February 12, 2007 12:00 PM

She is extremely overweight,” pediatrician Dr. Karen Young declares with a furrowed brow. Beside her, Kashavion Fisher perches impassively on an examination table. Her mother, Deidre, 32—herself conspicuously overweight—winces as dietician Valerie Kellam launches into a description of the girl’s diet: “Froot Loops and Frosted Flakes. Lots of pizza. Eats out three or four times a week. Wendy’s, McDonald’s, Popeye’s. Loves Red Lobster. Crab legs with butter.” “This child is in trouble,” says Dr. Young.

Big trouble. Kashavion, who weighs 120 lbs., is just 6 years old but already suffers from high blood pressure and sleep apnea as well as non-weight-related asthma. Sadly, at the Pediatric Fitness Clinic of Arkansas Children’s Hospital in Little Rock, where Dr. Young and a team of clinicians are helping her to fight her weight, she is hardly an anomaly. An epidemic of child obesity has hit the country, and Dr. Young and her colleagues are on the front lines. “What’s changed in the last 30 years?” she asks wearily. “It’s not our genetics, it’s our lifestyle.” An explosion of fatty foods and sedentary lifestyles. Kids moored to computers, strangers to the playground. The causes are easy to list. Finding a fix, says Young, whose outpatient clinic has treated 3,984 children, many with signs of diabetes and heart disease, is more difficult. Usually, the doctors prescribe exercise and diets high in protein, while low in fat, sodium and sugar. The details depend on the child, but the goal for each is to reduce the body mass index, or BMI, a ratio of weight and height doctors use to gauge obesity. Beginning last summer, PEOPLE followed three children, referred to the Little Rock clinic by their pediatricians, for six months, to illustrate the challenges of battling this epidemic. One thing is clear. Success depends not on an individual kid, but on the whole family. And failure can ruin a person’s life.

“Madison’s a fatty, Madison’s a fatty.” Schoolyard mockery haunts Haley Madison Grimes, an 8-year-old who weighs 109 lbs. “I predict she will weigh 300 lbs. when she’s 20,” says Dr. Samiya Razzaq, one of Young’s colleagues. Madison’s divorced parents, postal worker Brandi Johnson and trucker Randall Grimes, and grandmother Carrie Lawrence all shudder. “Her body inside,” Razzaq says, “is almost that of a 30-year-old.”

How did she get that way?

“I like the all-you-can-eat buffet,” Madison shyly explains.

“Do you go to the buffet a lot?” the doctor asks. She takes the patient’s sheepish silence as a yes. Later, when the family is out of earshot, dietician Deane Peck reviews Madison’s weekly menu—essentially, fast food and more fast food—and tells Dr. Razzaq, “She’s a train wreck.”

Peck issues her marching orders: Limit portions, restrict fried foods to once a week and fast food to twice a week. Madison and family begin a dietary overhaul. By late August the child had lost about 6 lbs. Her mom took her shopping for school clothes at JC Penney. “When summer began she wore size 16 girls,” says Brandi. “But now she was down to a 12 and had one skirt in a 10! We were in the dressing room jumping up and down.” That day Madison had her first-ever Kirstie Alley moment: “She told me ‘Mom, I’m gonna get one of those bikinis next year, and those boys will be thinking I’m looking good!'”

In late October Madison sits in her grandfather’s office at the Exit 44 Truck Stop, ticking off the foods she has given up. “Let’s see, there’s cheese enchiladas. French fries, cheeseburgers, cheese fries and Cheetos,” she says proudly. At a recent birthday party, she passed on ice cream and cake. “And every day I get some exercise, bike riding or softball,” Madison says.

Worn out from a long day’s work at the post office, Brandi, 27, talks about how her shopping list has been transformed—all soda is diet, all milk and cheese, 2 percent. Equal supplants sugar, and instead of chips or candy, it’s granola bars. “Madison’s school lunch is a sandwich with mustard; no mayo,” she says. “A Coke Zero. A banana and orange.” For dinner, Madison eats off a salad plate, to limit portions. The 20-Minute Rule is strictly enforced: Madison must leave the table and wait 20 minutes before having seconds. “Most of the time she doesn’t come back,” says Brandi. “She’s found something else to do.”

Madison lives a kind of shuttle childhood, splitting time between her parents and grandparents. So far, the whole family seems to have adopted her dietary program—a support system doctors consider crucial to the child’s treatment. “I’ve lost weight—we all do what she does,” says her paternal grandmother, Patty Faye Grimes, 55. “I used to have little wrapped candies in my house, but no more.” The all-you-can-eat buffet is just a memory. “We’ve only thrown caution to the winds once, on my birthday,” Brandi says. “We went to Red Lobster. Madison had one biscuit, some shrimp and salad, and not much of any of it.”

Madison’s self-confidence soared and even her grades improved, from Cs to mostly As and Bs. But there were bumps in the road. By December she had regained 5 lbs. The clinic offered advice: Control portions, buy a workout video and ramp up those green vegetables. “Do you like broccoli?” dietician Deane Peck asks Madison. She makes a sour face. Peck suggests a topping, even cheese. “I don’t care if you put chocolate on them,” she says, “as long as you eat them.”

Part of Madison’s problem is that she isn’t growing taller as quickly as some other children. As a result, her BMI has dropped only slightly. But 9-year-old Austin Morris, another child being treated at Arkansas Children’s, is sprouting like a weed. At 93 lbs. he has added a couple of pounds since his first visit last summer, but the doctors tell him he’s doing well during a December follow-up visit. A smiley, kinetic boy given to bouncing in his chair, Austin says, “I like Dr. Pepper, I really miss it!” But it is no longer allowed, says his mother, Angel, 31, a homemaker. “Any snack has to have eight or fewer grams of sugar,” she says. “If I can’t find anything, I don’t buy anything. If it’s not here, it’s not taunting him.” Austin still asks for his Froot Loops, though, and sometimes struggles to swallow his Flintstone vitamins. “He says they feel ‘funny’ in his mouth,” says Angel.

“Is he getting the 14 grams of fiber we talked about?” asks dietician Peck. Met with silence, Peck suggests non-starchy vegetables. “The only ones I can get him to eat are green beans,” Angel replies. Has the new regimen been worth all the effort? “Absolutely—I don’t want an overweight child, I want a healthy child,” Angel says. “I just hope we keep at it.” Austin has work to do, but the clinicians are pleased. Says Young: “I have no issues.”

Kashavion Fisher is another matter. After three visits, her BMI has increased. “It’s literally off the charts,” Young says. “I’m very discouraged,” Deidre sighs, slumping in her chair.

“Please,” the doctor implores. “Very few people get miracles after the first couple of visits.” The good news: Kashavion’s blood pressure and insulin are normal. “But she likely has fatty liver disease,” Young says. “The worst-case scenario is cirrhosis, but that’s typically a year away.”

Despite orders to follow a low-sodium diet, Kashavion has been eating fast food at school and at her daycare center, where she stays while her father, Kashaba, works evenings at a Coca-Cola plant and Deidre attends college classes in criminal justice. When the school year began, Kashavion complained to her mother that none of the kids there wanted to play with her. “‘Why?’ I asked,” says Deidre, tears rolling down her cheek. “‘Because I’m fat.'” In the background Kashavion, just moments after an afternoon snack, snores loudly on the couch. “I told her, ‘Your mama’s going to love you no matter what size you are.’ And she said, ‘I know, Mama, but I want to be skinny.’ I said, ‘We’re working on that.'”

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