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By Taylor Knopf

When Selma White stocks her neighborhood convenience store with fruit, she can hardly keep bananas on the shelves.

Stella’s, named after her mother, is a small, gray house on a mostly residential street just north of downtown Elizabeth City. White opened Stella’s in 2001 and stocked with it the usual corner store snacks.

Stella’s, named after her mother, is small gray house on a mostly residential street just north of downtown Elizabeth City. Photo credit: Taylor Knopf

But in January, White received some refrigeration units from the state through the corner store initiative. Now she is able to carry more healthy foods, such as yogurt, eggs and frozen vegetables.

Supplying her community with healthier food options is important to White, and she’s particularly concerned about the neighborhood children.

“Young children are coming down with old folks’ diseases,” she said. “I had this grandfather come in and he was telling me, … devastated with tears in his eyes, he said ‘My grandson is 10 years old and has been diagnosed with diabetes.’”

White is worried that people are moving away from healthy eating and opting for quicker, less nutritious meals.

“Kids coming in and getting potato chips and soda,” she said. “That’s filling the empty space and it’s not nutritious. That’s why you have a lot of obesity in younger kids.”

What White is seeing in her neighborhood is a reflection of the rising number of children in North Carolina and across the nation who are overweight or obese.

State of Childhood Obesity

Pediatric obesity has been on the rise in children ages 2 to 18 in North Carolina since 2012, according to The State of Obesity, an annual report sponsored by the Robert Wood Johnson Foundation. The latest N.C. data shows 15 percent of 2 to 4 year olds are obese, as well as 30.9 percent of 10 to 17 year olds and 16.4 percent of high school kids.

The graph shows percentage of children who had a BMI of 85 to 99, which is considered obese. The blue represents the number of children that fell in this range in 1971. The red represent the number of children with a BMI of 85 or greater in 2010. The green represents the numbers for the Eastern NC population.

North Carolina ranks 16th in the nation for adult obesity and seventh for obesity in teens.

According to the Centers for Disease Control and Prevention, one in six kids across the U.S. is obese.

Nationally, childhood obesity rates started rising in the 1980s. That rate of obesity in children ages 6 to 11 was 7 percent in 1980. And in 2014, it was 17.5 percent.

Similarly, the rate of teenage obesity was 5 percent in 1980; by 2014, that rate had quadrupled to 20.5 percent.

More recent findings by Duke University researchers paint a worsening picture. They found that 35.1 percent of kids in the U.S. were overweight in 2016, up 4.7 percent from 2014. Additionally, more children are becoming obese at an earlier age.

Obesity rate for children 2-19 by ethnicity in 2014. Courtesy of The State of Obesity.

And the problem is only made worse in rural areas of North Carolina due to poverty, demographics and less access to healthy foods and physical activity, said Suzanne Lazorick, associate professor of pediatrics and public health at East Carolina University.

After practicing as a physician in Johnston County, Lazorick said she was struck by the increasing severity of obesity in her patients and went to ECU to study childhood obesity. She sees patients at ECU’s healthy weight clinic and spends the rest of her time on community-based research projects.

“No group is spared. The groups at higher risk mirror what you see in adults,” she said.

Hispanics and African-Americans have higher rates of obesity, according to the CDC.

Fortunately, across the nation, providers have a better understanding of what’s causing obesity, she said. Michelle Obama’s “Let’s move!” campaign helped raise awareness about healthy eating and the benefits of physical activity.

Unfortunately, Lazorick said people have developed what she calls “obesity fatigue” around the topic.

“No one really wants to hear about it anymore,” she said. “But it should be the opposite.”

Data on measures from 7th graders in MATCH this school year, from 49 schools in the counties on the map.

People often get tired of hearing about a problem over and over, but Lazorick said there is some progress being made with the MATCH (Motivating Adolescents with Technology to CHOOSE Health) program.

MATCH is an obesity prevention program for middle school students. It’s currently in 49 North Carolina schools and showing positive results. During the 2016-17 school year, 3,852 students participated in the program. By the end of the year, 13 percent went from being obese to being overweight. And 27 percent moved from being overweight to being a healthy weight.

Lazorick said the key to working with children, especially older kids, is targeting what snacks they eat, drinks they consume, and what they do with their free time.

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“Those are the big three they have control over,” she said. “A kid cannot change how often they eat out or where mom shops, but there are a few things they can control.”

Side effects of pediatric obesity

It’s commonly known that obesity can contribute to Type 2 diabetes, stroke, heart disease and other health problems in adults.

But take that extra weight and apply it to a young, developing person and other issues arise.

X-ray of both legs in Blount’s disease in an 18 month old girl. On both sides, left more than right, shows a marked varus deformity with irregularity of the growth plate. Photo credit: Hellerhof, Wikimedia Commons

Lazorick said kids with obesity often deal with bullying, low self-esteem and fatigue. These can all hurt their education.

Additionally, extra weight on a growing frame can cause bone and joint development issues, especially in knees.

“We are probably going to have an epidemic of joint replacements in this upcoming generation,” Lazorick said.

Jalak Patel is a registered and licensed dietitian at Shriners Hospitals for Children in South Carolina who works with children who are overweight or obese. She’s seeing children with joint pain, increased numbers of fractures and musculoskeletal diseases such as Blount’s disease, which affects the growth plate at the top of the tibia, or shin bone.

If the plate doesn’t develop correctly, the leg will bow out. Though causes of the disease aren’t clear, many doctors and studies believe it’s caused by excess weight.

Patel also cited a 2015 study that found obese pediatric trauma patients are twice as likely to sustain fractures in their legs.

“The long bones in the body are extremely important for supporting weight,” Patel said. “Long bones in children as less calcified, more porous and lighter, and because they are more porous, that can increase kids’ risk for fractures.”

At Shriners, Patel said the team is finding more misalignment where the thigh and shin bones meet in overweight and obese children.

“When these kids come to clinic, they often have pains in the knees, either intermittent or constant,” she said. “It’s not normal for kids to just have pain.”

So what happened in the ’80s?

Childhood obesity has been on the rise for more than two decades, and the causes are numerous.

How do we fix obesity?

The big pushes for kids are:

  • Substitute sugary drinks for water
  • Healthier snacks, such as apples, carrots or popcorn.
  • More active play time
  • Less screen time (TV, iPads, gaming systems, smartphones)

Lazorick said a few things that changed in the 1980s and into the ’90s were an increase in two-family households, more access to convenience foods and the technology boom.

Later, the early 2000s brought an increased focus on school test scores which led to a cut in physical education and recess.

“It’s been 25 years since our nation decided we need to spend more time on the ABCs and we took physical activity out and music out,” said Leandris Liburd, associate director of the CDC’s Office of Minority Health and Health Equity.

“We thought we needed more time on the basics,” she said. “What that did in a lot of ways was contribute to obesity.”

At the most basic level, obesity results from eating and drinking more than your body is able to use or burn off, Lazorick said.

“It seems simple, but the forces that tip that balance in the wrong direction are stronger, especially in rural areas.”

People have less access to fresh food and fewer places to be active, such as gyms, parks or greenways. And if time and transportation are issues, eating healthy and staying active become even more difficult.

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...