Published: Mar. 27, 2008
Updated: July 19, 2010
As a practicing pediatrician I receive a lot of requests for advice about childhood obesity. “How did it happen? What should we do about it?” parents ask.
This epidemic did not start overnight. It began with the fast food boom in the 60s. If you want calories you can go and get them -- now. And portion sizes and caloric content have skyrocketed. A complete meal for one at a fast food restaurant could feed a family of four for a day in many other parts of the world.
In addition, we have gradually made our children less active. TV and computers for sure have contributed to this -- but air conditioning is also to blame: why go outside if it is too hot? It used to be too hot inside, too.
Fear for children’s safety has kept them closer to home and more often inside as well.
To unravel this problem and get us back on track will take the entire country to change course. Our schools, restaurants, families, and governments must all play their part in fixing the problem. The solution includes food choices, exercise choices, and, yes, emotional support choices.
Dr. Sarah Armstrong is a pediatrician at Duke who is the leader of Duke’s Healthy Lifestyles Program. The program tries to educate the child and family about a new way of coping in this time of plenty. It is a way to find the answer to “what can we do to help our child who is overweight?” Please read her comments below.
-- Dennis Clements MD, PhD, MPH
Here are some facts about childhood obesity:
There are many ways you and your family can start at home to live a healthier lifestyle. For example:
However, these changes can be difficult, confusing, or hard to incorporate into daily life. Parents also worry that their child may suffer a medical condition causing their weight problem, or that their child’s weight is the result of a medication or a toxin exposure.
Many children have been referred for many services only to be told they have to lose weight, but given no guidance.
To help families navigate this complex system, Duke University School of Medicine’s Department of Pediatrics elected to concentrate significant resources to combat the epidemic of childhood obesity. This led to the creation of the Center of Nutritional Disorders and Obesity (CENDO) in 2005.
The four key components of CENDO include:
CENDO faculty meet monthly to design and carry out important clinical trials to understand the causes for and to effectively treat childhood obesity.
The Healthy Lifestyles Program is the cornerstone of clinical care provided to overweight children and their families. Healthy Lifestyles is a multidisciplinary, evidence-based, family-centered approach to treating obesity.
The program is designed to provide comprehensive evaluation and management services to families from all ethnic and socioeconomic backgrounds. The structure of the program includes an initial assessment to provide a health risk factor profile, followed by monthly visits to the clinic for ongoing family lifestyle intervention.
The family’s “Healthy Lifestyle Team” includes a medical provider, a dietitian with certification in childhood weight management, and family support services as needed.
The monthly visits use the proven technique known as “motivational interviewing,” which has been validated for weight loss in children (Schwartz, 2007). We also provide written materials at each visit, which are based on CDC-approved guidelines for preventing chronic disease in children.
At each visit, the child receives a “fit kit” to facilitate the goal. Examples include a water bottle, a jump rope, a pedometer, or a resistance band.
After completion of the program, patients are seen bi-annually for ongoing education and surveillance for chronic disease. The program costs are only your primary care co-payment, and all insurance types are accepted.
Healthy Lifestyles has partnered with multiple organizations from which we receive referrals and provide to families as community resources. These organizations include the Emily Krzyzewski Family Life Center in downtown Durham, several local fitness facilities, the Downtown Durham YMCA, and the Durham Parks and Recreation programs, the John Avery Boys and Girls Club, the Lyons Park Center, El Centro Hispano, and the Downtown Durham Athletic Association.
We are also involved in local, state, and national health advocacy committees such as the Durham Health Department Obesity and Chronic Illness Committee, the NC State Health Department, Eat Smart, Move More NC, and the National Initiative for Child Healthcare Quality.
To make an appointment at Healthy Lifestyles, please call us at 1-866-530-5356 or 919- 620-5356. To learn more about the program, please call 919- 620-5394.
Here’s to your health!
-- Sarah Armstrong, MD, is a pediatrician with Duke Children's and director or Duke Children's Healthy Lifestyle Program.
-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.