a growing problem in both Napa County and California

Shoveling compost, tearing out old vegetable plants and assembling a new garden bed, a group of seventh and eighth graders at Redwood Middle School spend part of their Thursday afternoon working in the campus garden. The students were getting ready to grow new food — and hopefully — healthy food habits.

Redwood’s garden, located in a sunny area between two buildings at the school, is one way the Napa Valley Unified School District is exploring different ways to integrate gardens and garden-based nutrition into its curriculum.

“When students plant the seed, care for the growing plant, harvest the fruits of their labor, and then see these items on their school lunch menus and at home, we hope they will be more likely to select them,” to eat, said Karen Fleming, an environmental science teacher and garden coordinator at Napa Valley Unified School District.

“One of the most important things is getting students connected with the outdoors,” in ways they may not have access to at home, said Redwood Middle School Principal Peter Hartnack. “It’s never going to be something where you can just say ‘this will solve childhood obesity,’ but giving them the tools to have conversations with themselves and their peers and their families,” is part of the solution, he said.

“I think growing up with healthy foods is way better than just introducing them,” to kids all of a sudden and expecting them to instantly love vegetables, said Marina Holman, a Redwood Middle School seventh grader. “It’s easier to grow to like them,” a bit at a time.

Even with this school garden program and other wellness initiatives in both the state and county, the fact is that obesity rates for Napa County fifth, seventh and ninth graders continue to rise.

According to the most recent California Department of Education data, an average of 38.9% of fifth, seventh and ninth graders in Napa County were overweight or obese in 2019. In 2014, that rate was 34.4%.

Neighboring Napa Valley counties reported similar results. A total of 42% of Solano County fifth, seventh and ninth graders are considered obese and 42.4% in Lake County. Sonoma County beat Napa County with an obesity rate of 39.1%.

Yet even with more than a third of students affected, Napa County’s youth fared slightly better than the state as a whole.

An average of 39.7% of California fifth, seventh and ninth graders were considered overweight or obese in 2019. In 2014, that rate was 38.2%.

On the other hand, for younger children in the state, the trend has improved. The Centers for Disease Control and Prevention reported that in 2018 at total of 15.8% of California kids ages 2 to 4 who were enrolled in Women Infants and Children programs were obese. In 2010, that number was 18.4%.

“It certainly is a serious problem in our country that continues to worsen,” said retired Napa pediatrician Victoria Morgese. “And the pandemic made it much worse — I saw it with my own eyes.”

Children with obesity are more likely to have type 2 diabetes, risk factors for heart disease such as high blood pressure and high cholesterol, muscle and joint problems, and fatty liver disease, said the CDC website.

The COVID pandemic definitely didn’t help childhood obesity rates.

A study including children ages 2 to 19, from all 50 states, found the rate of body mass index (BMI) increase nearly doubled during the COVID-19 pandemic, said the CDC.

This faster increase was most pronounced in children with overweight or obesity and younger school-aged children, the agency reported.

“I’m not terribly surprised,” said Karen Relucio, Napa County deputy director of public health. Most kids get much of their physical activity while at school and from food they eat at school, “especially our low-income kids,” she said.

When COVID hit and schools went virtual, that all changed. Physical education and sports were unavailable or dramatically reduced. “That definitely had an impact on physical activity,” she noted.

Restaurant dining also changed dramatically, she noted. When most restaurants had to shut down or curtail operations, that left “fast food” as less expensive meal options. And those fast food companies could more quickly pivot to take-out service.

And if a parent wasn’t working due to the pandemic, that loss of income meant looking for cheaper and easier food sources, leading to more fast food meals.

In one step to help combat childhood obesity, the state created a program called Let’s Get Healthy California.

The goal is to provide “an ongoing statewide collaborative and systematic approach for assessing and monitoring the health status of California, identifying and prioritizing opportunities for health improvement, and promoting collective action towards comprehensive solutions that address the root causes of California’s toughest health challenges,” said Ron Owens, a spokesman for the California Department of Public Health.

As with the rest of the nation, California saw consistent increases in childhood obesity from the early 1970s, noted Owens.

Between 2013 and 2017, obesity rates appeared consistent between among fifth, seventh and ninth grade students.

However, there are consistent disparities in obesity rates among racial and ethnic groups. Year-over-year, obesity rates among Native Hawaiian and Pacific Islanders are the highest in the state, followed by Latino, American Indian and Alaskan Native, and African American youth.

In Napa County, as of 2019, obesity rates among Latino youth averaged 46.8%. Obesity rates for Filipino youth averaged 34.6% and white youth averaged 26.8%.

Owens explained that the California Department of Public Health provides funding to 60 local health departments in California to implement evidence-based obesity prevention strategies for adults and children as part of CalFresh Healthy Living, funded by the United States Department of Agriculture’s Supplemental Nutrition Assistance Program.

“These strategies include nutrition and physical activity education for people with lower incomes, along with strategies to create policies and environments to make healthy choices available and easily accessible in communities,” he wrote.

Some examples include “working with schools to change the cafeteria environment to promote healthy eating or to develop safe routes to schools; working with local planning departments towards new or improved walking and biking trails; and developing school and community gardens,” he wrote.

“The best approaches to reduce childhood obesity involve working at multiple levels and among multiple sectors, that is, working not only with individuals and families, but with schools, the food industry, community design, and local and state policy makers to make healthy food and physical activity opportunities available to all Californians,” wrote Owens.

Relucio noted that Napa County utilizes a number of programs to help fight childhood obesity.

The Women Infants and Children Farmers’ Market Nutrition Program provides support including booklets of “checks” to eligible recipients for use at WIC-authorized farmers’ markets and farm/roadside stands between May and November of each year.

CalFresh Healthy Living supports healthy, active and nourished lifestyles by teaching Californians about good nutrition and how to stretch their food dollars, while also building partnerships in communities to make the healthy choice, the easy choice. It provides a debit card that can be used at major grocery stores like Trader Joe’s and to order groceries online.

Napa County’s Health and Human Services, OLE Health and other agencies offer free produce markets on selected days of the month.

ParkRx, a multi-sector group representing public land agencies, healthcare providers and community partners, works to encourage residents to utilize parks, trails, and open spaces to reduce chronic disease and address health equity.

“We’re seeing more children with chronic medical conditions — such as diabetes — at a younger age,” said Relucio. Those children can then become adult diabetics. Childhood obesity can lead to more people with heart disease or at risk of stroke.

In addition to quality of life, such illnesses “massively impact” health care costs, she said.

The pandemic “has really done a number on childhood obesity,” said Allison Crisp, pediatric medical director at OLE Health.

“Lack of structure, lack of opportunities to get fresh air and proximity to food all lend themselves to the perfect storm of weight gain,” the doctor said.

She witnessed it personally.

“It was disappointing to see the rapid weight gain when kids came back into the office for their checkups and see such a drastic change in their growth charts,” she said.

Anecdotally, between 2020 and 2021, Crisp noted weight changes upwards of 20 lbs. for school-aged children and adolescents.

Between 2020 and 2021, “I had three or four new type 2 diabetes diagnoses, which is more than I had in my entire five years in OLE.” 

Healthy children make healthy adults, said Crisp. And if those adults have increased healthcare costs because of increasing rates of diabetes or hypertension or stroke, “this not only costs our society literal dollars but it costs our workforce (and) an emotional toll,” she said.

Two other concerns also worry her.

One is that food is only going to become more expensive, and that will impact those with fewer resources and access to healthy, nourishing food.

Secondly, she’s also concerned about normalizing obesity. “I have more parents with kiddos who are healthy weights … and the parents think they are too thin,” especially when compared to the growing number of obese children around them.

Morgese, a longtime Napa pediatrician, said that well baby and child checks include plotting height and weight measurements on a growth chart. As she charted the change, “I could see some escalating from overweight to obese, or normal to overweight.” She found herself diagnosing young children with high blood pressure and screening them for diabetes.

It’s not the child’s fault, she said. “They have to eat.” And no parent wants to hear they aren’t feeding their children the right foods. “It’s a very sensitive issue.”

Yes, during the pandemic, kids lived more sedentary lives, she said. “But the bigger part is what they are eating,” and how much of it.

“It all comes down what they have access too,” at home and at school.

Morgese fears for the future of those children. They will suffer from life-ending diseases, she said. “Their lifespans are going to be shorter.” And health care costs for everyone will continue to rise.

Monica Covarrubias is a community health investment leader at Napa’s Queen of the Valley Medical Center who works directly on programs associated with childhood health and obesity.

Covarrubias noted that the Queen created a program called Healthy for Life to address those issues.

It includes initiatives such as Cooking Matters, which helps provide education on how to cook healthy on a low budget and nutrition and hands-on cooking. A perinatal program focuses on supporting women who breastfeed or bottle feed. Another initiative, Rethink Your Drink, aims to educate people about sugary drinks and alternatives.

“We know health behaviors like lack of exercise and access to healthy foods affect our children,” Covarrubias said. “That ends up affecting their length and quality of their lives. It puts them at risk for increased disease in the future,” including diabetes, joint problems and cardiovascular issues.

During the pandemic, as access to food and mental health care rose to crisis levels, “Obesity kind of took a little bit of a backseat, but we know it’s a problem and it continues to rise,” Covarrubias said.

“We must continue to push for healthier options in our schools and workplaces. We as adults need to guide our children. We need to understand that changing behavior is hard but by doing things in small steps we have a higher rate of success.”