I present this as a Zen Koan. A Koan is a paradoxical question, the meaning of which cannot be understood by rational thinking. It derives from the Japanese words “ko” for public and “an” for ‘matter for thought’. This is clearly a public matter for thought in the current dialogue on childhood obesity. How do we best serve a seven-year-old girl whose high weight highly challenges notions of normal growth patterns?

Image by Debi Brady

This girl is not a nameless, theoretical child. Tanazia is an amazing girl who I know. She has keen inquisitive abilities, deep empathy for others, and sophisticated insight for someone so young. She is deeply connected to her family, respects her elders, and helps care for her three-year-old brother and emotionally reactive two-year-old foster-sister who she shares a room with. She excitedly tells me that when she grows up she would like to do something to help others. When her grandmother mentions the Peace Corps, she responds that there are people right here in her own community who are in need.

Tanazia—who is just one of many children who are accumulating weight in an inconceivable short amount of time–is in a relatively good situation. She now lives with a set of very caring grandparents who love her dearly. She has a stable roof overhead, and there is a modicum of food security. While some family members are overweight, her grandmother, who had gastric bypass surgery a few years ago, is generally food-savvy and keeps a relatively healthy home. Plus, she has a back yard–one large enough and safe enough to play in—a rare commodity in this part of the city.

Despite this, she has already had to armor her body with layers of body fat against many emotional wounds. She was born to a 15-year-old mother who has since had two more babies and is now pregnant again. Her father has died, and she was at an early age exposed to and a victim of domestic violence. Her grandmother has chronic health problems. And, she herself, has asthma–another player in the childhood obesity conundrum. Her mom has supervised custody and gets to see her daughter every other Saturday for just a few hours. Equipped with few ways to show her love, during their time together she usually takes Tanazia out to eat somewhere. It’s usually Chinese food or pizza with soda and candy.

This sweet child has already endured the taunts of kids. Going to school-squeezed into her charter school uniform skirt—is something she is already leery of by second grade. Though her grandma does give her breakfast at home and provides her with lunches to bring to school, controlling the intake at school is hard to do. Unfortunately, the meals provided by the school lunch programs do not meet nutritional recommendations and are a sad source of the low-quality foods and excessive fats, sugars and calories that are contributing to the problem. Turning down a free meal or two in a day would be hard for anyone to do, especially for those to whom the secure availability of food is not a given.

Declining the morsels of joy to be found in the cheap junk foods that easily find their way into all the cracks and crevices of our lives–cupcakes, bags of chips, Rice Krispie treats, fruit punch– is nearly impossible for those with easy and happy lives let alone for those who excessively use food as an easy and legal pursuit to push down painful life experiences.

And, although Tanazia has a backyard, the physical activity levels of young girls who live in vulnerable neighborhoods are amongst the most limited. Add in the cold winters in this part of the country and the possibility of expending calories diminishes even more.

Despite these challenges, this beautiful child tries hard to do what I—her nutritionist—have recommended. She drinks mainly water, she listens to her belly to see if it is really hungry—a task most adults find hard to do– and has only a small piece of cake at birthday parties and church functions.

My heart breaks at having to impose such harsh restrictions on such a young life. I know restriction breeds hunger. I know parental strategies require fortitude, patience, non-judgment, and structure. I don’t have many options nor enough solutions to fight all the forces that prey upon this innocent child and countless others like her. Current anti-obesity initiatives come far too late and offer little. Cute and catchy names of new programs belie the gravity of the situation and chew at my cynical side—the part of me who knows too many stories of real children’s lives. Societal weight stigmatization adds to the burden. I pray for this young girl to grow up healthy and whole, equipped with all she needs to be a powerful adult. Hopefully, size alone will not get in her way.

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In health, Elyn