Pediatric obesity program effectively improves outcomes for kids

A multidisciplinary pediatric weight management program can improve the weight status of high-risk patients, according to Joseph Skelton, M.D., a pediatric gastroenterologist and Director of the Pediatric Weight Management program (called Brenner FIT) at Brenner Children's Hospital.

Skelton's research was published online in the April 24 issue of Obesity and was conducted while he was Director of the Children's Hospital of Wisconsin's obesity program. Skelton, a national obesity expert, joined the faculty in August to head the center. He brought his multi-disciplinary approach and formed a team to help combat obesity in this part of the nation.

"One of the biggest keys to our success is our family centered approach," Skelton said. "We work to focus on the global picture - including the behavioral aspects - in addition to providing education for the family. Weight problems in families are a source of tension and stress. When we can turn the situation into one where family members support each other in a positive way, that's a win-win for everyone."

Skelton and colleagues studied 66 patients who met the criteria for the program. The children were substantially obese with 38 percent having a body mass index of over 40 kg/m2, which is considered morbidly obese in adults. More than 90 percent of the children had two or more weight-related co-morbidities and were taking an average of two prescription medications.

The children were evaluated over 10 visits in 13 months. They were given individualized treatment plans for their families to implement and follow. More than two-thirds of the children improved their weight status at one year. There were also significant improvements in total cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride levels, according to Skelton's research team.

"Our program was successful regardless of race, financial status of the family, gender, age or single or dual parent households," he said. "Through this research, we were able to identify a high rate of dropout in the program and make necessary changes to improve our participation rate."

Brenner Children's Hospital opened the region's first comprehensive pediatric obesity program last August. Called Brenner FIT (Families in Training), the program has several components, including a year-long, intensive treatment program for overweight children ages 2 to 18 with an underlying medical problem.

"The Brenner FIT program provides comprehensive, holistic, family-centered medical treatment for morbidly obese patients in the region," Skelton said. "Our program is comprised of medical care, research, community education and outreach. This summer, we hope to include a surgical component to Brenner FIT as well."

"Obesity has become such an extremely serious issue in this nation," Skelton said. "My team works to help patients understand that by making healthier choices they improve their overall lives in a significant way. And many times those choices are small ones - but ones that can have a huge impact on their overall health status. We work with the family very closely. Parents have to be on-board and participate in every aspect of our program."

Brenner FIT works with families to identify habits to change and then help them restructure their lives in a way that promotes physical fitness, healthy eating habits and overall wellness. Skelton consults with other pediatric specialists at Brenner Children's Hospital to treat children with high cholesterol, diabetes, sleep apnea and other obesity-related diseases. His team includes a family counselor, a physical therapist, a dietitian, and a nurse case manager. He accepts referrals to his intensive, year-long program from referring physicians. Patients who qualify for the intensive program are classified as obese (body mass index is greater than 95 percentile for age and gender) and have an associated medical condition as a result.

In addition to the Brenner FIT program, Skelton is working with pediatric surgeons at the children's hospital to offer the state's only adolescent bariatric surgery program. This program is an option for morbidly obese teens who, despite the family's best efforts, are not improving their weight or health. Teens are considered for surgery only after they have actively participated in the Brenner FIT program for four to six months. The first surgery is expected to take place in summer of 2008, Skelton said.

Skelton is also co-director of the Collaborative to Strengthen Families and Neighborhoods, a unique academic-community partnership at the new Gateway YWCA, which engages the community in addressing problems affecting the health of underserved children. This group is translating research-proven methods of preventing and treating obesity into a community setting. They have begun several research studies to combat obesity rates in Forsyth County.