Dr. William Muinos breaks down his patients — overweight or obese children — into three categories: “All in the family,” when everyone in a family is overweight; a “video game culture” child; and the “lone wolf,” when a child of higher socioeconomic status has lowered self esteem and is psychologically impaired.
Muinos, who leads the kids weight management program at Nicklaus Children’s Hospital, sees children as young as 4 or 5 years old with metabolic syndrome — a cluster of at least three medical conditions that include obesity, high blood pressure, high cholesterol and more. The condition, which increases with age, is associated with a higher risk of developing heart diseases and diabetes.
“I started seeing a lot of children with fatty livers — a disease that was only thought to be with alcoholics,” he said of his start with treating childhood obesity.
Muinos develops a diet and individualized exercise program for each child, taking each patient’s resources into consideration. “Can they go to a gym? Do they have exercise equipment at home? Do they have nothing?” Muinos said. “With the more obese patients, the only thing they can really do in the beginning is to walk. It’s the safest and simplest way to start an exercise program.”
Then, they sign a contract. Muinos sees 15 to 30 patients through his kids weight management clinic on Fridays.
When it comes to nutrition, he focuses on simplifying diets: Kids need to eat more fruit and vegetables.
Consuming large quantities of vegetables changes the metabolism, burning more body fat in the process. “My approach is to introduce vegetables. Especially in South Florida with the Hispanic population, the vegetable world is an unknown entity to many of them.”
He sits down with his patients and explains the reasoning behind his diet and exercise plans and grades them with A’s or F’s. The biggest challenge is behavioral modification. Muinos estimates that about one-third of his patients in the clinic are successful, one-third don’t return and one-third fail.
“A lot of what I do is motivational speaking. I show them what fatty livers look like, that physique can change,” he said.
Muinos’ clinic is one of a handful of programs in South Florida treating childhood obesity, which has skyrocketed in America over the past few decades. Today, one in three U.S. kids and teens are overweight or obese, nearly triple the rate of 1963, according to the American Heart Association.
Fit2Play, an after-school and out-of-school program in Miami-Dade County, aims to boost health and wellness through outdoor exercise.
The Miami-Dade County Parks, Recreation & Open Spaces Department, along with the University of Miami, runs the community-based program, which launched in 2005.
Sarah Messiah, research associate professor in the Department of Pediatrics at UM’s Miller School of Medicine, has studied and tracked county data from the program over the years. Because of that, she said doctors can now prescribe the program as treatment for overweight or obese kids.
Fit2Play serves about 8,300 children in 34 parks on an annual basis. It follows a play-based curriculum. “This is not a boot camp of militant style. You don’t stand in lines and wait for things. You are continuously moving for at least 40 minutes,” Messiah said.
The only rule for the kids is that they keep moving. They can participate in group sports, such as volleyball, soccer, tennis and football.
Since the program launched, UM has tracked data from 1,500 participants. The results? The program lowers the body mass index in overweight and obese kids, lowers blood pressure and improves overall physical fitness. Across the board, more children and teens have abnormally high blood pressure because of sedentary lifestyles and high sodium intake, Messiah said.
While most of the participating parks are adjacent to Miami-Dade County Schools, the county provides transportation to the parks at no additional cost. The program is open to kids from ages 6 to 14. “Our hope is that we’ve instilled the love of being active and maybe even competitive as an athlete,” she said.
Over at Jackson Memorial Hospital, Rickey Dickinson is the instructor of a kids’ boot camp — one that includes house music and strobe lights. Dickinson said it’s important for exercise to be fun so that kids continue those habits. “I always reiterate [the importance] of health,” he said. “I always tell them you have to work out to be strong.”
Other programs, such as the Grow2Heal Garden at Homestead Hospital, part of Baptist Health South Florida, provide field trips to teach children about healthy eating.
“For the most part, it’s the first contact for kids on where food comes from. It’s an eye-opening moment for everybody,” said Thi Squire, manager of the Baptist Health community garden.
Squire, a registered dietician, said she shows kids how to make their own non-processed meals, how to harvest plants and make better food choices. “We might make pesto and all of the sudden, guess what? You’re eating something green,” she said.
Squire reaches out to Title I schools, but said children come from all over Miami-Dade and Monroe counties. About 750 students have participated in Grow2Heal since November 2014.
. “It’s the only field trip where they hear, ‘Get dirty and eat everything you see.’ ”
Healthy Chicas, a four-week program at Nicklaus Children’s Hospital, brings mothers and daughters together for twice-weekly nutrition and exercise sessions. The program is open to girls from 12 to 17 and is geared toward Hispanic daughters and their mothers, who are often the “guard keepers of the food.”
Stephanie Quirantes, a registered dietician at Nicklaus, teaches healthy snacking as part of the program’s nutrition component. Classes can include taste tests of popcorn — air popped, microwaved or bagged — as well as recipes like brown rice and kale chips.
“Kids come home really hungry, so they’ll have a whole sandwich, for example, instead of a healthy snack,” Quirantes said. “We teach them how to eat — snack if you’re really hungry.”
Quirantes also stresses portion sizes, sometimes raffling off measuring cups or ramekins. “I have them come up and I ask, ‘what do you think 100 calories looks like?’ It’s always amazing to them.
“The goal is to change habits. That’s what we have to do. That’s the only way to make a lifestyle change,” she said.
Kids’ nutrition and exercise programs
Kids’ weight management program, Nicklaus Children’s Hospital
Cost: Varies depending on insurance
Kids boot camp at Memorial Hospital West
When: Mondays and Thursdays at 4 p.m., Saturdays at 10:30 a.m.
Healthy Chicas, Nicklaus Children’s Hospital
When: Twice weekly, days depend on group
Contact: Alina Fareas, coordinator
When: Monday through Friday, 2 p.m. to 6 p.m. after school throughout the year, during breaks
Contact: www.miamidade.gov/parks, or visit a Miami-Dade County park, or call 311
Cost: Ranges from $40 to $90 per week. Qualifying families can receive financial aid, including full scholarships.
Grow2Heal field trips
Contact: email@example.com or visit baptisthealth.net/homesteadhospital