Pediatric clinic focuses on family approach to weight management

Dr. Denise Edwards, director of the USF Healthy Weight Clinic, discusses food options with a patient and his mother.

Tampa, FL (June 1, 2007) —
Vanessa Waterson* wanted her 17-year-old granddaughter, Lorie*, who has high blood pressure and prediabetes, to lose weight for her health. She soon realized that adopting a healthier lifestyle would need to become a family affair.

“It was hard for Lorie to stick to eating fruits, vegetables and lean meat if the rest of us were eating pasta and bread, so we all started changing our eating habits and reducing our portions,” said Waterson, admitting she loved to cook Southen style and keep a well-stocked cupboard for her husband and four grandchildren. “Doing this together is helping us all become healthier.”

This type of family involvement is particularly important in helping reverse the growing obesity epidemic because lifelong habits of physical activity and nutritious eating – or lack of these – are developed in childhood and adolescence, says Dr. Denise Edwards, assistant professor of pediatrics and internal medicine at the University of South Florida. “It’s never too late to make these changes in lifestyle, but the earlier you intervene the better.”

The family-centered approach is emphasized at the USF Healthy Weight Clinic in Tampa, which Dr. Edwards directs. The program treats a comprehensive array of pediatric eating disorders, from obesity to anorexia and bulimia. In addition to medical assessment and supervision, the multidisciplinary outpatient program – one of few in the Tampa Bay area — includes nutritional counseling, psychological evaluation and behavior modification, and even access to physical therapy and a YMCA staffer who can help with customized exercise plans. No weight-loss medications are FDA approved for young children. Although some options are available for teenagers, Edwards seldom prescribes them. “I think medication detracts from the idea that achieving and maintaining a healthy weight requires lifestyle changes by the entire family,” she says.

In the long run, 80 percent of overweight or obese adolescents will grow into obese adults. Genetics play a role — studies have shown that children with overweight or obese parents have a greater risk for obesity. But, Dr. Edwards says, many environmental causes of obesity that interact with a person’s genetic predisposition, like too little exercise and too many high-calorie foods, can be altered.

Although the prevalence of childhood obesity has risen dramatically in the last several decades (nearly one in five U.S. children is obese), the condition is still underdiagnosed and undertreated, Dr. Edwards says.

The consequences of avoiding or delaying treatment can be steep – both physically and emotionally. As they develop into teens and young adults, overweight children are at greater risk for Type 2 diabetes, cardiovascular disease, joint problems, sleep apnea, asthma, gall bladder disease and other illnesses usually associated with middle-age or senior adults. Treating these obesity-related conditions over a person’s lifetime will be an increasingly costly proposition, Dr. Edwards says.

Obesity can lead to lifelong emotional distress as well as medical complications and reduced life expectancy. Excess weight has been associated with low self-esteem, depression and social withdrawal, particularly in adolescents, said Perry Kaly, a clinical psychologist who works with families at the clinic. “Studies have shown that kids as young as age 4 and 5 exhibit negative biases toward their overweight peers – identifying them as lazy, stupid and undesirable playmates.”

Dr. Edwards helps families develop weight management plans they can live with for the long haul, setting incremental goals for a healthier lifestyle rather than focusing on losing a specific number of pounds. In Lorie’s case, the family decided to initially work on three areas – reducing carbohydrates, eating lower calorie snacks, and increasing physical activity.

Lorie’s grandmother virtually eliminated rice, pasta and bread from the family’s diet and started using more spices instead of butter and salt to season her meals. She got rid of cookies and cakes, and stocked the refrigerator with snacks like fat-free yogurt and low-sugar jello. In addition, Lorie began daily 1 to 2-mile walks with her sisters. After three months, Lorie has lost 18 pounds, her blood pressure is dropping and she reports having more energy. She’s also eager to buy some new clothes before she leaves for college in August. “Now that I see the weight coming off and other people are saying ‘you look good,’ I’m even more motivated,” Lorie says.

The healthy weight clinic for children and adolescents fits into a series of USF initiatives making the prevention and treatment of obesity a priority. Last year, USF received a one-time appropriation from the Florida legislature to educate healthcare professionals on early recognition and treatment of obesity. The university is seeking additional support to establish a comprehensive center that would include research to better understand factors contributing to childhood obesity and evaluation of interventions promoting good nutrition, self-esteem and physical fitness among children in schools and the community.

For more information on the USF Healthy Weight Clinic, call (813) 259-8700

* Name changed.

Story by Anne DeLotto Baier
Photos by Eric Younghans