Pediatrician Catherine Vigran has fought the devastation of diabetes and obesity among her young Latino patients in determined and personal ways.

She has told parents, in painful conversations, that they must feed their families differently or risk their children's lives. Quarterly for the past three years, she has arranged healthy cooking classes for families in the Rancho Cordova neighborhood she serves.

But in one deliciously destructive dish – tamales – Vigran met a foe that daunted her.

The steaming pockets of cornmeal, meat and salsa are a quintessentially Mexican meal, with variations found throughout Latin America. Mexicans eat them year-round but especially at Christmas.

When Vigran's work partner, nurse practitioner Carrie Beale, suggested they give a lesson on making low-fat tamales, the doctor wasn't sure. Part of what makes tamales so tasty is the lard.

"I had my doubts," Vigran said.

"When they said tamales without the fat, I said 'No, those are not tamales,' " one Rancho Cordova mother recalled.

But the team of clinicians-turned-cooking-teachers from Kaiser Permanente in Rancho Cordova decided to tackle them anyway. Beale, who enjoys cooking, came up with a recipe. The pediatrics office sent invitations to patients' families.

Last weekend, about 20 parents and kids gathered around a table in the Cordova Lane Center school cafeteria to learn. Beale led the lesson, with Vigran – whose mother's family hails from the California-Mexico borderlands – translating into Spanish.

Rates of diabetes and obesity in the United States are high among Latinos. The federal Centers for Disease Control and Prevention estimates that nearly 12 percent of Latino adults have a diabetes diagnosis, compared with 7 percent of whites. Among Mexican Americans, the number rises to more than 13 percent.

Diabetes can lead to severe complications, including heart disease, kidney failure, amputations and blindness.

The problem has many roots, including poverty, the automobile culture and the ubiquitousness of fast food that immigrants encounter in the United States, said Vigran. Also, lots of traditional Mexican food is heavy on fattening ingredients like meat, cheese and corn.

Many of Vigran's young Latino patients "already have a lot of indicators that they're going to have significant health problems early in life," she said.

Cecilia Andrade's son David had been one of those. Three years ago, when he was 12, Vigran warned Andrade that her son appeared headed for high cholesterol and diabetes.

"I was worried," Andrade said, in Spanish. "I said no, we can't be in this situation just because of food. We're going to make a change."

Andrade, a native of the Mexican state of Michoacán, switched her family to whole-grain instead of white breads. She lightened her enchilada recipe and firmly insisted David learn to like vegetables. He has now lost nearly 15 pounds and voluntarily eats salads, she said.

At the tamale workshop, Andrade attentively jotted the recipe in a notebook. Beale aimed to replace the usual fat with powerful flavor from a homemade chicken broth cooked with garlic, onions and chiles.

Beale whipped up a light dressing for a cabbage salad to serve on the side. Into the blender went nonfat yogurt, garlic, green onion, cilantro, chipotle powder, honey and lime juice. Several mothers tried it and nodded approval.

"Does the dressing need any oil?" Beale asked her taste testers. They had a clear consensus: no.

The ingredients to make this meal would cost a family about $10, Beale estimated. She put the price of dinner for four at McDonald's at $25.

Each family wrapped their own tamales and left the lesson with large plastic bags full of them to steam and eat at home. Would they taste the same as the high-fat variety? A few days later, some participants reported that the tamales tasted good, although the cornmeal came out a little stickier than usual.

Andrade's family liked the tamales a lot.

"They said there wasn't much difference," she said. Changing eating habits "is hard at first. You get used to your old, traditional foods. It goes little by little, but you do succeed."

INSIDE

You, too, can make healthy tamales. Try the recipe along with cabbage salad on Page B4.CHICKEN TAMALES

1 whole chicken

1 carrot

1 onion, peeled

1 stalk celery

1 head garlic, plus 1 clove

5 California chilies or dried Anaheim chilies

4 cups masa flour (fine corn flour)

Salt

Corn husks, soaked in water to soften

1. Boil the whole chicken in 4 cups of water with the carrot, onion, celery, one whole head of unpeeled garlic, and two chilies. Boil until the chicken is soft, 45 minutes to an hour. Allow the chicken to cool. Separate the chicken from the stock, and strain and cool the stock. Once the chicken has cooled, remove the skin and shred the meat into small pieces.

2. Boil the remaining three chilies (stems and seeds removed) in 2 cups water until soft, about 20 minutes. Cool and blend the mixture with one whole, peeled clove of garlic.

3. Mix the masa flour with 1 cup of the strained chicken stock (be sure to remove most of the fat off the top of the cooled stock). Add more stock until you have a soft, moist paste – this usually takes 3 to 4 cups of liquid. Mix in 1 teaspoon salt.

4. Mix the shredded chicken with the blended chili sauce. Remove the corn husks from the soaking water. Spread about 1/4 cup of the moist masa in a thin layer on each husk, then top it with about 1 tablespoon of the chicken. Roll the leaf up into the shape of a closed packet. Tie it shut with strips of corn husk.

5. Steam the tamales for 1 to 1.5 hours.

Makes 30-35 tamales.

CABBAGE SALAD

1 head cabbage, shredded

2 green apples

2 limes

2 cups nonfat plain yogurt

1 garlic clove, peeled

2 stalks green onion

1 bunch cilantro

1/4 teaspoon chipotle powder

1 tablespoon honey

1. Thinly slice the apples, with peels on, and squeeze the juice of one lime over them.

2. Zest one lime to get about 1 tablespoon of zest.

3. In a blender, mix the yogurt, garlic, green onion, cilantro, chipotle powder, honey, juice of one lime, and lime zest. Blend the dressing until combined and toss with the cabbage and apples.

Serves 15-20.

Courtesy of Carrie Beale, Kaiser nurse practitioner

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