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To steer her child away from obesity, a mother turns her life upside down



Irie Mazas & # 39; s hands hovered over boxes of bright red strawberries at Adams & Vermont Farmers Market in Los Angeles.

"Mami" The 7-year-old called Miriam Bautista, who were several steps behind.

"How much?" Bautista asked the stall supplier in Spanish. Before the strawberries put it in a shopping bag, Irie was chomping on one, the juice dripping on her shirt.

Her mother frowned on the stain. Then she smiled.

A few months ago, Bautista worried that she would never get her daughter to eat healthy food. Oddly overweight since about 4 years, she would consume salt snacks, fast food and sweets, but cry if her mother put as much as a carrot on her plate.

Bautista had shot it away. Her Mexican relatives proclaimed the tubbiness that made her daughter even better. Then Bautista was diagnosed with gestational diabetes while pregnant with her second child. It affected her that the family's choice of food was not just her own health but also Irie.

"That was when I started reading labels to pay more attention to what I was buying," she said. "I realized that everything I ate was harmful. I said," My daughter must also learn it. ""

Bautista's struggle with his daughter's weight is hardly unique. Former childhood obesity is one of the most tireless health problems in Los Angeles County, where about 20% of 3- and 4-year-olds are overweight. Among schoolchildren, 45% are overweight or obese when they reach fifth grade ̵

1; higher than the percentage of Californians as a whole.

Miriam Bautista is trading for fruit and vegetables in Los Angeles. (Dania Maxwell / Los Angeles Times)
Miriam Bautista was diagnosed with gestational diabetes when she was pregnant with her son Carlos, who led her to seek healthy solutions for the whole family. (Dania Maxwell / Los Angeles Times)
Miriam Bautista is trading for fruit and vegetables in Los Angeles. Bautista was diagnosed with gestational diabetes when she was pregnant with her son Carlos, who led her to seek healthy solutions for the whole family. (Dania Maxwell / Los Angeles Times)

Obesity is particularly acute among young Latinos, a fact that alarms are officials because more than half of the babies born in Los Angeles County are latino. Nearly a quarter of 4-year-old Latin children in the county are overweight, compared to 17% of whites, 15% of blacks and 11% of Asians, according to federal data.

Health consequences grow with age. Dr. Juan Espinoza, a pediatrician in Los Angeles, said he regularly treated obese children in elementary school and middle school with "50-year-old man" problems such as fatty liver disease, hypertension, type 2 diabetes and joint pain.

"Most of these children have been overweight for a long time," Espinoza said. Overweight children are likely to remain overweight as adults and increase the risk of heart attack, stroke, cancer and premature death.

Their offspring are also more likely to be overweight, show studies. One of the major risk factors for childhood obesity is a maternal body mass index before becoming pregnant.

"Larger adults should have larger children," says Michael Goran, director of the diabetes and obesity program at CHLA. "This becomes a generation problem."

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Bautista knew she was going to fight an upward battle to improve Iries dining. Extra pounds are the norm in her husband's family, and Iries grandparents loved to discard the daughter with cakes and other treats.

After several attempts to get Irie to eat vegetables ended in tantrums, Bautista sought help from the girl's pediatrician. She referred them to a seven-week obesity prevention program called BodyWorks. Run by CHLA and AltaMed, an outpatient care provider, use BodyWorks games, exercise, videos and healthy snacks to steer the kids towards a better way.

Irie started getting around. She tried vegetables for the first time: salad, then broccoli and then carrots. She learned that her plate should look like a rainbow, and about the vitamins and minerals she should cultivate.

Bautista learned about setting limits: no snacking before meals, not eating fast food several times a week. She now offers Irie a healthy snack before leaving the house and brings together nuts and water, so her daughter does not ask for junk food. She has the children at her husband's house when she goes to the supermarket so she does not have to fight with demands for chips, cakes and sweets. And they go to the farmers market every week instead of taking the car.

With her husband's support, Bautista stood up for her in-laws and urged them not to give Irie unhealthy treats. Iries grandmother pushed back first, Bautista said, but has complied with the request.

At a recent checkup six weeks in the BodyWorks program, Irie was no longer overweight, Bautista said.

"It makes me feel good to see these changes," she said.

Irie is also happy. She proudly told how to eat fruit and vegetables at every meal. Broccoli, whom she first thought "tasted strange", is now her favorite vegetable, she said.


Irie leads participants in exercise at BodyWorks, a family-based lifestyle intervention program at the Los Angeles and AltaMed Children's Hospital. (Dania Maxwell / Los Angeles Times)
Licetz Montoya, a program coordinator with BodyWorks, talks to children about possible benefits and damage to the screen. (Dania Maxwell / Los Angeles Times)
Fruits and vegetables are served in the BodyWorks program. (Dania Maxwell / Los Angeles Times)
Incidentally, Irie leads participants in BodyWorks, a family-based lifestyle intervention program at the Los Angeles and AltaMed Children's Hospital. Left, program coordinator Licetz Montoya talks to the kids about the pros and cons of screen time. Fruits and vegetables, then make the snacks served at BodyWorks. (Dania Maxwell / Los Angeles Times)

Prevention efforts

BodyWorks are just one of numerous initiatives aimed at breaking the cycle of early childhood obesity in Los Angeles. Other efforts have included free family nutrition classes at community health clinics; An anti-obesity campaign is run by the Los Angeles County Department of Public Health, which offered workshops and grocery tours; a state law that sets milk and water as the default settings for children's restaurant goals; and a ban on selling soft drinks in public schools.

But experts are frustrated that childhood obesity rates remain so unacceptably high.

"Unfortunately, we are still at obesity levels comparable to the top rates in 2009," said Shannon Whaley, director of research and evaluation at the largest of the county's seven agencies managing the federal nutrition program for Women, Infants and children .

And things can soon get worse, experts say. Families are releasing programs like the WIC for fear that their information will be shared with immigration enforcement officials or will undermine their efforts to obtain legal residence. In the fall, the Department of Homeland Security said it was considering a policy change that would deny permanent residence for immigrants using public benefits such as WIC or Medi-Cal.

Joy Ahrens, Director of WIC for Northeast Valley Health Corp. San Fernando said patients had asked to be dropped from the program or not show up for their appointments.

"We're trying to tell them it's in the interest of your child and your pregnancy," she said. "But there is certainly a lot of fear out there."

Irie joins her father, Miguel Mazas, mother, Miriam Bautista and brother Carlos, near their home from home.

Poverty Reduction

Poverty also contributes to obesity and pummels families from multiple angles.

Single mothers who work with multiple jobs have little time to breastfeed or pump breast milk, cook healthy meals, or make sure their children get enough exercise. Small-money parents are less likely to live close to supermarkets, pushing them to trade in March and liquor stores filled with processed, calorie-dense foods. Even when fresh produce is found, parents may not be able to prepare them.

"I have patients who live in garages, or live in places where they do not have access to a kitchen. Sometimes they do not have access to refrigeration," says Dr. Gina Johnson, Pediatric Medical Director of Northeast Valley Health Corp., operates 14 clinics, primarily serving low-income Latin American families.

The questions the parents are asking are revealing: Is it ok to sweeten milk with chocolate powder? Can I really only give my child a cup of breakfast for breakfast?

"For this population, just have enough to eat," says Victor Solano, a healthcare professional at a San Fernando clinic. "Therefore, they focus on the amount of food, not so much quality."

It is not surprising that children in Los Angeles County's lowest income quarters are far more likely to be overweight than children in wealthy communities, research shows.

"If you look at Malibu or Beverly Hills, the incidence of childhood obesity is 5% or less," Goran said. "But if you look at East LA or South LA, it may be 30% or 35%."

Estelita Sebastian, a single mother in MacArthur Park who works part-time as a housekeeper, began buying fast food for 11 and 5-year-old sons after they became too old to qualify for the WIC. She didn't own a car, so stopping for food on the way to and from school seemed more convenient than walking 15 minutes to her local Smart & Final and transporting groceries home, she said.

Last summer, Doctor Sebastian informed that her children were overweight and that her eldest, Gustavo, had hyperglycaemia and high cholesterol. She and her sons enrolled in BodyWorks, losing several pounds and are no longer overweight. Through trial and error, she realized that she could save money by cutting junk food and cooking at home. But she has to condense her work schedule and stop an hour later every night to get everything done.

"It was hard," Sebastian said. But Gustavo's diagnosis gave her the strength to endure. "I felt guilty and I thought," No, it needs to be changed. ""


Using a tip she learned in the BodyWorks program the day before, Irie adds strawberries to a salad. (Dania Maxwell / Los Angeles Times)
Before I started the BodyWorks program, Irie ate barely vegetables. Now she eats fruit and vegetables at every meal. (Dania Maxwell / Los Angeles Times)
Irie Mazas skips rope after dinner. (Dania Maxwell / Los Angeles Times)
After dinner, Irie Mazas does her homework with the help of her father, Miguel Mazas. (Dania Maxwell / Los Angeles Times)
Clockwise from top left; Using a tip she learned in the BodyWorks program the day before, Irie cuts and adds strawberries to a salad; Irie and her father work on homework; The 7-year-old jumps rope after dinner. (Dania Maxwell / Los Angeles Times)

Some Progress

In the Bautista household, meals are very different than they were 6 months ago. The family eats fewer tortillas, chips and cakes and more fruits, vegetables and sugar-free foods. Chocolate milk has been replaced with low-fat plain milk. Parts are carefully measured and fill only the center of each plate instead of the entire dish.

Instead of making all goodies, Bautista limits offers. Irie can eat pizza, but only a slice that must be accompanied by fruit. She can get an ice cream, but only if she goes with her mother to the store and back.

CHLA still considers the BodyWorks program's long-term impact, but experts believe that training initiatives like it will help push the needle on childhood obesity.

They have limited evidence to back them up. Between 2013 and 2016, the County Public Health Department and its nonprofit partners trained 6,000 pre-school and day care providers to prevent obesity and worked with community agencies to provide educational workshops to parents of children aged 2 to 5. Subsequent studies showed a 13% to 37% Increase in parents' understanding of proper nutrition and tactics to encourage children to eat better. (County has continued to support some of these efforts during a $ 15 million program called Champions for Change.)

Jaimie Davis, a obesity scientist at University of Texas in Austin worked in Los Angeles for many years, many obesity strategies said promise, but they need to be coordinated and funded on a larger scale.

"It's not a systematic approach," she said.

Espinoza at CHLA said there is a special need for initiatives aimed at the youngest children. "This is a disease that can be prevented from affecting people's lives in the long term if properly addressed early."

At a checkup six weeks in the BodyWorks program, Irie was determined to no longer be overweight. "It makes me feel good to see these changes," said Miriam Bautista. (Dania Maxwell / Los Angeles Times)

Bautista sees that change must begin with parents taking childhood obesity seriously, educating themselves on nutrition and controlling what their children eat.

"It's not that people's children can be thin, that's how they can be healthy," she said. "We must do this even if the children do not want to because they are not in charge. We are responsible."

Claudia Boyd-Barrett writes for the Center for Health Reporting at the Leonard D. Schaeffer Center for Health and Economics at USC . Reporting was supported by a First 5 LA grant.


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