Principal Elizabeth Jacome leads kindergartners in 22 jumping jacks at Coronado K-8 School in the Amphitheater School District.

Tomatoes freshly picked from the Tucson High Magnet School's community garden.

Over the last decade, discussion about the importance of healthy eating at home and on school campuses, as well as the need to reduce screen time and increase physical activity amongst children has grown louder. 

However, across the country and here in Arizona, the percentage of adolescents with obesity has steadily risen, with 15.5% of those ninth- through 12th-graders considered obese in 2019 nationally, up from 11.8% in 2009; and 13.3% falling into that category in Arizona after getting down to the 11% range over the last few years. 

Despite federally-funded programming aimed at battling childhood obesity, access to nutritious foods, poverty, and limited resources in schools impacting physical education continue to contribute to the health crisis. 

Dr. Nicole Person-Rennell, medical director of the University of Arizona Mobile Health Program in Tucson, travels in a mobile clinic and examines medically uninsured families while the recreational vehicle is parked in lots at churches, schools and community centers. She also sees insured families at Abrams-El Rio Health Center at Banner - University Medical Center South, 3950 S. Country Club Road.

"I see my share of healthy kids, but I have noticed an increase in my practice of children who are struggling with weight. Parents struggling with obesity are much more likely to have children with obesity," says the doctor. "Kids will get the food parents or families have, and I say a quarter to a third of the kids I see are struggling with weight."

She recalled a 6-year-old Latino boy who was 25 pounds overweight. Having viewed him as a typical child, much like those around him, his parents were stunned to hear the news. 

The boy's mother stays home, caring for her 3-year-old who doesn't have a weight issue, and an elderly relative. His dad works construction. 

With a diet that consists of too much refined or processed carbohydrates, both parents are also obese. Rice, potatoes and flour tortillas are main staples. Another favorite is fried beef tacos and refried beans with lard. Favorite snacks include the popular Takis, a Mexican brand spicy and crunchy rolled tortilla chip, and Flamin' Hot Cheetos. 

Similiarly, an 8-year-old white girl who is 15 pounds overweight has two working parents. She frequently eats fast food meals and munches on chips and sweets. White bread and rice, pastas and potatoes are also eaten frequently, and soda is the favorite drink.

Both children's parents said they would take note of the meals and snacks, and would change the daily diets toward more fruits and vegetables, chicken, meat and fish. They also plan on doing physical activity as a family — be it walking in the neighborhood or going to a park. They will work on cutting soda to once a week, and instead work more at drinking water. Their children's screen time watching television, playing video and computer games will also be swapped for more physical activity. 

Obesity among children, teens and their parents is an increasing health issue that surfaced decades ago, and the chronic condition across the nation and in Arizona is sobering. Obesity increases the risk of heart disease, diabetes and some cancers.

Among its work in dealing with obesity, the Arizona Department of Health Services is administering AZ Health Zone, a nutrition education and obesity prevention program funded by the federal Department of Agriculture Food and Nutrition Service. The state health department receives $13.8 million for the program, and works with 50 community partners across Arizona. This includes the UA's program, which has 110 partners and 31 sites in Pima County where nutrition programs encourage healthy eating and physical activity for wellness. The UA receives $1.2 million for its health zone.

To improve the health of more Arizonans, disparities in public health must be eliminated so individuals can get access to physical fitness opportunities and medical care, says Carla Berg, state deputy director for public health services.

"Our health programs work to help families meet their goals, and community health assessments at the local and county levels identify the best practices, which are shared to further strengthen areas in our state. There are key pieces to increase better outcomes. We need to ensure we have partners at the table to reflect and support our communities," Berg says. 

The UA zone team works with Amphitheater, Sunnyside and Marana school districts, Catholic schools in the Diocese of Tucson, and Mexicayotl Academy of Excellence, a charter school, says Brenda Picasso, program coordinator for AZ Health Zone Cooperative Extension-Nutritional Sciences at the UA. In addition to students, the team works with parents, caregivers and teachers in workshops. Since 2005, more than 10,000 have participated in activities in the county.    

Kindergartners jump on one leg while playing "Simon Says" during a break from class at Holladay Magnet Elementary School in the Tucson Unified School District.

Sabrina Plattner, health educator for the UA Department of Health Promotion Sciences at the Mel and Enid Zuckerman College of Public Health, teaches courses on childhood obesity prevention to university students majoring in nutrition and public health, and has worked with kindergarteners up to 12th-graders teaching the importance of nutrition and physical activity for health wellness.

"We spent decades creating the obesity problem. It is not going to be a quick fix. We have seen increments of improvements, including healthier school meals and exercise initiatives, including former First Lady Michelle Obama's 'Let's Move!' initiative in 2010," says Plattner. "I am hoping that my children's generation has better health outcomes then my generation."

Plattner is also co-chair of Activate Tucson, a community coalition that since 2004 has worked with the College of Public Health promoting healthy lifestyles, physical activity during recess in public schools, and community gardens. The organization also has advocated for improved streets with lighting, pedestrian walkways, bicycle paths, jogging and walking trails and renovated parks. Activate Tucson is comprised of community leaders, government officials, educators, business owners, physicians, and representatives from the county health department.

"We must keep in mind that there are other challenges that we must overcome, specifically the challenge of poverty that has the biggest impact on our children's ability to be healthy," says Annemarie Medina, co-chair of Activate Tucson and director of corporate and community relations for UA Health Sciences. "We must not stop working toward our goals of providing our children with every opportunity to be active, healthy, happy and safe. We will continue advocating for our schools, working with parents, working with our legislators to ensure our policies and systems support children's abilities to lead a healthy lifestyle."  

Affording nutritious foods can be a real struggle, especially for families who have tight food budgets and must make their dollars stretch, says Person-Rennell. "This is where buying potatoes, pasta and rice is much cheaper than meat, chicken and vegetables," she says.

According to the Arizona Department of Health Services, the state receives $38.7 million for WIC, and Pima County is allocated $2 million a year.

WIC is a federal program for health care and nutrition of low-income pregnant women, breastfeeding women, and children under age 5. In Arizona, 13.1% of 2- to 4-year-olds in the WIC program are obese, according to 2020 data.

"There are 10,250 participants in the county, but there is a significant number of eligible families who are not participating in the program," says Monica Nicholas, manager of the WIC program for Pima County Health Department.

More outreach must be done to get the word out about eligibility, says Nicholas, adding that the county passes information to pediatricians, OB/GYN doctors, and Head Start, a program that promotes the school readiness of infants, toddlers and preschool-aged children from at risk families.

Obesity in WIC children has decreased across the state from 16% in 2010, says Nicholas. Educating families about nutrition and exercise, and additional funding for families to purchase fruits and vegetables this federal fiscal year, which ends this month, aided parents dealing with stress because of food and job insecurities. WIC officials are waiting to see if Congress extends the funding to help pay for healthy meals, Nicholas says.   

For school-age children, Tucson Unified School District, the largest school district in the Tucson area, and Sunnyside Unified School District, the second largest district, operate the National Breakfast and Lunch Program for school meals, following federal mandatory guidelines to provide free or reduced-price meals to families in need.

"There has been lots of attention over the past decades for nutritional meals, and school meals are better than what mom packs from home because the foods are low grain, low sodium and there is close attention paid to added sugar in the foods," says Lindsay Aguilar, a nutritionist and director of food services for TUSD. She said the district's wellness policy includes that the food services department staff monitor foods sold for fundraising and items in vending machines to make sure they meet the nutritional guidelines.

"We have a food literacy program to teach students the full A to Z spectrum about vitamins and nutrients. We have culinary meal kits that feature a local grown item in a school garden or local farm, and it includes a recipe that students can make at home with their families," says Aguilar, adding that families can attend healthy cooking classes at the district's family resource centers. Of the 87 schools in the district, 60 qualify for free meals for students. The district serves about 25,000 meals a day.

Moses Thompson, associate director of the University of Arizona's Community and School Garden Program, picks tomatoes at the Tucson High Magnet School's community garden.

John Oakley, food services director for Sunnyside district, says all school cafeterias have salad bars loaded with fruits and vegetables. He says "82% of Sunnyside district students qualify for free or reduced meals" and the federal government reimburses the district $7 million annually for free and reduced breakfast and lunch programs at 21 schools. "What I see kids bringing in to eat would not be able to be on our menu," says Oakley, referring to Lunchables, processed foods high in fat and sodium, along with chips, candy and soda.  

This past year, the Arizona Department of Education made two contributions for physical health through a $3 million investment, using American Rescue Plan monies, to Valley of the Sun YMCA to provide memberships for youth and expand services for sports programs and diabetes prevention. The second investment was $2.8 million to Arizona State University Mary Lou Fulton Teachers College to implement Play On, an after-school physical education program at 14 schools in Mesa Public Schools, the largest school district in the state. The after-school programs will include snacks and hot meals for participants, says Melissa Conner, associate superintendent of health and nutrition services for the state education department.   

Teresa Mortara is a physical education teacher in the Sunnyside district where she has worked for 18 years. At Desert View High School, she teaches volleyball, basketball, tennis, weight training, low-aerobics and a walking class for sophomores on up to seniors. As a graduation requirement, high school students need one credit of P.E. and half a credit of health. She said the majority of students take additional P.E. classes as electives, and she sees those struggling with weight working hard to burn off the pounds.

She says she cannot emphasize strongly enough the importance of physical activity for a child's health. When she teaches her students about exercise, she encourages them to pass on their knowledge to their families and work to make exercise a way of life.

In TUSD, Jaime Bly Bernier, a professional development academic trainer for physical education and health in grades K-12, says over the years, district budgets were slashed and today, there is a handful of full-time and part-time P.E. teachers in elementary schools. Classroom teachers are filling in and doing what they can, but it is difficult for many to teach structured and skill based lessons and tie it to the importance of health and movement, explains Bernier. Some schools are hiring instructional specialists to teach P.E. classes, and other schools are sharing physical education teachers. 

As a health educator, Sabrina Plattner teaches courses on childhood obesity prevention to university students majoring in nutrition and public health for the University of Arizona Department of Health Promotion Sciences. She has worked with kindergarten students up to 12th-graders teaching the importance of nutrition and physical activity for health wellness. Plattner is also the co-chair of Activate Tucson, a community coalition that since 2004 has worked with the College of Public Health promoting healthy lifestyles, physical activity during recess in public schools, and community gardens. Video courtesy Sabrina Plattner.

Dr. Nicole Person-Rennell, medical director of the University of Arizona Mobile Health Program, is seeing an increase in childhood and adolescent obesity.

Contact reporter Carmen Duarte at cduarte@tucson.com or on Twitter: @cduartestar

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