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With New York City Kids, Doctors Work to Change Obesity's Roots

New York (Jul 5, 2011)

youngsters play at a CHALK event
Youngsters play during an event sponsored by
Choosing Healthy and Active Lifestyles for Kids
(CHALK) – a program at NewYork-Presbyterian.

Physicians and staff at NewYork-Presbyterian are trying to address a vexing problem: how to decrease the high rates of obesity among New York City's less affluent children who are frequently mired in unhealthy habits and lack the means or access to information to easily change their lives.

According to data released in 2010 by New York City's Department of Health and Mental Hygiene the problem is significant. Overall, 40% of youngsters in the city are overweight or obese – a rate higher than the national average of 35%. But while children in affluent zip codes were more likely to be of normal weight, children in less affluent neighborhoods were far more likely to be overweight or obese – and dramatically so. For example, only about 15% of kids in Tribeca or SOHO were overweight or obese; compared to nearly 50% of kids in parts of Harlem or Washington Heights.

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Two programs – Choosing Healthy and Active Lifestyles for Kids (CHALK), affiliated with NewYork-Presbyterian/Columbia University Medical Center, and Health for Life (H4L) at NewYork-Presbyterian/Weill Cornell Medical Center – aim to curb obesity by changing habits among both children and their parents using some non-traditional methods.

CHALK

The CHALK team does not focus on weight loss but rather on 10 healthy habits that evidence shows reduce a child's risk of becoming overweight. CHALK tries to infuse these 10 habits into people's daily routines, in a way that embraces cultural norms and economic realities. "We have to make sure our message is relevant in a community where people's activities are rooted in specific cultural and economic conditions," says Stephanie N. Pitsirilos-Boquín, M.P.H., CHALK's Program Manager. "We are not about trying to get people to suddenly eat granola with blueberries and yogurt in a neighborhood where breakfast might mean toasted bread and cheese." Instead, CHALK works with community leaders, agencies, businesses and pediatric providers to focus on modifying behavior.

Stephanie N. Pitsirilos-Boquin, M.P.H.
Stephanie N. Pitsirilos-
Boquín, M.P.H.

When a child and his family go to the pediatrician, they are asked five questions: How much soda do you drink? How much TV do you watch? How many times per week do you eat fast food? How much physical activity do you get? How much sleep do you get? "The answers to these questions tell us a lot about how we can help the people in this community live healthier lives," says Patricia A. Hametz, M.D., M.P.H., the Director of the Center for Best Practices in Childhood Obesity Prevention and Reduction at NewYork-Presbyterian/Columbia University Medical Center and the Medical Director of CHALK.

With meals, for example, CHALK encourages families to keep the recipes they like but adjust them toward a healthier way: grill, rather than fry, substitute low-fat dairy for whole milk products and include plenty of fruits and vegetables. "We try not to preach – that really isn't a successful way to reach children and teenagers," Ms. Pitsirilos-Boquín continues. "We use a health promotion, not a deprivation model. As an example of programs in the community, we organize a family fitness night once a week where parents and kids can be active together at the local Y."

Patricia A. Hametz, M.D.
Patricia A. Hametz, M.D.

"From a public health standpoint, we need to prioritize prevention over treatment," says Dr. Hametz. "Our goal should be to use whatever methods make sense within this community to empower children and families to live healthier lives."

The CHALK team also asked neighborhood restaurants to advertise healthy menu selections and put up signs in the hospital urging people to take the stairs. "The biggest victory," says Ms. Pitsirilos-Boquín, "was establishing a hospital-based community Greenmarket every week during the growing season that now attracts 1,000 people a day." The market brings additional access to fruits and vegetables to the neighborhood. It also features healthy cooking demonstrations, dietician consultations and coupons for discounts on fruit and vegetable purchases.

H4L

Health for Life (H4L) is a program for children ages 8-18 at NewYork-Presbyterian/Weill Cornell Medical Center that encourages lifestyle changes, including healthier eating, increased physical activity, and weight reduction and management. Maura D. Frank, M.D., the Director of H4L and Medical Director of Ambulatory Care at NewYork-Presbyterian/Weill Cornell Medical Center, agrees that prevention is best but feels there is a need to work with children and teens who are already overweight or obese. She also feels that any program trying to address weight management needs to involve both parents and children. "Parents have to be involved because they control what goes on at home," she says.

Maura D. Frank, M.D.
Maura D. Frank, M.D.

Health for Life follows participants for at least one year, with both individual visits and a 10-week intensive training program that includes once a week sessions of exercise and discussion for kids and teens, and a separate parent group as well. Dr. Frank's program also encourages families to modify their lifestyles and monitors these behavior changes. Clinicians track the children's lipids, liver enzymes, insulin and glucose levels, blood pressure and BMI as well, and follow up with training program graduates every three months for one year.

"In three of our last four groups," says Dr. Frank, "between 50 and 100% of the kids either maintained or decreased their BMI after one year. Our data show that in 80% of our participant families, parents have made major changes in the home – changes like cutting down on TV time, cutting out soda and juice, increasing fruits and vegetables, and increasing physical activity time." In addition, LDL ("bad cholesterol") levels decreased in 70% of the children in Dr. Frank's first 14 groups.

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"What is truly amazing is the effort families make to get to this program – most travel more than an hour to get there each week," says Dr. Frank. But as the children get older retention becomes an issue. "The younger crew – once they're in, they're in. But the older kids are tougher to retain – most of their meals are dominated by fast food dining, and many of them don't have access to organized after-school athletics."

Clearly, childhood obesity is a problem faced by many cities and neighborhoods. But through programs like CHALK and H4L that offer untraditional interventions, advocates hope to reach children and their families at a young age, and empower entire communities to adopt habits that lead to healthy weights and lifestyles.

Contributing faculty for this article:

Maura D. Frank, M.D. is the Director of Health for Life (H4L) and Medical Director of Ambulatory Care at NewYork-Presbyterian/Weill Cornell Medical Center. She is also an Assistant Professor of Clinical Pediatrics at Weill Cornell Medical College.

Patricia A. Hametz, M.D., M.P.H. is the Director of the Center for Best Practices in Childhood Obesity Prevention and Reduction at NewYork-Presbyterian/Columbia University Medical Center and the Medical Director of Choosing Healthy and Active Lifestyles for Kids (CHALK). She is also an Associate Clinical Professor in Pediatrics at Columbia University College of Physicians and Surgeons.

Stephanie N. Pitsirilos-Boquín, M.P.H. is the Program Manager at Choosing Healthy and Active Lifestyles for Kids (CHALK).

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