Two cities, one vast gap in child obesity

About 20 miles to the northeast, Lorena Hernandez takes her 6-year-old daughter to McDonald's at least twice a week and frequently gives her Kool-Aid and soda. They go to the park often, but when they are in their Bell Gardens, Calif., home, the television is usually on.

The families' divergent attitudes toward food and exercise reflect just part of the challenge facing officials as they try to close a vast and costly gap in obesity rates across the greater Los Angeles region.

Just 4 percent of children in affluent, mostly white Manhattan Beach are considered obese, the lowest rate countywide, according to public health officials. In poor, predominantly Latino Bell Gardens, the rate is 36 percent - higher than in any other city.

"They are like two different worlds," said Paul Simon, who directs chronic disease prevention for the county health department.

Obesity among the young is starting to level off in California and around the nation. But stark disparities persist, posing vexing obstacles to further change.

In Los Angeles County alone, the obesity epidemic costs about $12 billion a year for healthcare and in lost productivity, according to a 2006 report by the California Center for Public Health Advocacy.

The challenges are plain at the Bell Gardens Community Health Clinic, where physician Jacqueline Lopez, deals with the consequences: diabetes and heart disease. She delicately coaches families to pick healthful foods and break through cultural barriers. Many Latino parents, she said, simply don't recognize the risks of their children being overweight.

"There is a misperception that bigger children are healthier children," she said. "I am trying to be sensitive, but really what we are talking about is these children are at risk of having a shortened life span."

Arturo Gonzalez said his 13-year-old daughter's doctor recently told him she is 30 pounds overweight and showing early signs of diabetes. "I am worried," he said, watching his 5-year-old son play on a swing set in a Bell Gardens park. "We talk about the consequences of being overweight. ... She listens, but it goes in one ear and out the other."

Gonzalez said his children watch too much television, snack too much and complain when he makes them take walks. He has enrolled his daughter in an after-school program to cut down on TV time and snacking.

But he doesn't think poverty is a culprit. "In Mexico, we were poor, but we weren't overweight," he said, recalling that children in his homeland drank water instead of soda and walked a lot.

Bell Gardens' officials are trying to combat the problem. They recently declared obesity a "serious public health threat," banned sodas from park vending machines and are discussing adding track and fitness equipment as part of a park renovation.

"We are trying policy-wise to make changes, but we can't dictate what parents do in their homes," said city recreation director Pam Wasserman. For parents on tight budgets, she said, healthful food isn't always the least expensive option. "It is hard for us to compete with 10 tacos for $10."

Lorena Hernandez said her family often chooses fast-food restaurants because they are cheap. At home, she cooks Mexican specialties, such as beans, rice, tortillas and soups. Her husband has diabetes, but both she and her 6-year-old daughter, Leanne, are thin, so she doesn't worry about what they eat. "We don't really talk about it at home, honestly," she said.

Bell Gardens falls at the opposite end from Manhattan Beach on many economic and demographic indexes.

About 80 percent of Manhattan Beach's 36,000 residents are white, and the median household income is $127,000. Only 3 percent of people are living in poverty and three-fourths of residents over 25 have college degrees. There was a single homicide and 48 other violent crimes in 2010, according to the FBI.

There are relatively few fast-food restaurants and several upscale grocery stores emphasizing fresh foods, including Trader Joe's, Whole Foods and Bristol Farms.

In Bell Gardens, 96 percent of the 44,000 residents are Latino, and median household income is less than one-third of Manhattan Beach's. Nearly one in four residents lives in poverty and just 4 percent of those 25 or older have a college degree. Crime is far more prevalent, with five homicides and 210 other violent crimes in 2010.

A 2009 survey by the Campaign for a Healthier Bell Gardens, started by a community clinic, found 141 convenience or fast-food restaurants within the city's 2.4 square miles. Many grocery shopping options are smaller corner stores, where fresh produce choices and availability tend to be limited.

Researchers have drawn strong links between obesity and such socioeconomic disparities. Families in low-income areas are less aware of the harm that beverages and foods sweetened with high-fructose corn syrup can cause, said Dr. James Marks of the Robert Wood Johnson Foundation. And schools in low-income areas generally have fewer physical education programs and may offer less healthful options in school cafeteria lunches, he said.

"If people who want to make the healthy choices are unable to, they are not going to succeed," Marks said.

County health officials have noted more obesity in communities with less parkland, where children can get out and exercise. Manhattan Beach, for example, has 5.7 acres of parkland per 1,000 residents, more than three times the ratio in Bell Gardens, according to a 2007 report. And parks in poorer areas may be considered less safe and operate fewer hours, researchers say.

Health advocates are working with Bell Gardens' city government, businesses and educators, as well as the county, to plant gardens, hold mini-farmers markets and take mobile health clinics to schools, encouraging the students to become advocates of better diets and more exercise. A major challenge is getting families to prepare healthful versions of traditional Latino dishes.

"We are nowhere near where we need to be," said Lani Cupchoy, who is directing the health improvement campaign. "We can't really say we have a healthy city, but we are on the path."

Manhattan Beach Mayor Nicholas Tell noted that his city has a natural advantage to encourage healthy lifestyles: two miles of open waterfront. Residents ride bikes, run along the beach-side path or go surfing and play volleyball on the sand. "We have this amazing beach that tells people to go outside," he said.

Manhattan Beach resident Barbra Fontana, 46, a former professional volleyball player, said her sons - ages 6 and 8 - go boogie boarding or bike riding on weekends and play soccer, basketball and baseball other days. On a recent afternoon, they kicked a ball around Sand Dune Park as she looked on.

"This is what I like my kids to be doing," she said. "Sitting at a computer or a TV isn't my cup of tea."

The differences extend indoors. At the Manhattan Beach Trader Joe's, Chang, 39, filled her basket with fruit, bread, vegetables, eggs and yogurt. She generally avoids junk food, but lets the grandparents occasionally take the children out for ice cream or to McDonald's.

"I'm not inspecting every single package," she said. "But I try to eat wholesome foods."

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