CHARLESTON, W.Va. -- At 9 years old, third-grader Lexi Winnell knows how to scrape a deer hide. She can sing in Cherokee, start a fire with a flint, and beat solid rhythm on the family drum. Her grandfather, Mark Winnell, taught her to do all those things.

"My grandfather named me Wah-le-lu before I was born," Lexi said. "That means hummingbird in Cherokee."

She is descended from Cherokee, Blackfoot, Delaware and Shawnee ancestors through her grandfather and grandmother's family lines. A straight-A student, she likes to talk about black holes and Leonardo da Vinci. She wants to be a doctor or a fashion designer, she says, "or maybe a fashionable doctor."

Lexi has lived with her grandparents, Mark and Kelly Winnell, all her life. Last fall and winter, she and her grandfather took a walk together every day, a half-hour walk, "rain or shine." They hunted for treasures -- special rocks, feathers, sometimes an arrowhead -- along the winding country roads surrounding their Jackson County home.

They were walking to keep Lexi healthy. She was dodging diabetes.

At age 7, her blood tests showed she was insulin-resistant, a condition that leads to type 2 diabetes. Insulin resistance also means she gains weight more easily than most people.

Millions of young Americans are in the same boat. According to new research in the journal Pediatrics, at least 23 percent of American children between 12 and 19 now have pre-diabetes or actual diabetes, compared with 9 percent in 1999. Insulin resistance and obesity are major components of pre-diabetes.

West Virginia's numbers are even more alarming: 29 percent of fifth-graders and 23 percent of second-graders were obese in 2011. "One in four of our young children are at risk of early diabetes and heart attacks in their 30s if we don't do something," said Jamie Jeffrey, director of children's medicine at CAMC Women and Children's Hospital.

Lexi's grandparents are determined to do something. She had put on so much weight by age 7 they took her to the doctor. They know that, nationwide, American Indians get diabetes at twice the rate of Caucasians.

Insulin, a hormone, helps blood glucose (sugar) feed the body's cells. Lexi's body has trouble using insulin her pancreas produces, so glucose can't easily get into her cells. Instead, much of it stays in her bloodstream and is deposited in the body as extra weight.

"Her doctor told us daily exercise and healthy, nonprocessed food can lower Lexi's insulin resistance and diabetes risk, so we've built our family lives around making sure that happens," Mark Winnell said in December. "As it turns out, that's been good for us all.

"The doctors say the very best time to head it off is childhood, because that's when the body sets the number of fat cells it will have for the rest of your life," he said.

Diabetes can shorten people's lives between 11 and 17 years, researchers say. "We want Lexi to have a long, good-quality life. If we don't address the insulin resistance now, there's a good chance she'll have a shorter and lower-quality life than she could have."

"It's not as easy as it sounds to keep her active," Kelly Winnell said. Both grandparents have full-time jobs. Mark Winnell is outreach pastor at Charleston's Ruffner Memorial Presbyterian Church and South Park Presbyterian.

Kelly Winnell is a Kanawha County school cook. "If she got P.E. every day at school, it would be a lot easier and the problem might be less serious," she said. "That's frustrating." West Virginia law requires physical education only a half-hour, three times a week for grade-schoolers.

At 9, Lexi isn't allowed to ride her bike alone on narrow, curving roads with no shoulders, and her grandparents don't want her playing in the woods out of their sight. There are no neighborhood kids to play with.

Still, they managed to put together an effective program. Lexi loves to swim. Last fall, her grandmother let her try out for the Charleston YMCA's Small Fry swim team. She made it. Three times a week last fall and winter, they drove her to the Y for two hours of practice.

They also signed her up for Charleston Area Medical Center's Healthy Kids program. West Virginia's only multiweek program intended to help children avoid diabetes. "We felt blessed to get in," Mark Winnell said. "They've got a long waiting list."

"[Healthy Kids] is a lot of fun. Dr. Jeffrey and I raced on treadmills!" Lexi said.

Jamie Jeffrey is also the Healthy Kids director. "We teach kids how to live in a healthy way that helps them avoid diabetes," she said, "but we can only see a few kids, compared to the need."

Each week, Lexi met one-on-one with Jeffrey and Amy Gannon, the dietitian, to learn how to manage her weight. Gannon taught her the "stoplight system," classifying foods as green, yellow or red.

In the evening, Lexi's grandmother helped her write down everything she ate and drank. Each week, Lexi and Gannon went over her food log and talked about food dilemmas.

She learned to read food labels and found out how her body reacts to protein, calories and fat. "I stick to six grams of sugar for breakfast," she said. "The mini wheats they have at my school are reduced in sugar, but the regular kind have about 20 grams of sugar in one bowl."

Once a week, Healthy Kids students meet to compare ways to handle dilemmas: If a kid says something mean to you, what could you say back? What if your school serves mainly red foods? If you eat a piece of birthday cake, what can you do to burn it off?

And every day, Lexi walked with her grandfather. "So she was getting six hours a week swimming, two hours at Healthy Kids and a half-hour of walking every day," Mark Winnell said. "At the same time, we've changed our diet as a family."

CHARLESTON, W.Va. -- At 9 years old, third-grader Lexi Winnell knows how to scrape a deer hide. She can sing in Cherokee, start a fire with a flint, and beat solid rhythm on the family drum. Her grandfather, Mark Winnell, taught her to do all those things.

"My grandfather named me Wah-le-lu before I was born," Lexi said. "That means hummingbird in Cherokee."

She is descended from Cherokee, Blackfoot, Delaware and Shawnee ancestors through her grandfather and grandmother's family lines. A straight-A student, she likes to talk about black holes and Leonardo da Vinci. She wants to be a doctor or a fashion designer, she says, "or maybe a fashionable doctor."

Lexi has lived with her grandparents, Mark and Kelly Winnell, all her life. Last fall and winter, she and her grandfather took a walk together every day, a half-hour walk, "rain or shine." They hunted for treasures -- special rocks, feathers, sometimes an arrowhead -- along the winding country roads surrounding their Jackson County home.

They were walking to keep Lexi healthy. She was dodging diabetes.

At age 7, her blood tests showed she was insulin-resistant, a condition that leads to type 2 diabetes. Insulin resistance also means she gains weight more easily than most people.

Millions of young Americans are in the same boat. According to new research in the journal Pediatrics, at least 23 percent of American children between 12 and 19 now have pre-diabetes or actual diabetes, compared with 9 percent in 1999. Insulin resistance and obesity are major components of pre-diabetes.

West Virginia's numbers are even more alarming: 29 percent of fifth-graders and 23 percent of second-graders were obese in 2011. "One in four of our young children are at risk of early diabetes and heart attacks in their 30s if we don't do something," said Jamie Jeffrey, director of children's medicine at CAMC Women and Children's Hospital.

Lexi's grandparents are determined to do something. She had put on so much weight by age 7 they took her to the doctor. They know that, nationwide, American Indians get diabetes at twice the rate of Caucasians.

Insulin, a hormone, helps blood glucose (sugar) feed the body's cells. Lexi's body has trouble using insulin her pancreas produces, so glucose can't easily get into her cells. Instead, much of it stays in her bloodstream and is deposited in the body as extra weight.

"Her doctor told us daily exercise and healthy, nonprocessed food can lower Lexi's insulin resistance and diabetes risk, so we've built our family lives around making sure that happens," Mark Winnell said in December. "As it turns out, that's been good for us all.

"The doctors say the very best time to head it off is childhood, because that's when the body sets the number of fat cells it will have for the rest of your life," he said.

Diabetes can shorten people's lives between 11 and 17 years, researchers say. "We want Lexi to have a long, good-quality life. If we don't address the insulin resistance now, there's a good chance she'll have a shorter and lower-quality life than she could have."

"It's not as easy as it sounds to keep her active," Kelly Winnell said. Both grandparents have full-time jobs. Mark Winnell is outreach pastor at Charleston's Ruffner Memorial Presbyterian Church and South Park Presbyterian.

Kelly Winnell is a Kanawha County school cook. "If she got P.E. every day at school, it would be a lot easier and the problem might be less serious," she said. "That's frustrating." West Virginia law requires physical education only a half-hour, three times a week for grade-schoolers.

At 9, Lexi isn't allowed to ride her bike alone on narrow, curving roads with no shoulders, and her grandparents don't want her playing in the woods out of their sight. There are no neighborhood kids to play with.

Still, they managed to put together an effective program. Lexi loves to swim. Last fall, her grandmother let her try out for the Charleston YMCA's Small Fry swim team. She made it. Three times a week last fall and winter, they drove her to the Y for two hours of practice.

They also signed her up for Charleston Area Medical Center's Healthy Kids program. West Virginia's only multiweek program intended to help children avoid diabetes. "We felt blessed to get in," Mark Winnell said. "They've got a long waiting list."

"[Healthy Kids] is a lot of fun. Dr. Jeffrey and I raced on treadmills!" Lexi said.

Jamie Jeffrey is also the Healthy Kids director. "We teach kids how to live in a healthy way that helps them avoid diabetes," she said, "but we can only see a few kids, compared to the need."

Each week, Lexi met one-on-one with Jeffrey and Amy Gannon, the dietitian, to learn how to manage her weight. Gannon taught her the "stoplight system," classifying foods as green, yellow or red.

In the evening, Lexi's grandmother helped her write down everything she ate and drank. Each week, Lexi and Gannon went over her food log and talked about food dilemmas.

She learned to read food labels and found out how her body reacts to protein, calories and fat. "I stick to six grams of sugar for breakfast," she said. "The mini wheats they have at my school are reduced in sugar, but the regular kind have about 20 grams of sugar in one bowl."

Once a week, Healthy Kids students meet to compare ways to handle dilemmas: If a kid says something mean to you, what could you say back? What if your school serves mainly red foods? If you eat a piece of birthday cake, what can you do to burn it off?

And every day, Lexi walked with her grandfather. "So she was getting six hours a week swimming, two hours at Healthy Kids and a half-hour of walking every day," Mark Winnell said. "At the same time, we've changed our diet as a family."

Their plan worked.

In December, eight weeks after she joined Healthy Kids, Lexi had lost 15 pounds. "For a child her age, that's like an adult losing 50 pounds," Jeffrey said. Her body mass index dropped 2.7 points. "That's huge," Jeffrey said. "We'd be happy with a half-point."

Healthy Kids lets program graduates keep using their children's gym. So every week, the Winnells kept bringing Lexi to the gym. Her grandfather lost 27 pounds himself. "It turned out to be good for the whole family," Kelly Winnell said.

That was last December.

An unexpected crisis

In February, Mark Winnell began having severe headaches. They developed into a complex condition CAMC has not yet been able to completely diagnose. It is affecting his speech, his balance and his memory.

Kelly Winnell took a leave from her job to care for him. "I just can't be away from him all day," she said. He was not able to take the long walks with Lexi. The family focus has, by necessity, shifted away from her.

When Mark Winnell was in the hospital for more than a week of tests, "I cried every night," Lexi said. "I couldn't sleep."

Kelly Winnell took a two-month leave from her job. "We had to stop all other activity. I took Lexi to school, but we just couldn't do anything extra. That's when I really wished we had daily P.E."

Lexi dropped off the swim team. The stress, lack of sleep, loss of the swim team, all affected her weight. "I was so worried, I lost control." She gained back the weight she had lost.

Now, as school ends, the family is making Plan B. "That's the important thing for Lexi to learn," Kelly Winnell said. "Life will bring you unexpected setbacks when you least expect it. The question is, how do you handle them? How do you pick yourself up and go on?"

Lexi helped make the new family plan. She has already started gymnastics. She will start a zumba class next week. "We'll take her swimming several days a week this summer, and we're getting a small pool so she can be active at home," Kelly Winnell said. "But more responsibility for keeping it up will have to be on her."

"We've got a plan, and I'm sticking to it like superglue," Lexi said. It includes walks with her grandfather, "but they're going to have to be slow walks," said Mark Winnell. He is back at work, but his symptoms and tests continue.

"I'm starting again, but I know I can do it," Lexi said. "I want to tell other kids, don't ever, ever give up when something knocks you back. If you fall off the horse, get back on.

"I'm OK now," she said. "As long as he's OK, and our family's OK, then I'll be fine."

Remember 5-2-1-0

Kids and parents who want to lose weight, remember these numbers:

Five: Five servings of fruits and vegetables per day. A serving can be the size of an apple.

Two: No more than two hours of screen time per day. That's video games, TV, texting, Internet -- anything with a screen. People are not active when they're on a screen, and they tend to eat more.

One: At least one hour of moderate to vigorous physical activity per day.

Zero: Zero sodas, sugar-sweetened sports and fruit drinks. Instead, drink water and skim or 1 percent milk.

Source: Healthy Kids, Charleston Area Medical Center, adapted from Let's Go, state of Maine

Reach Kate Long at katel...@wvgazette.com or 304-348-1798.

"The Shape We're In" was written with the help of the Dennis A. Hunt Fund for Health Journalism, administered by the California Endowment Health Journalism Fellowships at the University of Southern California's Annenberg School for Communication and Journalism.