Generation Extra Large: Rescuing Our Children from the Epidemic of Obesity
By Lisa Tartamella, Elaine Herscher, and Chris Woolston
Basic Books
255 pp $25

By now, anyone who has kept up with the news is aware that Americans are heavier than ever: Two-thirds of them weigh more than the Centers for Disease Control and Prevention advise for good health. The epidemic is especially troubling among children: 9 million kids are significantly overweight, putting them at higher risk for diabetes, heart disease, and a host of other ills.

Amid these alarming statistics comes a new book that presents an unexpectedly hopeful examination of the epidemic plaguing American children. Using poignant stories of ordinary people around the country -- physicians, teachers, youth program leaders, and parents -- who have found creative ways to sell kids on a healthier, weight-reducing lifestyle, Generation Extra Large is a distressing but ultimately optimistic analysis of how to reverse this disturbing trend. It doesn't place the blame squarely on any single fattening influence -- junk food, television, video games, the food industry, schools, parents, or lack of exercise. Instead, it shows how all these factors combine, often without our realizing it, to create what the authors call a "toxic environment," a frightening new world where it's all too easy for kids (and adults) to gain weight.

Co-authored by noted Yale University dietitian Lisa Tartamella and two veteran journalists, Elaine Herscher and Chris Woolston, Generation Extra Large builds its case so carefully as to leave absolutely no doubt. It piles on the statistics like extra toppings on a "supreme" pizza.

We learn, for example, that since 1970, the proportion of overweight 6- to 11-year-olds has tripled; in the same period, the percentage of kids' calories that come from fast foods increased 500 percent. Kids' soft drink consumption has almost doubled, to an average of a can and a half a day, and according to the medical journal The Lancet, each daily serving of a sugary soft drink boosts obesity risk 60 percent. Meanwhile, three-quarters of U.S. schools raise money by having Coke or Pepsi vending machines in their halls, and many school lunch programs feature items from McDonald's, Taco Bell, and KFC.

The fast food industry, increasingly under attack for high-fat fare, has responded by touting "healthier" options. Problem is, they're often no healthier. Wendy's Chicken BLT Salad packs more calories than a Big Mac. Meanwhile, according to the American Journal of Clinical Nutrition, kids are adding pounds faster than McDonald's adds outlets, and only 1 percent of American kids have diets that meet all the recommendations of the U.S.D.A. food pyramid for children.

But the obesity epidemic is more than just statistics. The book makes a compelling case for its high cost in lives. Obesity-related conditions include heart disease, cancer, stroke, thyroid disorders, sleep problems, arthritis, hip fractures, polycystic ovaries, and diabetes complications such as heart disease, blindness, kidney failure, and limb amputations.

Only a generation ago, there were two kinds of diabetes, juvenile-onset and adult-onset, the former caused by a dearth of the insulin-producing cells in the pancreas, the latter by weight gain and a sedentary lifestyle. But since the 1980s, so many kids have developed obesity-related "adult-onset" diabetes that medical authorities have changed their terminology. Juvenile-onset is now "type 1." What used to be called adult-onset is "type 2." Since 1980 the number of kids with type 2 diabetes has soared tenfold. The health impact of obesity is so devastating that unless today's kids start losing weight, they are predicted to be the first generation in U.S. history to have a shorter life expectancy than their parents.

In examining who's to blame for childhood obesity, Generation Extra Large cites surveys showing that two-thirds of parents blame themselves. Of course, parents bear some responsibility. But as the book makes abundantly clear, no parent can counter the immense pressure of the toxic environment in which we now live, a world where it's ridiculously easy to avoid exercise and make poor food choices. As a result, parents often feel paralyzed and depressed, convinced that they can't make a difference as their children's weight -- and their own -- soars out of control.

Generation Extra Large supplies the antidote to this paralysis and depression. It tells many quietly inspiring stories of adults around the country who, for a variety of reasons, got fed up with the supersizing of America's youth and decided to do something about it. Their efforts have produced surprisingly positive results. In Sarasota, Florida, school dietitian Beverly Girard replaced Kool-Aid with milk and orange juice and ordered schools to cut back on serving french fries.

In Folsom, California, Al Schieder, head of food services for the local school district, ditched the greasy burgers, nachos, and donuts and began offering low-fat pastas, sushi, and oven-baked chicken. Activists persuaded the Los Angeles School Board to ban soft drinks from elementary and middle schools -- and they're working on a ban in high school. New York now prohibits the sale of candy and sodas at schools until after the final lunch period.

And in San Antonio, the U.S. city with the highest proportion of obese adults, the public health department launched a walking program that has enrolled 10,000 residents, and schools have substantially increased the amount of exercise in P.E. programs, including anything and everything that gets kids moving, from traditional sports to hip-hop dancing. The school district also banned sales of candy and junk food in its schools; community-based workers began an intensive effort to identify young type 2 diabetics and work with their families to get their weight and blood sugar down.

Generation Extra Large shows that in an environment where so many forces conspire to subvert healthy nutrition and exercise, even the smallest step toward lower-fat eating and more physical activity is a step in the right direction. Instead of blaming themselves and feeling paralyzed, parents would do better to buy fruit juice instead of Coke (and drink it themselves as an example); to cut down on trips to fast food outlets and make a big pot of minestrone soup; to take walks with their kids; to choose the stairs instead of the escalators at the mall -- in short, to see every food item they serve and every little bit of physical activity as a small but significant skirmish in the war on childhood (and adult) obesity.

Little steps add up. When Georgia state legislators passed a law allowing cash-strapped school districts to save money by firing P.E. teachers and eliminating recess, parents in Gwinnet County volunteered to supervise. The result: more exercise for the kids -- and fewer behavior problems for teachers. As 9-year-old Cydney Torrez said, "When I don't have recess, I feel like I want to jump out of my seat and run around the classroom. When I have it, it helps me sit down and work better."

When Linal Ishibashi became the principal of Aptos Middle School in San Francisco, she found the cafeteria serving huge cheeseburgers, sodas, and potato chips. Appalled, she organized a parent committee to poll kids on what they wanted for lunch. The kids voted for soups and sandwiches. Ishibashi found a vendor, and now the kids eat much lower-fat fare, along with fruit and salads. Ishibashi spurred acceptance of the healthier menu by visiting the cafeteria and giving little prizes to kids she found eating well. Soon, kids were running up to her saying, "I'm eating an apple!" and "I had a salad!"

The voices of real kids are a big plus. When Molly Markus of Billings, Montana, was 8, she was well on her way to being seriously overweight. She already had high blood sugar and weighed about 145 pounds. Today she is two years older and eight pounds lighter, thanks to her determination, support system, and healthier diet. She also spends less time in front of the television and more time climbing trees.

"If you have a chance you should try to eat something healthy. Don't think about fatty foods when you're hungry," Molly says. "Think of fruits and vegetables. It doesn't have to be greasy to be good."

These stories show why Generation Extra Large is ultimately a hopeful book, an important book, and one every parent should read. It shows that the tide of obesity can be turned, and it inspires readers to get off the couch and start doing it.

-- Michael Castleman is a San Francisco-based health writer and the author of There's Still a Person in There: The Complete Guide to Treating and Coping With Alzheimer's (Perigee, 2000).

First published February 1, 2005
Last updated November 28, 2007
Copyright © 2005 Consumer Health Interactive

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