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A weight-loss win

How one program changes the way kids drop pounds and gain self-esteem

By Karen Weintraub
Globe Correspondent / April 5, 2010

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Derick Sylvestre used to be big. He topped 150 pounds sometime between his 11th and 12th birthdays, and rounded 200 less than a year later.

Now 15, Derick says he was embarrassed to take his shirt off at the beach, unhappy about needing to shop in the XXL section of his favorite stores.

Then, near the end of last summer, something clicked.

“I didn’t want to live my life that way,’’ Derick says.

He started working out, playing basketball and jogging. Since August, he’s grown more than half an inch, to 5 feet 8 inches, and dropped to 181 pounds — still heavy for his age, but no longer obese.

“Are you more popular now?’’ a dietitian asks during a recent visit.

“Something like that,’’ he answers, smiling as his cellphone buzzes.

Clearly, Derick’s determination was key to his success. But he also had help from a weight-loss program at the Whittier Street Health Center in Roxbury, where he has been a patient for three years.

The Healthy Weight Clinic at Whittier, as well as at seven other community health centers across Massachusetts, is taking a nontraditional approach to caring for overweight young people. Instead of the normal route — simply telling kids, “You really should lose weight’’ and handing out a list of do’s and don’ts, or even sending them to in-patient programs, where dropout rates are extremely high — Healthy Weight offers a doctor, dietitian, and case manager all in one place, available in one short visit close to home.

A doctor addresses health problems and oversees the patient’s care; a dietitian offers advice on eating better and exercising more; and a case manager helps resolve problems common among the clinics’ low-income patients, such as a lack of access to fresh foods or even to adequate sneakers.

The program doesn’t cost Derick’s family anything, because like most clinic patients, he’s covered by the state-subsidized MassHealth insurance program.

Childhood obesity has reached epidemic levels across the country, with 17 percent of American children now considered obese and 32 percent overweight. Most of those children, doctors fear, are headed for a health catastrophe — and very few programs have successfully helped kids lose weight.

A study of the Healthy Weight Clinics’ first patients appears in this month’s Health Affairs journal, a national peer-reviewed publication that focuses on health policy and research. Conducted by clinic founder Dr. Shikha Anand and colleagues, the study of 174 patients found that half lost weight relative to their height — meaning they either shed pounds or grew taller without gaining weight.

“Even weight stabilization is great,’’ says Anand, Derick’s doctor. Children can reduce their body-mass index without lowering their numbers on the scale, just by “growing into’’ their weight, she says.

Nearly 80 percent of patients in the study made some kind of lifestyle change, either by increasing physical activity or by improving their diet, including such alterations as decreasing consumption of sweetened drinks, the study found.

Not taking steps to fight childhood obesity is a prescription for medical trouble. Cardiovascular problems once seen only on the far side of middle age are now trickling down into the 20s and even the teens, doctors say. Overweight children and teens are also more likely to be teased and bullied than leaner peers, and more likely to suffer lower self-esteem.

But it’s very hard for kids to drop pounds. And most programs that try to help them, fail.

“The challenge is that it’s not like a lot of other diseases, like asthma — we know what’s wrong, we know what to do, and we just have to educate people and make sure they have access to the proper resources,’’ says Dr. Shari Nethersole, medical director for community health at Children’s Hospital Boston. “Obesity — it’s not a straightforward medical issue the way other health issues are.

“If you don’t make any changes before age 12, I think it’s really hard to make them,’’ Nethersole says. “The success rate is really poor — about like adults.’’

And that’s why the success by Derick and others in the Healthy Weight Clinic is so remarkable.

Derick, now a freshman at Monument High School in South Boston, lost weight when he first started coming to the clinic three years ago, then he yo-yoed to his highest weight ever. Anand says she sometimes thought she was wasting time with him.

Now, she knows he was listening, even when he didn’t seem to hear her — which gives her faith that some of her other patients are doing the same.

“That’s a lot of weight,’’ she tells Derick about his 7.5-pound loss since Thanksgiving. “I’m impressed. And I’m not easily impressed. You know that.’’

When patients come in regularly — this was Derick’s eighth visit in three years, and he’s asked to return in a month — Anand says she can build a relationship with them. Both grow comfortable with each other, which helps the doctor’s gentle ribbing carry more influence.

“That is part of how it works,’’ Anand says. “He’s already not nervous when he comes in. You can start out already at the second step.’’

Exercise, Derick says, has made the difference for him. In addition to his basketball and jogging, he’s lifting weights and doing sit-ups and jumping jacks four times a week at home.

“Exercise is great for you,’’ he says. “I’m into it now.’’

Some days, he works out with a cousin who also has weight to lose. He’s teaching her what he’s learned at Whittier, he says.

For many in the Healthy Weight program, exercise is a challenge — to more than just their willpower.

Some live in apartments where neighbors will call police if they hear feet pounding during aerobics or jumping rope; other patients belong to cultures that strongly discourage girls from exercising in public. By providing sneakers or gym memberships or tips on culturally appropriate ways to exercise, the clinics try to remove patients’ hurdles.

At one visit, Derick got a medicine ball for his workouts. Another patient had gained some weight since his free Y membership expired; a case manager says she’ll do what she can to renew it.

Clinic staff members act as cheerleaders as much as coaches.

“You’re doing awesome with your activity,’’ dietitian Kerry Ann Mendes tells Derick, though she raises her eyebrows when he says that he spends about seven hours a day — slightly below the national screentime average for teens — watching TV and sending text messages on his cellphone.

Mendes wants to know what Derick has eaten during the last 24 hours.

For breakfast, it was Raisin Bran and — “You’re going to kill me,’’ he says — a chocolate chip muffin. Mendes’s eyebrows go up again, but she urges him to continue. For lunch, a peanut butter and jelly sandwich and chocolate milk. After school, a Fiber One bar, and for dinner, steak, rice, corn, and a Coca-Cola. “I’m sorry — I’ve got to have my Coke,’’ he tells her.

“What about the corner store?’’ she asks.

“I don’t go anymore,’’ he says.

Mendes wants to be sure Derick doesn’t slip up, now that he’s made so much progress.

“I don’t want you drinking sweet drinks,’’ she says. “But I do want you drinking milk.’’ She then advises him that he can get used to the taste of low-fat milk by diluting his whole milk bit by bit.

“I’ll give it a try,’’ he says, and the two shake on it.

Karen Weintraub can be reached at karen@karenweintraub.com.

Why fat matters

Obesity is more than an appearance issue for children. These are among the risks:

PSYCHOLOGICAL
Obese children and adolescents are often targets of early and systematic teasing and bullying that can lead to low selfesteem, which, in turn, can lead to academic and social problems well into adulthood.

CARDIOVASCULAR DISEASE
High cholesterol levels, raised blood pressure, and abnormal glucose tolerance — usually thought of as adult problems — can also affect kids. In one sample of 5- to 17-year-olds, 70 percent of obese children had at least one cardiovascular risk factor while 39 percent had two or more risk factors.

OTHERS
Additional childhood health problems associated with obesity include asthma, sleep apnea, and Type 2 diabetes.

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