more than twice the BMI for the average 12-year-old. His glucose tolerance was 177. Normal tolerance is 140; a diabetic's is 200. And his insulin resistance was 13.2. Because insulin resistance has never been a problem for children before, doctors are not sure what a normal range is. Normal for adults is 2. "He really had the metabolic syndrome," Mirza said, a new condition marked by a cluster of risk factors that lead to heart disease and diabetes.
That scared David. The summer before, he had found his father collapsed in the driveway, in the early stages of a heart attack.
For 13 weeks, David, his younger brother, William, and their parents went to Mirza's clinic in Adams Morgan every week. They set goals and talked about overcoming barriers to healthy eating. They met with a psychologist to talk about self-image. The boys exercised, then learned about nutrition -- they were shown test tubes filled with Crisco equaling the fat content of their favorite fast foods. Marisol Quiroz attended nutrition class with other parents and shopped with a nutritionist who taught her what to look for on food labels: no more than 3 grams of fat and 12 grams of sugar per serving, and high fiber -- 5 grams plus the child's age.
The family learned about proper portion size. If Quiroz serves white rice, she serves no more than a half-cup for each person. She began packing David's lunch, substituting white bread and tortillas with whole-wheat tortillas and whole-grain white bread, because David does not like whole-wheat bread yet. She began cooking fish and baking chicken instead of eating out so often. If the family ate out, they chose Subway over McDonald's, and ordered half-subs instead of foot-longs.