She is 24 months old, and her tiny frame is struggling to support her. Doctors say getting her to a healthy weight means that she cannot gain a single pound for the next three years. She is not an anomaly.

In the United States, an estimated 16 percent of children and adolescents ages 6 to 19 are overweight. The challenge and frustration for doctors who treat these youngsters is breaking through the apathy.

"We don't get it as a culture yet," says Dr. J. Mike Gilbert, a Salem, Ore., pediatrician. "Being obese is not painful, it doesn't cause anguish, and so we just don't get it."

The medical price these children will pay includes more heart disease and more strokes. Some will develop high blood pressure. Some will suffer the debilitating consequences of diabetes.

More immediate problems include skeletal strain, resulting in back pain and knee pain.

"Even if you don't keep statistics, it's just dramatic, and when you work in a pediatric office, it just assaults you and comes at you every day," says Dr. George Miller, medical director at Salem Hospital. "It's a combination of a sense of alarm and a sense of incredible discouragement."

Only in the past decade have doctors started to see childhood obesity as an epidemic, says Gilbert.

"We see five or six kids a day that should be 25 percent less in weight than they are," Gilbert says. "When you talk about one out of four kids being overweight, that's an epidemic. If we had that many cases of influenza, everybody would be up in arms."

The reasons are as complex as any solution to the situation, which the American Academy of Pediatrics cites as a "crisis" in the United States.

The most popular scapegoat is sugary breakfast foods, prepackaged lunch snacks loaded with sodium and fat and "super-sized" dinners that are quick and cheap.

But food is only part of the story, experts say.

Children aren't moving. Riding a bicycle or walking to school is almost unheard of. Climbing trees and jumping in puddles have given way to sedentary entertainment such as surfing the Internet or playing video games.

At Whiteaker Middle School in Keizer, Ore., physical-education teacher Kathy Arquette says she sees today's students as less active than those of the past.

"The biggest shift that I've seen is the entrance of technology, which is great for the cognitive end of our students, but it has aided in their inactivity," Arquette says. "When kids didn't have the video games and the televisions in their rooms — the quick access to entertainment — they went outside and entertained themselves."

In the absence of all other physical activity, a school P.E. class is not a cure-all.

"We have to wake up the parents," Arquette says. "We can't see kids for 45 minutes a day and change their lives."

Obesity gets worse because these children are uncomfortable with movement. Overweight children are embarrassed to undress in the locker room, they tire faster and their skin chafes, says Miller of Salem Hospital.

Overweight adults and a growing acceptance of "pleasantly plump" presents another challenge in getting children fit.

Thus, prevention efforts are starting sooner and doctors are working to establish a level of parental responsibility.

More and more, pediatricians are turning their attention to preschoolers and toddlers.

Gilbert, the Salem pediatrician, notes that addressing a mother or father about an overweight child no longer is a "delicate" subject. It is a frustrating one.

"Eighty percent are nonchalant," Gilbert says of parents, adding that most say, "Oh well, that's the way things are."

Gilbert finds that reaction unbelievable, especially when it's about a child who is unable to do basic physical tasks.

"How can this family put up with this and accept that this child is so limited already?" Gilbert says. "And yet, I never hear them complain."

"We've become indifferent to it," he says with a sigh.

Doctors are scrambling to slow childhood obesity, throwing weight-management and prevention programs at this health care crisis.

"We've known about this problem for a long time, but it is preventable, and that's what we're trying to teach," says Sandy Frank, a registered dietitian at Salem Hospital.

Frank is the director of the hospital's chapter of Committed to Kids, a national weight-management program that teaches and develops habits of healthy living to obese children and their parents.

At the root of the 12-week program is a message that Frank and her staff hammer home to parents: Childhood obesity isn't solely a child's predicament. It's a family's predicament.

Parents and children attend Committed to Kids classes together. Parents are expected to help their children design an exercise program and dietary regimen that then is implemented at home.

Laura and Larry Peterson believe in the program. They enrolled their son, Larry J., 9, in the spring.

Larry J. has completed the program and lost weight, but more important to his parents, the family has a better understanding of healthy living that they continue to put in practice.

It's this type of lifestyle change that Dr. Daniel Marks, an assistant professor and pediatric endocrinology researcher, and his colleagues at Oregon Health & Science University are promoting.

"We're looking at this like the way we looked at getting out the message about the dangers of smoking 30 years ago," Marks says. "This has to be a widespread, community-based movement that targets the awareness of the general population."

Marks adds that it is important for parents with obese children to understand that losing weight is not a quick process, just as a child doesn't become obese overnight.

"Part of our mandate, I think, is to come up with a pharmacological component, but we can't get lost in the search for a pill," Marks said. "The answer lies in our lifestyle."

Contributing: Matt Monaghan, Statesman Journal