The evidence of America's obesity epidemic is all around us. But the problem is particularly acute among African-American women.
About half of African-American women in the U.S. are obese, compared to 30 percent of white women. Black women not only carry more weight, but they start piling on extra pounds years before their white counterparts.
So when does it begin, this excess and unhealthful weight? Research suggests the problem starts early, and it may have a lot to do with when girls give up regular exercise.
Doctors and public health specialists want kids to exercise at least 60 minutes every day, but among all children, black girls are most likely to report they got no physical activity in the past week. A lack of access to exercise opportunities may be one big reason why, says Shiriki Kumanyika, an epidemiologist and public health professor at the University of Pennsylvania.
Research shows that opportunities for recess, sports, physical education and just going outside aren't spread evenly among children.
"If you kind of add up those situations in urban, inner-city neighborhoods — where most African-Americans live — they are not as available. That's been documented," says Kumanyika, who studies patterns of illness and health behavior.
But research suggests that even those girls who do engage in sports and other forms of regular physical activity tend to abandon it in their teen years — and that's true not just for urban girls or black girls, but all girls.
A National Institutes of Health study that followed girls for 10 years, beginning at age 8 or 9, found that, over time, their leisure-time physical activity declined dramatically. That drop-off was steepest for African-American girls.
"What they found was that by the age of 17 — so that's the junior, senior year of high school — more than half of black girls, and nearly a third of white girls were reporting no leisure time physical activity at all," says Temple University researcher Clare Lenhart says.
There are lots of reasons why teen girls drop exercise from their lives, says Lenhart: "They have found changes in enjoyment of activities, in peer support or social support for physical activity. They found a lot of competing interests — be it part-time jobs or caring for younger siblings or other family members."
Walter Stewart says he's witnessed the phenomenon first-hand. He's the longtime coach of the Anderson Monarchs, a soccer team of mostly African-American girls from inner-city Philadelphia.
"Eighth grade — that's where it gets to be difficult," he says. "They are making the transition from young kids to more teenagers, and they are more interested in boys and what boys think."
Jennifer Johnson was determined not to let that happen to her daughter, Alexandria. Johnson discovered the Monarchs when she was looking for an affordable way to keep Alexandria active.
Alexandria is now 15 and an assistant coach with the team, but her interest in soccer dipped in middle school, around age 12, says Johnson.
"In come the friends, and in come the extracurricular activities at school, and as a parent you really have to press on. I said to her, 'If it's not this, you will be involved in something,' " Johnson says.
So Alexandria stuck with soccer, and so did her mother. Johnson is on the sidelines at games and during most practices.
That's an approach that obesity researchers would approve of. Researchers say that family support — especially mom's presence — may motivate girls to keep playing.
This story by Taunya English is part of a reporting partnership that includes WHYY, NPR and Kaiser Health News.
And it is African-American women who have the highest rates of being overweight and obese compared to other groups in the U.S. Reporter Taunya English looks at why.
TAUNYA ENGLISH, BYLINE: So when does it begin, this excess and unhealthy weight? Temple University researcher Clare Lenhart says: It starts early.
CLARE LENHART: By the age of 17, nearly 60 percent of black girls and about a third of white girls were reporting no physical activity participation at all.
ENGLISH: A National Institutes of Health study followed girls for 10 years, beginning at age eight or nine. Exercise declined dramatically over that time, and the drop-off for African-Americans girls was steepest. Researchers are trying to figure out what keeps some girls from getting the recommended 60 minutes of exercise.
LENHART: Sometimes it's very simple things. It's not wanting to run very hard or get sweaty during gym class, because they don't want their hair to be messed up for the rest of the day. It can be more larger things, where their friends maybe aren't participating anymore, and so it's not considered cool for them.
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UNIDENTIFIED MAN: Players, come in, coaches too.
INDIA BARNES: My name is India Barnes. And I'm nine years old. And I go to school at Holy Spirit Catholic School.
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ENGLISH: India plays soccer for her club team, the Anderson Monarchs.
BARNES: I play striker. Her job is to score, give good passes and try to help the defense too.
ENGLISH: At age nine, India still thinks sports are pretty cool.
BARNES: Yeah, I'm an athletic kind of girl. It makes me feel confident.
ENGLISH: The Monarchs are mostly African-American girls from urban Philadelphia. Coach Walter Stewart says the club gives city girls a chance to play a sport. For girls, team sports and structured activities may be the most consistent way to get exercise.
WALTER STEWART: In a soccer game at their age, as they get to be, say, 13, 14, they're probably running in a game three, to four or five miles.
ENGLISH: The Monarchs practice two or three times a week and travel to games on the weekend. Stewart says by the end of middle school many players lose interest and commitment.
STEWART: That's where it gets to be difficult, they are making a transition from young kids to more teenagers and they're more interested in boys and what boys think.
ENGLISH: And less interested in sports and fitness.
Concerns about black women and weight surfaced a full decade before the obesity epidemic hit the general population.
University of Pennsylvania Professor Shiriki Kumanyika says black women's weight started out high, then in the 1990s went higher.
SHIRIKI KUMANYIKA: So we used to be 30 percent, maybe white women were 15 percent. And now it's like 50 percent versus 30 percent. So everybody's gone up.
ENGLISH: Kumanyika is an epidemiologist, a detective of sorts, looking for clues to the weight gap. Research shows that opportunities for recess, sports, physical education or to just go out and play, aren't spread evenly among children.
KUMANYIKA: Add those situations up in urban, inner-city neighborhoods where most African-Americans live, they're not as available, and that's been documented.
ENGLISH: And that can be costly, both in terms of health and money. Obese people cost nearly $1,500 more a year in medical expenses compared to healthy-weight people.
UNIDENTIFIED GIRL #1: Who has India?
UNIDENTIFIED GIRL #2: I do.
UNIDENTIFIED GIRL #1: Who has Carissa?
UNIDENTIFIED GIRL #3: I do.
ENGLISH: Mom Jennifer Johnson discovered the Anderson Monarchs when she was looking for a way to keep her daughter active. Alexandria's 15 and a committed assistant coach these days, but her interest dipped around age 12, and that worried her mom.
JENNIFER JOHNSON: In comes the friends, and in comes the extracurricular activities at school, and as a parent you really have to press on. Because I said to her: If it's not this, you will be involved in something.
ENGLISH: Johnson says ultimately, good friendships kept Alexandria on the team.
JOHNSON: It's about the running around. It's about the fitness. And twice a week they have a common playing ground, you know, they have this team.
ENGLISH: Johnson also makes sure she's on the sidelines. Obesity researchers say that kind of family support may be another way to motivate girls to keep playing. For NPR News, I'm Taunya English.
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MONTAGNE: That story is part of a project on health care in the states, a partnership of WHYY, Kaiser Health News and NPR. Transcript provided by NPR, Copyright National Public Radio.