January 25, 2014

Hospitals offering prevention, treatment programs to combat childhood obesity

More and more hospitals and community organizations are offering prevention and treatment programs to deal with the growing problem of childhood obesity.

For years, John Lizano had borne the taunts of classmates because of his weight. He tolerated the embarrassment of shopping for outsized clothes and the frustration of being out of breath when he climbed just one flight of stairs.

Until last Mother’s Day. After years of half-heartedly trying to lose the extra pounds, something clicked. At six-foot, one-inch, he clocked in at a hefty 265 pounds.

“I looked in the mirror and I asked, ‘What am I doing to myself?’ " recalled the 13-year-old, who is now in eighth grade. “I realized I was my own worst enemy."

Under the direction of Dr. William Muiños, director of the weight management program at Miami Children’s Hospital, John changed his eating habits. He used to drink a two-liter bottle of Coke and a jar of Nutella every day, but he’s had neither in about nine months. Gone, too, are the enormous portions of everything, including the numerous desserts he would scarf down in one sitting.

Also with the help of a pediatric gastroenterologist, John’s mother, Mabel, changed the ways she cooked. Now the entire family eats “lots of vegetables, and the fish and chicken breast is grilled or baked. No more frying in this house."

John, who has lost 40 pounds, also jogs for 45 minutes six days a week, a vast improvement for a boy who didn’t want to leave the couch. He boasts that he’s just getting started. “I still have work to do, but this is what I’m going to do the rest of my life."

John’s weight problems are far from unusual. Childhood obesity has more than doubled in children and tripled in adolescents over the past 30 years, according to the Centers for Disease Control and Prevention. The percentage of children ages 6 to 11 who were obese increased from 7 percent in 1980 to nearly 18 percent in 2010. For adolescents ages 12 to 19, those numbers went from 5 percent to 18 percent in the same time period.

If you add the number of kids who are overweight — defined as having excess body weight for a particular height — a staggering one-third of all children and adolescents carry more pounds than they should.

The effects are both dangerous and long-lasting. John, for instance, suffered from high blood pressure and fatty liver disease, an accumulation of fat that can irreparably damage the liver. He had also been diagnosed as prediabetic.

None of these conditions are rare in obese children, however. Studies show that 70 percent of obese youths had at least one risk factor for cardiovascular disease and were more likely to develop diabetes, bone and joint problems, sleep apnea, and psychological problems.

Muiños said he became interested in weight management for children when, as a hepatologist, he kept diagnosing obese pre-adolescents with fatty liver disease. “It was astonishing to me," he recalled. "Here I was, seeing children with a disease you commonly see only in fat, old men."

As weight issues continue to be a problem for American children, more and more hospitals and community organizations are joining the fight by offering prevention and treatment programs. At Miami Children’s Hospital, the weight clinic opened in 2007 and now sees between 25 to 30 patients three Fridays out of the month. Muiños and his staff start new patients with a full medical and psychosocial evaluation, focusing on the cultural diversities found so frequently in South Florida. He sees most patients once a month in the beginning, then less often.

"Behavior modification is the cornerstone," Muiños said. "You have to educate the parents, and you have to educate the kids. You have to change the mindset from the very beginning."

This requires everything from teaching parents what food to buy and how to prepare it to encouraging the family to get out and exercise. "I call this a Mommy and Me program," he added, "because everybody’s habits — not just the child’s — have to change. Children are a product of their environment."

At the University of Miami Miller School of Medicine, public health researchers Sarah Messiah and Guillermo Prado are pairing up with obesity experts to target Hispanic youths in Miami-Dade County Public Schools. They recently received a five-year, $2 million grant from the National Institutes of Health to add an obesity-prevention component to Familias Unidas, an existing program that works with minority adolescents to prevent risky behavior.

The obesity-prevention program will add nutritionists and exercise physiologists to educate parents and children. Though still in the development stage, Messiah and Prado are planning a three-month curriculum that will include 12 weekly sessions with parents, including four sessions with their children, to teach the family about eating healthy and staying active. The program is expected to launch this summer, with follow-ups over a two-year period.

The researchers know they may encounter some resistance. Prado, a Cuban American who was overweight growing up, said there is a tendency among many cultures to regard an overweight child as a healthy child.

"I remember when I lost the weight and started going to the gym. I was healthier, and my blood pressure was normal, but my mother was worried — she thought I looked sick," Prado said.

The UM team hopes to enroll 280 families in the research study.

Also at UM, another program aims to reverse obesity and teach children the importance of healthy eating and fitness. Targeting kids from 5 to 18, Children’s Rehabilitation Unit for Nutrition & Cardiac Health — or CRUNCHTIME — starts with an in-depth, two-day assessment by pediatricians, nutritionists and psychologists and a fitness experiment. A tailor-made diet and exercise program is developed for each child, and it’s tweaked during twice-a-week fitness sessions at a special pediatric gym.

Boot camps have proven popular for the younger set, too. Rickey Dickenson, a personal trainer at Memorial West Hospital in Broward, teaches a 45-minute, high-powered exercise class combining cardio and stretching three times a week. About 70 percent of the kids who come are overweight or obese. The youngest is 6, the oldest 11.

For some, this is their first exposure to real exercise. "Technology has taken over, and kids just don’t go out to play," lamented Dickenson. "They want to stay inside with their video games."

While the classes don’t include nutrition, most of the participants are in a weight-management program. Dickenson, however, also talks about healthy eating choices.

His goal? "I hope they take with them an appreciation of physical activity," he said. "Working out changes your life. You feel great when you do it."

Some hospitals team up with community organizations to offer weight-loss programs. Team Fit, a weight-loss program for children ages 8 to 12, is offered at the Alper Jewish Community Center in partnership with Baptist Health Systems and United Way. During the eight-week program, a certified personal trainer leads group fitness workouts in circuit training, as well as outdoor and indoor activities. Nutrition sessions in which parents are required to attend are scheduled for two hours every Saturday.

At UM’s School of Medicine/Mailman Center for Child Development, Ruby Natale, an assistant professor of clinical pediatrics, is taking a whole new approach to obesity prevention. With funding from the Health Foundation of South Florida, her team targets preschoolers (2 to 5 years old), their parents and their teachers at about 150 childcare centers in Miami-Dade. The idea is to teach about healthy choices at a very early age. Daycare centers were the obvious choice because so many children spend long hours there. As a result, Natale said, daycare centers have changed their menus and children are choosing broccoli over chips.

Research, she added, shows that a child needs to be exposed to a new food 14 times for them to like it.

"After a few weeks of exposure, they’re all for it," Natale said. "I have parents who tell me the kids are going home and asking for rhubarb."

And that kind of request is sweet music to any adult’s ears.

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