"My reaction as a practitioner," says Graf, "is that Kayla's at the highest risk for these adult diseases that we're seeing younger and younger in childhood, like high cholesterol, fatty liver, high blood pressure and diabetes. I feel very worried for her and her family. And I also just want to ensure that all the medical reasons that she might be at an extremely high weight have been ruled out."
Graf says children as overweight as Kayla are becoming more and more common.
"I am seeing more and more over time," she says, "and it just seems to be getting younger even infants are coming in very overweight. Often times it's due to the family situation and not the child."
Graf says it is very important that families eat meals together, without TV or other distractions. That's what they do in the Galo-Matos home, but inevitably one parent is working. And inevitably Kayla dominates with her demands.
Back at the Matos home it's more of the same. "No! I said no! I don't like corn! Just put it back!"
Kayla's 10-year-old brother, Jaylen, sits patiently at the table.
"She hits me," he says with tears in his eyes. "She hits me."
Yet he still finds room to love his little sister. He has just one wish for her.
"To make her skinny. Make her the weight that she's supposed to be."
Matos knows that as the mother, most people will automatically blame her for Kayla's weight and her behavior. But she also knows, she's trying to be a good mother.
"Got any suggestions?" she asks. "I don't know what else to do."