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Teyonna vs. calories

In a fast-food culture, health issues pile up. With help from MU professionals, one teen is trying to buck the trend.

Teyonna Ruppert

Teyonna Ruppert works at losing weight with the help of health professionals at MU.

What Teyonna Ruppert misses most are pepperoni pizza rolls, white rice and chocolate. Before August 2010, she didn’t hesitate to eat these American staples. But now her meals regularly feature less-satisfying ingredients such as “gravel in a tube.” That’s what Teyonna, 15, calls whole-wheat pasta. “It literally tastes like rocks inside of a noodle,” she says, laughing at the notion that healthy food choices might taste good.

One recent night, she and mother Karen Ogden of Gravois Mills, Mo., thought they’d finally found a diet loophole: chocolate swirl ice cream. It was sugar-free, of course, but they had high hopes that the flavor wouldn’t disappoint. After reading the nutritional label, they realized they could have only half a cup. That small portion looked pathetic in their bowls, but the taste was even worse. Teyonna thought about feeding hers to their eight cats — but even the cats are used to tastier daily servings of half-and-half. “They say smokers have a three-day hump,” Teyonna says. “With food, it’s a three-month hump.”

In spite of the temptation to eat like her friends, Teyonna, with help from mother Karen and grandmother Margaret Ogden, is trying to change her diet permanently. A patient at the Adolescent Diabetes Obesity (ADOBE) clinic at MU Children’s Hospital, Teyonna is among the one-third of Missouri youth who are overweight or obese.

Contrary to preconceptions about this demographic, Teyonna doesn’t want to slim down so that she can be popular — she already has seven best friends. She doesn’t waste hours sitting idly in front of a computer — she’d rather chase her three dogs or swim. And, she doesn’t have poor self-esteem — she laughs, which usually leads to snorts, every chance she gets. Sayings posted around her house indicate that this family doesn’t allow the extra pounds to define them. Hanging above the pier to their backyard pond, a wooden sign announces: “We don’t skinny dip … We chunky dunk.”

Healthy competition

Yet, Karen knows there’s a fine line between worrying too much about weight and not worrying enough. High cholesterol, diabetes and obesity run in her family. Her father died at age 46 of a heart attack; her sister had gastric bypass surgery after reaching nearly 400 pounds. When Teyonna started gaining weight around her midsection, Karen initially thought she was just going through adolescence. When Teyonna developed a dark ring around her neck, Karen thought she just wasn’t scrubbing enough in the shower. The ring, however, was acanthosis nigricans, an early sign of insulin resistance and pre-diabetes. Teyonna also was diagnosed with metabolic syndrome, a group of risk factors including a larger waistline, high triglyceride levels, cholesterol problems, high blood pressure and insulin resistance.

For two years, Teyonna tried eating healthier foods, but she failed to make any substantial progress. “The problem was that I had cut her off completely, and she had kind of rebelled,” says Karen, who’s been a single mother since Teyonna was 2.

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Teyonna’s pediatrician, Kristen Theobald, who completed her residency at MU Children’s Hospital, referred them to Aneesh Tosh, a physician who directs the ADOBE clinic. After only two visits, the mother-daughter duo established a bond with Tosh. “He gets our sense of humor,” Karen says. “Dr. Tosh knows we always have something up our sleeves.” Tosh, BS ’97, MD ’01, started the ADOBE clinic in August 2007 to help children and teens confront the health complications associated with being overweight. He and ADOBE dietitians — Elizabeth Freeman, BS HES ’03, and Jill Schremp, BHS ’02, BS HES ’07 — meet with patients and their families, and they devise plans to gradually decrease fatty, sugary foods and increase physical activity. There’s no cookie-cutter formula; they consider family grocery budgets, medical histories and personalities.

Since 2007, the clinic has seen more than 200 patients, and about 40 percent of them have reduced their body fat. “Ultimately, when we treat obesity, we’re trying to change behavior, and that’s hard to do in a 30-minute doctor’s visit,” Tosh says. “We’re trying to get patients and parents motivated to make these changes permanent. Many times that doesn’t happen. When it does happen and patients lose weight, it’s a testament to their dedication.”

For Teyonna and Karen, improving their health has become a competition. Who can go the longest without a soda, find the best-tasting sugar-free treat and lose the most weight? After two months, it’s Teyonna, six pounds; Karen, five. These days, Teyonna polices herself and her mother. She cooks supper five nights a week and limits herself when pizza or candy is served at parties or events. Not an easy task. More than a medical issue One morning, for example, Teyonna admits that she isn’t looking forward to working the concession stand at the upcoming middle school football game. She’s a soprano in the Morgan County R-II High School choir, which is raising money for new robes. “I don’t want to be working because of all the chocolate in there,” says Teyonna, who has planned to handle the money while others dole out snacks.

As an American teenager, Teyonna must navigate a high-calorie culture. Fast food has even permeated her homework. While eating a ground turkey taco salad with fresh tomatoes and onions, Teyonna practices pronouncing her Spanish vocabulary: “Las papas fritas” (French fries). “La pizza” (pizza). “El helado” (ice cream).

“We have no helado,” Karen notes.

School lunch menus, with specials such as Taco Tuesdays, Chicken Patty Wednesdays and Pizza Fridays, frustrate Karen. “I didn’t know that ketchup is considered a fruit,” she says. “And French fries are a food group that’s probably served three times a week.” Tosh challenged Teyonna to take her lunch to school three times a week. Since then, she’s toted a ham sandwich and a couple snacks every day though the vast majority of her classmates eat cafeteria food.

A multifaceted approach

School lunch programs were actually started to combat malnutrition in the same population now suffering weight problems, according to Chris Hardin, chair of MU’s nutrition and exercise physiology department. “Some of these kids with obesity-induced hypertension and diabetes may never work a productive day in their lives,” he says. “This isn’t a red or blue issue. It’s purple. Nobody wins.”

In fact, several factors — cultural, economic, agricultural and societal — contribute to the childhood obesity epidemic. With no single culprit and no simple solution, it’s tough to put a dent in the weighty statistics. But Hardin hopes that MU researchers can harness their varied expertise and campus resources to attack childhood obesity from several angles.

MUNCH, the MU Nutritional Center for Health, is expected to open in 2013 and will include an observational research lab, teaching kitchen and metabolic kitchen for developing and testing new foods and diets. Much research that will contribute to the center’s efforts is already under way, though.

Teyonna, for example, just joined a study to examine whether high doses of Vitamin D could improve insulin resistance. Recent studies have shown that 75 percent of Americans (and 80 percent of ADOBE patients) aren’t getting enough Vitamin D. Tosh has helped refer participants to lead researcher Catherine Peterson, associate professor of nutrition and exercise physiology. Peterson’s previous research indicates that low Vitamin D levels correlate with increased inflammation, which is typically found in obese individuals and those suffering from chronic diseases. The study, which will use Vitamin D supplements, could lead to a safe and affordable dietary solution.

Squeezing in fitness

Moving to a 40-acre property on a gravel road in Gravois Mills was quite an adjustment for Karen and Teyonna. They had lived in Woodstock, Ill., a Chicago suburb. YMCA after-school programs, deep-dish pizza and efficient city transportation were givens. That is, until Karen was hit by a drunk driver seven years ago and moved to be near mother Margaret, a Gravois Mills resident for 23 years. Neither Karen nor Teyonna are fans of the remoteness. Basic tasks and errands eat up precious time. Teyonna’s high school is 35 minutes away. A visit to the ADOBE clinic or orthodontist’s office, both an hour and a half away, costs Teyonna a half-day of school.

Teyonna doesn’t want to slim down so that she can be popular — she already has seven best friends. She doesn’t waste hours sitting idly in front of a computer — she’d rather chase her three dogs or swim.

Tosh says weight struggles tend to be a greater problem in urban and rural areas where there’s less access to safe activities and healthy food. Luckily, Karen and Margaret’s homes sit on a property designed for outdoor activities, and these two women are anything but slouches. Karen kayaks, throws pottery, teaches tie-dye lessons and raises chickens. Margaret hunts deer, fishes and cuts weeds. All three generations regularly volunteer at the Society for Treatment of Abandoned and Fractured Friends, an animal rescue and adoption center and thrift shop in Sunrise Beach, Mo.

In summer 2010, Teyonna started doing TaeBo aerobics and spending 18 minutes a day on an elliptical machine. But now that school’s in session, it’s been a challenge to find exercising time. Fewer physical education requirements don’t help; only one PE credit is needed to graduate. Teyonna, a ninth-grader, says her biggest adjustment to high school has been the hour or more of daily homework. Some evenings, she tutors elementary students in math, and her “mathalete” competitions can consume an entire Saturday. By 8 on most nights, she’s yawning.

Revising their menus

Although many of her friends don’t talk about college, Teyonna plans to attend and hopes to return to city life.

“Dude, you’re going to leave me one day,” Karen says. “What will I do without you?”

“Eat frozen dinners,” Teyonna retorts. “The freezer will be filled with White Castle burgers and Swedish meatballs.”

“White Castle. I miss that along with Chicago pizza,” says Karen. “It’s probably a good thing we live here.”

Grocery shopping and meal planning have taken on a new level of complexity. Teyonna’s current goals are to eat whole-wheat bread, have a vegetable and fruit with every meal, and transition from 1 percent milk to skim. Breakfast, which Teyonna used to skip in exchange for extra sleep, is now a given, even if it’s just a granola bar.

Heather Leidy, MU assistant professor of nutrition and exercise physiology, has discovered that teens who eat breakfast, particularly a higher-protein (about 35 to 40 grams) breakfast, feel fuller and eat less later in the day. “Primarily, our eating habits are established during adolescence,” she says. “Targeting that population is the best chance of having this change toward eating healthy.”

Teyonna’s morning routine takes a little longer with breakfast to eat and a lunch to be packed. But to Teyonna, it’s worth it. After all, it’s Taco Tuesday, and she couldn’t be happier about her ham sandwich. Plus, she gets to bring chocolate pudding. It’s sugar-free, of course, but this time the flavor doesn’t disappoint. “It’s actually really good and feels like a real treat,” she says. “It’s like you’re indulging,” Karen says with a relieved smile, “but you’re not.”

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