Four friends start child obesity pilot

EAGLE, Idaho – It was on their morning runs that a pediatrician, dietitian, physical therapist and exercise therapist thought up a way to tackle childhood obesity.

They decided to blend their specialties into a free pilot program involving the whole family to help children ages 6 to 16. The friends wanted to get beyond old methods of doctors advising kids to miraculously cut calories and increase exercise to lose weight.

The old way doesn’t work, say care providers who have watched the childhood obesity rate rise to 17 percent nationwide.

“As a pediatrician I’m constantly frustrated with, ‘How can I help these kids?’ ” said Mindy Gaddis, one of the running partners. “I really cannot do this by myself.”

Gaddis teamed with dietitian Stacy Beeson, physical therapist Sima Tavazoie and exercise specialist Maria Covey to create Youth Engaged in Activities for Health, or YEah!

It’s “more of a cooperative effort, instead of a more traditional medical model where I give advice and expect them to take my advice,” Gaddis said. “Let’s identify together what the barriers are to change.”

Through YEah!, which is in its seventh month, families visit a grocery store with Beeson to learn economical and healthy cooking ideas. Beeson directs them to the perimeter of the store, saying that’s where the healthy foods are found. And she recommends filling the cart at least one-third with things that don’t need labels, such as fruits and vegetables.

“Foods high in sugar and fat almost always cost more,” Beeson said.

A social worker counsels families on reasons why children overeat – such as boredom or for comfort – and advises parents on helpful ways to talk to kids about their weight.

“Just telling the patient’s family to eat an apple, that’s not going to make them do that,” said pediatrician Victoria Rogers, who directs a childhood obesity prevention program at the Maine Medical Center in Portland.

Kids in the YEah! program exercise together with Covey once a week at a YMCA. The families stay in touch with Gaddis and coordinator Sue Peterson, a nurse, through meetings and phone calls to discuss goals and lifestyle changes.

Programs like YEah! that involve families have been popping up around the country.

“The programs that have shown the most robust effect are programs that have a multipronged approach,” said Denise Wilfley, a specialist on childhood obesity who teaches psychiatry and medicine at the Washington University School of Medicine in St. Louis. “They work to change behaviors at multiple levels.”

But most insurers don’t cover obesity treatment, so pilots like YEah! need to find continuing grants or other funding.

Wilfley said she’s hopeful Michelle Obama’s new focus on childhood obesity, and the health care overhaul will direct more money to obesity prevention. Her childhood obesity program is supported by a grant from the National Institute of Child Health and Human Development; 500 families called to see if they could get one of the 120 spots.

Mary Savoye, a dietitian who is medical director of Yale University’s Bright Bodies obesity treatment program, said insurers hesitate because many childhood obesity programs haven’t yet published results showing that they make a significant difference. The programs also require long-term, repeated visits to care providers.

Gaddis and her partners started YEah! with a $50,000 grant from PacificSource, a not-for-profit health insurance company, and with help from their own employers, who are donating their time. The founders are donating their time as well.

Apart from cost, another obstacle to effective treatment is the busy schedules of kids, Gaddis said. While food and video games take their share of the blame for obesity, Gaddis said she was also startled by how many families in the program have told her their kids’ involvement in organized sports forced them to stop for fast food at dinnertime.

“Time seems to be the largest barrier in our culture to change, in terms of incorporating exercise into our daily life and changing our eating habits,” Gaddis said. “People are on the go with all these extra afterschool activities, so there is not time to cook a healthy dinner at home. I have been surprised at how significant that issue is.”

Organized sports themselves aren’t necessarily an antidote to weight problems. Calories from fast food and snacks served on the field can more than compensate for the energy used in soccer practice.

“Everywhere you look, it’s really easy to get food,” said Rogers, who developed the 5, 2, 1 formula to structure nutritional advice. That’s five or more servings of fruit and vegetables, two hours of screen time (or less), and at least one hour of exercise (Rogers includes 0, for limiting sugar-sweetened beverages).

Jill Chick, of Boise, whose 8-year-old daughter Emily takes part in YEah!, said the whole family now exercises more, using Wii Fit.

Collaborative programs with families and counseling take treatment in a new direction, Rogers said.

“When we started using 5, 2, 1, 0 in a health care setting in 2004, we weren’t trained in nutrition,” Rogers said. “Doctors shied away from talking about weight because it’s such an emotional issue.”

The numerical formula helped put providers and patients at ease.

“When doctors started to use 5, 2, 1, 0, they could have a really good discussion about drinking soda, and didn’t have to talk about weight,” she said.