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Giving Your Teenager Support for Healthy Decisions

04/01/2013

Being a teenager is challenging. But being an obese teenager can be an overwhelming struggle, especially if the young person doesn’t know the first thing about healthy nutrition or is embarrassed to be seen exercising.

Enter the Center for Youth Wellness at Floating Hospital for Children at Tufts Medical Center. Two years ago, it launched an innovative 10-week adolescent obesity group program designed for young people from 11 to 18. Today, the program is available in Boston, at Lowell General Hospital and at MetroWest Medical Center in Framingham, with plans to offer it at other Floating-affiliated community hospitals in the near future.

Most importantly, it’s changing young lives for the better.

“Our program provides a safe, supportive environment where teens can feel comfortable learning new knowledge and skills so they can build healthier habits on their own,” explains Clinical Director of the Center for Youth Wellness Michael Leidig, RD, LDN.

“The group approach has real benefits,” he continues. “Social isolation is common among obese teens who often are struggling with friendships, teasing and bullying. In the group setting, it’s more fun and they see they’re not alone. Yet we keep the group small enough so each participant gets individual attention.”

One teen’s perspective

Sixteen-year-old Malik Ferguson, a sophomore at Boston Preparatory Charter Public School in Hyde Park, is one participant who has seen the program work. He says that losing weight is his number-one priority because he realizes he needs to be healthy in order to get good grades – and he wants to attend college to study mechanical engineering. Ferguson attended the Boston program in the fall of 2012, driven by his motivation to focus on his schoolwork and plan for his future.

A few weeks into the program, he said, “So far it’s really helping a lot; I’ve already lost five pounds. This opportunity is basically my life.”

The program is designed exclusively for 11 to 18 year-olds with a body mass index (BMI) at or above the 95th percentile, or above the 85th percentile with a complicating condition such as high blood pressure or high cholesterol. It starts with two assessment visits – which at least one parent or legal guardian must also attend – and 10 weekly group sessions that are held after school for two hours. There also are follow-up visits at three and 12 months after program completion.

At the first 90-minute assessment visit, the teen meets with a physician, psychologist and dietitian to identify any underlying medical, psychological or nutritional conditions that could affect weight loss. At the second visit, held two to three weeks later, the physician shares the results gathered by the team at the first visit, including lab results, and discusses the teen’s interest in and eligibility for the 10-week group program.

The first hour of the after-school program, taught by dietitians and psychologists, focuses on nutrition, stress reduction and how to successfully make dietary and behavioral changes. During the second hour, teens take part in a variety of fun physical activities at YMCAs located in Chinatown, Lowell and Framingham (all program participants receive a 10-week membership to their local Y). Kids also are taught how to exercise at home.

Impressive results

About three-quarters of the adolescents who’ve been assessed go on to start the group program. About 75 percent complete it, which is good for this type of program. Floating Hospital was involved in a national focus group with 24 other children’s hospitals with pediatric obesity programs, and most had a 50 percent dropout rate.

“Most teens have participated in other weight management programs and often feel judged and deprived of the foods they love, which sets them up for a negative relationship with food and healthcare providers,” Leidig says. “We focus on teaching the knowledge and skills they need to navigate the many eating situations they find themselves in.”

“For example, they may not be eating breakfast at home, they’re eating school lunches, and maybe hitting a fast-food restaurant or convenience store after school,” he continues. “We teach them healthy options to choose in all of these situations. We’re not giving out a diet or putting them on a strict calorie-, fat- or carbohydrate-controlled diet. We’re empowering them to makes the changes they want to make versus being told what to do.”

“We don’t eliminate treats, but encourage them to reduce portion size and be mindful of what, when and why they’re eating,” he says, noting that many kids engage in emotional eating, turning to food without really being hungry.

“We don’t expect teens to lose a ton of weight during our 10-week program,” he adds. “But it’s 10 weeks of helping them build healthy living skills and empowering them to make some important long-term changes. As a result, we start to see participants consuming more fruits and vegetables, and reducing consumption of sugar-sweetened beverages in particular.”

It’s an approach that’s resonating with the youth who take part in the program.

"This program taught me that it is possible to eat and be healthy without starving myself,” one teen wrote in an evaluation of the program. “It gave me the tools to lead a healthy life and with patience and determination changes can be made. It was also very supportive. I made amazing friends and had great discussions. Through this program I learned how to lead a healthy lifestyle, and that I am not in it alone."

Another wrote, "This program was a great success. I was able to learn something that actually worked.  I noticed that I was losing pounds. I was able to meet people with the same problem as me and we were able to help one another out. I'm glad I joined the program. I truly recommend it."

“It’s unusual to get positive comments from an adolescent going through a weight management program,” Leidig says, “but during our program, a light bulb goes off and teens realize ‘I can do it.’ They decide to make the changes versus being told to do so by a parent or doctor. And they’re so much more likely to succeed when the idea to make a healthy change is their idea.”

Talking to Teens and Parents about Obesity

Leidig says that at times it can be difficult for busy pediatricians to get patients and parents to discuss weight issues. To jumpstart the process, he and his team have developed a simple 10-question survey about teens’ eating and activity patterns (see graphic).

“Pediatricians can have patients complete the questionnaire in the waiting room prior to a well visit,” he says. “Then it can be used as a conversation starter during the visit. It’s a way of engaging the patient in a spirit of inquiry and concern, using his or her own responses, versus providing unsolicited advice. And it’s not perceived as judgmental since you’re letting the patient decide if he or she is concerned about any specific behaviors.”

“The first two assessment visits require trips to Boston, but if you can make the case to teens living north and west of the city that it’s worth it, then the 10-week program is right in their own community,” he adds.

The 10-week after-school teen program is currently available at the MetroWest YMCA on Tuesdays, the Greater Lowell Family YMCA on Wednesdays and the Wang YMCA of Chinatown on Fridays. Currently, the only out-of-pocket cost to families is a $50 administrative fee and whatever insurance copayments apply for the first two assessment visits and the 3- and 12-month follow-up visits. To learn more, please call 617-636-3381 or visit www.floatinghospital.org/cyw