Melissa Parrinno is a school cafeteria manager on a mission. She tries to inculcate healthy eating habits in school going children at the South East Middle School in Baton Rouge, Louisiana. "When I first started a salad bar seven years ago there were only 20 takers a day. Today its about 50," she says. Despite the small number, Parrinno knows it's a step in the right direction.

The southern state of Louisiana, of which Baton Rouge is capital, is bogged down by its "foodie" culture. Heavy (largely red meat), fried foods have long been synonymous with a way of life. At the other end of the spectrum, a large part of the population is poor and colored, so eating cheap, junk food is their only option. Result: A huge population of fat and weak bodies.

Louisiana has the dubious distinction of being the last state in health ratings in the US. Since 1990 obesity rates have more than doubled from 12.3 per cent to 24.8 per cent according to the Center for Disease Control and Prevention, Atlanta. "If the epidemic doesn't abate by 2020, obesity related health costs will also more than double," according to the Rand Corporation, a non-profit think tank that advises both public and private sectors. This will put the state's obesity related heath care spending to about 3 million dollars as obese people suffer more problems and need more health care.

This well documented obesity epidemic began in the mid-1980s, spurred by sedentary lifestyles, computers, TV, fast food, hectic pace of life. And today, obesity is being targeted as a disease, (an estimated 365,000 Americans nationwide die due to obesity linked conditions annually) - with far reaching implications on long term health and the health care system. It is higher in women, minorities and low income groups. Overall it will cost the entire country $117 billion annually, says the Rand study.

Obesity in children is a key focus area in the battle of the bulge as they grow into obese adults, with all the attendant health problems like diabetes, hypertension and liver malfunction. According to a survey by the National Institute of Health, childhood obesity in the US Has doubled in the last three decades. Experts say the health care system just cannot sustain under the projected impact of younger people with chronic diseases caused by obesity.

Catching them young is now top priority in states like Louisiana, where poverty and poor awareness make healthy eating habits a hard choice for most. The good news is that in August 2005 a new law in Louisiana came into being mandating that half the snacks in school vending machines should fit healthier guidelines. School systems are also being compelled to implement holistic wellness programs for children to enable them to make better food choices and exercise more.

Since 2004, elementary schools in Louisiana are providing 30 minutes of physical education a day, the focus of this having shifted from the old Physical Training (PT) to actual education on food habits, exercise and holistic health. In addition to health related problems like high blood pressure, diabetes and high cholesterol, doctors are concerned about the social consequences of obesity to their clients. Obese people have low self esteem, are viewed as lacking control over their bodies and actions, and have poorer social skills than the non obese. "After my gastric bypass surgery for weight reduction, I find that people take me more seriously," says Nikki Dicappio, 20.

She started thinking of surgery when her mother died recently from obesity related illness. Her mother was 6 feet tall and weighed 370 pounds. Nikki opted for the less invasive lapband surgery, where an adjustable band is fixed around the upper stomach. She has lost 30 lbs since. But her doctors have warned that this is only an additional tool: she will have to eat well and exercise regularly if she wants to reduce further. Basically then she will have to commit to lifestyle changes. Is she ready for it? "Oh absolutely," she says. "Its hard work but worth it."

Another surgical option, the gastric bypass, is also gaining popularity among the genetically obese. Here, only a small portion of the stomach is left attached to the digestive system. But again, doctors warn that it is no quick fix. "The bottom line is that people must realize its better to be fit than fat," says a doctor at the General Hospital here.

Researchers at Baton Rouge Pennington Bio Medical Center say that a lot of people fail to lose weight or fail to keep it off because life's patterns and schedules get in he way. So if an office deadline has to be met, a fat person, already habituated, would rather grab a hamburger than a salad. Why? Because it is a pattern, a habit. Weight loss then isn't just about balancing calories, but also about changing habits and set patterns.

On a macro scale, experts are joined in the belief that it will take more time, money and commitment to address obesity in all sections of the populace. And ultimately, only small, micro efforts will actually succeed in bringing about attitudinal changes that can work in the long run.

Parrini's efforts show precisely this. In addition to her day job, she also is the wellness coordinator of her school's child nutrition program. "I hope the obesity epidemic will prod changes," she says. "Until we make a conscious effort to change the exposure of this generation, they will continue to grow fat." Until then, each extra salad she sells is a huge victory.