05.07.12

Obesity and Diabetes Afflict a New Jersey Family Fighting to Stay Fit

Three generations of the Rivera family have contended, often unsuccessfully, with obesity and diabetes. Tony Dokoupil presents the personification of a nation at risk.

For two generations, obesity and its henchman diabetes have stalked Alicia Rivera’s family. They took her mother-in-law’s lower legs, which were amputated after ulcers formed that wouldn’t otherwise heal, and have consigned Alicia and her husband to daily injections and pills. The couple now lives within arm’s reach of an EpiPen—a payload of adrenaline behind a long needle—in the event of an insulin coma. All this the 46-year-old mother of three has weathered without collapse. 

But in January the epidemic announced itself in a third generation. Alicia’s 17-year-old daughter, Becky, started complaining of fatigue. Just a year earlier, at her 16th birthday celebration, she looked vivacious dancing in new heels with her father. But now when Alicia tested Becky’s blood sugar levels, they were high. A day later they were high again. A doctor later confirmed Type 2 diabetes—the type attributed to lack of exercise and weight gain. “You try to protect them,” says Alicia, surrounded by walls of family photos in her living room in Camden, N.J. “You tell them, ‘I don’t want you to become me.’” 

The desire to stop obesity, however, is rarely enough. In 1960, President-elect Kennedy saw a country where 13 percent of adults and 4 percent of school-aged children were obese, and he fretted about the new “soft American.” Five decades later, Americans themselves spend an estimated $40 billion dollars a year trying to keep off the pounds, yet the pounds keep coming: today, more than 35 percent of the nation is counted as obese, including 17 percent of school-aged children. 

Obesity-related diseases—including five of the country’s 10 leading killers—have spread in tandem, ballooning health-care costs and raising the real threat that Becky’s generation could be the first to live shorter and less healthy lives than their parents. Becky herself recently broke down under the strain, telling her mother, “I just want to be normal again.” But she’s now more "normal" than ever. As Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention, has been saying for years, “If you go with the flow in America today, you will end up overweight and obese.” 

Amid this public scourge, the Riveras' private trial represents only a few data points. But to spend an afternoon with them, as I recently did, is to glimpse the whole epidemic in portraiture, including how hard it will be—despite  a new round of national fretting—to get back to even Camelot-era standards of health. Like America, the Riveras have tried to manage their weight for decades, and, like many Americans, their story is full of paradoxical examples of discipline and excess, strength and weakness, along with an ever-renewed commitment to getting it right. “I don’t want to die young,” Alicia says. “I want to help my kids.” 

Her efforts are being documented in Generation at Risk, a film that, among other things, follows the creation of the New Jersey Institute for Food, Nutrition and Health, and the residents who may benefit from its work. With funding from the Robert Wood Johnson Foundation, NJIFNH is a Rutgers University–based effort to study—and devise ways to combat—the causes of obesity in New Jersey, which is among the nation’s fattest states, with Camden ranking as one of its fattest cities. 

When Alicia arrived from Puerto Rico in 1972, however, she says everyone was thin. She was a school kid helping her mother and older sister, seasonal pickers of the Garden State’s plentiful blueberries, apples, peaches, cantaloupes, and watermelon. No one seemed to care about diet or questioned the nightly feast of white rice and beans and some kind of meat. By high school in the ’80s, however, fast food edged into the picture. Alicia worked at Burger King, her older sister worked at McDonald’s; both girls brought their work home with them, and for the first time Alicia noticed a weight gain. 

After graduation, she got a packing job in a factory and started the first of dozens of diets. Some of the weight came off, but more weight went back on, a cycle that would repeat itself for decades. Still, she was young. She met her husband, Basilide, at another factory job. “Oh my,” she remembers, “we used to go out. I used to dance and jump rope and everything.” 

But then she hit the anti-treadmill of domestic life. Every day was a shower of stress from 5 a.m. to 11 p.m., a race to get it all done. She had Vanessa, now 20, then Becky, 17, and finally, Taina, 9, who has Down syndrome. As a working mother, dinner was often “whatever is easiest.” She, and the rest of the family, poured on the pounds. Today, the Rivera family’s body-mass indexes range from 31 to 45. Anything above 30 is considered obese. Above 40 is considered morbidly obese. 

The “facts” of the obesity epidemic have been molded into many forms, usually to support one of two explanations for America’s peerless girth. The first holds that fat people are individually responsible, having tailored their extra large pants out of years of self-indulgence and the absence of willpower. This is what one might be tempted to conclude about the Riveras, after lunch at the Golden Corral buffet near their home. 

At the ticket counter, Alicia ordered Sprites—“no ice”—for herself, her husband, and her daughter, Taina, a talkative charmer in purple Nikes. At the buffet, the family embraced the restaurant’s invitation to “Help Yourself to Happiness,” piling nine-inch green plates with fried rice, sweet potatoes, batter-fried shrimp poppers, and glazed chicken, beef, and ham. Dessert was ice cream and chocolate-covered heart-shaped cookies, punctuated by cheeseburger sliders, which Taina was scolded for not finishing. “I don’t know why we’re not on a strict diet,” Alicia said later. “You get tired ...” She trailed off. “You do want to reach for that cheeseburger.” 

The second explanation for America’s size all but forgives Alicia and others for their flights of gluttony. Their problem isn’t personal but environmental, it holds, an inevitable result of living in a country of cars, televisions, cheap corn, snack foods, and immoral advertising to children. These forces and “the forces within us,” according to The Weight of the Nation, a diet-book companion to the new HBO documentary, “work in ways beyond our control and outside our awareness.” This idea was on display at the Riveras’ local supermarket. Alicia walked me and her family to a pile of red apples, an “everyday value” at $1.99 a pound. Alicia took two and placed them on a scale. “You see that?” she said. The cost would be a dollar an apple. At the end of the aisle jumbo bags of chips leaned toward us for half that price. The next aisle was a gauntlet of breakfast cereal and candy, a seemingly odd combination unless you’ve ever walked such an aisle with a child. Taina zigzagged from boxes of toy-and-cartoon-festooned sugar cereals to candy bars and back again, as Alicia tried to subdue her with promises of “later, later.” “They don’t make it easy for us,” she said, wearily.  

‘I don’t want to die young,’ Alicia says. ‘I want to help my kids.’

At home, she tries to control portions, avoid sugary snacks, and divide the family’s dinner plates into quarters, leaving half for veggies, a quarter for carbs, and a quarter for lean meat, as a nutritionist once suggested. She tries to walk more. But it all takes energy she doesn’t always have, not to mention money she isn’t making. She and Basilide are out of work. She owns a treadmill, but it's broken. 

More than nine out of every 10 diets fail, but as the weather improves, Alicia is feeling optimistic. She’s going to start walking again this spring, she says, and she’s taking Becky with her. “We can do this together,” she told her daughter. “As your mother and your friend, I will help you do it.”