When the doctor gave her the news, Tracy Footes responded like many parents in her position: Not my child.
She stared at the weight chart during her son Jason's checkup at age 11, as the doctor pointed to the part that read "borderline obesity."
Months later, Footes began to notice dark circles around her son's neck.
By the next visit, she found out it was an early sign of diabetes. At age 12, Jason stood 5 feet, 4 inches tall, and weighed 164 pounds, putting him in the obese category.
"I felt out of the ordinary, especially when I tucked in my shirt," Jason recalled recently. "I felt too big."
The family felt forced to make immediate changes. "It was rough to tell Jason he couldn't have seconds because he just looked so sad and you wanted to give in," said Tracy Footes, 47, of West Philadelphia. "Then my husband was like, 'you're killing him. We have to stop.' "
Even as childhood obesity rates have more than tripled in the last 30 years, parents may find it hard to accept that what they see as harmless "baby fat" may be cutting years off their children's lives.
The Footes family's intervention had many aspects; it included smaller meal portions, more fruits and salad, and getting Jason involved in the youth running program Students Run Philly Style.
The family also took on Jason's challenge collectively by exercising more as a group and treating meals as important family time.
But would it all help?
More than a third of all U.S. children ages 6 to 19 are overweight or obese, according to government statistics. Without intervention, researchers say, parents may bury more of their children because of early death from obesity-related illness like diabetes and heart and liver disease.
While obesity afflicts all races, this epidemic is especially prevalent for African Americans. Nearly 39 percent of African American children ages 6 to 19 are overweight or obese, according to a study this year in the Journal of the American Medical Association. African American children are also likelier to get diabetes than white children.
"Twenty years ago, you never saw anyone less than 20 years of age with so-called adult diabetes," said Gary Foster, director of the Center for Obesity Research and Education at Temple University. "Now we're seeing children as young as 10, 11, 12 years old who have adult diabetes."
Every child Foster has seen with type 2 or adult-onset diabetes during his recent work in Philadelphia middle schools was either overweight or obese.
"If you get diabetes when you're 10, you may be looking at an amputation, at eye problems, at kidney problems as early as 30 or 40 years of age," he said.
Although obesity is most prevalent in Southern states and rural areas, it has a chokehold on the city famous for cheesesteaks and soft pretzels. In Philadelphia, the number of obese children is double the national rate.
In the Footeses' neighborhood of West Philadelphia, half of all children ages 6 to 17 are overweight or obese, according to data from the Public Health Management Corporation.
The Footeses live in what some experts call a food desert for its lack of healthy choices. Fast-food chains and pizza shops dominate their Race Street neighborhood. With the nearest grocery store out of sight, the most convenient options are corner stores and mini-markets, which are often overpriced and poorly stocked.
"The worst food that you could possibly eat for nutrition they make it easy for you to get to," said Jason's father, Ben, 56, a U.S. Postal Service mail handler who does the family's grocery shopping. "On every other corner, you can pick up a cheesesteak, fries, pizza, or Chinese chicken wings."
University of Pennsylvania professor Shiriki Kumanyika said high-calorie foods and beverages are heavily advertised, and healthier options are harder to find in many African American and low-income communities.
"This type of food marketing environment poses a major challenge to any attempts to combat obesity in black communities," she wrote in an e-mail.
She thinks policymakers need to focus on solutions that are "economically profitable, politically feasible, and culturally acceptable."
One example she cited is the Healthy Corner Store Initiative, in which The Food Trust and the city's health department are seeking to help upgrade 1,000 corner stores. Their owners can apply for grants to have new shelves installed for fresh vegetables and healthy snacks or refrigerators to store more water and fruits.
The Food Trust and the city are also working to establish 10 farmers' markets in low-income communities. Four have already opened in Grays Ferry, Norris Square, South Philadelphia, and Point Breeze.
And yet another project aims to set up 200 wellness councils to help public schools create their own action plans to improve food choices. The district will also add breakfast carts in public schools with cereal and other healthy options.
"We know that kids who eat breakfast are more alert and make better food choices throughout the day and the school food is better than what they have to choose from in neighborhood stores," said Sara Solomon, nutrition and physical activity program manager for the city health department.
Weight has been a persistent struggle for Tracy Footes and her family.
"I don't come from a family of just really small people. We're all pretty big so it wasn't a surprise that Jason was chunky," said Footes, who works in marketing for a publishing company. "I saw it, but I'm thinking, that's just how he is."
Jason's love of food was one obstacle. "We always would joke around and call him a meat-and-potatoes boy because Jason could put away three nice plates of food," Footes said. "When you told him he couldn't have seconds, he had a look on his face like he was being punished because he wanted more food."
The family learned how Jason would eat two dinners - one at his grandmother's and another at home - and stopped that. They also made smaller changes like adding salad and a vegetable and cutting back on fried foods and starches.
"We had to take baby steps with him because we didn't want him to feel bad," Footes said. "We would see him go into the kitchen and sneak a potato or some chicken. We saw it and we didn't want that."
Another challenge was finding a physical activity that Jason liked:
"We tried football, then basketball, and taking him out, and he wasn't enjoying it," she said. Then the family found Students Run, a nonprofit that helps youngsters train for marathons.
Jason wasn't old enough to participate early on, but he caught on quickly.
"At first I felt a little nervous that I would mess up," said Jason. "But my mom talked me into it and as soon as we got there everyone was so surprised that I joined Students Run."
"Over the first couple of practices I ran with a couple of coaches because I didn't know my way around that much," he said. "Soon enough I started running on my own."
Ben Footes said he set "little goals" to help Jason, such as, "Today you can make it a quarter of a mile; next week let's try to make it a half a mile until we worked up to a mile. He's not like a speedster but he has the heart and desire to go and do things. He doesn't want to be the one to say I quit."
Since he joined Students Run, Jason has completed two 3-mile runs and two half-marathons, and competed in last year's Broad Street Run.
"That's a big accomplishment for someone to be able to run those distances from a person who was coming from ground zero," said Ben Footes.
Added Tracy, "We all would go out as a family three times a week. We were out there and encouraging him, but at the same time we were out there as a family. It just made our family closer."
The Footeses also approached meal time as a communal experience.
"We would eat at the table as a family," Tracy Footes said. "One of us doesn't go off and watch TV. You're sitting down at the table and you can talk about your day and ask how school was. We eat. We talk. We laugh. We joke. Jason is extremely shy and that kind of pulled him out of his shell because he asks questions, and we answer them the best we can. It definitely makes him more confident."
Now 14, Jason credits his new regimen with helping to control his weight. At 6 feet tall, he weighs 185 pounds, within healthy limits.
"We're not obsessed with healthy food," he said. "We'll order cheesesteaks from Jim's. But when we eat at home we will have a side vegetable with our meal like broccoli, collard greens or salad."
Jason gave this advice to his peers: "I know most Americans are fried-chicken lovers," he said. "I hope ya'll don't kill me when I say this, but don't eat a lot of fried chicken."
Three videos by Heather Faison depict the dietary struggles of African Americans in Philadelphia.
Go to www.philly.com/teendiet.
Contact Heather Faison at firstname.lastname@example.org.