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Shawn Ruiz used to start his day with a sausage, egg and cheese croissant sandwich plus fries at Burger King. Now he eats a bowl of Special K with a cup of milk and maybe a couple of eggs.

"That fills me up," said the Roseland Accelerated Middle School student, who doesn't consider himself on a diet or deprived. Nor does his family doctor, Cheryl Green at Santa Rosa Kaiser Permanente, whose goal for her 13-year-old patient is a life of healthy choices.

"It's not about setting a weight loss goal but a behavior change," said Green, who has made childhood obesity her passion.

Dr. Green didn't say I had to starve myself," said Ruiz. "She just said to watch what I eat, make better choices and get more exercise."

That's one message from health experts trying to reverse the national epidemic of childhood obesity. Show kids what they have to gain — healthy habits — rather than the number of pounds they need to lose.

"I feel very lucky that I'm doing this now because I know when you get older it's tougher," said Ruiz.

Doctors, of course, would prefer to start before 13 to recruit a child to healthy eating.

Ideally it starts before birth, said pediatrician Mark Sloan, also with Kaiser, who said the first thing a parent can do to prevent overweight children is to keep a healthy pre-pregnancy weight. Then comes breastfeeding, he said, "the second most important obesity prevention measure," because not only is it the "perfect food for infants, it also helps parents to not over-feed their infants."

Pediatricians, he said, are now starting to emphasize obesity prevention at the first well-baby visit and then keep the message going through high school graduation.

Sometimes a child's growing girth can go unnoticed, especially in our giant soda, fast-food, screen-obsessed culture. Parents don't see it on their kids because they don't look that different from other kids, said Green, noting that "43 percent of parents with overweight children think the child is about right. That's because the percent of overweight children has tripled in 30 years."

Virginia Mendez of Santa Rosa wasn't concerned about her son Martin, now 12, until his doctor urged both mother and son to enroll in Tomando Pasos (Taking Steps), a bilingual healthy-weight program at the Northern California Center for Well Being. That was last summer and since then the whole Mendez family of Santa Rosa is eating different. Martin's given up junk food. His mother has joined Weight Watchers and her husband's diabetes has improved.

In Sonoma County there is no lack of programs aimed at getting kids to eat better and move more. Kids at Salmon Creek School in Occidental grow their own salad bar ingredients in the school garden. Santa Rosa grade-school girls learn the fun of exercise through the popular Girls Can Run program.

A summary of programs is on the Healthy Students Initiative webpage for Sonoma County Health Action — www.sonomahealthaction.org/hsi

In Sonoma County, like the rest of the country, the highest obesity rates are in low-income groups. In Sonoma County, 38 percent of low-income children, ages 2 to 11, and 44 percent of teens are overweight or obese, according to Health Action figures. Those numbers have held fairly steady for the last few years and match overall state rates.

Despite the many efforts to reduce obesity, the big challenge is to convince children and their parents to commit to a new lifestyle.

"It takes a lot to get families to enroll," said Alena Wall, director of the Center for Well Being which offers several healthy weight programs. "These are lifestyle classes and so people have to be ready to make changes. But with those who attend we have success."

At the center's classes, Martin Mendez played ball, did yoga and lifted weights with other kids while his mother talked with other parents about healthier ways to stock the refrigerator and cook. As a result Virginia Mendez stopped buying soda, replaced fried meat with grilled and introduced daily salads.

The difference in her son from a year ago, she said, is obvious. "He used to come home, grab something to eat, go to the couch and watch TV." Now, she said, "he has a snack, does his homework and goes outside and plays a sport."

The snack is usually celery sticks with peanut butter and raisins.

It's important to not make parents feel like they've done a bad thing, said Wall at the Center for Well Being.

"We're not blaming families," said Wall. "They already have enough pressure on them. Environment influences health decision. A lot of families don't have access to fresh fruits and vegetables that are reasonably priced. Or they don't know that frozen fruit is a good substitute for fresh. And you can use food stamps at farmers markets."

Martin Mendez has lost 10 pounds on his new regimen, developed muscles and seems to appreciate his newfound energy.

"When you're overweight you get tired fast," he said. "You can't run as fast. You feel sleepy all the time."

Pediatrician Green studiously avoids using the words fat or obese. Instead she prompts a discussion about healthy eating with her patients, using a questionnaire she developed and calls the Get Healthy Action Plan.

Some of the questions include: how often do you eat out? How many sweet or salty snacks do you have a day? How many sugary drinks? What type of milk does the family drink? Do you add chocolate and strawberry flavoring? How much screen time do you get, including TV, Facebook and texting? How much sleep do you get?

"We have evidence that all of these things affect a child's weight," said Green who teaches at the Santa Rosa Family Medicine Program where there is a growing emphasis on childhood obesity.

Her teenage patient Ruiz has become an ambassador for healthy eating, recently speaking to a roomful of adults at the Latino Health Forum. He said his moment of truth came when he signed up for football.

"I stepped on the scale and they said for my weight I'd have to go up two divisions. I was, like, wow."

Now he claims to love salads. "With vinegar and oil. I don't even like ranch dressing."

Susan Swartz is a freelance writer and author based in Sonoma County. Contact her at susan@juicytomatoes.com