Rachel Creel, age 16, shares a story she still can’t believe. “One day I went with my friends to McDonald’s, and we just pigged out.”

As part of her participation in the Duke Children’s Healthy Lifestyles Program, she begrudgingly recorded the burger blitz and sent it to her dietitian, Jenny Favret. Then she waited for the lecture.

She got a lecture, but not the one she thought she’d get. “Jenny called and told me that I hadn’t eaten enough calories that day,” she says incredulously. But she’s learning through this new program not to demonize foods or brook punishment for the occasional overindulgence.

Instead, the Healthy Lifestyles Program seeks to encourage healthy, balanced choices and foster lifestyle changes that will last.

Established in 2006, the Healthy Lifestyles Program serves families with children who are struggling with obesity. Located in Duke Children’s Primary Care clinic in Durham, the outpatient program is a six-month intervention covered by most insurance policies as well as Medicaid.

An initial visit includes a thorough medical, psychological, and nutritional assessment. The family is given recommendations for nutrition and physical activities that are available in their area, and they return for monthly follow-up and ongoing support.

Pediatrician Sarah Armstrong, MD, who designed the program, says the initiative grew out of deep concern over the growing number of children with serious, chronic medical conditions due to pediatric obesity, which has tripled since 1980.

“At least 60 percent of overweight children under age 12 have at least one risk factor for heart disease,” says Armstrong. “If we can reverse this risk during childhood, we not only give the child a happier, healthier life, but we help prevent adult disease.”

Rachel’s blood pressure was high at her initial visit, so her nutrition plan was based on the DASH diet, shown to reduce hypertension as well as cholesterol and weight. Compared to the other programs she has tried, she says what she has learned through Healthy Lifestyles feels doable.

“Salads are my favorite thing,” she says. “But my problem was that I loaded on the dressing. Now I know to make smaller salads, so I can enjoy the amount of dressing I like and not overdo it.” Her father, Chris, moved a television into the family’s home fitness room, which Rachel says makes the exercise machines more palatable.

And now Rachel’s mother, Trish Creel, doesn’t have to “be the bad guy anymore,” she says, noting how emotionally tricky it can be to tell your child to eat less. “It’s not like talking to your kids about other kinds of risky behaviors, like not smoking, not doing drugs. It’s difficult when you’re talking about food and weight. This program gives me somewhere to go.”

Rachel says learning to eat breakfast has been one of the hardest things for her, though she can already tell that breakfast curbs her hunger during the day. “Sometimes I still don’t feel like it,” she says, “and then my mom will remind me to eat some yogurt or a cheese stick. Now it’s part of my morning ritual.”

Mother and daughter agree that the positive attitude of the staff is their biggest inspiration. “They’re all so upbeat,” says Rachel. “And they never use the words diet or exercise.”

“It’s really refreshing,” agrees Trish. “They talk about activity and nutrition instead. They don’t make them seem like obligations; they make them seem like opportunities to be healthy.”