In her dreams, Danielle Puckett is thin, and life is better. She isn’t haunted by memories of relentless teasing, and she doesn’t struggle to lose weight, only to gain it back.

But reality invades the 18-year-old’s dreams, reminding her that she is 385 pounds and fighting high blood pressure, asthma, sleep apnea and low self-esteem. She usually wears sweatpants because size 32 jeans are hard to find.

“Some days I never want to get on a scale again,” said the 5-foot-4-inch Susquehanna Twp. resident. “It’s such a roller coaster of losing weight and gaining weight.”

As Danielle battles her weight, she struggles with the scars of childhood taunts — a daily occurrence that she says made her school life “a living hell” — and ongoing rude stares and remarks uttered within earshot when she walks through the mall.

“I think people don’t understand obesity. They think it’s my fault, and I should just lose weight. Well, it’s not that easy,” Danielle said. “I’d like to tell them, try putting yourself in my shoes and see how I feel.”

Childhood obesity has become a national hot-button issue, largely because its ramifications are so far reaching: An overweight child is 80 percent more likely to become an overweight or obese adult, which can lead to chronic, yet preventable, medical conditions that are costing $150 billion every year to treat.

Nationally, one in three children is overweight, and the number is increasing. New research from the National Institutes of Health reports that, among children age 10 to 17, the obesity rate grew from 14.8 percent in 2003 to 16.4 percent in 2007.

In Pennsylvania, it’s no different.

“The childhood obesity rates have tripled in this country in just 30 years, and Pennsylvania children are reflective of this national trend,” said state Secretary of Health Everette James. “If there’s something we can do across this state to impact our children, this is it. We’ll have a whole generation of healthier children to show for it.”

First Lady Michelle Obama is spearheading a campaign to solve the childhood obesity epidemic within a generation. She’s enlisting community leaders, teachers, doctors, schools and parents to join her in “Let’s Move,” an initiative designed to “give parents the support they need, provide healthier food in schools, help our kids to be more physically active, and make healthy, affordable food available in every part of our country.”

This is the first story in a four-part series examining the issue of childhood obesity. We’ll look at the importance of nutrition and exercise, and we’ll also see what schools are doing — some with grants from the state Department of Health’s Active Schools initiative or Highmark’s School Challenge — to get kids moving during the academic day.

However, through Danielle’s story, we’ll also see that obesity is much more than a national problem that’s impacting our health care system; it’s a deeply personal problem affecting our children’s emotional health. The root goes beyond poor nutrition or lack of exercise — it involves family dynamics, emotional struggles and generational habits.

“When I was 10, I began to realize I was fat. The teasing began, and I used to come home crying, and I’d tell my mom I was never going back to school,” said Danielle, who has been seeing a psychiatrist since age 13 for emotional problems she said were caused in part by the cruel remarks. “My mom told me to ignore them. I wanted to punch them, but I never did.”

Three years ago, with the hope of changing not just the number on the scale but her lifestyle, Danielle enrolled in the Penn State Milton S. Hershey Medical Center’s Pediatric Multidisciplinary Weight Management Program.

There, she and her mother, Dawn Keller, learn about the importance of nutrition and exercise for the whole family.

“My No. 1 rule is: Parents have to do it with the child. That takes a huge psychological pressure off the child,” said Dr. Ronald Williams, director of Hershey’s program. His mantra: Eat less and move more. It’s that simple. Doing it, however, is not.

“For those that do what I ask of them, there is success. More than 50 percent of the children I see will lose weight from their first visit to the next one, one to three months later. But keeping it up, making it a habit, is very hard,” he said. “There’s no magic bullet.”

The key, then, is prevention, Williams said. “The kids we need to be targeting now are the 5 and 6 year olds.”

Childhood obesity in Pa.

Obesity is defined as a generalized accumulation of body fat. By measuring a child’s height and weight, a body mass index is calculated, along with a percentile that compares a child’s BMI to his or her peers. A child is considered obese if he is significantly over the ideal weight for his height, with a BMI of greater than the 95th percentile.

“In Pennsylvania, we have more obese children than overweight children, so children are going right from being overweight to obesity,” Williams said.

That increase is apparent at Hershey’s weight program, which opened seven years ago for one half-day twice a month. Now, children are seen five half-days a week, and there’s a waiting list of about three months, Williams said. Twenty new obese children a week are being seen, he said.

“Thirty percent of the children I see have high blood pressure,” Williams said. “There’s also been an increase in Type 2 diabetes in children, sleep apnea, fatty liver, High cholesterol and Blount’s disease, or bow legs, related to obesity.”

Dr. James Mosher, a pediatrician with Jones, Daly, Coldren Associates in Camp Hill, said weight management comes up at least twice a day during his patient visits. “Seventy-five percent of parents at least have a clue why their child is overweight — maybe too much snacking or too much time playing video games — and many of them want suggestions on how to address it,” said Mosher, who deliberately builds in five minutes to each office visit to talk about weight issues if necessary.

With 70 percent to 80 percent of all health care expenditures spent on treating chronic diseases, many of which are related to obesity and therefore preventable, “we cannot afford not to address this issue,” Mosher said.

A solution requires buy-in from all players involved to communicate a uniform message to kids that a healthy lifestyle begins in childhood and becomes a way of life, experts said.

The causes of obesity

Research shows that the leading causes of childhood obesity are: availability of high-calorie snack foods, parents’ attitudes toward food or ignorance of healthy eating habits, increased consumption of fast foods, use of food as a reward, increased television watching or computer/video game playing, lack of regular exercise and heredity.

The common denominator is the home.

“Obesity is a family problem,” said Jacqueline B. Sallade, a licensed psychologist in Lewisburg. “Children learn from their parents that filling your plate to the brim and having seconds is a good thing. They learn to crave sweets because parents give that as a treat. We need early childhood training for smaller portions, fruits and vegetables as treats and limited sweets.”

Registered dietitian Diane Harris, who works at Holy Spirit Health Systems in Camp Hill, tells it straight to parents she works with: “Parents are responsible for what is purchased, how it is prepared and how it’s cooked.”

Midstate families want to address childhood weight issues, judging by the response to KidShape, a healthy lifestyles program that has had a waiting list since it was launched last fall.

“We require that at least one family member accompany the child, but the whole family has been coming,” said Barbara Terry, vice president for mission effectiveness at PinnacleHealth, which runs KidShape.

KidShape includes time with a mental health professional who talks with the kids about self-esteem because, Terry said, developing a positive self-image is another key for children to grow up healthy and hopeful for their future.

Danielle, who has kept her weight stable for a year and a half, said she hasn’t given up on her dreams, which include becoming a registered nurse. “It’s just going to take me a while to work toward them,” she said.

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