Trying to Win a Losing Battle

Hours after Monroe Elementary School students have gone home in this immigrant Santa Ana neighborhood, there’s commotion in a portable classroom on the playground.

“Down with soda. Down with sweetbread,� cries Francesca Leal as she leads 40 overweight parents and children in leg lifts, abdominal exercises and light aerobics.

“Si, se puede. Vamos. (Yes, we can. Come on.) Uno, dos, tres,� she continues in Spanish. The trailer shakes as they all move to Latin music.

Among the students is Aylin Rivera, who has lost five pounds since joining the class. She’s stopped drinking soda and eating Cheetos, two favorites among her classmates and neighbors. She’s trying to eat more vegetables. And at age 7, she’s learning the value of exercise after school instead of watching television.

“I was so worried because we had to keep buying her larger and larger clothes,� said her mother, Angela Rivera. “I want her to be healthy and I want to know what to do.�

Mother and daughter are exercising and taking nutrition classes at the Healthy Weight program run by Latino Health Access, just one of several hard-won resources geared toward educating Latino families in Santa Ana.

The city has the second-highest child obesity rate in California among cities over 100,000. State statistics show 34.8% of Santa Ana children are obese, compared to the California average of 28.1%. The city also has a high rate of diabetes.

Experts say the obesity problem is compounded in cities such as Santa Ana that have poor immigrants who buy cheap, processed food and drinks and don’t have ready access to parks or other recreational areas.

And although recent immigrants often cook large meals, “the food they eat is the food their grandparents ate when they tended fields and walked all over the place, not when they sat and played video games and watched television,� said Alberto Gedissman, who runs PowerPlay MD-OC, a pediatric weight management program.

Greg Critser, author of “Fat Land: How Americans Became the Fattest People in the World,� said immigrant communities offer “a calorie-rich environment. But [they’re] poor in opportunity to expend calories.�

Last year, Gov. Arnold Schwarzenegger approved laws to restrict fat and sugar in foods sold on school campuses during school hours beginning next year, ban soft drink sales during school hours starting in 2009 and provide $18.2 million to include more fresh fruits and vegetables in school meals.

But there still aren’t comprehensive state and federal strategies to tackle growing childhood obesity, said Manal Aboelata, program director at the Prevention Institute, a national nonprofit center in Oakland that focuses on community health.

A recently released report by the Institute of Medicine concludes that childhood obesity is one of the 21st century’s most critical public health issues, yet the programs to combat it are fragmented and small.

A handful of cities in California, Santa Ana among them, are emerging as “a cadre of leadership on this issue,� Aboelata said.

Officials from the Santa Ana Unified School District, the YMCA, city government and the nonprofit Latino Health Access have worked to secure nearly $1.2 million from private foundations for programs in Santa Ana. “I think we are one of the few places where we see the convergence of several big-time grants that are letting us do all this work,� said Leah Fraser, policy director at Latino Health Access.

The battle against obesity in Santa Ana is being fought on several fronts. CalOptima, an agency that provides the benefits of Medi-Cal and Healthy Families insurance programs to Orange County, recently began a pilot program involving about two dozen mostly low-income Latino children to help them lose weight and learn with their families about healthy eating and exercise.

Latino Health Access has ushered 160 children through a course to lower their weight. It has also lobbied the Santa Ana City Council for a new park and new policies to promote good eating.

The City Council recently limited what could be sold in vending machines on public property and made fitness the theme for its annual Youth Expo on Oct. 8.

Other communities, such as Baldwin Park and Chula Vista, have also used private grant money to, among other things, create teams of health educators to talk to neighbors in Spanish and English.

The efforts in Santa Ana still reach only a fraction of its residents, many of whom are newly arrived immigrants more concerned about how to pay high rents with minimum-wage jobs than nutrition.

Lorena Alvarez, curriculum director of the Nutrition Network Program in the school district, conducts vegetable tastings at city public schools and book readings with nutrition themes.

She says parents often don’t limit unhealthy foods, serve large portions to children and buy what’s economical, such as sugared drinks, instead of juice or milk.

There are other obstacles to reducing obesity. Exercise is challenging in a city with little parkland and dozens of apartment complexes that prohibit children from playing on the premises, Fraser said.

Santa Ana, with 339 acres of parkland in 41 parks, ranks far below the nation’s 50 largest cities in terms of acres of parkland per person, according to a survey by the Trust for Public Land, a nonprofit land conservancy headquartered in San Francisco.

Latino Health Access has been trying for more than 18 months to open a privately funded one-acre park with exercise equipment and a jogging track, but has faced roadblocks at City Hall and from neighbors.

Officials also say the ubiquitous vending trucks that roam the city are magnets to children tempted by candy and soft drinks.

Santa Ana resident Blanca Pineda has three overweight children. Jonick, 7, who weighs 86 pounds, and Eric, 9, who weighs 137 pounds, have high blood pressure. Lizbeth, 13, who weighs 277 pounds, was found to be pre-diabetic. They are now participating in Gedissman’s yearlong program through CalOptima.

Until last week, the children had breakfast at home and a free school lunch, usually hot dogs, hamburgers or pizza.

Back home, they ate a large midday meal, as is done in Mexico.

When the children heard the music from a vending truck outside, they rushed out to buy Cheetos, Cokes, lollipops, Airheads and M&Ms.; For dinner, they had a bowl of cereal.

That stopped last week when they entered the Gedissman program. They said they had each lost two pounds.

“We the parents are to blame,� Blanca Pineda said. “We let them have what they wanted. Where we came from, in the countryside in Mexico, we had nothing. There were no stores. If you got a treat, you had to share it. Here, everything is available and we can have it. And we have had too much.�

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Tipping the scales

Los Angeles and Santa Ana have the highest adolescent obesity rates - 36.3 and 34.8% - of the state’s largest cities, but many smaller cities and communities in Southern California have higher rates, according to a study of fifth-, seventh- and ninth-graders. The statewide obesity rate was 28.1%.

Highest percentage of overweight students in Southern California*

*--* So. California % over- Community County weight Wilmington L.A. 41.2 Pacoima L.A. 40.6 San Ysidro San Diego 39.8 Bloomington San Bern. 39.5 Hunt. Park L.A. 39.4 South Gate L.A. 39.1 Santa Paula Ventura 38.8 Bell L.A. 38.3 Duarte L.A. 38.2 Gardena L.A. 38.1 Baldwin Park L.A. 37.9 Coachella Riverside 37.8 San Fernando L.A. 37.7 Sun Valley L.A. 37.4 El Monte L.A. 37.3 Sylmar L.A. 36.9 Compton L.A. 36.8 N. Hollywood L.A. 36.8 Ontario San Bern. 36.8 Calexico Imperial 36.5 Hawthorne L.A. 36.4 Cudahy L.A. 36.4 Los Angeles L.A. 36.3 Mira Loma Riverside 36.3 Van Nuys L.A. 36 Paramount L.A. 35.9 El Centro Imperial 35.9 Lompoc S. Barbara 35.4 West Covina L.A. 35.3 Fontana San Bern. 35.3 San Bernardino San Bern. 35.2 National City San Diego 35.2 S. El Monte L.A. 35.1 Thermal Riverside 35.1 Oxnard Ventura 35 Norwalk L.A. 34.9 Azusa L.A. 34.9 Santa Ana Orange 34.8

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*Only cities and communities are listed that have a population of 10,000 or more, with 5th-, 7th- and 9th-grade enrollment of more than 1,000 students in 2003-2004. Students were tested in the 2004 California Physical Fitness Test.

Source: California Center for Public Health Advocacy. Graphics reporting by

Jennifer Delson