It is a Saturday night, and Donna Mirabile is tucking her youngest son David into bed when he says the kind of thing that breaks a mother's heart. "Mom, I hate being an overweight kid," the 8-year-old tells her. "Kids at school tease me."
She offers a hug, words of encouragement and a promise that tomorrow they'll stock the refrigerator with his favorite fruits and vegetables. "This is the hardest thing I have had to do - take care of my own weight issues while helping my child avoid his genetic option towards obesity," Donna Mirabile says later.
This West Jordan family - Donna, husband Michael, sons David and 13-year-old Jonathan - are among families nationwide battling excessive weight caused by genetics, life- style, eating habits or some combination of these factors.
One in every four children in Utah age 5 to 14 is either overweight or at risk of becoming overweight. And many of these children have a parent who is overweight, too.
Consider this: More than 20 percent of Utahns in the "parenting age group" 35 to 44 are obese; more than 15 percent of those ages 25 to 34 are obese.
Having one obese parent can triple the odds a child will struggle with weight as an adult. But more than genetics is at work here: Like their parents, children consume too much sugar, fried and refined foods and don't get as much exercise as they need.
The extra pounds kids pack on bring a host of health problems once largely the bane of adults: Type 2 diabetes, high blood pressure, sleep apnea, liver disease and cardiovascular disease - problems that are likely to also plague them as adults if they can't get their weight under control.
Health officials believe that is one reason obesity is likely to soon replace cigarette smoking as the leading cause of preventable death.
"This is perhaps the first generation that is unlikely to live longer than their parents," said Margaret Braae, an outpatient dietitian at Primary Children's Medical Center in Salt Lake City.
Just as damaging, according to the American Academy of Pediatrics, is the social stigma that brands overweight children.
All of this has parents like the Mirabiles scared, even as they confront their own weight-related health issues.
Donna Mirabile, 44, weighs 345 pounds and has been told she needs to lose 190 to 200 pounds if she wants to see her sons reach adulthood. A more immediate goal: to fit into an amusement ride during the family vacation in San Diego next summer.
"It's just going to have to be an entire lifestyle change," she says.
The obstacles - from genetics to health conditions and the family's habits - are sizable.
Mirabile, who works at Salt Lake Community College, has polycystic ovary syndrome, which contributes to her weight problem. Her mother is obese and her grandmother weighed 550 pounds when she died.
Husband Michael, a former software engineer for Intel, took a disability retirement after being diagnosed with chronic fatigue syndrome in 2000. His condition contributes to the family's challenges in staying active, as well as his own weight creep.
"I'd probably feel better if I lost weight," Michael Mirabile says. But, "I have to be really careful because it doesn't take much [exercise] for me to overdo it."
For the Mirabiles, food has often served as a stress reliever, too.
"There was no problem so big a doughnut couldn't make it better," Donna Mirabile says.
Three years ago, Donna Mirabile managed to get down to 317 pounds with the help of a friend who put her through a five-times a week exercise program. She fell off the routine, though, and her diabetes surged.
And worse, David began to put on weight. A third-grader, David is 4 feet, 9 inches tall and weighs around 118; that gives him a Body Mass Index of 25.5, greater than the 97th percentile for his age group.
In July, a family physician suggested the Mirabiles enroll in the Family Food Fitness Class at Primary Children's. After balking at its $150 cost, the Mirabiles signed up.
"I knew I wasn't going to be able to do it without everybody else's help and Weight Watchers won't take children under 10," Donna Mirabile says.
Offered three times a year, the six-week program brings families together for two hours each week to learn, hands-on, about healthy eating and exercise.
Those two things, not dieting, are what helps kids achieve normal weight, experts say.
"In general, we want kids not to lose weight, but to gain height and prevent [additional] weight gain," says Karen Ortiz, a pediatrician at the University of Utah's Health Sciences Center who specializes in childhood weight issues. "We do want them to change their way of eating, but we don't want to reduce calories beyond the point . . . they prevent proper nutrition and growth.
Or trigger an eating disorder or psychological hang-up with food.
Experts say that family involvement is the best way to achieve success - for both child and parent.
"Where we come from, it's not just the child's issue," says Braae, the dietitian. "In most families it is not just the child who needs to improve their diet."
Heidi Dickman of Salt Lake City had come to that conclusion when she signed up her family for the Family Food Fitness class after seeing a flier at her pediatrician's office.
Of her three children, one child's baby fat has turned into pudginess and that - coupled with the child's constant eating - prompted Dickman to seek help.
"I wanted to get on top of it while [the child] is still young and be aware of it as a family," Dickman says. "It's made everybody more aware of what our eating habits were and how to change those."
As it is, most families don't give a lot of thought to what, how and when they eat.
They have no idea how much sugar is in the can of soda pop (10 teaspoons) consumed with many meals or even how many fruits and vegetables they eat in a day.
Braae has found that some clients who keep a three-day food diary don't eat a single fruit or vegetable in that time span - and french fries, a fast-food staple, don't count.
"That's a big problem," Braae says. "I'm looking at everything other than fried potatoes. I'm looking for corn, peas, broccoli and cauliflower."
Braae blames the grind of daily life for sabotaging the family diet. "It is easy to cook up tomato sauce, some noodles and there's dinner," she says. Many families settle for a bagged dinner at a fast-food joint.
And many families eat together infrequently, which the pediatrics association says is contributes to lower consumption of fruits and vegetables.
The work/family crunch also affects physical activity. Many latch-key kids are told to stay inside after school, where it is "safe." So they plunk down with a video game or in front of the TV.
A majority of the advertisements that run during those afternoon and Saturday morning programs tout sugary cereals, processed fruit snacks, candies and fast-food restaurants.
Braae says research has shown the more television a child watches, the more likely he or she is to be overweight; some studies indicate the odds are even higher if the child has a TV in his or her bedroom.
"We like to limit children to 30 to 60 minutes of 'screen time' a day," Braae says, "which sometimes is hopelessly unrealistic."
Getting families to pay attention to their eating habits is a struggle, too - and for now, there is little evidence that time pressures on families will ease or that people are making healthier food choices.
"It is hard to be optimistic that things are going to get better," Braae says.
Only five of the 22 families on a waiting list for the most recent Family Food Fitness class ended up attending the class; McKay-Dee Hospital in Ogden, canceled its initial class, slated to start in October, after only one family signed up.
But health experts believe most parents are motivated to do whatever it takes to help their children overcome weight problems.
"It's a cruel world out there," Dickman says. "You are a lot more conscious when it's your kids."
Listen to David Mirabile: "It makes me feel kind of sad, pretty mad," he says of the teasing he gets from older kids at school. "I can't run as fast and kids have been teasing me about that."
For his parents, it's a comment that brings back painful memories of their own (both experienced weight issues during childhood) and a hardened resolve to adopt a healthier lifestyle.
Using tools learned in the Family Food Fitness class, the Mirabiles are trying to exercise more - they've just bought Leki Nordic Walking Poles as an incentive to get active - and eat better.
Mom, Dad and boys pay attention to food labels, rely on the traffic light guide to foods (for example, green: an apple; yellow: canned applesauce; red: apple fritter) and offer each other support. And it is paying off: Donna has lost 7 pounds; Jonathan, 5 pounds; Michael 3 pounds, and David is holding steady.
"I think it's a good thing and we all need to work at it," says Jonathan. "I don't want Mom to die."
Says Donna Mirabile: "We're pretty determined. We're putting exercise and diet first because otherwise it won't get done. We're hoping to make lifestyle changes that are with us a long, long time."
BY THE NUMBERS
Percentage of Utah children between the ages of 5 and 14 who were overweight or at risk of being overweight
Percentage of Utah kids who were obese
Percentage increase in third-grade boys in Utah who were at-risk of being or were overweight between 1994 and 2002
Percentage increase in third-grade girls in Utah who were at-risk of being or were overweight between 1994 and 2002
Source: Utah Department of Health; National Health and Nutrition Examination Survey, 1999-2002