Reena Dulfon, 14, trudges home every day after school, and no matter how much she begs, her mother won't pick her up in the car. Robin Dulfon is not being a mean mom, but is helping Reena accomplish her goal. And though Reena sees this 30 minutes of daily exercise as a chore -- after all, it's all uphill -- she's secretly proud of walking the distance.
Mother and daughter have twice participated in Dr. Lydie Hazan's eight-week PowerPlay Program for overweight and obese children and teenagers.
When Reena first entered the program a few years ago, she was a shy and baggy-outfitted 12-year-old, weighing 170 pounds, unsure if this would be just another boring visit to the doctor. But her single mom, a registered nurse, is acutely aware of the health issues involving overweight children.
"She made me do it," Reena said, "but it was fun." They learned about nutrition, how to read labels and count calories, and did aerobics, hip-hop and other exercises.
"It worked! The first week I lost a couple pounds, and then lost one pound a week," said Reena, who is now a svelte 146 pounds and still counting ... down.
Obesity in children is no small matter, but a health crisis of epic proportions. According to a July 2000 Newsweek article, one out of three children in this country are seriously overweight.
That statistic seems hard to believe, until you look around. Go to any mall or playground and see the results of a fast-food, fried-food diet. Children as young as 3 are being referred to Hazan, and that's not exactly what she had in mind when she started her clinic.
"I thought I would make a difference to the older children, but I have 6-year-olds crying in my office because they are so ashamed [of] getting teased at school. I have a 7-year-old in the program that weighs 242 pounds."
Five years ago, as an energetic Los Angeles emergency-room pediatrician, Hazan began to notice the correlation between severe asthma attacks and obesity.
"To give you an idea of the enormity of the epidemic, kids would come into the E.R. and have to be intubated [have a tube inserted to help breathing] twice a year. One night a girl almost died because we couldn't tube her, she was too big," Hazan said. "After that, I swore I would make sure she lost weight."
Hazan found, however, that there were no resources for overweight and obese children in Los Angeles. And it wasn't only Los Angeles; the entire country was lacking.
Eventually, Hazan hooked up with the Center for Disease Control's Dr. Bill Dietz, a pediatrician specializing in overweight and obese children.
"By talking with Dietz, I soon found out there were no immediate solutions available, so I started thinking about long-term [solutions]. I developed PowerPlay based on that," Hazan explained.
PowerPlay is a comprehensive eight-week weight-loss program that combines medical, psychological, nutritional and physical treatment, and that seeks a balance between what goes in and what goes out. A child cannot double his exercise routine for a day and expect to pig out the next, although, Hazan confesses, there are some compromises. But consistency is key, for both children and parents.
"Lead by example" is Hazan's mantra for what she believes makes the program work. "When a child enters the program, the whole family begins to lose weight," she said.
As a first step, Hazan gives each child two medical screenings, during which health problems, such as type-two diabetes, are often detected.
"It used to be that type-two diabetes was considered an adult-onset disease, but no more," Hazan said.
After the medical screenings, the program provides nutritional consultation with a licensed dietitian, daily fitness classes, group and/or individual therapy, art and music therapy and continual progress assessments of both child and parent. Hazan estimates a weight loss of 10 to 30 pounds can be accomplished during the eight-week session.
"When talking to the parents, I try to demystify the whole stigmata -- that weight is health -- and that's it."
Still, Hazan fights against cultural and societal pressures. She finds the stigma attached to being overweight crosses all cultural boundaries, a little less for African Americans, a lot more for Latinos, and a whole mixed bag for Jews.
Being overweight or obese is a "huge epidemic among Orthodox Jews," Hazan admitted. "And especially among Orthodox girls," for whom Hazan has developed a special program.
"First of all, there are no healthy places to eat. All of the kosher restaurants serve fried foods on white or rye breads, with huge portions. Secondly, there is Sabbath, a celebration where instead of a three-course meal, there are four-course meals that start on Friday and continue until noon the next day. Challah is loaded with calories," Hazan said.
Nevertheless, Hazan has developed a few tricks. "I'll talk to the kids and work out a compromise for Sabbath. 'OK, you can have half a portion of kugel, if you take a walk afterwards.'"
"I know why doctors avoid this [issue]," Hazan sighed. "It's a very frustrating field. Kids stop losing weight, stop being motivated, and you have to be the cheerleader, the evil endorser of the program. Parents love me for that, because their child must be accountable to me."
Robin Dulfon couldn't agree more, appreciating that her daughter "knew I wouldn't be nagging her anymore." She added, "I'm such a believer in this program, I want Reena to do it again!"
Reena isn't so sure about that, but both agree that PowerPlay is effective. Her weight loss "makes me happy," Reena said, "and makes me look better. My friends at school really didn't say much about it, but my family members said, 'Wow! You look good.' "