email@example.com. CHARLESTON, W.Va. -- On a sunny April afternoon, two fifth-grade West Side boys, Michael Smith and Dada Mitchell, walked to Charleston's Celebration Station playground to hustle a basketball game.They found two grown-ups shooting hoops. They talked their way into the game.During a break, all four answered this question: What does exercise do for you?"I'm an accountant, so I sit all day," one man said. "If I don't exercise, I gain weight."Flashing a toothy grin, 11-year-old Michael threw up his hand. "Exercise makes your blood pump harder through your heart!" he blurted. "It makes your heart stronger.""It keeps you from getting heart attacks and diabetes," his buddy Dada chimed in. They clearly knew this stuff and enjoyed telling it.Startled, the adults stared at them. "Helps you lose weight and makes your bones stronger!" Michael continued, passing the basketball from hand to hand. "Makes you live longer!"How do they know all that? Dada shrugged. "School," he said, grabbing the ball from Michael and taking a shot at the basket."School and my grandma," Michael echoed. "They tell us, 'Get out and do stuff, get your blood moving.' That's what we're doing, getting our blood moving.""Somebody's doing a good job at their school," one of the men muttered.Reasons to hopeWest Virginia still tops Gallup Healthways' "Worst Health" list. Yes, the state is still at or near the top of every ranking of every awful obesity-related disease: diabetes, heart disease, arthritis, hypertension, you name it. Yes, the adult obesity rate rose last year to 33.5 percent.But there are reasons to hope. The child obesity rate appears to be dropping.Something is happening with the kids.At Celebration Station, next to Michael and Dada's hoops game, Lois and Marvin Bell were playing ball with 2-year-old Marvin Jr. "We're here because my 5-year-old badgers me every day to let her go outside and play," Lois Bell said. "She's overweight, and they told her at school that if she goes out to play an hour every day, it will help."So the whole family went to the playground. It's catching. A year ago, the Sunday Gazette-Mail reported that one in four fifth-graders had high blood pressure and abnormal cholesterol. Almost 29 percent were obese. Those were West Virginia University numbers from actual screenings in the schools."Those kids are headed straight for diabetes and heart disease," Dr. Bill Neal said at the time. Neal directs the CARDIAC program that screens the kids.Legislative reports were warning that, if obesity keeps growing at 2008 rates, the cost to state taxpayers of treating those diseases will double by 2030.There's reason to hope that won't happen. In 2012, the percentage of fifth-graders with high blood pressure dropped from one in four to one in five, WVU's numbers show. So did the percentage of fifth-graders with abnormal cholesterol.The fifth-grade obesity rate edged down a point. The kindergarten rate dropped from 18 percent to 15 percent. Each one-point drop represents thousands of children.Neal credits the school system's campaign to improve school meal nutrition and get children more active. "We may be at a tipping point for child obesity," said Dr. Ron Stollings, a physician and chairman of the West Virginia Senate's Health and Human Resources Committee."It's no time to let up," said Don Perdue, chairman of the House health committee. "The question is, will the numbers keep going down? We're still above national average."Last week, Dr. Jamie Jeffrey, medical director of Children's Medicine Center at Charleston's Women and Children's Hospital, announced that the obesity rate at her center had dropped."Five years ago, we found that 44 percent of our patients between the ages of 2 and 14 were obese or overweight," she said. This year, they repeated the study. "The rate dropped to 36 percent," almost 20 percent. "That's truly significant, really encouraging." Five years ago, many of their patients were obese by age 3. "Now, the age of onset is up to five," she said. "We're headed in the right direction."This is what they did: For the past five years, Jeffrey's staff has preached nutrition and physical activity to parents, showing them their children's charts, listing diseases that obesity can lead to."We can't say for sure why this happened, but it seems to have worked," she said. "When kids hear it at the doctor, then they hear it at school, then they see it on TV, it's more likely to take hold."Many of Jeffrey's patients attend Mary C. Snow West Side Elementary School, where Dada Mitchell and Michael Smith are in fifth grade.What's going on at that school? On a recent Friday at Mary C. Snow, school nurse Janet Allio was showing astonished fifth-graders how much sugar is in a two-liter bottle of Pepsi. Their jaws dropped as she measured out 52 teaspoons.Students leaned forward over their desks. "Dag! Look at all that sugar!"Thirty teaspoons in a two-liter Mountain Dew, she said, "but there's a lot of caffeine and bad stuff in there, too." Twenty-three teaspoons in a two-liter Gaterade."We decided as a staff to promote healthy lifestyle throughout the school," said Principal Mellow Lee. "Everyone does it, not just the nurse or the P.E. teacher.Ninety-seven percent of the school's students qualify for free or reduced-price lunch. "A lot of our kids haven't had advantages," Allio said, "so we try to give them every edge we can.""We're teaching these children to be leaders," Lee said. "Taking care of yourself is an important part of that. It doesn't cost extra money to do it that way, but it does require planning and intention."Our teaching style is to keep kids moving from group to group. You won't find any children sitting for hours. They take a short 'wiggle' break."Physical activity and healthy diet improve concentration and academic performance, she said. Every child gets at least 90 minutes of P.E. a week, plus daily recess. The school has a school-based health center.Every child eats breakfast in the classroom. "That gives teachers a chance to talk about good food choices," Lee said. Breakfast-eaters are less likely to become obese, research shows. The cooks work from scratch, Lee said, avoiding processed food. Behavior problems and tardiness have dropped since the universal breakfast began, she said.More activity is neededLee likes the story about Michael and Dada on the playground. "They got it," she said. "We don't want to just get kids active for the sake of getting them active. We want them to understand why they're getting active."Just telling them to skip or run won't help them adopt a long-term goal of having a healthy lifestyle. If we can teach them why exercise is helpful to their bodies and minds, it's not as much of a change for them later, as adults. It's just something that's already integrated into their lifestyle."A problem: West Virginia requires only 90 minutes a week of physical education at the grade-school level and only one semester in all of high school. "Nowhere near enough," Jeffrey said.The federal Centers for Disease Control recommends that every child get an hour of exercise every day to stay fit and sidestep obesity. Mary Weikle, health coordinator for the state Office of Healthy Schools, agrees with that standard. "The goal is five-day-a-week P.E.," she said.But phys ed has been cut back to make time for a sizeable list of academic requirements. So Weikle's eight regional wellness specialists have adopted Plan B: helping schools and teachers weave more activity into the day during classes, before school, etc. More than 300 of 730 state schools are signed up as "Let's Move! WV" schools. More than 200 now use Xbox projector exercise games and programs."Next year," Weikle said, "we'll add academic software to help get kids moving while they study content areas."Schools are expected to meet state "content standards and objectives" in health and wellness, Weikle said, but nobody checks to see if they do. "We need serious discussion of the need for more activity in schools," said WVU's Neal. "This is a critical moment in our effort to get a grip on child obesity." Just 10 years from now, current fifth-graders will be adults, he noted. "We could go either way."If West Virginia schools can increase physical activity, and if doctors will give parents good lifestyle advice, and if West Virginia communities can keep creating playgrounds and trails and other good things, I expect the children's rate will keep dropping."A lot depends on what we do to keep the momentum going. In many ways, it's up to us."Reach Kate Long at firstname.lastname@example.org or 304-343-1884. The Shape We're In" has been supported by a Dennis A. Hunt Fund for Health Journalism fellowship, administered by the California Endowment Health Journalism Fellowships at the University of Southern California's Annenberg School for Communication and Journalism.