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
"The technique we use is not to make drastic changes, but small, permanent changes," Mirza said.
It's not about dieting; it's about life choices. If a child watches six to eight hours of television a day, the first goal is to reduce the amount by an hour or two. If a child consumes several sugar-laced Gatorade drinks, juices, sodas and VitaminWaters, Mirza asks them to cut back.
She encourages families to eat meals together slowly and wait before reaching for seconds, as it takes 15 to 20 minutes for the stomach to signal to the brain that it is full. New research is showing that many overweight children who, like David, developed uncontrollable appetite habits very young, are often unable to recognize when they are full and need to relearn to listen to their internal hunger drive.
Mirza asks children to get a good night's sleep, because when the body is sleep-deprived, it craves fatty, high-sugar foods. And she wants them to exercise. The children wear a pedometer and are asked to take at least 10,000 steps a day, or about five miles.
When David first put on the pedometer, he barely made it to 300 steps. His mother found a kid-friendly gym, FunFit, in Gaithersburg. She drives her sons there at least three times a week. They play around on mats and do a 30-minute circuit on a treadmill, stationary bike and kid-friendly machines. On days when the weather is good, she takes a walk with the boys and kicks a soccer ball in a park. Some days, David gets up to nearly 5,000 steps.
In February, David went again to Mirza's clinic. He now goes once a month. At his weigh-in, he had lost nearly 30 pounds. His BMI was 30, and his insulin resistance has been reduced by half. "To lose six BMI is amazing. I am very proud of him," Mirza said. "We're not at a camp. He's still living in the free world, and there's so much temptation out there."
David is proud, too. "I feel better about myself since losing weight," he said. He is no longer the last to finish the mile run in PE. He is able to concentrate better in school. He still does not go to school dances, though he is thinking he might for the first time.
But he struggles. On days when there are class parties with cupcakes, his friends circle him and remind him how well he is doing.
On a recent day at lunch, David opened his small blue lunch box and ate a sandwich with low-fat turkey and provolone cheese spread with low-fat mayonnaise. He drank a 10-calorie juice and ate a banana. He was finished before his friends made it through the lunch line and took seats around him with their pepperoni pizzas, fried chicken patties on buns, chocolate milk and french fries. The snack line stretched nearly into the hall as students bought ice cream, candy, cookies and pretzels. Vending machines lined the hallways and one wall of the cafeteria.
David walked through the lunch line to see if there would be anything Mirza would approve of. He found a tray of bruised fruit and another of wilted iceberg lettuce and tomato slices. The low-fat yogurt had 40 grams of sugar. He looked wistfully at his friends' meals. "Sometimes I miss it," he said. "But then I think of my health."
Change is hard. His mother said she sometimes finds french fry trays in his lunch box. And though he is eating healthier, he sometimes does not know when to stop. He still thinks the treadmill is boring. And his favorite thing on television remains the Food Network. He likes to watch the bakers on "Ace of Cakes" deliver confections like three-layer chocolate pound cakes.
"I'd love to do that," he said wistfully. Then he smiled. "I just hope I don't eat all the cake before I deliver it."