Mold grows thick and black on the walls of Celeata Bailey's Norris Square bedroom.
Because most of the ceiling is missing, Bailey, 21, gets soaked in bed when it rains.
Her family puts up duct tape to keep the bathroom wall from collapsing. Raw sewage burbles in the basement, and the family stores surgical masks in the kitchen for anyone who has to descend into its putrid depths.
Bailey's poverty is evident throughout the house, which sits in the First Congressional District, the second-hungriest in America, according to a Gallup-Healthways Well-Being Index, one of the largest polls ever taken.
But poverty is also written on Bailey's body, made heavy since childhood by a poor person's diet of cheap, fattening, processed foods larded with high-fructose corn syrup, fat, and salt. As a result of her diet, Bailey has suffered from diabetes since she was 13.
It is, doctors acknowledge, a paradox that hunger and obesity are linked. And doctors say obesity and diabetes among the poor are on the rise, as many families faced with hunger have little choice but to eat nutritionally disastrous foods to survive.
"You can't find fresh fruits and vegetables in this neighborhood," said Bailey, a high school graduate who has not found work since her census job ended in the summer. She was raised by her grandmother Etherline Bailey, 73, who lives with her.
Bailey said she had to leave community college because of money trouble and was taking steps to return.
She gave up jogging in the neighborhood after she was mugged and now tries to do kickboxing indoors.
"I ate a lot of instant noodles and drank a lot of Hawaiian Punch from the corner stores up here," said Bailey, a sweet-faced woman who is afraid of dying young of a heart attack, as her mother did when Bailey was 3.
In Philadelphia, around 25 percent of nonpoor adults are obese, compared with about 34 percent of poor adults, according to Public Health Management Corp. figures from 2008 analyzed by the Philadelphia Department of Public Health.
Children are measured differently, with overweight and obesity combined. The overweight/obesity rate for nonpoor Philadelphia children is around 40 percent. For poor kids, it's almost 52 percent.
And 17 percent of poor adults in the city have diabetes, compared with 12 percent of those who aren't poor, PHMC figures show. Diabetes rates for both groups have been increasing since 2000.
Bailey says her being overweight is "60 percent" her fault because she ate unhealthy foods. Some say that's the wrong way to think.
"One of our biggest misconceptions is that it's poor people's fault," said Adam Drewnowski, a University of Washington epidemiologist and obesity expert. "The poor, without access to healthy foods, are making the best possible choices under difficult circumstances."
When there's money, Bailey said, she treks to relatives in West Philadelphia who live near a supermarket. But the four-bus round trip for groceries can be daunting, she added.
And on the rare occasions she can return home with healthy food, Bailey has to eat it in the same dilapidated house. It's not clear who owns it. No one has paid taxes on the property since 1987, records show, and the family
doesn't know where to send the rent.
These days, Bailey writes poetry to cope with the moldy house, the diabetes, the endless poverty:
I had no shield, no umbrella to run from them . . . rainy dayz. Like an animal caged and chained up - no movements, no sounds, just rage.
Renee Turchi is a pediatrician who has been battling pediatric cancer - in herself.
The doctor at St. Christopher's Hospital for Children is being treated for Ewing's sarcoma, a bone cancer found 90 percent of the time in children, not in their doctors.
She has lost her hair after 31 rounds of radiation and 13 of a scheduled 15 rounds of chemotherapy. But Turchi, who's been told her cancer is gone, simply covers her head with a Phillies cap and goes to work.
"You learn from being a patient," Turchi said. "You're more responsive to families in the waiting room."
Collected in those rooms these days are low-income children, many of them becoming obese and diabetic from eating inexpensive foods, said Turchi, who estimates that 80 percent of her patients' families are food insecure - unable to afford enough food for a healthy life.
Particularly popular, instant noodles and juice are the pediatrician's bugaboos - low-priced foods with outsized health consequences. They are the staples of corner stores, which outnumber supermarkets citywide by 17-1, according to an analysis by the Food Trust, a Philadelphia nonprofit working to provide access to healthy food.
As a result, "there's a childhood epidemic of obesity that is developing diabetes in children," Turchi said.
In St. Christopher's, Turchi sees too many mothers holding blue or red or orange bottles to their babies' mouths - filled with juice rather than water or pricier milk.
"If we see a mom with a colorful bottle, we need to work quickly with that family . . . to forestall developmental delay," Turchi said.
Parents think they're doing something beneficial.
"They know soda is no good and won't feed that," said David Bennett, psychologist at the Grow Clinic, which treats underweight children at St. Christopher's and was created by Mariana Chilton of the Drexel University School of Public Health.
"They think juice is a better alternative to soda. But we preach the evils of juice."
It's often called "quarter water" for its 25-cent price.
The 8-ounce children's drink known as Little Hug - a brightly colored child-size plastic barrel covered with foil - is "enormously prevalent" in the First District, according to Terri Lipman, a professor at the University of Pennsylvania School of Nursing.
"Kids prefer Hugs to bottled water. Poor African American kids say drinking bottled water is viewed as a white people's thing."
Loaded with sugar (100 calories in 8 ounces) until recently, Little Hug drinks are the subject of nostalgic paeans on Facebook.
They're also referenced in hip-hop star Jay-Z's song "On to the Next One," in which he's drinking Little Hugs with Oprah Winfrey:
. . . Had Oprah chillin' in the projects
Had her out in Bed-Stuy chillin' on the steps
Drinkin' quarter water's gotta be the best.
Little Hug drinks are found mostly in urban corner stores and in Wal-Mart, said Tim Barr, vice president of marketing for American Beverage Corp., manufacturers of the drink outside Pittsburgh.
"It tastes good, and it's cheap," Barr said.
Others offer different assessments.
"It's the food of the devil," said Kristin Marozsan, social worker at the Grow Clinic.
"It's not uncommon to hear that," Barr acknowledged.
To answer such criticisms, American Beverage removed sugar from Little Hug drinks within the last two years, switching to sucralose, an artificial sweetener marketed as Splenda, Barr said. Now Little Hug drinks are 10 calories per 8 ounces. But that hasn't assuaged experts.
"Hugs gets kids accustomed to high levels of sweetness," said Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. That kicks off a lifelong craving.
Beyond that, artificial sweeteners are of "questionable safety for children," said Sandy Sherman, director of nutrition education for the Food Trust.
Along with Little Hug drinks, First District stores are stacked with instant foods such as ramen noodles. They're cheap, and they defeat hunger. But they can pack 790 milligrams of sodium, 3 grams of saturated fat, and 190 calories per serving, a typical block of noodles cut in half, said Angela Ginn, dietitian with the American Dietetic Association in Baltimore.
For a single meal, a person should not eat more than 400 milligrams of sodium, said Ginn, who added that most people eat a whole package of instant noodles in a sitting and are taking in 1,600 milligrams of sodium - four times the healthy amount. (There are 2,300 milligrams of sodium in a teaspoon of salt.)
High sodium levels are especially worrisome for African Americans, who have a greater incidence of high blood pressure than white Americans, Ginn added. The First District is 47 percent black.
"There should be a warning label on instant noodles," she said: " 'Overconsumption of high-sodium foods may lead to hypertension and stroke. Eat at your own risk.' "
At 6 a.m. recently, Turchi and a nurse went on a home visit to a Kensington child with lung problems.
Taking a break outside, Turchi said: "People sometimes say there's nothing to eat in their house. But many families out here have nothing-nothing: a can of soup and an empty fridge."
Standing on a buckled sidewalk at dawn in the second-hungriest place in America, Turchi, a sucker for Rocky movies and positivity, said she still believed children could be helped - if the rest of the city decided to get involved.
"It's the starfish theory," she said. "You can't save all the starfish washed up on the beach. But pick up one and put it back in the water, and you've saved it."
Then the woman who beat back cancer tugged on the brim of her Phillies cap and added: "It isn't hopeless."
Contact staff writer Alfred Lubrano at 215-854-4969 or firstname.lastname@example.org.