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Biggie Fries and jumbo Cokes at 10. Wheezing at 20. Heart attack and dialysis by 30. As if poor kids needed another handicap.

Photographs by Pilar Vergara

The epidemic is as plain as the thick, dark, velvety patch on the neck of that overweight boy standing in front of you at CVS. Which is to say, it’s obvious if you know what you are looking at: acanthosis nigricans. The ominous marker of an overloaded pancreas under assault, poised to explode into a form of diabetes once seen only in adults.

At Howard University Hospital, the crisis is visible down in the laundry room. It’s the only place in the building with a scale big enough to weigh some of the sick children who come in suffering from high blood pressure.

In Southeast Washington, the telltale sign is Ashley Stewart, a national discount clothing chain specializing in plus-size clothing. The third Ashley Stewart in the District opened at Good Hope Marketplace two years ago.

These disparate signs point to an alarming illness that is spreading across D.C.’s poorest neighborhoods. The disease is childhood obesity, and it brings with it a host of attendant killers.

Record numbers of low-income minority kids are turning up in D.C. hospitals suffering from obesity-related complications never before seen in children. The cholesterol clinic and cardiac rehab program at Children’s Hospital are now overflowing with adolescents suffering from high blood pressure, high cholesterol, asthma, adult-onset diabetes, sleep apnea, polycystic ovarian syndrome, and orthopedic problems brought on by serious obesity.

“In the past it was unimaginable, but now it’s happening with such frequency,” says Dr. Audrey Austin, a pediatric endocrinologist at Children’s.

And the casualties are already mounting. Last winter, for example, doctors at Howard watched helplessly as a 15-year-old girl from Southeast D.C. died from an enlarged heart. A transplant might have saved her, but high blood pressure, diabetes, and a body mass of more than 400 pounds made surgery impossible.

If the victims of this epidemic were affluent, their plight would undoubtedly have already triggered an aggressive public-health response. Instead, the public response has been…sellout crowds for Big Momma’s House.

The case reports are mostly anecdotal—assembled by doctors on the front lines of the epidemic—since these sick city kids haven’t caught the attention of anyone except gene-hunters who have flocked to D.C. to take advantage of the research possibilities offered by the growing number of second- and third-generation diabetes cases. But their numbers are staggering.

Austin has seen the number of her young clients with adult-onset diabetes increase from 10 to 50 in the past four years. Her counterpart at Howard University Hospital, Dr. Gail Nunlee-Bland, chief of pediatric endocrinology and metabolism, now reports 45 kids—mostly Medicaid patients—in treatment for adult diabetes, up from less than a dozen three years ago. And for every one of the obese diabetic kids in their care, these doctors fear another is going undiagnosed, because this form of diabetes can be asymptomatic for years.

There’s no mystery as to why these kids are getting so sick, says Nunlee-Bland: “It all stems back to that one common thing: obesity.” No hard numbers yet exist to show just how wide the collective adolescent girth has gotten in the District or other areas with concentrated poverty. But obese adults tend to have obese children, and according to a 1998 article in the Journal of Health Care for the Poor and Underserved, fully 50 percent of all poor black women are now obese. Nunlee-Bland notes that nationally, 30 percent of all adolescent African-American girls—rich and poor—are obese, a number that she says has almost doubled from 15 years ago.

While it’s old news that the entire American populace is getting fatter, the children landing in city hospitals with adult diabetes and high blood pressure aren’t just carrying around a little baby fat. These are 300- and 400-pound adolescents. And coming up behind them are 100-pound 4-year-olds. Such skyrocketing rates of obesity are taking a particularly deadly toll on D.C.’s black community, which is genetically much more susceptible to diabetes and hypertension than whites.

Diabetes is already epidemic in the District’s African-American population. In a 1997 study, the D.C. Diabetes Control Program reported that 8 percent of all black D.C. residents have diabetes, compared with 3 percent of nonblacks. And thanks to poor medical care, African-Americans also die from diabetes at three-and-a-half times the rate of whites in D.C.

But rather than prompt a massive public-health campaign, the overweight African-American has merely become a staple of pop culture. Later this summer, for example, Big Momma will make way for the return of the Klumps.

“I’m really frightened of it,” says Nunlee-Bland of the power of popular culture to undercut health warnings about the dangers of obesity. “We’re really going to be paying the price for self-inflicted diseases.”

Sweet, shy Shala Morton loves babies. She baby-sits for a friend almost every night. When her sister goes to Run n’ Shoot, the popular basketball gym, Shala, 18, takes care of her sister’s child, too. Today, there’s a month-old baby boy nestled in her twin bed—another charge in her collection. As much as she loves babies, though, Shala can’t have one of her own.

When she was 10 years old, a school nurse discovered that Shala’s blood pressure was high enough to put an adult in the hospital. After a trip to the emergency room, doctors recommended follow-up with a specialist to figure out why a 10-year-old, even a heavy one, would be suffering from such dangerously high blood pressure. Shala’s mother, Evelyn Morton, took her to the specialist, but when she learned how much the consultation and tests would cost, they left. They had no insurance to cover them.

Again and again over the next four years, medical professionals would see Shala’s blood pressure, gasp, and refer her to a specialist. And again, lacking health insurance, she never went. Doctors would write in her medical records, “Mother noncompliant.”

It wasn’t until 1996 that Shala finally got an answer to what ails her. Her mother took her to the Zacchaeus Free Clinic in Shaw, where Dr. Gloria WilderBrathwaite, the medical director for Georgetown University Hospital’s mobile pediatric clinic, used some connections to get Shala admitted to Georgetown for 24 hours. WilderBrathwaite used those precious hours to run every test imaginable.

Finally, one of the tests came up positive, revealing a blockage in one of Shala’s kidneys, which was causing her blood pressure to skyrocket. Understanding the financial barriers to Shala’s health care, WilderBrathwaite cajoled another doctor into performing an expensive procedure, for free, right there on the spot to try to unblock the kidney. They put Shala on the operating table and ran a catheter up through her leg and into the kidney. And then they waited. As the free time in the hospital was running out, the procedure failed. The blockage had been left untreated for too long.

Dejected, WilderBrathwaite sent Shala’s records to surgeons all around the metro area to see whether there was a way to salvage her suffering kidney. But every single one of the surgeons responded with the same answer: The kidney could be fixed surgically, but not one of them would put Shala on the operating table. The reason? She was severely overweight—extra baggage that made surgery all but impossible. There wasn’t a ventilator in the world that could have kept her breathing mechanically under anesthesia, according to WilderBrathwaite.

If Shala had been admitted to the hospital as a middle-class white teen wasting away from anorexia rather than a low-income African-American suffering from obesity-related complications, her story would likely have turned out very differently. Once she was diagnosed, her insurance company would probably have paid for individual and group therapy. She would have gotten regular nutritional counseling and doctor visits, or even been hospitalized until her weight stabilized. And she would have been showered with a wealth of feminist sympathy to remind her that her condition was not her fault but rather a symptom of society’s warped definitions of female beauty.

But Shala is not frighteningly thin. So most of the medical establishment treats her weight problem as an individual failure, the product of a lack of willpower, or the result of irresponsible parents: “Mother noncompliant.”

After she left Georgetown Hospital four years ago, Shala went home, left largely to her own devices. Today, she is even heavier. (Like any teenage girl, she prefers not to reveal her actual weight.) She takes three different kinds of blood pressure medication and has given up the idea of having a baby of her own.

Sitting in her living room inside a sunny apartment near Kenilworth Gardens in Northeast, Evelyn Morton puzzles a bit over what has happened to her daughter, who came into this world three months early weighing only 2 pounds, 6 ounces. “I don’t know what made her blow up. But she’s my baby,” Evelyn says with a laugh. (In a cruel biological irony, part of what made her daughter “blow up” could have been the very fact that she was premature: Prematurity is an established risk factor for obesity later in life.)

Since Shala was diagnosed with high blood pressure, Evelyn has abolished salt and other treats from their kitchen and tried to get Shala to follow nutritionists’ instructions. But it has been a struggle. “I stay on her, try to watch what I buy, ’cause I need to lose weight, too,” she says. “Really, she ain’t changed nothing.”

Moreover, Evelyn believes she can do only so much for her daughter in the toxic environment that encloses them. “When we were coming up, we

didn’t have McDonald’s or Burger King. You didn’t eat that junk food. Now, every corner there’s something—Eddie Leonard’s, Jeepers. Every time you look around, they’re putting up another Chinese food place. They’ll even deliver it to you,” she says.

Compelling her daughter to start her day with a decent breakfast is difficult because Evelyn is already working behind a cash register at 6 a.m. Then, at lunchtime, the school system conspires against Shala. Anacostia High School, from which Shala just graduated, sells pizza in the cafeteria—in competition with the official school lunch menu—and a whole glut of junk food in vending machines. Both practices violate federal and D.C. school regulations—and infuriate Evelyn. “If you put a wholesome food in front of a kid and junk food over here, you know what they’re going to choose,” she says.

Exercise might mitigate some of the nutritional problems, except there’s nowhere to exercise. Getting to somewhere is more than a chore: The nearest bus arrives on the corner every 45 minutes on the weekend, and the Mortons don’t have a car, so their Kenilworth neighborhood might as well be on Mars. That means Shala’s exercise, such as it is, consists of walking back and forth on the three blocks of sidewalk outside her apartment. “I would like [for Shala] to go somewhere to work out, but everything costs money, money, money,” Evelyn laments.

It’s easy to say that inner-city obesity is the result of too many Biggie Fries and not enough Little League. But it’s not enough to explain why poor minority kids are getting so fat, so fast. Middle-class kids are eating McDonald’s and gaining weight, too, but not enough to make diabetes epidemic among them. And although it is now delivered in bigger packages, fast food has been with us for a long time. Moreover, African-American diets have traditionally included foods—fried chicken, sweet potatoes—that are not exactly low-calorie.

So what is causing the obesity epidemic now?

The answer is as complex as poverty itself. There are the obvious things—bad food, sedentary lives—mixed in with poor education, rampant depression, and working parents who are unavailable to keep their kids out of Wendy’s after school. But there are also more subtle reasons, such as the collapse of inner-city neighborhoods.

The adolescents who started appearing in D.C. hospitals with diabetes four years ago were born almost exactly at the beginning of the last big non-infectious inner-city epidemic. Crack cocaine changed the inner city and its residents in profound ways. Even those poor families that weren’t succumbing to the ravages of drug addiction were touched by its side effects: unrelenting violence, the disappearance of vast numbers of men into the criminal justice system, and the emptying out of neighborhoods, of both residential and commercial elements.

Food, in such an environment, joins drugs and alcohol as a ready painkiller.

“It’s tiresome being poor,” says WilderBrathwaite. Many of her obese patients are suffering from depression, which she sees as a perfectly common-sense response to the environment in which they live.

WilderBrathwaite understands that environment better than most. Growing up a child of welfare and food stamps in the Bedford-Stuyvesant neighborhood of Brooklyn, N.Y., WilderBrathwaite was an obese child and has struggled with her weight her whole life.

The way she sees it, poverty tends to amplify the ills of the larger society. What is merely troubling for the middle class becomes pathological in the ghetto. WilderBrathwaite likens the obesity epidemic to cocaine abuse: When suburbanites use cocaine, the drug comes in the expensive powder form and it’s called a “recreational drug.” But in the inner city, cocaine comes in the form of crack, a highly destructive $3 high.

In a similar way, WilderBrathwaite says, middle-class people can get away with being fat because they have a safety net—such as better medical care, which can save them from some of the more damaging side effects of obesity, like hypertension and high cholesterol. The more affluent also have more choices. Some D.C. neighborhoods don’t even have supermarkets, much less a decent, affordable supply of fresh produce that might provide some relief from a steady diet of barbecued wings.

Then, too, overeating is socially acceptable—and a habit that is passed on from parents to children. Parents use food to comfort fussy and unhappy children, who grow up to use food to comfort themselves. Bingeing on Twinkies won’t put you in prison, it won’t keep you from working, and most people don’t see it as something that can kill you.

And unlike crackheads, heavy people, WilderBrathwaite says, are not social outcasts. “People like fat folks. We’re supposed to be the jolly people….In the African-American community, obesity in and of itself is not negative.”

Howard’s Nunlee-Bland did a survey of some of the diabetic patients she sees at D.C. General Hospital to understand how they viewed their weight problems. She says the kids’ legs were chafed from so much flesh rubbing together and their shirts were stretched tight across their arms. But she says, “They thought they looked good. They don’t see [obesity] as a beauty stigma.”

In fact, WilderBrathwaite says, obesity can be a conscious reaction against a society in which the ideal image of fitness is a thin Caucasian woman. “In rejecting that stereotype,” she says, “some of us go to the other extreme.”

The effects of overeating also have some overlooked psychological benefits. “Living in the cocoon of obesity is a very comfortable thing to do,” says WilderBrathwaite. “It protects you from a lot of things. It’s wonderfully comfortable because people will focus on your physical appearance, not anything else that may be wrong in your life.”

For many of the adolescents WilderBrathwaite treats, the extra weight effectively deters romantic relationships, thereby protecting the youths from the emotional turmoil, and risks, of intimacy.

“None of these explanations alone explain why this is happening,” says WilderBrathwaite. “It’s all of those things.”

Childhood. The word conjures up images of perpetual motion, elastic limbs that haven’t yet stiffened with age. Jumping on beds, jumping rope, running without fear of falling, being tossed in the air by compliant adults, reveling in the small child’s lightness of being.

Quenten Giles doesn’t really remember any of that. At 15, he hobbles at middle-age speed. His joints flare up with pain from the stress of supporting more than 360 pounds on his 5-foot-7 frame. A badly strained knee now makes it hard even to walk, much less run. “I’ve always been big for my age. When I was 5, I weighed, like, 80 pounds,” he says.

His mother, Shirley Giles, says Quenten really started to put on weight as a toddler after he spent three months in the hospital being treated for lead poisoning he got in the old house they lived in on 6th Street NW. But Quenten says the weight gain accelerated about four years ago, after his father died of pancreatic cancer at age 53. Quenten was close to his father. When he died, says Quenten, “I ate a whole lot. I kind of chunked down.”

Yet Quenten insists that now, “I don’t eat a lot. I really don’t.” Although he does indulge in the sugar-laden Powerade served up by his school’s vending machines, Quenten says that most days, he doesn’t eat breakfast, and after getting food poisoning from a bad hamburger, he doesn’t eat school lunches, either. It’s a common pattern among obese kids, who believe that skipping meals will help them lose weight. In fact, as any nutritionist will tell you, such eating habits only slow the body’s metabolism, making fat people even fatter.

For dinner, his mom usually cooks one big meal a week that the pair eats for a couple of days. The rest of the week, they order dinner from the local carryout. “I eat a lot from that one meal,” Quenten concedes. “I should probably eat instead of one steak, just a half of one.”

Quenten doesn’t get much exercise. There are no sports teams at his school, and his mother doesn’t like him to be outside in their Columbia Heights neighborhood at night. “There was a real bad shooting out here last night,” she says. “A lady got killed coming home from the laundromat.”

So Quenten spends much of his free time in the day sleeping—and then stays up all night watching SportsCenter and playing video games. “I have insomnia,” he explains. It’s a common problem, often related to sleep apnea, among severely overweight kids. Summertime, Quenten says, is particularly bad. “That’s when I eat the most, ’cause there’s nothing to do,” he says.

Inside their Section 8 basement apartment on upper 14th Street NW, Quenten and his mother live insulated from the world by mountains of stuff piled up neatly against every wall—videotapes, stuffed animals, TVs, even a little Christmas tree that Shirley left up two years ago because Quenten liked it so much. Powdered milk, matzo crackers, potato flakes, cereal, and canned food, all stacked neatly in milk crates and laundry baskets, rise up several feet against the kitchen wall—a bulwark against memories of want and a cozy nest for the mouse that scampers across the living room.

The apartment is so packed with their food and belongings that a housing inspector is threatening to put them out as a fire hazard—which infuriates Shirley. The foodstuffs come from Shirley’s daily rounds to local churches. Soon, she says, she’ll start filling the freezer with meat so that she won’t have to stray far in the winter. (On her senior-citizen’s fixed income, fresh fruit and vegetables are expensive luxuries.)

Shaking his head with amusement over his mother’s pack-rat habits, Quenten says, “I know I could lose weight if I wanted to. It’s just not fun.”

And losing weight is really not much of a priority for Quenten or his mother. That’s because Shirley sees a much more pressing problem developing in her son: He won’t go to school. Last year, he missed 42 days and then had to repeat eighth grade. This year, his attendance hasn’t been much better, in part because of his injured knee, which has gone untreated because he doesn’t have health insurance.

Shirley gets up every morning at 7 a.m. and tries to goad Quenten into going to school. “I tell him to get up and walk. All he wants to do is lay in that bed and play that PlayStation,” she says. But she can do only so much yelling. “I have sugar [diabetes], hypertension. My vein starts to hurt and pull when I get yelling at him. That’s a stroke coming.”

Now retired after working 41 years as a cook and caterer, Shirley is distraught over her son’s situation. Quenten is her baby, the one God gave her when He took away her mother. Shirley was 46 years old at the time. A good son, Quenten has never given her any grief, and he has made her proud. In grade school, he wrote lovely poems about riding the bus—his favorite pastime—and he won a Supreme Court essay contest by writing about senior citizens. He even met the wife of Supreme Court Justice Thurgood Marshall. “I have no other problem with him except going to school,” says Shirley.

She’s worried that Quenten has been overtaken by a sense of fatalism that she is helpless to remedy. “The other day he told me, ‘I’m not going to be here long. I’m not going to be nothing but a bum or a hobo. I can’t even get out of bed. How am I going to hold down a job?’”

She tells him to read the Psalms for comfort, and she’s been trying for weeks to get him enrolled in the new Healthy Families Medicaid program so that he can see a doctor for his apparent depression. But that effort has required multiple frustrating, and so far fruitless, trips to various city offices. Dragging deeply on a cigarette, Shirley laments, “He used to be a happy-go-lucky child. He was a Boy Scout, smiled all the time. This all happened when his father died.”

The year 1998 was a bad one for Dorothea “Dot” Williams. First, the grandmother who had raised her for most of her life died of a massive heart attack at 63. Not long afterward, Dot, then 14, was plagued with headaches, chest pains, and a nagging, unquenchable thirst. One day, while shopping with her mother, she had a 32-ounce soda from Burger King, and as soon as she left the restaurant, she was begging for another drink. Alarmed, Dot’s mother took her to the Southern Maryland Hospital Center emergency room. The doctors, Dot says, told her that her symptoms were all in her head and tried to send her home. But her mother demanded further tests.

After several hours at the hospital, the results came back showing a serious and unusual diagnosis: Dot was suffering from Type 2 diabetes, a disease that normally doesn’t strike until middle age. It’s nearly unheard of in children. But Dot was heavy, with more than 120 extra pounds padding her 5-foot-3 frame. Those extra pounds, added to a strong family history of diabetes, had turned Dot into one very sick child.

She was transferred to Children’s Hospital, missing nearly two months of school. For four months, Dot had to give herself injections of insulin to bring down dangerously elevated blood glucose levels. She is now on oral medication that controls her glucose levels—and will stay on it for the rest of her life unless she can manage to shed a significant amount of weight and keep it off. “I’m blessed because I don’t have to take the shots,” Dot says, revisiting unpleasant memories of her stomach polka-dotted with needle marks.

Although she might think the absence of needles means her illness isn’t serious, Dot’s future health prospects are hardly rosy. Diabetes is a progressive disease, and its complications promise to arrive on her doorstep far sooner than she seems to realize. Foot amputation, for example, is usually the problem of senior citizens who first developed diabetes in their 40s. Get diabetes at 14, though, and the amputations can come at 30—or dialysis, or kidney or pancreas transplants, or a heart attack brought on by elevated cholesterol levels.

But please don’t tell Dot that she should lose weight. Doctors have been telling her for two years now that she could control her diabetes without drugs if she lost some weight. But Dot is 16—and a typical teenager. She doesn’t want to be bossed around by anybody. Not by the doctors, not by the nutritionists, and not by her family—to whom she often retorts, “Y’all not picture-perfect, either.”

With her arms crossed defiantly across her chest and a tattoo with “Big Red”—her grandmother’s nickname—blazing on her shoulder, Dot declares: “I hate when people tell me I need to lose weight. I’m going to lose it when I’m ready. I don’t want nobody forcing me to lose it.”

Dot has been heavy her entire life, as are many of the women around her. Her mother is so overweight she must use a machine to help her breathe while she sleeps. Her overweight grandmother had diabetes, and she died of a massive heart attack doctors said was the result of the disease. In spite of the family history, Dot notes, her mother doesn’t eat too well, often having Oreos and a soda for lunch. “We don’t really know how to turn things down,” she says.

Resigned to her fate, Dot has blithely ignored much of what doctors and nutritionists have told her about the seriousness of her disease. “If it’s my time to go, it’s my time to go,” she says defiantly. Even two years after her diagnosis, she still can’t articulate exactly what the complications of diabetes might be as the disease progresses, particularly if she fails to slim down. Kidney failure, blindness, strokes and heart attacks are all too distant to faze her.

One thing she does think about, though, is driving. She just got her license in Maryland, and her mother just bought her a car. “My grandmother told me that I could lose my feet. I need my foot. That’s my driving foot,” Dot says.

Doctors say that Dot’s nonchalance about the long-term implications of her illness is an example of what makes the obesity epidemic in kids so dangerous.

“It’s hard to get to a teenager. Ten years for them is a lifetime,” says Howard’s Nunlee-Bland. And Type 2 diabetes is not a disease that makes kids feel unwell, so they have little incentive to give up Cokes and PlayStation in favor of more healthful habits. By the time they fully appreciate how serious the disease is, it’s already too late. Their kidneys are damaged, their ventricles enlarged. “These kids are so sick, and they don’t even realize it,” says Austin, Dot’s endocrinologist at Children’s.

Sitting in her dining room watching “Strippers Who Dress Too Sexy” on The Jenny Jones Show, Dot confesses, “I guess I have to try harder to lose weight. It’s not easy, you know, when there’s a Snickers bar sitting on the table. I keep saying I’m going to start Monday, but Monday has come and gone for about three weeks.”

Indeed, simply telling Dot to lose weight is about as effective as asking her to cure cancer. For starters, the extra weight she was carrying around disrupted her menstrual cycles, so she had to go on birth control pills—which in turn made her gain even more weight. And then she got the car, her pride and joy. Although she loves driving and its inherent freedom, she can see how it’s affected her lifestyle: “I guess I got lazy because I have a car now.”

Then there was the accident. For the past month, Dot has had to stay home from school doing nothing. That’s because in April, she was the victim of a hit-and-run accident. As she was pulling out of the liquor store parking lot in her new car, she was struck by a man driving a stolen car. He disappeared, leaving Dot with a back injury that is still healing and a banged-up car. The injury has made her more sedentary than ever, and since she’s been stuck at home alone for the past month, she says, “I’ve been eating everything in sight.”

Not that staying slim was easy before. Dot spent her first 14 years in D.C., but after her grandmother died, she moved in with her mother in Capitol Heights, Md. She says it’s actually harder for her to get out and about in the suburbs than it was in D.C., where there was a rec center nearby and people around that her family knew and trusted. “There’s not that much to do around here,” Dot says.

Her family has a treadmill in the basement, but Dot says, “I have not used that treadmill except to move it around and watch the TV.” She would like to find some place to go work out, but, she says, “I don’t have the money to go to Bally’s Fitness every day and work out. I have to pay my car note.”

Indeed, much of Dot’s free time now goes to working to pay for her beloved wheels—which makes it even harder for her to find time to exercise. School starts at 7:20 a.m., and when it’s over, she heads to the Laurel Giant, where she works part-time as a salad-bar stocker.

Dot says her mother tries to help her stay on top of her diabetes by making her a special meal of baked chicken when everyone else gets fried, but sometimes she’s too tired to make two different meals. And that’s when Dot’s mom has the energy to cook. Jacky Williams-Johnson is up at 4 every morning to go to work at the State Department, and then she, too, works at Giant, until 9 p.m.

So on many nights, Dot and her 12-year-old sister fend for themselves. They usually put TV dinners in the microwave or have Oodles of Noodles or go out to McDonald’s, where, Dot says, the fries are too tempting: “They so good you just can’t help it.”

Since she has been going to the nutritionist every three months at Children’s Hospital, Dot has been making an effort to eat a healthy breakfast. “I try to eat a bowl of Froot Loops and a banana,” she says. But since she’s been stuck at home, she’s largely fallen off the wagon. Already this week, she’s eaten McDonald’s sausage biscuits twice. “McDonald’s is a problem,” she sighs.

Dot’s resolve to eat better is occasionally challenged by other members of her family, who don’t see any need to change their diets along with her. Sometimes, Dot says, she fights with her mother about food, like when her mother loads up the freezer with steaks or burgers from Shoppers Food Warehouse. Dot tells her steaks aren’t healthy, but her mother tells her, “We aren’t vegetarians. You have to eat.”

Mostly, though, Dot takes responsibility for her weight problem: “It’s nobody’s fault but mine. Nobody’s forcing me to eat.”

Trying to head off the wave of disability that is likely to accompany this great rise in pediatric diabetes and other obesity-related illnesses will require a concerted effort. Unlike AIDS or other infectious diseases, obesity is curable, and its complications are largely reversible if they are caught in time. But right now, kids like Dot aren’t even on the radar screen of the public-health establishment.

Over the past month and a half, Dr. Ivan C.A. Walks, director of the D.C. Department of Health, which administers the city’s Medicaid program, has turned down repeated requests for interviews on the subject of adolescent obesity. But then, his agency is doing little to head off the coming crisis. Its diabetes control program has collapsed completely; there is no director nor staff, not even anyone who answers the phone. And D.C. Medicaid has never even tried to require its health maintenance organizations to offer obesity prevention services.

The American Diabetes Association, headquartered in Alexandria, Va., doesn’t have a single program or support group for kids in the District, even though diabetes is already epidemic among adults here. The D.C. Department of Parks and Recreation, the one organization that might offer poor kids a chance for good, rigorous exercise, is more focused on putting computers in rec centers than on hiring tennis instructors.

When the D.C. inspector general last year criticized a school principal for improperly allowing the sale of fast food inside his public school, elected officials rushed to his defense, arguing that he had found a creative way to raise money for extracurricular activities. Not a single person stepped up to suggest that feeding kids fast food might be making them sick.

As a result, while eating-disorder clinics focused on problems like anorexia and bulimia abound, there are almost no programs in the District to combat obesity in kids. When children reach the point where they are suffocating from sleep apnea or plagued with nosebleeds from uncontrollable high blood pressure, doctors must send them to southern Virginia, to the closest hospital with a weight-loss camp. The program works miracles simply by giving kids a balanced diet and a place to exercise. The only problem is that the children have to go home to D.C.

Children’s Hospital cardiologist Dr. Eric Quivers sent one of his young patients to a weight-loss camp in Massachusetts recently. The boy lost 100 pounds and came back feeling like a new person. A year later, he had gained back 150 pounds. “It’s difficult for the child to do on their own,” Quivers says.

To foster real change in behavior, doctors say kids need regular, almost weekly, visits with nutritionists and other people who can show them the essentials of good nutrition, like how to cook or how to choose healthy foods, even from a movie-theater menu.

Yet that kind of close nutritional supervision is all but impossible in the era of managed care. Most insurance companies won’t pay for such attention when kids are given a diagnosis of obesity, even though treating the malady early can head off much more serious problems down the road.

“Until we realize that it’s a chronic illness, we’re not going to get much success in reducing obesity,” says Ann Loranger, pediatric nutritionist at Children’s Hospital.

Even when there is money for nutritional outreach, the environment of the inner city is tough to surmount. With the help of a new grant, Georgetown’s WilderBrathwaite hired a nutritionist who went out to churches and other community locales to teach cooking classes to overweight kids. The nutritionist also took them shopping to show them how to select more healthful food.

WilderBrathwaite says the program worked well for the first couple of sessions, but then the nutritionist started complaining. She couldn’t do more, she said, because she couldn’t find enough healthy food in neighborhoods lacking decent grocery stores with good produce. Even as a professionally trained nutritionist, she couldn’t figure out how to help the kids eat healthy at carryouts. So she quit.

WilderBrathwaite hasn’t been able to fill the job. CP

Art accompanying story in the printed newspaper is not available in this archive: Photographs by Pilar Vergara.