Active Medicine: How Children's Hospitals Support Weight Management

Born at 10 pounds and 13 ounces, Gigi Eisenstein of Philadelphia had been a robust baby. But when her weight was still outpacing her height at her 6-year check-up, the pediatrician referred her parents to Children's Hospital of Philadelphia. There, in consultations every six weeks or so including a medical evaluation and dietary, behavioral and fitness counseling, the family has learned ways to prepare healthier meals together and squeeze more physical activity into their day. Now Gigi and her sister and parents sub baked zucchini sticks for French fries, eat seconds of vegetables only and walk the dog each night as a family. Gigi, 10, has seen her body mass index drop from 24 to 21. (Nineteen is ideal.) "I used to be the snack mom -- I always had something for the girls to eat," says Sarah Eisenstein, Gigi's mom. "Now I tell them 'I know you're hungry, but you'll be OK until we get home and make lunch.' "

It may seem surprising that families are getting this sort of hands-on help from a children's hospital. But in recent years many of these institutions have launched comprehensive weight-management programs like the one at CHOP -- and it's help that is sorely needed. Childhood obesity rates have nearly tripled since 1980; overall, nearly 18 percent of children and teens are now in that zone, putting them at risk for high blood pressure, high cholesterol, heart disease, diabetes, sleep apnea and other respiratory problems, and fatty liver disease. "We live in a toxic environment where the easy choices are overwhelmingly bad choices," says Dr. David Ludwig, an endocrinologist and director of the Optimal Weight for Life, or OWL, program at Boston Children's Hospital, the country's oldest weight-management clinic for children and adolescents. "The consequences are grim."

Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, is another pioneer. As early as the late 1980s, Nemours pediatrician Sandra Hassink, who became president of the American Academy of Pediatrics upon retiring and now directs the AAP Institute for Healthy Childhood Weight, became alarmed when she began seeing a growing number of kids with serious weight problems. She assembled a team that included a nutritionist, psychologist, exercise physiologist and nurses to help young patients get healthier. The multidisciplinary model has caught on. The comprehensive programs at CHOP, Boston Children's, Nemours and other centers bring children and their parents in regularly over the weeks or months that they're working toward a goal weight for evaluation and any needed treatment. This could include bariatric surgery in extreme cases, plus nutritional and behavioral counseling, education about physical fitness and even exercise sessions, provided by a team of experts.

In the sparkling mock kitchen of CHOP's Healthy Weight Program, for example, families learn to read labels and give recipes a healthier spin. They can also take part in a community-supported agriculture program, receiving regular deliveries of locally grown fruits and vegetables. CHOP boasts its own gym, too, and provides active programming for kids ages 2 to 19, everything from dance parties to scavenger hunts. When parents and siblings are included, "children have a lot more fun," says Amanda Holdridge, a Healthy Weight pediatric nurse practitioner. "The goal is to keep it fun and light" and to inspire families to get moving at home. Youngsters in the OWL program can work out by rowing in groups on the Charles River.

[See: 6 Ways Obesity Can Weigh on the Brain.]

"Just sitting in a room and telling kids to lose weight doesn't work," says Dr. Madhu Mathur, a pediatrician and obesity medicine physician in Stamford, Connecticut, who developed and formerly directed the Kids' Fitness and Nutrition Services clinic at Stamford Hospital. "We needed something more." Participants in KIDS' FANS come in weekly over 12 weeks for nutrition guidance and an exercise session and adopt a new mantra: Eat fruits and vegetables, limit screen time and get moving.

Besides the intensive weight-management services for patients, many hospitals offer guidance and resources to the community at large. Boston Children's has created a 10-week "OWL on the Road" curriculum, guided by a dietitian and a psychologist, that it provides free at several inner-city community health centers. Nemours offers guidance and resources about obesity prevention and treatment to local doctors. "Most pediatricians have not been trained to tackle childhood obesity," Hassink says.

Children's Hospitals and Clinics of Minnesota, partnering with other community organizations, offers its city's Latino residents the Vida Sana program, featuring instruction on healthy living (and dance classes). The Children's Hospital of Pittsburgh works with pediatrics practices, schools and the Pittsburgh Parks Conservancy to get the word out. Texas Children's Hospital runs a two-week residential camp for kids ages 10 to 14 who are struggling with their weight, plus a Saturday wellness program designed to teach children and teens about active living and nutrition. Besides running a summer camp and offering cooking classes, Children's Hospital Colorado provides bikes and safety training to local kids.

Some institutions are broadcasting their message statewide. The Barbara Bush Children's Hospital of Maine Medical Center in Portland has launched a Let's Go! campaign that forges connections with schools, child care sites, after-school programs and doctors' offices to teach healthy living habits to hundreds of thousands of children. The campaign uses an easy-to-remember meme to put kids on a healthy track: 5-2-1-0, for five or more servings of fruits and vegetables; two hours or less of screen time; at least one hour of exercise; and zero sugary beverages a day. Students take a five-minute active "brain break" each hour, and in some places sit at their desks on large inflatable balls so they can balance (or fidget) while they learn. They grow vegetables that are served in the school cafeteria. ("If you label carrots 'X-ray vision carrots,' kids will eat more of them," notes pediatrician Dr. Tory Rogers, the program's director.) Radio ads and posters displayed in schools and in doctors' offices reinforce the healthy message.

Crucially, schools, recreation centers and after-school programs pledge not to use food as rewards for good performance and to nix the hundreds of calories of pizza, cupcakes and candy typically served up at every birthday party and soccer practice. The latest data show obesity rates in the state are leveling off. The program has also made forays into New Hampshire.

[See: 8 Weird Ways Obesity Makes You Sick.]

Georgia hopes to duplicate that success with its statewide Strong4Life initiative, which was launched by Children's Healthcare of Atlanta in 2010. Like other efforts, the program uses multiple channels -- pediatric practices, schools and community partnerships -- to spark change in families whose children are overweight. Instead of overwhelming them with onerous food and exercise rules, the Strong4Life idea is to make one small change at a time. Says Dr. Stephanie Walsh, the program's medical director of child wellness: "Our message is you don't have to get there tomorrow. If your goal is to eliminate soda, it might take six months to make the change. If you do it slowly, and patients have the experience of succeeding, you get buy-in."

So far, the program has trained 3,000 health care providers and 1,200 school nutrition staff across the state and racked up 2 million visits to its website, Strong4Life.com.

A cornerstone of most weight-management programs is making lifestyle change a family affair. "The child gets more support when parents are modeling healthy behaviors and the rules apply to everybody in the home," Ludwig says.

And just as curious toddlers need the safety of a baby-proofed house, a child struggling with weight issues needs the home to be made nutritionally safe, a place "where all choices are healthy, so parents don't have to micromanage a child's behavior all day long," Hassink says. Experts endorse eating together as a family, and on as regular as possible a schedule to minimize grazing. And it's important to keep in mind that children are still growing and may still grow into their weight.

Finally, Rogers says, parents should remember that change is tough and the process is ongoing; there will undoubtedly be setbacks. It's an outlook that easily applies to reversing the childhood obesity epidemic itself. "It took 30 years to get into this predicament," she says. "Turning it around won't happen overnight."

[See: 10 Ways to Live Healthier and Save Money Doing It.]

What Parents Can Do

Further tips on how to safeguard children from gaining too much weight -- or help them lose it:

-- Set the stage at birth. Excess weight gain during pregnancy can result in a bigger baby and increase the risk of weight struggles. Ask your doctor what is appropriate based on your pre-pregnancy weight. After birth, "breast-feeding and delaying solid foods for six months have a protective effect," says Dr. Sandra Hassink, director of the American Academy of Pediatrics Institute for Healthy Childhood Weight. You can help babies develop a taste for healthy fare by introducing fruits and vegetables early on.

-- Establish boundaries for screen time. Sit down with older children and a weekly calendar. If the TV shows they want to watch add up to more than two hours a day, ask what they are willing to give up. "Letting children negotiate is more apt to be successful than just turning the TV off," says Joanne Ikeda, co-founder of the University of California--Berkeley Center for Weight and Health. While they're watching favorite shows, have them get up during commercial breaks and do jumping jacks or silly dances. "In an hour of TV, that's 20 minutes of exercise," says Kristi King, a senior dietitian at Texas Children's Hospital in Houston.

-- Think outside the activity box. Children, particularly young children, do not need special classes or sports to get the exercise they need. You might, for instance, turn on some music and dance. Ikeda recommends getting active with inexpensive dollar-store toys: punch balls, gliders constructed of balsawood to throw around, balloons, a bottle of bubbles.

-- Promote eating habits that last a lifetime. It's best to avoid putting kids on a diet. "It's risky because it can stunt their growth in height," Ikeda says. And restricting certain foods can lead kids to crave them more than ever. Encourage eating breakfast, even if it's just a spoonful of peanut butter on a banana. When kids skip a morning meal they tend to binge later.

This article is an excerpt from the upcoming "Best Hospitals 2017" guidebook (ISBN #978-1-931469-77-7), available on August 2 from the U.S. News Store.