Walk into 6-year-old Rachel Freedman's room and all you see -- everywhere -- is pink. She shows off her stuffed animals, costume jewelry and an American Girl doll. Then Rachel takes her favorite dress from her closet and twirls it around.
"I wear it for parties! It looks like flowers and purple hearts. We found it online," she says.
Online, because Rachel has stopped shopping in malls. She's 98 pounds. To put it in perspective, she's more than twice the size of the average American 6-year-old. Typically, a child's age corresponds with his or her clothing size, but Rachel's mother, Lois Freedman, says that the guideline doesn't mean much. When Rachel was 4, she was wearing a size 10. At 6, she's wearing a size 14.
"She's wearing clothes that an adolescent or a tween would wear," Ms. Freedman says. "So it's tight or riding on her backside. Things with a push-up bra built in. You don't want your 6-year-old in that."
When Rachel was just 18 months old, her parents, Lois and Bob Freedman, knew she had a serious problem. But they didn't understand what was wrong. All medical conditions traditionally associated with obesity were ruled out, and they fed her exactly what they fed her brother Stephen when he was her age. His weight is normal.
"We went to the pediatrician and expressed concern and the answer was, 'Well, she's just fat,'" says Ms. Freedman.
Adds her husband: "We were told cut out whole milk, go to skim. That's it! That's all we were told."
As she got older, they tried to restrict her food intake by saying "no second helpings". They resorted to sneaking food to Stephen -- who is three years older -- after Rachel was in bed, because at the dinner table when their son asked for more, Rachel would get upset.
"And we try to explain to her, he's older, he's growing, he needs more food. And her response is, 'I'm hungry too'," says Ms. Freedman. "It's heartbreaking."
Since then, it's been a nearly four-year journey to learn how to manage Rachel's weight as a family.
It's almost mealtime. Mr. Freedman adds broccoli, carrots, mushrooms and onions to the pasta sauce they are serving over baked squash. "Two years ago this meal would have been using white pasta, not adding anything to the sauce unless we had ground meat, and serving garlic bread," his wife says.
"You don't want them to have that in their head, 'If I'm good, I eat. If I'm not, I don't.'"
Now they eat -- as she puts it -– "whole grain everything", and keep a family food diary. A nutritionist told them genetics probably plays a large part in Rachel's weight. Neither parent is obese, but Mr. Freedman has been asked to lose 20 pounds. The Freedmans have learned several strategies around eating.
According to Ms. Freedman, "the rule now is Mom and Dad decide what to put on your plate and you decide what to eat."
Italian ices have replaced ice cream, and dessert is just once a week now. If Rachel or Stephen is offered treats at someone's birthday, they have rules to follow. "I ask for a bag and I put it in my backpack and I bring it home for a Silly Band," says Rachel.
"We trade candy in for either a Silly Band or a Japanese eraser," says Ms. Freedman. "And in the summer Rachel did so good she got a [Nintendo] DS game!"
Sometimes, just so their children don't feel left out, they'll make a gingerbread house or bake cookies, but there is strict rationing.
"You want them to have that experience. But they get to try one each and we get rid of them," says Ms. Freedman. It may work for Rachel's weight struggle, but the tactic promotes another ethic that Mr. Freedman can have a hard time swallowing. "For me that's tough," he says. "Throwing away food is tough."
The Freedman parents can control what happens inside the home, but even a simple dinner with family or friends can mean ruffled feathers. "Let's say a family member makes something and we say, 'No, sorry,'" says Mr. Freedman. "Their feelings do get hurt."
They're trying very hard to separate food from positive and negative connotations. "We don't use food to reward, don't take food away to punish. You shouldn't send your kids to bed without supper if they misbehave," says Ms. Freedman. "Choose another consequence. You don't want them to have that in their head, 'If I'm good, I eat. If I'm not, I don't.'"
Changing that paradigm within their family "is a struggle," adds Mr. Freedman, "because it goes against the norms of American society."
The Freedmans are both college-educated, but still find it incredibly hard to find fitness resources for a girl Rachel's age. She's too young for cardio classes at the gym. And a recent summer camp they picked for its fun activities turned out to be a problem rather than a solution.
"Their camp throws candy at them for dancing well, throws candy at them for performing well. It's awful," says Mr. Freedman.
"It's amazing when you truly think about it as parents," adds Ms. Freedman, "not knowing all the opportunities that your kids have to buy food and all the wrong kinds of food."
Now, Rachel takes taekwondo and swim classes and the family goes on long walks together.
The Freedmans try not to dwell on what they call "the two wasted years" it took them to get their insurance company to pay for visits to a specialized nutritionist. Or the children who tease Rachel saying she "takes up too much space". Or how all this attention on their daughter might have affected their smart and funny son.
But late at night when it's quiet, Ms. Freedman can't help but lie awake wondering what she did wrong. She knows that people are quick to blame overweight kids' parents, especially their mothers. She's heard it all.
"'You must have been feeding her, or giving her a bottle all the time to keep her quiet,'" says Lois. "That was from the pediatric endocrinologist. So it was very apparent we were being blamed."
"I love Rachel the way she is," she adds. "But I mean, it would take a pretty sick person to want your child to go through such pain in every aspect of her life."
Rachel's weight gain has slowed down but not stabilized. Mr. Freedman says when Rachel steps on the scale every Monday they remind themselves the numbers are a just a guideline.
"Because we'd go crazy we'd be so worried," he says. "It reminds us to just keep trying."
This is part one of a five-part series on childhood obesity in America from WAMU 88.5 News.