Dr. Yolandra Hancock used to be an elementary school teacher, and it shows. She's patient, encouraging, and has an endearing way of ending her sentences with "my love" and "my sweet."
Today, she's examining 7-year-old Willie Allen. He's of average height but weighs 136 pounds. What's most worrisome, however, is that he suffers from chest pains.
"Willy's blood pressure today is 132/77," says Hancock. "Plus the fact we've had ongoing concerns about his chest pain, it's time to take him back to the cardiologist."
Willie's younger brother Kenny is obese as well. He's 5 years old and weighs 105 pounds. Sitting in Hancock’s office, their parents, Renee and D'wayne Allen, say they have several family members who are large. But they didn't think much of it until recently, when Mr. Allen's niece died of a heart attack. She was 25.
Shortly after, Ms. Allen says she had a dream about her four children. In her dream, her children died in their sleep because of their weight.
"When I checked on their breathing, they were dead," she says of the dream. "I found them dead."
Hancock says this acceptance was a radical shift from when the family first came to see her.
"Weight wasn't a concern for their children, and the children were morbidly obese when we met five years ago," recalls Hancock. "The 2-year-old was barely able to walk. And when I attributed it to weight, his parents were convinced he had some sort of bone disorder."
Both boys don't walk as much as shuffle slowly because their feet hurt so much. During the examination, Willie says it hurts when Hancock touches his swollen toes.
There was a three year wait for children at I.D.E.A.L. clinic's Spring Valley location in Northwest D.C., so they opened a second one in Southeast. Patients at the new office include a 13-year-old who is 400 pounds, a child whose teeth are so rotted from her diet she can't bite into carrots, and many others who are diabetic.
Willie has been gaining approximately four pounds per month. He misses a lot of school because of his health issues, which include stomach pain, sleep apnea and asthma. When Willie is able to attend school, Ms. Allen says he finds it difficult to climb the stairs to get to his class on the third floor.
His teachers complain, saying her son needs to physically "pick up the pace," and she wonders how to talk to them about her son's situation.
"There's no need for him to be sent home because his joints hurt," says Hancock. "His joints are going to hurt because he weighs more than his frame can comfortably carry." She makes a note. It's one of several issues she'll bring up with school officials. Another item on the list is Willie's frequent bathroom breaks, which has been a recurring issue in the past.
"Because he has such a large abdomen, it puts pressure on the bladder, which means he has to use the restroom more often," says Hancock. "Every six months I have to write a letter on letterhead requesting he be allowed to use the restroom on demand."
Even with Hancock's intervention, Willie still has an uphill battle in school. He's constantly in trouble for fighting in class, something that's hard to believe as he sits in the doctor's office, cuddling his baby sister and gently kissing her soft cheeks while she's sleeping.
"I hit them because they called me fat, big boy," Willie says. "They told me my pants, my clothes was too big."
Wille's younger brother Kenny pipes up to say he fights too. "Cause I don't get to go to recess," explains Kenny.
After a little probing, Hancock figures out what's happening.
"Oh, so if you don't finish your work, your teacher won't let you go to recess and the kids think that's funny," she says to Kenny. "And then you get upset? Well I'm going to have to talk to your and Willie's teacher because taking recess away is not the appropriate way to punish kids."
Hancock says she often calls schools because her patients are teased. One 7-year-old patient told her she didn't want to live anymore –- not just go to school –- but live anymore.
While she is petite, Hancock says she has family members who have struggled with complications from obesity, and she understands how important it is to involve the whole family in making changes and celebrating successes.
And Ms. Allen has made changes. The family goes on walks when the weather is nice. Chicken is now baked instead of deep-fried, and she's cut back to just one meal per week at McDonald's.
"I've gone from burgers to nuggets and from fries to apples," says Renee.
On this visit, Hancock sees the Allen family for more than an hour and a half. (Bear in mind, an average pediatric appointment is 15 minutes.) She's asked them to bring in some of the food they eat to explain what the nutrition labels mean. During their last visit, Hancock discussed calories with them.
"Don't look at trans fats and saturated fats; that's all too complicated," Hancock explains. "Look at the sugar. Remember 5 grams is about one spoon of sugar. Does that sound like it could work for you, my love?"
Hancock painstakingly goes through every item. She then asks the family to individually think of small goals and sign a promise. Kenny says he'll eat greens, although with a little questioning, the physician realizes he’s trying to pull a fast one.
"How many times are you going to eat greens?" she asks him. "One," he says. Turns out, he’s already been eating them twice a week.
"You're going to eat them less? You're supposed to eat them more!" she says. "You're going to finish your greens is that what I'm hearing?"
As Kenny signs the piece of paper, Hancock stops.
"Why do I see cookies in your teeth?" she asked. “Did you sneak you some Oreos? You weren't supposed to eat the demonstration!"
It isn't just him. As they pack up to leave, Hancock notices all the unhealthy food has been opened. Ms. Allen is eating the yogurt. Willie's eating the cheese and crackers, and the two girls are munching on the fruit snacks.
So given the fact that the Allens had no problem indulging right before her eyes, does Hancock really think she’s getting through?
"That thought certainly crosses my mind," says Hancock. "But the cheese crackers are much better than the cheeseburger that was in her purse before.
"That, in and of itself, is a reason to encourage her," she adds. "The next time I will say to them, 'My love, you made some excellent changes, but I need for you to understand how eating even that small amount can impact their health.'"
Nationally, approximately half of all families identified for specialized obesity programs drop out, according to Hancock. So she's encouraged the Allens keep coming back.
Besides, she says, change takes time. "It's baby steps. It has to be baby steps."
Hancock doesn't have time to get frustrated or dwell on the challenges of her job. She has another patient waiting to see her in the next room, and she's running late.
This is part three of a five-part series on childhood obesity in America from WAMU 88.5 News.