HoustonChronicle.com -- http://www.HoustonChronicle.com

Oct. 5, 2002, 10:24PM

By MARY ANN FERGUSand JEANNIE KEVER Copyright 2002 Houston Chronicle

Look at Franny Smith, and you'll see the face of a growing public health crisis: a 12-year-old who weighs more than 300 pounds and has health problems more common in a 60-year-old. {Good heavens!!!]

Get to know Franny Smith, and you'll see something more, a sweet-faced girl with caramel-colored skin and a shy smile, a girl who makes good grades, has a family that loves her and, despite the dismal odds, is trying to regain control of her life.

Franny is one of millions of overweight children in America, many of them dealing with life-threatening health problems: high blood pressure, high cholesterol, Type 2 diabetes, sleep problems, liver and gall bladder disease.

They bear internal scars as well, the lonely legacy of living in a society where magazines and movies tell us that beauty wears a size 6.

Children trying to lose weight must overhaul their diet and exercise routines -- even as their peers watch TV and continue to down sodas and chips. More importantly, they must exchange their daily habits with new, more healthy behavior. In order to be successful, children need the support of their parents and families. Without it, they are doomed to failure.

Growing up in Houston's Fifth Ward, Franny ate her way into an increasingly isolated world, unable even to walk comfortably through a shopping mall. Not yet a teenager, she has Type 2 diabetes, sleep apnea, chest pains and an orthopedic condition affecting her lower legs.

The damage is less visible, but no less painful, for Evelyn Sanchez and too many other kids.

"You name it, they would call me it," said Evelyn, a 14-year-old from north Houston, describing years of teasing and cruelty from her classmates.

While the most severely overweight children struggle with depression and other serious illnesses, many, including those just 20 or 30 pounds overweight, pay in dreams unrealized: losing a coveted position on a sports team or being excluded from games and parties.

Thirteen percent of children were seriously overweight in 1999, triple the number 30 years ago, according to the U.S. Centers for Disease Control and Prevention. The figures are even higher for Hispanic and black children.

But doctors and other specialists walk a tightrope with overweight children, balancing looming health disasters with the fact that these kids already have borne too many ego-busting criticisms.

Children teased Evelyn Sanchez from the moment she walked into a first-grade classroom. In the cafeteria, they dared her to eat their lunches, along with her own. She would, flush with the attention and hoping it might lead to friendship.

It didn't.

"It was hell for me," Evelyn said of elementary school.

When other kids hit and pushed her, she ignored them or locked herself in a bathroom stall to cry.

At home she ate -- six pieces of chicken, a 24-ounce Coke or a gallon of ice cream in one sitting. She could go through a box of cereal in a day.

"I wouldn't eat because I was hungry," Evelyn said. "I would eat because I was angry. I thought if nobody cares about me, then I shouldn't care, either."

She hid inside the only clothes she could find: big T-shirts, shorts and tennis shoes. Despite her fine features -- long dark hair, bright brown eyes, delicate lips -- she was sometimes mistaken for a boy when she added a baseball cap.

In fifth grade, she weighed 260 pounds; she fought her way through school that year, hitting the children who made fun of her.

By the end of the year, weary of the teasing and the fighting, she was finally ready to lose weight.

She starved herself, landing in the hospital suffering from dehydration.

Her parents begged her to try something safer. Straining an already-tight budget, they paid for acupuncture treatments to suppress her appetite. After a 12-hour work day, her father took his only child to a park to run. She followed a high-protein diet, and she took karate, volleyball and basketball at school.

By the end of sixth grade, she had lost 50 pounds. Last summer, she lost 30 more.

Now a high school freshman, she wears dresses, high heels, makeup and jewelry for the first time. At 5 feet 9 inches, she weighs 180 pounds.

But despite the outer changes and many new friends, Evelyn still feels insecure, even ugly.

"People who do all that (teasing) -- they don't know what damage they're doing," Evelyn said. "I don't think that hole that is in me ... I don't think that's going to heal."

She still occasionally eats pizza, hamburgers and french fries, but not in large portions. She doesn't eat after 5 p.m. Four nights a week, she takes an aerobics class and then runs three miles.

"It's not about looking good," Evelyn said of her efforts to lose another 30 pounds. "I don't want to die of diabetes."

A family effort

Other families, too, have taken charge of their children's weight.

For Jill Hightower of Tomball, the motivation was clear: At 15, Kendall has Type 2 diabetes and depression.

Patrick and Jill Hightower began to worry about Kendall when she was 3 years old and already weighed 52 pounds. None of her three older siblings were overweight.

Looking back, they know they weren't helping with their meat-and-potatoes diet, with high-calorie treats on the side.

"You don't think anything of putting a Ding-Dong in a lunch," said Jill Hightower, although she wouldn't do it now.

Kendall's weight and the resulting fatigue grew so severe that her mother pulled her out of school and taught her at home from first grade through sixth grade. At age 9, Kendall weighed 172 pounds and slept as much as 18 hours a day. She rarely exercised.

Three years ago, she was diagnosed with Type 2 diabetes and depression. She was 12.

The Hightowers bought a treadmill and installed a lap swimming pool and a trampoline to get her moving.

Kendall resisted. She kept the treadmill running but rested on the side when no one was watching. She ate candy and chips alone in her bedroom, hiding the wrappers behind her bed.

Earlier this year, Kendall joined Texas Children's Hospital's weight-loss program. At 5 feet 1 inch, she weighed almost 200 pounds.

Instead of continually locking horns over food, Jill Hightower learned to give Kendall choices -- all of them healthy -- so she could control her own diet.

Kendall has lost 15 pounds since January. She now weighs 178 pounds and would like to lose 30 more. She takes an insulin shot every day, along with other medication, including that to treat depression.

Depression is a common complement to obesity, according to those who treat overweight children, especially among adolescent girls.

But if Kendall keeps losing weight, doctors say she may be able to stop taking antidepressant and diabetes medication. So she watches what she eats, cares for the family's horses, walks the dogs, takes karate -- and keeps her feet on the treadmill for up to 30 minutes at a time.

Despite the progress, Jill Hightower worried that the teasing Kendall escaped as a young child might surface when she started high school last month. But as she looked at the teenagers headed for class, she decided her daughter was safe, even if society is not.

"There are a lot of large children there now," Hightower said. "There are kids up there a lot bigger than Kendall."

Losing weight is a daunting battle for children, just as it is for adults. Texas Children's Hospital's Weigh of Life program has been around for almost 20 years, but it still has more failures than successes.

Seventy percent of kids drop out before completing the program, although 80 percent of those who do complete it keep the weight off for at least a year.

The program is expensive -- $1,200 for 15 sessions, rarely covered by insurance. The hospital this month will begin offering group sessions for $19 each.

Success in any program is elusive unless both kids and their families want it, said Dr. Mona Eissa, assistant professor of pediatrics at the University of Texas Medical School in Houston. And starting young is important.

Since younger children like to be active, said Eissa, director of a clinic for overweight children at LBJ Hospital, it's easier for parents to channel them into calorie-burning activities. Parents can also more easily control what younger children eat, while teenagers have more opportunities to raid vending machines and convenience stores (See Personal Health column on Page 11E).

Parents wield enormous power over their kids, in ways both obvious and subtle, but they are often among the last to recognize the problem.

"It's a family issue," said pediatrician Dr. Julie Boom. "I tell parents, `You're the one who controls what's in your pantry.' "

A family legacy

Salena and Willard Harvey of Conroe uneasily watched their son Will struggle with his weight, worried their middle child would face the teasing and health problems that dogged them.

Salena Harvey, 40, hasn't been overweight since childhood, but she can't forget being called a "tub of lard" and buying "husky" clothing.

Now, at 5 feet 4 inches, she weighs 140 pounds and is training for a half marathon. But the memory of being fat never went away.

"Mentally, emotionally, yeah, it still does affect me," she said.

Willard Harvey remained overweight in adulthood, and in 1997, just before his 39th birthday, he was diagnosed with Type 2 diabetes and high cholesterol.

As the Harveys kept watch on Will's weight, he stayed so active that they weren't overly concerned. Will swims, rides his bike, plays baseball and football. He dreams of playing in the NFL.

But at 5 feet 1 inch and 156 pounds, his weight already has prevented him from becoming a linebacker; the South County Football League says children weighing more than 145 pounds can't play that position.

Earlier this year, the Harveys enrolled Will in a children's weight-loss program at the YMCA of South Montgomery County.

"I think we were looking for something to help him become more aware ... that you are responsible for making food choices," Salena Harvey said.

Will agreed halfheartedly.

"I already knew what was healthy," Will said before heading to a football game late last month. "I already knew about the food pyramid."

But his competitive spirit soon kicked in, and he found he liked keeping an exercise and food journal. His father joined a weight-loss program at the same time.

The family changed the way they cook, using less oil and butter. Perhaps even more beneficial, they now fill their plates at the stove instead of serving from the table, where it's easier to take a second helping. They also switched to smaller plates.

Will had lost 10 pounds by the end of the 15-week program last May -- leaving him slim enough to play linebacker. But he regained the weight over the summer.

The blond-haired boy offers a few reasons: It was too hot to exercise, and his friends were away on vacation.

But he also concedes that he simply likes to eat, especially meat and potatoes, mashed if possible.

But Will still wants to be a linebacker, and he and his parents believe he will drop more weight as he works to increase his speed on the football field.

"It's going to come from within," Salena Harvey said. "That's what's going to do it for Will. It's all about when he decides internally that he wants to get faster."

Creating new habits

For Will, as for most overweight kids, new behaviors are the bottom line.

Planning ahead for meals, scouring the house of tempting foods, keeping a food journal and eating as a family at a table -- not in front of the TV -- are all places to start, said Laura Laine, senior clinical dietician for the Weigh of Life program.

Even skipping one soda a day can add up to losing 20 pounds a year, said Boom.

"The power of doing something small every day is huge," she said.

That's part of the reasoning behind giving more responsibility to the schools.

Physical education teacher Muriel Jackson has watched her students grow -- literally -- during 30 years on the job. "A lot of students will come back and say, `Ms. Jackson, you haven't changed,' " she said. "I say, `Oh, but you have.' "

Jackson works at Foerster Elementary School in Southwest Houston, and she is a prime proponent of new regulations requiring Texas elementary schools to offer 135 minutes a week of structured physical activity.

Some Houston schools already did, but others didn't even have a P.E. teacher on staff, said Rose Haggerty, manager of health and physical education for the Houston Independent School District.

The U.S. Department of Agriculture also pulled the plug this year on school vending machines dispensing candy, soft drinks and other high-calorie nutritional black holes during lunch times.

Private organizations have stepped up, too.

Several Houston YMCAs offer strength training, conditioning and yoga classes for youth; last year, the South Montgomery County YMCA and Post Oak YMCA offered youth weight-loss groups for about $60. Additional classes may be offered through the YMCA of Greater Houston in the future.

Children lost an average of three pounds each during the 15-week program.

"But the biggest change was awareness of their habits -- their eating habits and their exercise habits, " said Dione Booker, senior program director for the South Montgomery County YMCA. "It's teaching them habits they're going to use forever."

"We stay on the go"

It will take that and more to save Franny Smith.

She started life large, as big as a baby twice her age by the time she was 3 months old. By age 6, she was noticeably overweight. Within a few years, she was gaining as much as 10 pounds a week.

Last summer she weighed 353 pounds, almost triple the average weight for a 5-foot-6-inch adolescent girl, and she was paying for it with her health.

Still, she kept eating, at mealtimes and late into the night. She ate, Franny said, "because there wasn't anything else to do."

Then Franny left the Fifth Ward, where she had lived with her mother and grandmother, and last summer moved in with her aunt, Shevanda Amboree, and Amboree's three children in Fort Bend County.

No boredom. No indulgence. No fooling around.

"We stay on the go," Amboree said. "You don't get to sit there and just eat. I buy sweets, but I may buy them once a month, not every week, and I may not buy them at all."

Cereal for breakfast, lunch at school. Water and diet soda, not calorie-laden fruit juice and regular soda.

"When you get home, you get a decent dinner, and that's it," Amboree said.

The upshot? Franny has lost 26 pounds in three months and, although she still weighs more than 320 pounds, she can see the results.

No more riding through stores in the electric carts provided for the disabled; Franny is on foot. After school, she's outside with her cousins and neighborhood children. And if the clothes she can buy now aren't the trendy styles worn by her fellow sixth-graders at Christa McAuliffe Middle School, at least they are the T-shirts and knit pants appropriate for a pre-teen.

"I can walk and be happy about myself," she said.

But if she doesn't continue to lose weight -- and keep it off -- she is at serious risk of dying early, said Boom, the pediatrician who first saw Franny almost a year ago and quickly referred her to a battery of specialists.

With that bit of success behind her, Franny is optimistic she can lose 200 more pounds within a year. That would put her at about 130 pounds, average for a girl her age and height.

Whether that is realistic, Boom declines to speculate.

Regardless, Franny already has the most important ingredient for a child trying to lose weight: a family who cares.

When Franny moved in with Amboree, her aunt was blunt. "It's time to be interested in your hair," she told Franny. "To be interested in clothes. You ought to be going to the movies, going to sleepovers. Nobody's going to ask you over because ... they always have to wait for you (to catch up)."

That hurt. But Franny knew it was true.

Most of all, she knew Amboree was speaking from her heart. "She's like a mama to me anyway."

Franny denies ever fretting about her weight, insisting she has been teased only once.

Maybe so, said Amboree. But that doesn't mean she is giving up.

"It's good when someone says something about you and you don't care, because you know who you are," she tells Franny. "You don't care what people say, but it's time you started to do something for yourself."

-- Anonymous, October 06, 2002