The MyActivity Pyramid handout is based on the 2005 Dietary Guidelines for Americans and MyPyramid.
Saquont'e Wilkinson usually skips school lunch, so by 3 p.m. he's hungry. Today, the 16-year-old is making instant noodles.
"I just eat them because it's tasty and it's quick," he says.
Saquont'e is 5-foot-5, and the last time he checked, he weighed 315 pounds. He says he's been big his whole life and is used to hurtful comments, but recently his girlfriend broke his heart.
"She was cheating on me," says Saquont'e. "I found out it was because of the weight. She would say stuff like, 'You're too fat to do this' or she 'doesn't go with fat people'. The sad thing about it was when I found out about her cheating on me, it was Valentine's Day."
Dealing with obesity as a teenager
Criticism from his girlfriend is the kind of thing that has made Saquont'e want to lose weight. It's what experts such as Eleanor Mackey, a clinical psychologist with Children's National Medical Center, call "the motivating factor." Mackey says that often, health concerns don't prompt teens to lose weight. Instead, for boys it's usually a desire to play sports, and for girls it's a longing to shop.
"That can be hard for a child who's obese," says Mackey. "One, they can't try on the same pretty dresses. Two, it can be exhausting to walk around the mall when you're carrying excess weight."
Saquont'e joined the football team. His face lights up when he talks about the drills.
"I started liking it more and more. I liked the teammates and support," he says. "It was hard work, don't get me wrong!"
Unfortunately, his time on the team was short-lived. "I was having a little trouble breathing after a practice, and the coaches were concerned," he explains. "They told me to go to the doctor. They said if I lost weight I can play again."
Doctors may need some education too
Even when obese children finally make it to the doctor's office, however, their physician might not have all the answers.
"Most physicians are up a tree when asked what to do about a heavy child," says Dr. Jack Yanovski, a pediatrician and researcher at the National Institutes of Health.
Many pediatricians haven't been trained to treat children who are 300 or 400 pounds, he says. A doctor might suggest exercise, but it isn't that simple.
"Because of their extra body weight, they reach their maximum exercise at an earlier stage," says Yanovski. "So that means for very heavy folks, exercise programs have to be designed to involve a very slow progressive rise in the amount of exercise so that they can learn to tolerate more and more physical activity."
Saquont'e's doctor told him the instant noodles he enjoys eating aren't healthy, but Saquont'e isn't sure why. He doesn't know the few mouthfuls he snacks on are 400 calories and more than 65 percent of his maximum daily salt intake.
In search of sustenance in D.C.'s 'food deserts'
What aggravates the situation further is that his healthy food options are limited because he lives in the District's Ward 7, which has been designated a food desert. With so few grocery stores selling fresh produce in the area, fruits and vegetables aren't easily accessible.
"If your choices are taking two or three buses and then paying someone $20 to get home to go to the grocery store versus a couple of dollars to eat in your own neighborhood, the choice is obvious for someone operating on a very limited budget," says Kristen Roberts with D.C. Hunger Solutions, the group that authored the food deserts study.
Roberts says many factors are calculated into a person's eating habits.
For instance, Ward 3 –- in Northwest, east of Rock Creek Park -- has 10 public schools and 11 grocery stores, while Ward 7 -– east of the Anacostia River, where Saquont'e lives -– has almost 40 public schools and only 4 grocery stores. What's his alternative? Well, within a one-mile radius of his home are two Chinese takeout eateries and three fast food restaurants -- a tempting alternative to purchasing fresh fruits and vegetables at an out-of-the-way grocery store.
Saquont'e admits when he goes to fast food restaurants, such as McDonald's, he'll try to order the biggest thing on the menu, like a Quarter Pounder with Cheese or a Big Mac.
"Some of the fast foods or any other food I get usually just fills me up and holds me through the night, or until my mom gets home," he says.
Neighborhoods can hinder exercise
Saquont'e knows on top of eating healthy foods he should be exercising as well. But he isn't sure how much, or what calories actually mean.
Saquont'e signed up for martial arts classes, but he had to take two buses and a train to get there so he stopped. And walking around his neighborhood after school isn't a safe option. Just a few months ago, there was a shooting right inside the apartment complex where he lives.
"A black van pulled up and just shot up this whole area trying to get this one person," says Saquont'e. "My mom was there but ran to the laundromat."
No one was killed, but people were hurt. Now, he stays indoors after school, either sleeping or playing video games. That's the reality for many children, but some groups are trying to provide more options.
Making the workout work
Approximately five miles south of Saquont'e's home in D.C.'s Ward 8, a dozen girls step dance -- a dance which involves elaborate footwork and handclaps.
Dr. Yolandra Hancock with Children's National Medical Center says it's perfect because the routine doesn't need a lot of space or any special props, so the students can practice at home. They burn approximately 300 calories a session.
"These exercises help to build your tolerance," says Hancock. "So that when you do a performance for 15 or 20 minutes, you're not winded. Part of it is encouraging them to engage in activities that they are passionate about."
Jayla Williams walks two blocks to her school. Other than that, this class is the only exercise she gets.
"You're working out a lot, and you're still having fun while you do it," says Jayla.
Hancock measures the girls' height, weight, and neck and arm circumference. Afterward, she makes a note of their pre and post sit-up and push-up tests. She does this to document their progress –- information that's needed as much for the students as it is for grant funders.
Sustaining grant funding is always a challenge. Hancock says the only community-based family weight loss program in Ward 8 ended last year because the funder changed priorities, despite the program being successful.
Seeking guidance, taking initiative
Many teenagers, including Saquont'e, who want to make the effort to live healthier lifestyles, are on their own. He says he could use some guidance, "someone who could tell me what's not healthy or prepare food so I know how much to eat or someone to play with on weekends."
Saquont'e is gentle and thoughtful. His poetry has won prizes, and he cheerfully looks after his baby brothers when his mother works long hours as a security guard. He adores his mother and worries she blames herself for his weight.
"She says she might be the cause," says Saquont'e. "I know she loves me to death, but she puts burdens on herself that she shouldn't. I always tell her, 'It's not your fault.' It's actually mine."
He's making strides though. He thinks he's lost a few pounds after cutting down on cheese and some fried foods.
"People around here been saying I look skinnier than I used to, so hopefully yes!"
Saquont'e says he tries to keep a good attitude and tells himself, if he put on this weight, then he can take it off.
This is the fifth of a five-part series on childhood obesity in America from WAMU 88.5 NewsObesity and Food Deserts In D.C.