The Bronx Ink

Students at P.S. 73 warm up for their health lesson.

At 8:15 am Thursday, nearly 30 4th graders sent mini tremors through P.S. 73.

“Who can last longer than Mr. Rios?” said Juan Ramon Rios, director of Healthy Highbridge. He was trying to get children half his height through a warmup routine of jumping jacks.

Despite all the activity, 37 percent of the students in this class are overweight or obese, according to body mass index measurements that Rios and his team at Highbridge Community Life calculated this week. Two classes even measured in at 59 percent.

The overall rate of overweight students at the Anderson Avenue elementary school is consistent with that of the entire South Bronx, where 40 percent of students are overweight or obese. That percentage is higher than the alarming national level, which the American Heart Association estimates at 33 percent.

Healthy Highbridge meets with fourth and fifth graders at P.S. 73 once a week to combat the repercussions of obesity in an area that has a lot of obstacles to staying healthy. In the South Bronx, 38 percent of the residents live below the poverty line, according to the 2010 American Community Survey. Highbridge also has too few supermarkets to meet the needs of its 34,000 residents, a 2008 city study says. Rios said these factors lead to poor food choices and, by extension, poor health for area children.

“We’re losing a generation,” Rios said three days earlier from his cramped basement offices at Highbridge Community Life Center. “All of this is going to create a health cost”—that is, unless everyone gets moving.

After the exercise, Rios instructed students on how to take their pulses.

“Why did we do that?” Rios asked as 60 index and middle fingers pressed against 30 wrists.

“To lose some weight,” said Fatumata, 9.

“Because it could be fun to exercise,” said Shantel, also 9.

“Because we need to get exercise,” said 10-year-old Jonah.

These children are all participants in Healthy Highbridge’s year-long health education program, funded by a $30,000 grant from the Communities Impact Diabetes Center, which in turn receives its budget from the federal Centers for Disease Control and Prevention.

Before they start their education curriculum, Healthy Highbridge staff must measure the students’ body mass indexes, test their prior health knowledge and survey them on exercise and eating habits as well as their attitudes and beliefs regarding working out and eating. These initial studies will be used as a baseline to track students’ progress, as Rios and team return each week to tackle a different health subject: Michelle Obama’s “My Plate” and “Let’s Move” campaigns, diabetes, nutrition, and exercise, among others.

P.S. 73 students eat a breakfast of sausage, biscuits and orange juice.

The goal is to help youngsters understand what it takes to be healthy, said Michelle Ramos, the diabetes center’s community project manager.

“As attitudes around healthy behavior improve, hopefully the behavior itself will improve,” she said from her Harlem office. Ramos said that while she doesn’t encourage children to lose weight, she believes that as they grow, they’ll maintain their weights and their body mass indexes will drop.

“Hopefully they’ll pick up healthy habits and go and share them with their families,” Ramos said.

P.S. 73’s principal, Jean Mirvil, said sharing health information with the parents is critical to solving the obesity problem. Many of the families, he said, come from different countries and have a hard time making the proper, healthful adjustments in their new homes (34 percent of people in the South Bronx are foreign-born).

“The kind of food they’re used to does not present itself in the same way as they are making the adjustment with this country,” Mirvil said.

He expects that the children will bring information about what and what not to eat home to their parents.

“At school, they are given a full picture of what a regular, healthy meal should look like,” Mervil said.

To combat the obesity problem, this September the school instituted a salad bar at lunch, so students can add a rotating variety of produce—spinach, corn, radish—to their meals. The main courses vary according to the Board of Education menu. Recently, Mervil said, students had chicken and a choice of pasta or rice. Students can choose milk—not chocolate milk—or water for a beverage.

On the day of the Healthy Highbridge visit, breakfast consisted of a sausage and biscuit sandwich, and orange juice.

During this class, students were asked to pick which food choices they would make: chicken with the skin on or off, whole wheat or sweet bread, regular peanut butter or freshly ground.

Shannon takes her pulse after a round of jumping jacks.

Shannon, 9, said she preferred popcorn without butter, low-fat milk to skim, and would eat an apple before a piece of candy most days.
“Salt? Ew,” she said, her neat cornrows jostled back as she shook her head.

Winston, the largest boy in the class and the first to cease his jumping jacks, said he was less into self denial. He puts butter on his popcorn because, otherwise, “it doesn’t taste like anything.” The nine-year-old did acknowledge that salt isn’t always necessary.
“Sometimes, if you don’t add salt, food can still taste good,” he said.

Jaheim, 10, said he couldn’t replace french fries with potatoes, nor could he exchange a burger for a salad. “French fries?” he asked rhetorically as his hands shot from his striped hoodie to the sky. “I love them.”

As for burgers? “They’re very good,” he said. “You could even put bacon on them.”

When asked if all his poor eating choices left him a healthy individual, Jaheim was confident.

“Yeah, I do weights.”

There are two Richard Izquierdos that Bronx locals recognize. One man, Richard Izquierdo Arroyo, made headlines last year when he was charged with embezzling more than $100,000 from a non-profit low-income housing organization. The other, Richard Izquierdo, known as the “Doc,” is a man who walks with a cane and often plays with his iPhone. He is a pediatrician who founded two health centers in the borough and is now hoping to heal a new generation with The Dr. Richard Izquierdo Health & Science Charter School that opened this fall.

With that resume, Izquierdo–the doctor–doesn’t worry that Bronx residents will confuse him with the other Izquierdo.

Richard Izquierdo was nicknamed Doc because he’s been a pediatrician in the Bronx since 1962, with now-famous patients like U.S. Surgeon General Dr. Richard Carmona, Bronx Borough President Rubén Díaz Jr., and Supreme Court Justice Sonia Sotomayor.

Trained at the University of Madrid Medical School and the University of Lausanne Medical School in Switzerland, Izquierdo founded a Hunts Point-based bilingual public health center, Urban Health Plan (UHP), now run by his daughter, Paloma Hernandez, and his private clinic, Multi Medic Physician Services, run by his son, Richard. He has chaired the local Community Board and has won many recognition awards from Bronx organizations.

He recently turned 81 and still goes to friends’ homes to perform minor procedures like applying butterfly closures or giving injections, but what he’s most excited about is his new job as chairman of the Dr. Richard Izquierdo Health & Science Charter School in Morrisania. “I live from dream to dream, mountaintop to mountaintop,” said Izquierdo. “I’m a salesman. I sell dreams and then make them come true.”

After the Board of Education denied two requests to open the school because the health and science theme had to be more integrated into the curriculum, Izquierdo teamed up with John Xavier, who wanted to start his own health care school. Xavier gave up that plan and is now the principal of the school, which received a start-up grant from the Walton Family Foundation.

“The school wouldn’t be what it is without him,” said Xavier. “It’s a long, complicated name for a school but every word in that name is essential to what we’re doing. The more I know Izquierdo, the more important it is to me that this school becomes his legacy.”

The 100 sixth grade students (according to Izquierdo, there were a few more enrolled at the beginning that ended up not showing up or moved out) are each given an iPad (which they keep at the school), chess and fencing classes, and instruction on capoeira, the Brazilian no-contact martial art. Starting in January, the students will have to build a science project of vertical plants to study how photosynthesis works, which Izquierdo hopes will help educate them to care about their environment. In keeping with the medical theme, students must wear scrubs (“I don’t do things in a small way,” said Izquierdo). Their science classes run for 90 minutes as opposed to the typical 45 so the students can have an accelerated science instruction that will more readily prepare them to pursue further education or find employment. They will be certified as Emergency Medical Technicians by the time they graduate and, if the school is successful in its mission, their chances of landing a job will be higher than most in the Bronx, which has a daunting 12.5 percent unemployment rate, the highest in the New York metropolitan area.

Not long after school started, Izquierdo chatted with 11-year old Shailoh Cervantes, a student who addressed the school at orientation and who hopes to become a doctor one day. Izquierdo reminded Cervantes of what he said during orientation:

“There are three important things: One, that we were going to give you an education so that you could make a living,” said Izquierdo. ”The second was to be proud of who you are, of your name; and the last one was to make this place a better world to live in and to help other people. Do you remember that?”

“Yeah, I remember that,” said Cervantes. “I think that what you said should help us throughout our lives so that we can have a better life. My dream is to become a famous doctor, that people would remember my name for helping a lot of other people.”

The school received a grant from the Charter School Center, a non-profit organization that helps start charter schools, to hire an award-winning documentary filmmaker, Antonio Ferrera, to record the students as they develop throughout the year. The administration’s hope is that the school can then look back and observe their work objectively and learn from their mistakes. “Nobody’s paying attention to the South Bronx but Izquierdo is making sure there’s a new generation of children that are paying attention to it,” said Ferrera.

Izquierdo wants to develop programs in first aid and health literacy, and try out different curricula to see if an increase in exercise classes will result in higher performance and weight loss. He wants to battle the Bronx’s obesity problem (47 percent of kids are overweight) starting with these students.

“We let the students know what’s expected of them and what they can expect from us,” said Izquierdo. “I call it the CPR of relationships: Consistent, Predictable and Reliable. Cardio Pulmonary Resuscitation. CPR.”

Izquierdo has a strip of white mustache cut in a way that appears to pay homage to his Puerto Rican heritage–a perfectly straight and trimmed line. Though his family is Puerto Rican, Izquierdo was raised in New York City. At 14, he used to sneak into the city’s hottest night clubs because he already had a little bit of this mustache–just enough that he would get away with it–and so he got to know many Latin legends like Noro Morales and Machito. His phrases are interspersed with Spanish sayings like, “Dios los cría y ellos se juntan” (“God creates them and they unite”) and he loves typical Puerto Rican dishes such as rice and beans and plantains. He claims that his salsa moves are still so good that a couple of months before the Urban Health Plan’s annual Christmas party, “The young ladies would say, ‘I want to be on your card.’ ”

“He’s not just always been a medical doctor,” said Jessie Harris, a Bronx Community Board member and book distributor who has known him for 25 years. “He’s also a community doctor. He’s been one man I’ve known whose had goals and reached them–medically, socially and academically.”

Izquierdo’s medical legacy lives on: his daughter and son have taken over the management of the health care businesses he started and he hopes the Health & Science Charter School will help young Bronxites follow in his steps. But Izquierdo is already working on his next dream as a “community doctor.” He’s planning to buy what used to be his father’s bodega and convert it into a green grocery store with health education classes and a salad bar offering hearty meals.

It’s all part of his longevity strategy, he said: “I’m bribing God because if I’m busy with projects, he can’t take me away.”

Seven-year-old Mileidy Merino waits for her mother, Araceli, to finish dinner. Photo by Irasema Romero

The small rural town of Tecamtalan is covered with natural colors. They are the colors of acres of harvested land, where food like tomatoes, watermelons, peanuts, beans and corn dot the central Mexican state of Puebla. These are the lands where only three years ago Sindy Cecilio, then 10 years old, climbed up and down wooden ladders picking plums from their trees. Agriculture was a family business. The Cecilio family sold fresh produce in a market 15 minutes north of their home.

The fresh air and open spaces are a contrast to the life she now leads as a seventh grader at M.S. 328 in the Kingsbridge section of the Bronx. Gone are the afternoons playing and running in open fields or the Saturday mornings helping her father in the harvest. Now instead of selling food in the market, she accompanies her mother Araceli Merino to buy fruits and vegetables twice a week from the small Green Cart that parks on West 231^st Street and Kingsbridge Avenue.

Keeping her three children healthy is important to Merino, a stay-at-home mother, because she knows it is easier for them to gain weight now that their new lifestyle requires less physical work than what children are used to doing in Mexico. That’s true for her as well. In Mexico, she had to wash clothes by hand, one piece at a time. Today she just goes to the laundromat down the street.

For evidence of how their new lifestyle has influenced her children’s health, Merino has only to look at her. Last September, Mileidy’s doctor told Merino that the little girl needed to lose 12 pounds.

“In Mexico children eat but at least they go out and walk, run and play outside,” said Merino in the hallway of the family’s two-bedroom apartment.

Unlike her sister, Mileidy did not experience the active lifestyle helping in the field.  Merino said that other than weekends when the weather is warm and they go to Van Cortlandt Park, the children spend their free time at home. And because P.S. 207 is only a few buildings south from their Godwin Terrace ground-floor apartment, Mileidy’s physical activity is limited to a school dance class once a week.

Forty-six percent of Hispanic children across the New York City public school system are overweight or obese, according to a recent study released by the Department of Health and Mental Hygiene.

Mileidy has become part of this statistic after living in the Bronx for three years. This weight gain may be influenced by her family’s adjustment to a new lifestyle because in Puebla, physical activity and healthy eating were rooted in their livelihood.

Mileidy's family moved to the Bronx three years ago from Puebla, Mexico. Photo by Irasema Romero

The U.S. Census estimates there are 282,965 Mexicans living in New York City, with nearly half originating from Puebla, a state known for its agricultural richness.

While the weight gain for recent immigrants may seem relatively small, public health experts worry that it’s an indicator of bigger problems to come.

As children become accustomed to the American culture, their body mass index levels increase. The National Council of La Raza released in November their latest installment of a 12-part series titled Profiles of Latino Health: A Closer Look at Latino Childhood Nutrition, which indicates that “first-generation immigrant children were significantly less likely (24.6%) than second-generation children (U.S.-born children of immigrant parents) (32.1%) and third-generation children (U.S.-born children of U.S.-born parents) (31.7%) to be overweight or obese.” In the Cecilio family, those statistics translate into the fact that one of the four children is experiencing weight issues.

Merino attributes her daughter’s weight gain to her diet both at home and at school, which serves pizza for lunch every Friday. Since September, she has tried to make the meals at home healthier. She stopped making spaghetti, which they ate at least once or twice a week. She returned to caldo de pollo (chicken soup), cemitas (a sandwich specialty from Puebla) and the traditional mole poblano.

“They used to eat a lot before,” said adding that she has now restricted Mileidy from eating her favorite evening snack: Mexican white cheese with sour cream.  After 6 p.m., the family is now only eating healthy snacks like oranges and Mileidy’s favorite fruit, the mango. Before that, they were having a full meal right after school and again at around 8 p.m.

The second grader has since lost three pounds and her mother keeps working for more.  Merino said she will continue buying fresh fruit from the Green Cart and going to a live poultry shop called a vivero on 231^st Street and Broadway. She said she does not buy prepackaged poultry or meat from the supermarket because she is used to growing chicken in her home in Puebla.

“I think it’s because they spend more time in the supermarket, and in the viveros you can buy them the way you like them,” said of her interest in keeping her Mexican customs and not buying frozen food.

According to Andrew Rundle, a professor of epidemiology at Columbia’s Mailman School of Public Health, her desire to buy fresh fruit from farmer’s markets and poultry from viveros is consistent with what his team found in recent studies of health-conscious New York immigrants.

In his interviews with 350 Hispanic immigrant women about what makes food healthy, the majority suggested they want to know where the food comes from and they like to be able to choose the meat or poultry they want. These women did not use terms like gluten-free or organic, which in local supermarkets can mean a higher cost in food, to describe their nutritional choices.

The idea of healthy food originated in the lifestyle of their native Latin American countries, but also echo the slow food movement that started in Italy, Rundle said.

The slow food movement was established in 1986 as an alternative to fast food, suggesting a need for fresh and organic food that is not altered for faster growth.

“This is an idea that is seen as very elitist, yet these women who are immigrants and live in poor areas have these ideas and attitudes that are very familiar to slow foods,” said Rundle, adding that the women in the study perceived the dirt on the vegetables they buy at farmers’ markets as an indicator of freshness.

This principle of freshness is valued among other Poblano immigrants in the Bronx who are used to eating organic produce their family harvested. At the age of 22, Ines Juarez moved to the Bronx from a small town in the mountains of the Mexican state of Puebla, where her family planted corn, oranges, and bananas in the fields adjacent to their home.

“[In Mexico] things are more natural,” Juarez said speaking of the fruits and vegetables she now tries to buy for her family. “Here they regularly have to have chemicals to help them grow faster for production.”

Her two boys, who are also students at P.S. 207, did not get to experience that rustic lifestyle in her native Mexico, where she woke up to the sound of roosters and chickens. In contrast, Jonathan, 9, and six-year-old Bryant’s childhood experiences are limited to the busy city streets surrounding their Bailey Street apartment, where the #1 train rushes through in the background and honking cars crowd the nearby Major Deegan Expressway.

Juarez tries to continue the customs she learned in Puebla, where the women in the family would spend time making food from scratch, including rolling and pounding on dough to make corn and flour tortillas. Food was not purchased in cans or packaged to last for weeks. If they wanted something sweet to drink, they would pick oranges from the ground near the fruit trees around their home and have freshly squeezed orange juice.

They rarely watched television because they were busy harvesting the field and tending to the chickens and turkeys the family grew.

When the children were not going to school or helping the family, they had lots of room to run and play, Juarez added. Because other family members lived nearby, it was easier for children to go out with relatives without worrying about where they were.

Although she still makes tortillas from scratch and stays away from canned food because her family doesn’t like the taste, Juarez believes Jonathan is about five to 10 pounds over his healthy weight.

But as a first-generation Mexican immigrant, the factors influencing Jonathan’s weight may be defined by his mother’s struggle to maintain hints of a Poblano lifestyle while not limiting her children’s American experience.

“Their friends bring snacks to school and they want some,” said Juarez. Often, Jonathan and Bryant are asking for cookies and chips. “I tell them ‘no’ because it’s not as healthy and they don’t need it…But it’s difficult to limit so many things.”

Arminda Muñoz took her three children to Fitness Fun Day at M.S. 45 to help her 11-year-old son Jeffrey stay active. Photo by Irasema Romero

Juarez’ children are easily tempted by snacks from the bodegas surrounding their school. According to “Disparities in the Food Environments of New York City Public Schools,” another study completed by Dr. Rundle and his team, there are on average 10 bodegas within a 400-meter radius of New York City public schools.

Even though Juarez, who is a stay-at-home mother, tries to maintain a healthy diet, other Mexican immigrants may not be as aware of the low nutritional value of processed food.

In the 2009 study “Moving to the Land of Milk and Cookies: Obesity among the children of immigrants,” Dr. Jennifer Van Hook, a professor of sociology and demography at Penn State, and her team followed approximately 20,000 children from kindergarten through 8^th grade and found that 40 percent of first-generation Hispanic children are overweight or obese by the time they get to eighth grade. About two-thirds of Hispanic children in the study were of Mexican descent.

She said that immigrant parents may not understand the significance of childhood obesity because it may not have been a major problem in their native countries. Even in the U.S., it has only become an issue in the last 10 to 20 years.

Van Hook said that children in the study whose parents come from the poorest countries had the highest obesity rates.

“The idea of dieting, the idea of exercising… is probably foreign to a lot of these people coming from pretty rural areas of Mexico and agricultural backgrounds, especially if parents grew up in situations where they did not have enough,” Van Hook said.

Although Puebla has a prominent agricultural economy, it is still one of the poorest states in Mexico. CONEVAL, Mexico’s council for the evaluation of economic development reported in August 2010 that over 61 percent of youth in Puebla live in conditions of poverty. In all, over half of Puebla’s five million residents live in poverty.

Children in Mexico who live in rural areas are thinner than those who live in urban areas of Mexico, said Van Hook, which suggests that a higher income does not translate to a healthier lifestyle.

“There’s more opportunities to go out to dinner and to eat more, and to eat more sort of non-traditional preprocessed foods when you live in an urban area,” she said adding that immigrant families who have gained a level of financial stability in the United States are also still at risk of gaining weight.

Although family economics may be better than when they arrived to the Bronx almost 10 years ago, Juarez rarely eats out, and instead takes her children to Van Cortlandt Park on the weekends She said she tries to keep the children as physically active as possible even if it’s inside the house.

Sixty minutes of daily physical activity are recommended for children, but, according to the New York City Department of Education, only 40 percent of the city’s six- to 12-year-olds achieves it. The department’s 2009 Child Health Survey suggests that one in every 10 children did not get even one hour of physical activity outside of school the week before the survey was administered.

Jeffrey Muñoz plays games at Fitness Fun Day in October. Photo by Irasema Romero

With the goal of providing fun alternatives to exercise, Manhattan-based USA Fitness Corps partnered with Thomas C. Giordano Middle School in the Bronx to offer Fun Fitness Day this past October.

Jaci Van Heest, a professor of kinesiology and child psychology at the University of Connecticut, designed the workout for the event using traditional activities and modifying them with fun new elements. For example, the simple act of kicking a soccer ball incorporates body movements to increase physical activity as children participate in a circle.

“If you use the word exercise, it conjures up images and feelings that are typically negative – work, sweat, sore, not fun,” Van Heest said. “If adults think that, why would children think or say anything different?”

Seventh grader and Puebla native Jeffrey Munoz enjoyed playing Van Heest’s modified soccer version as he gathered with other children in the southeast corner of the M.S. 45 Doc Serpone playground on East 189th Street and Lorillard Place.

The session was led by a group of retired veterans of the U.S. armed forces. Jeffrey watched the ball closely to kick it during his turn. When it went out of bounds, he took a breather, bending down and restings his left elbow on his knee.

The 11-year-old said that sometimes he does not get a chance to play soccer, his favorite sport, with his friends because they don’t want to go out a play.

“My dad told me that I needed to lose weight because I’m getting a little fat,” Jeffrey added.  “It makes me feel like he wants me to exercise.”

Jeffrey, who moved to the U.S. with his family five years ago, is now 10 pounds over his healthy weight, said his mother Arminda Muñoz.  “He likes to exercise but he also eats a lot,” Munoz said of her son, who also watches at least two hours of television each day. “I want him to get healthy because he’s at risk of having diabetes and other health problems.”

A doctor advised Jeffrey to lose weight earlier in the semester and Muñoz now wants her two younger children to learn the value of being healthy and staying active.  That’s why she brought her children to the fitness session at Jeffrey’s Mott Haven middle school.

Principal Annamaria Giordano said the school decided to become the first to offer Fitness Fun Day in the Bronx as a way to provide school families resources to fight childhood obesity.

“The small steps are perfect because they lead to the big steps,” she said of that Saturday’s two-hour activity series. “We are trying to ensure that our children are healthy and fit. Our small part can help a child or two or more.

Van Heest said Fun Fitness Days strives to change the perception of exercise for the over 100 schoolchildren who participated. The next time they have the opportunity to be active, she hopes they will bring back the memory of “the last time I had fun.”

Similarly, parents like Merino, Juarez, and Muñoz rely on memories of the Puebla they left behind to continue influencing their children’s diet and exercise habits. Their children may grow up as Americans but they each strive to preserve the best of what their families experienced in Mexico – if only for the sake of their children’s health.

Fun Fitness Day will be held at the M.S. 45 Don Serpone schoolyard. Photo: Irasema Romero

Military veterans will lead Belmont children in a series of interactive games during Fitness Fun Day Oct. 16 from 10 a.m. to 12 p.m. at M.S. 45.

According to the New York City Department of Health, 40 percent of city children are overweight or obese. Fitness Fun Day is designed to promote more physical activity by students from kindergarten through 12th grade. The free program is sponsored by USA Fitness Corps, a non-profit organization established in 2009 to fight childhood obesity with veteran volunteers. “We want them to be as much like Saturday morning, and less like school,” said USA Fitness Corp spokesman Arthur Pincus.

Fitness Fun Day uses a custom curriculum designed by Dr. Jaci VanHeest, a professor of kinesiology and child psychology at the University of Connecticut. With names like Wicked Ball, Attack the Snack, and In the Pickle, each activity offers an opportunity for students to have fun while being physically active.

For Attack the Snack, the captain selects a food product, and along with his or her team, decides what physical activity is necessary to burn calories consumed in each serving. Depending on the calorie amount, the group collaborates to burn calories with jumping jacks, jogging or push-ups.

During training last week, participating veterans were advised not to use the word exercise with students because that makes it sound too much like work. “If they are fun, they will want to do more of those kinds of activities,” said David Haney, USA Fitness executive director. “All of that leads to a healthier and happier kid, and happier families.”

Parents may still register their children for free at the site. The school is located at 2502 Lorillard Place. For more information,  email info@usafitnesscorps.org.