Late Thursday afternoon, San Francisco General Hospital's (SFGH) pediatric waiting room fills with families. Many of the children are obese, here for the hospital's Healthy Lifestyle Clinic.

Down the hall, eleven year-old "Gilberto" listens as an occupational therapist talks gently to him about his love of basketball, encouraging the obese young man to continue playing when he can find safe places to do so. The therapist turns to Gilberto's mother and in halting Spanish explains that there is a program in their neighborhood with organized sports activities. The therapist also suggests that Gilberto cut down from his average of four sodas per day. From the boy's one-word answers and the mother's silent nods, it's difficult to tell if they will follow through.

Yet amongst the many difficult cases clinic staff has seen today, Gilberto offers hope. A year ago, he made a dangerous leap in weight, but on this visit, his weight is down. Though he is still obese, the mark on the graph that charts his weight causes visible elation in the staff's cramped office.

A Complex Epidemic

Despite this elation, in many ways Gilberto personifies the difficulty of addressing an epidemic that reportedly claims 300,000 lives per year and costs $100 billion in direct medical costs.

Surrounded by societal influences that tell him to drink soda and eat processed foods, with poor access to health services, with adult supervision limited by his parents' job options, Gilberto is fighting an uphill struggle. Dr. Cam-Tu Tran, the director of the Healthy Lifestyle Clinic and Chief of Pediatrics at SF General says that if she's lucky, she'll see Gilberto once a year. She has no resources to follow up, to make sure he's staying with a program. She and her staff have to hope that an hour or so of discussion and education will make a significant mark. Too often, she says, it doesn't.

And Gilberto made it through the door of the clinic. Not many even take that first step.

The members of the CHC's Obesity Center came together because they recognize that individually their ability to help the Gilbertos of the world is limited. But by bringing together their considerable accomplishments in this field - and creating something new out of their experience - they may be able to strengthen their attacks on the many forces that sustain the obesity epidemic.

Here we highlight some of their work to date, and discuss their hopes for what can emerge from a coordinated effort.


(See links below for complete six-part article.)


Part 2: Genetics Provides Clues, Not All the Answers

Part 3: "Our Biology Is a Mismatch for Our Environment"

Part 4: Exploring the Intersection Between Body and Mind

Part 5: A "Toxic" Environment

Part 6: One Size Does Not Fit All