Outside Dr. Riba’s Health Club, a newly opened clinic in Santa Ana that specializes in childhood obesity, trainer Brandon Farmer is leading three kids in lunges. “Chest open,” Farmer exhorts as the kids kneel and rise, kneel and rise. “Six … seven … eight … good!”

Inside, Dr. Patricia Riba is meeting with the 19-year-old brother of one of the three kids, an overweight 12-year-old who is a first-time patient. (Patients’ names are not disclosed.)

The initial visit is normally Riba’s chance to learn about the food habits of the patient’s parents. In this case, however, the father of the boys couldn’t afford to take off from his construction job, and their mother works seven days a week assembling packages of cosmetic products.

Riba told the 19-year-old that his brother was showing a ring of darker coloring on his neck that is often an indicator of diabetes. After a detailed discussion about food choices, she ordered tests to measure changes in the 12-year-old’s blood sugar over three months.

Riba’s nonprofit clinic is making the latest assault in Orange County’s war on youth obesity. Her team of experts combines clinical treatment; psychological and social intervention, if needed; nutritional education; and free fitness classes five days a week.

The team’s work reveals the commitment required to treat youth obesity in a city where 34 percent of young people are overweight. Nationally, childhood obesity rates have tripled in the last 30 years, fueling an epidemic of type 2 diabetes and soaring health care costs.

A graduate of Boston University School of Medicine, Riba started treating overweight children as a pediatrician at a Huntington Beach clinic. There, she and her assistants helped two young men lose 95 pounds in nine months. The effort involved hands-on nutrition education — picking up groceries, teaching about labels — and helped her see the benefits of what she calls a “bilingual, bicultural, multidisciplinary” approach.

By looking at each case individually and earning patients’ trust, Riba found that she and her team could pinpoint obstacles to better health.

In one example, Riba’s staff couldn’t understand why they were having a hard time persuading a parent to serve vegetables. “We found out they were living in a garage with no refrigerator,” she said.

In other cases, patients have sometimes confided key information, such as a parent’s alcoholism, to Riba’s younger assistants, allowing her office to steer the family toward help.

In treating patients, Riba saw that excess weight made kids susceptible to diabetes but also to sleep apnea, which can cause snoring and waking at night, which in turn can cause poor school performance. She also diagnosed in a 3-year-old non-alcoholic fatty liver disease, a condition commonly found in aging men.

“We’ve seen some of the toughest cases in Orange County,” she said.

Building on her work in Huntington Beach, Riba began treating obesity in other communities in Orange County and established fitness and nutrition programs at schools in Santa Ana and Costa Mesa. Fifty-five percent of children in her programs have reduced their body mass index (BMI). In one program, 87 percent reduced their BMIs.

Funded largely by the Children and Families Commission of Orange County with help from Hoag and St. Joseph hospitals and others, the Santa Ana clinic opened in May. The atmosphere inside is festive and upbeat, with colorful murals of ballparks, beaches, ski slopes and even a real snowboard and surfboard on the walls.

Adjacent to the clinic is a fenced-in play yard that allows kids to work out in a more private setting without the brutal teasing that occurs in school gym classes. The play yard also helps show kids how to exercise in tight spaces, since Santa Ana offers few parks and open areas, though Farmer sometimes leads dodge ball games and other activities in an adjoining field.

Riba strongly discourages putting kids on diets, which she believes causes feelings of deprivation that lead to bingeing. Instead she tells parents it’s their responsibility to set out a variety of nutritional offerings from key food groups at meal time and to let the child choose what to eat, even if it’s chicken for two days straight followed by three days of carrots.

“Coaxing has a bad effect,” Riba said. “Just keep offering variety and make meals enjoyable.” She said research shows that a child needs as many as 28 exposures to a food before he or she will try it. Kids need to learn self-regulation and respond to feelings of fullness, she said.

Mike Ruane, executive director of the Children and Families Commission of Orange County, said Riba has an obvious rapport with kids and their parents and understands families’ time and budget limitations. “She’s not just telling people what they can’t do but telling them what they can do and helping them do it,” Ruane said.

Being a physician adds to her legitimacy and professionalism, Ruane said, but at the same time it poses a challenge, since her emphasis on education and prevention are not in sync with a medical system that primarily rewards procedures. “The system is driven by billings, and fitness and nutrition aren’t covered by traditional medical billing,” he said.

Fitness and nutrition were the topics at the clinic recently as Riba questioned the 19-year-old who was there on behalf of his younger brother. What did they eat for breakfast? Brown rice or white?

It turns out that last night’s dinner included salmon and vegetables, which pleased Riba. She offered a few pointers. For example, fresh fruit is better than fruit juice, and corn tortillas are better than white flour. She concluded her meeting by volunteering the 19-year-old for a rigorous workout with Farmer.

Later that day, Riba and her assistant, Karla Rentie, a fitness trainer who also acts as translator, met with a mother of two overweight children — a son in kindergarten and a daughter in fifth grade.

Riba inquired about asthma and snoring, both of which are problems for the daughter, who is minimally overweight and excels in school. But the son, who weighs as much as a child twice his age, is having a harder time, his mother said. He is harassed about his weight, is easily distracted and must attend summer school.

Riba ordered blood tests for diabetes, allergies and lead. She asked the mother to send the kids to the free exercise classes and explained her opposition to imposing a diet, advising the mother instead to offer her son nutritional options and trust him to make healthful choices.

After all, Riba said, “He’s five. He shouldn’t be worried about his weight.”

Amy DePaul is a freelance writer and lecturer in the University of California, Irvine Literary Journalism program. You can reach her directly at depaula@uci.edu

Since you've made it this far,

You are obviously connected to your community and value good journalism. As an independent and local nonprofit, our news is accessible to all, regardless of what they can afford. Our newsroom centers on Orange County’s civic and cultural life, not ad-driven clickbait. Our reporters hold powerful interests accountable to protect your quality of life. But it’s not free to produce. It depends on donors like you.

Join the conversation: In lieu of comments, we encourage readers to engage with us across a variety of mediums. Join our Facebook discussion. Message us via our website or staff page. Send us a secure tip. Share your thoughts in a community opinion piece.