Americans today are an exceptional people: We are the heaviest in the world. Now the federal government’s Centers for Disease Control and Prevention warns that as we supersize ourselves we are skyrocketing our risk of developing diabetes.


Especially at risk are children in Ventura County.

   
The rate of obesity has risen at an unprecedented rate in recent decades. From 1974 to 2004 the rate of childhood obesity more than tripled, from about 5 percent to more than 15 percent. Most American adults now are either a few pounds overweight or — more seriously — obese.

Obesity can lead to diabetes. Edward Gregg of Harvard and the CDC in August published a study projecting that four in 10 people in the nation will be at risk of developing diabetes by 2050, and five in 10 people of Latino background.

Although the prevalence of diabetes in Ventura County today is just 7.2 percent, according to the Ventura County Health Care Agency, in towns such as Fillmore, Oxnard and Santa Paula, the number of children who are overweight or obese already has reached nearly 48 percent, one of the highest such numbers in the state.

 


(Clockwise) Erynn Smith of The Abundant Table in Santa Paula, Jeremy Schoengart, director of child nutrition services for Santa Paula Unified School District, Alondra Navarro, a senior at Santa Paula High School, and Mireille Vargas, a student at Santa Paula High School (both Navarro and Vargas are members of the group Students Encouraging Social Political and Environmental Action) talk about better nutrition and exercise to fight against childhood obesity. Photo by: Heber Palayo.

Risk factors for developing diabetes include obesity, low household income, poor diet, lack of exercise opportunities, and a Latino background — all of which can be found in high numbers in Santa Paula.

Against these risk trends stands a group of Santa Paula students, who call themselves SESPEA (Students Encouraging Social, Political, and Environmental Action). With the support of two activist groups, they have resolved to do something about obesity and its risks to health in their town.

When they heard a presentation on the numbers of overweight and obese children in Santa Paula from mentor Erynn Smith of The Abundant Table, a progressive Christian farm nonprofit based in Santa Paula, they were shocked into action.

“When we as a group looked at the numbers that showed that Santa Paula was tied with Oxnard for the highest rate of childhood obesity in the state you could hear a pin drop,” said Smith. “We had to let those numbers sink in, knowing that they represent our neighbors and our families.”    

Years ago Santa Paula had a farmers market, but it faded into oblivion after a move away from downtown. For the sake of their health, the students set out to see if they could find a way to revive it.

The obesity and diabetes threat to Santa Paula and VC
“What we know is that at this point, the probability that any youth, adolescent, or young person will develop diabetes is about 40 percent,” said Gregg of the CDC. “Given the risk factors characteristic of Ventura County, the lifetime risk is likely to be even higher than 40 percent.”

Complications of diabetes include numbness in the extremities, exhaustion, eye disease and blindness, kidney stones and kidney failure, with the potential for amputation of feet and limbs as well as a substantially increased likelihood over time of developing heart disease, cancer and/or dementia. Extreme obesity can lead to a liver disease — fatty liver syndrome — that doctors usually see after decades of drinking.

Dr. Jerry Noah, who works at the Santa Paula Medical Clinic, has seen such cases.

“We’re seeing a certain number of patients with full-on cirrhosis of the liver, as if they’ve been drinking for years, even though they never drank,” he said. “We’re also seeing a lot of metabolic syndrome, that constellation of high blood sugar, hypertension and hyperlipidemia [high blood fats], which leads to an incredible number of risks and consequences, including kidney disease, diabetes and, of course, heart attacks and stroke. The numbers are going to grow exponentially unless we can make some changes in lifestyle.”

Gregg of the CDC echoed this warning for diabetes.

“The whole population now is at a higher risk for diabetes because of the changes that have occurred in our culture,” Gregg said. “Although a young person is not very likely to come down with it at age 22, it’s different for his parents and grandparents. If he looks at these facts he may think, ‘Wow, I really am at risk of getting this disease — I better make some changes now to prevent this from happening.’ ”

The good news about diabetes is that lifestyle changes — reducing weight, increasing activity and eating healthy foods — can reduce a person’s chances of contracting the disease. It’s also true that people who contract diabetes live years longer than they did in the past.

But the statistics remain sobering. On average, people with diabetes will still see their lives shortened by about six years. Avoiding or managing the disease requires making changes for life — beginning with losing weight.

It’s not easy being a green pea pod: fighting obesity in kids
Julie Chessen, the assistant director of Child Nutrition Services for the Oxnard elementary school district, on a March morning in the Lemonwood Elementary School cafeteria, wears a lumpy superhero-type outfit that reveals only her face and transforms her into one giant lime-green pod with lumpy peas spilling out the front of her bulky outfit.

To motivate the kids to eat healthy foods, in March she spent a morning — with other food service workers outfitted as grapes, a carrot and a banana — cheerleading at an enthusiastic celebration of the new fruits and vegetables menu at the school district, which serves nearly 6,000 elementary school children in Oxnard.

Thanks to a $300,000 grant from the USDA for the 2013-2014 school year, the district will be able to provide 30 percent of its produce from local farms, including kale, tomatoes, radishes, strawberries and apples.

“Of course students prefer to eat fruits more than vegetables,” she said, breathless with exertion. “To increase vegetable consumption, we are offering dips such as lemon juice with chili powder. The children love it!”

To medical experts, it’s not surprising that Ventura County’s children are at great risk.

“Any species adapts to its circumstances,” said David Katz, a physician at Yale who also edits the journal Childhood Obesity. “We’ve gone from living in a natural world where physical activity was unavoidable and calories were scarce, to a world where calories are easily available and physical activity is unnecessary. We now live in a sea of highly processed glow-in–the-dark bet-you-can’t-eat-just-one processed foods. In this environment getting fat is incredibly easy and staying thin is incredibly hard.”

Obesity and low income: What’s the connection?
It’s especially difficult, the statistics say, in low-income cities such as Santa Paula, Fillmore and Oxnard. In 2007 a survey found that the three areas had few accessible grocery stores and many fast-food outlets, convenience stores and liquor stores. Each town was dominated by billboard advertising for fast food, and each was categorized as a “food desert,” meaning that healthy foods were hard to find.

Health experts believe many different factors combine to push people toward diabetes, but obesity is first on the list. According to the CDC, America kids are obese because they exercise less (far fewer kids walk to school even than in the 1990s), eat more high-caloric junk foods (the amount of food consumed by Americans has jumped hundreds of calories in recent years) and fewer vegetables, as fruits and vegetables have become more expensive in comparison to junk food in recent years.

The income/weight connection becomes unavoidable when comparing Santa Paula, a town of about 32,000 people, 78 percent of whom are of Latino ancestry and about 18 percent of whom are white, with Ojai, a mirror-image town of 77 percent white residents and 19 percent Latino.

In Santa Paula, per capita income is about $20,000 a year, according to the Census bureau, and the median home price was about $323,000 in 2012. Ojai has almost double the per capita income, at about $38,000 a year, and homes were worth an average of $615,000 in 2012, according to the Census bureau.

(The comparison is imperfect because Ojai the town is smaller than Santa Paula, but the Ojai Valley includes several other small towns, all part of the Ojai school district, with similar demographics, adding up to 30,000 people.)  

According to a “Transforming Communities” report released last year by the Ventura County Health Care Agency, nearly 60 percent of fifth-graders in the Santa Paula school district were overweight or obese. By contrast about 39 percent of kids in Ojai schools were overweight or obese.

Wealth vs. obesity: A protective effect?
For Jamshid Damooei, an African-born economist at California Lutheran University who works with the county’s health agency, it’s not so much Ojai’s income that protects it from obesity as its interest in education and its desire to protect its culture, both arts and agricultural.

He points out that Ojai’s income per household, of about $58,000 a year, isn’t enormously higher than Santa Paula’s of $54,000. He attributes this to the high number of retirees on fixed incomes, since Ojai as a town has the highest percentage of seniors in the county. Ojai households are smaller too — about 2.5 people per household, versus about 3.5 in Santa Paula.

But it’s not just about money, he stressed:

“Ojai is very guarded and very conscious of its social values,” he said, “and these values include education and regulations on growth.”

In 2007, the Ojai City Council approved a regulation that does not allow chain stores with more than 10 outlets within the city limits. McDonald’s, Wendy’s, Taco Bell and other fast food can be found in the nearby town of Oak View, but that’s three miles from the high school, and farther from the junior high and elementary schools — too far for kids to walk.

Chris Wilson, who grew up in Santa Paula and now serves on the school board, has noticed the same thing.

“It’s worth mentioning that Ojai has kept fast food at bay,” he said. “They’ve kept McDonald’s and these other places outside the city limits in Oak View, whereas in Santa Paula we’ve got a whole batch of fast-food places right in town. It’s affordable food, and in a city with a lot of economically disadvantage people, that’s attractive, but this kind of cheap food is not necessarily good for you.”

McDonald’s, Kentucky Fried Chicken, Carl’s Junior, Starbucks and other fast-food outlets can be found within four blocks of Santa Paula High School. For Katz, it’s part of a pattern: We’re all in the same obesity-creating boat but some people on the boat are better equipped to survive than others.  

“Look at the Titanic,” he said. “What do we take away from that story? The ship sank. It’s true some people escaped. Some people were better defended. They could get help, they could get to lifeboats.”

“It’s the same thing with obesity,” he said. “Some people can better afford fruits and vegetables, and they can find the time to pay to prepare them. Some people can even afford cooks. They find ways to step up their standards of nutrition. But still, the big story is that the ship sank.”

Santa Paula: In search of parks and places to play
As part of Katz’s work as a health educator, he has promoted exercise in schools. Chris Wilson points out that when he was kid in the ’50s and ’60s, children in Santa Paula could play in the schoolyards far more easily.

“I think Santa Paula is under-parked,” Wilson said. “When I was a kid the schools were unfenced and they basically served as parks after school. A custodian might be there cleaning bathrooms, or a neighborhood watch parent. Now with the school shootings and such we have to lock them down, and so schoolyards aren’t accessible for playground use. On the school board we’re trying to find a way to keep campuses open and make them more welcoming to parents: and then once you have a couple of adults around, hopefully we can find a way to use the playgrounds.”

Rick Cook, mayor of Santa Paula, supports using schoolyards as parks if possible as well, but says the city can’t afford to pay fees to the schools for maintenance without passing on the cost to students.

“One of our problems in Santa Paula is that we don’t have enough parks,” he said. “They didn’t think about that when they were putting up housing 70 and 100 years ago.”

According to an advocacy walking group, Walk Score, Santa Paula scores a mediocre 57 on a scale of 1-100 in walkability, meaning that it is “somewhat walkable, with some errands can be accomplished on foot.” The town has one small park downtown.

Ojai by contrast scores an almost ideal 83, meaning that it’s “very walkable.” Not only can most errands be easily managed on foot, but also the small central downtown has a large park, and the town has hiking paths and several other community parks, and schools with parent volunteers that often stay open after school.  

Students working for health in Santa Paula
Many other examples can be found of how Ojai kids are “better defended” against obesity and diabetes. The Ojai schools have a burgeoning schoolyard farm program, with seven of the eight public schools having organic gardens in their schoolyards and a paid co-coordinator and volunteers who help the kids grow vegetables, funded by local nonprofit Food for Thought. Ojai Rotary has a “Fit Kids Fit, Ojai” program raising money for exercise and healthy food programs. The town has a thriving farmers market, two supermarkets, multiple health-food stores, a popular bike path, hiking trails at the edge of town and a community gym with many low-cost programs for kids.

In Santa Paula, most of the effort being exerted against the rising tide of obesity and the scourge of diabetes has come from county and state agencies. The state, through voter-approved taxes on tobacco sales, has a “First 5” program that funds produce giveaways on the first Friday of every month, and helps support programs providing nutritional advice and support to mothers of children under the age of 5. The Ventura County Health Care Agency (VCHCA) has backed low-cost Zumba dance exercise programs popular with Latino women, as well as diabetes screening programs, a “Baby Friendly” hospital program for breast-feeding and mother-child bonding, and support for a community garden.

The federal government’s efforts, despite First Lady Michelle Obama’s well-publicized Let’s Move! program, have had less apparent impact. The VCHCA won a five-year million-dollar federal Community Transformation Grant, part of a $700 million effort launched nationally in 2010 by the CDC to balance the scales of health between richer and poorer towns, but the county lost that grant at the end of 2013 when the program was eliminated under pressure from Congress.

In 2010, as part of an omnibus new farm bill, the Department of Agriculture rewrote federal school lunch guidelines to require half a cup of vegetables and fruit per student per day. But according to Suzanne Lugotoff, who oversees nutrition programs for Ojai schools, the funding only gives an extra 6 cents per student per meal for those vegetables, out of a total food cost of $1.80, which makes it difficult to offer appealing choices.

Alondra Navarro, a senior at Santa Paula High School and a leader in a student-run group interested in bringing healthier foods to Santa Paula, said that Santa Paula High offers a salad bar and a sandwich bar, but both tend to be slow and messy. She said most students go for frozen pizza every day.  

“A majority choose the pizza, even though it’s on cardboard bread,” she said. “I would say about 60 [percent] to 65 percent.”

Navarro and her handful of fellow students allied with The Abundant Table, a Christian group that grows vegetables for schools around the county, and an activist group called CAUSE (Central Coast Alliance for a Sustainable Economy) to bring “vegetable of the month” demonstrations to the school.

They also won a small grant to research the possibility of a farmers market for fresh fruits and vegetables in Santa Paula. Ninety-seven percent of the residents they surveyed supported the idea.

Noah, who sees patients every workday at the Santa Paula Medical Clinic, has noticed an increasing awareness of the importance of diet in his patients, especially young people.

“I think there has been a change, even in the last five years, in Santa Paula,” he said. “I definitely see a difference in people’s awareness of diet and what they’re putting into their bodies, in terms of health and weight. I see it more in the younger generation.”

Speaking to the five city councilmen in Santa Paula on Aug. 18, Navarro spoke of “alarming” statistics reported by the VCHCA, that “Latinos were twice as likely [as Caucasians] to die of complications from obesity.” Pedro Gaxiola spoke of the help the group had received from city officials and local growers. The group concluded by saying that they have an idea for an immediate beginning — an informal farmer’s market offered at a popular Cruise Night for classic cars downtown on the first Friday of every month.

“Our main goal remains the same,” said Mireille Vargas, concluding for SESPEA, “to have an established, permanent and economically successful farmers market in Santa Paula. Who would like to join us?”

Mayor Richard Cook and all four city councilmen all but physically jumped at the chance, each pledging support, with numerous councilmen encouraging the students to call or write if they needed help.

After the unanimous “yes” vote, outside the council chambers the students and their supporters buzzed with excitement. Erynn Smith, of The Abundant Table, a mentor who first brought the numbers on obesity and diabetes to the students, beamed happily at their success.  

“[Those health numbers] created a sense of outrage and a desire to do something,” she said. “That means getting more fruits and vegetables into our community, and creating the support systems to keep us healthy,”   


Kit Stolz wrote this story while participating in the California Health Journalism Fellowship, a program of USC’s Annenberg School of Journalism.