Although she's only a teenager, Shauna Harrington recalls a day when she was overwhelmed with despair.
She refers to it as the day she hit "rock bottom," and it happened when she couldn't zip up her size 26 jeans.
In an essay she titled "Rock Bottom," Harrington wrote about the experience, which she says woke her up to a reality that changed her life.
"This was the point in my life where I had to pick a path, either to go on eating for all the wrong reasons and accept the fact that my weight was causing problems for me in every possible way (emotionally, spiritually and definitely physically)," she wrote. "I chose to realize that I was a good person and that I was worth a lot more than all the pain and suffering that I had been going through due to my weight."
Harrington began an extensive search for a program that could help her reach a more healthy weight. In the course of her investigation, a physician referred her to Bright Bodies, a weight management program for children offered by the School of Medicine's Section of Pediatric Endocrinology.
Since joining that program over a year ago, Harrington has lost about 35 pounds, and has also made some eating and lifestyle changes that she intends to maintain throughout her life.
Equally important, she says, she has made new friends who understand what it feels like to be obese. Once feeling alienated because of her size, she now has peers who have experienced the same issues about food and anxieties about their weight.
The Bright Bodies program was started five years ago by Mary Savoye-Desanti, a registered dietitian and certified diabetes educator who specializes in obesity and diabetes, with Rich DeStefano, exercise physiologist of pediatric cardiology at Yale, who formerly worked with Savoye-Desanti in the Section of Pediatric Endocrinology. They wanted to offer a treatment option for overweight children that would combine nutrition education, behavior modification and exercise -- tailored to the needs and interests of their young participants -- that would help them have more healthy attitudes and behaviors.
Since its inception, the program has expanded rapidly. In its first year, less than a dozen children were enrolled in the program, and Savoye-Desanti, DeStefano and the program's physician, Yale endocrinologist Dr. Sonia Caprio, served as its only staff members. Today, Bright Bodies serves nearly 200 children annually and has a staff of eight: program director and dietitian Savoye-Desanti, Caprio, another dietitian, two exercise physiologists, a nutrition specialist, a dietetic intern and a social worker.
The staff uses a team approach to help children between the ages of 8 and 16 learn how to reduce their weight through lifestyle changes. The children are referred to the program by local and Yale-based pediatricians and physicians, doctors at Yale-New Haven Hospital and by the Yale Pediatric Weight Management and Hyperlipidemia Clinic run by Caprio, among other sources. Once referred, the youngsters are screened for any metabolic or other medical problems that may be associated with their obesity, including diabetes, high blood pressure, high cholesterol and thyroid disorders.
Those with diabetes are placed in a Bright Bodies group with other children who have the disorder, while those without any medical problems are grouped according to age. Thus, in each 12-week session of the program, there is one group for 8- to 10-year-olds, another for 11- to 16-year-olds and one for diabetic children. Each group is kept small in size (generally there are 10 or fewer children in each session).
The children in each group gather twice weekly on the second floor at the Pediatrics Specialty Clinic at Yale-New Haven Hospital, where the Bright Bodies program is run. There, in small coeducational groups, they learn about good nutrition and weight-control skills with Savoye-Desanti, dietitian and certified diabetes educator Paulina Rose, nutrition specialist Sara Taksali and dietetic intern Julie Chmielewski. Following their 40-minute nutrition class, the children take part in a 30-minute cardiovascular exercise class taught by exercise specialists Melissa Shaw or Brad Serrecchia.
In their nutrition classes, the children learn about low-fat but nutrient-dense foods; how to read food labels; how to order healthier foods from such fast-food restaurants as McDonald's, Wendy's or Subway; how to identify situations in which they have used food -- and overeaten or eaten unnecessarily -- as a way of coping with stress, disappointment and other emotions; and how to make healthy food choices.
"We use a non-diet approach to weight management," says Savoye-Desanti. "In other words, rather than putting the children on diets, we teach them about how to make good food choices in general. For example, we'll talk about how pretzels are a better choice than chips, and how they can drink Crystal Light instead of juice. We try to avoid talking about 'bad' foods, instead focusing on getting them to think about what would be a healthier choice."
The children are also encouraged to think about times they tend to overeat and about what might have caused that behavior.
"We do a behavior chain, showing how one event leads to another event," explains Savoye-Desanti. "We'll talk, for example, about how your aggravation about doing poorly on a test might result in your reaching for cookies and chips. This kind of discussion helps the kids see where the weak link is in terms of how certain feelings resulted in certain behaviors. Then we'll talk about other options they might choose, such as taking a walk to relieve stress, for example."
Gaining such insight into their behavior with respect to food is especially crucial for overweight children, who are at a much higher risk of developing Type 2 diabetes than normal-weight children, particularly if there is a family history of the disease, Savoye-Desanti says.
In fact, a recent study by Bright Bodies physician Caprio showed that 25% of the obese children and 21% of the obese adolescents referred to her for weight management were glucose intolerant and at high risk for developing Type 2 diabetes, while 4% of the obese adolescents had "silent," or undiagnosed, Type 2 diabetes. In the past, Type 2 diabetes did not manifest itself until a person was middle-aged or elderly. However, says Caprio, an epidemic of childhood obesity in the United States has resulted in an increase in the prevalence of Type 2 diabetes among children and teenagers.
"This increase of Type 2 diabetes in children is one of the reasons that we feel it is so important to help children change their eating behavior while they are still young," says Savoye-Desanti. "There are many possible long-term complications from diabetes, including kidney and eye disorders, coronary artery disease, premature artherosclerosis and nerve problems. What's most disturbing is that these complications can be detected as soon as 10 years after diagnosis, so children can be in their early 20s when such problems develop."
About 10 children with Type 2 diabetes are participating in the current 12-week Bright Bodies session. These children learn about diabetes and its treatment, including the importance of regular blood sugar testing, how insulin and other diabetes medications work, the way carbohydrates and other foods effect blood sugar levels, the importance of exercise, and how to balance meals, among other topics.
For 14-year-old Nicole McDaniel, the Bright Bodies program has resulted in a major change in her overall health. When she started the program, she needed to take insulin and the diabetes medication Glucophage. She has since lost about 30 pounds and is now entirely off medication. In fact, by making healthier choices about food and getting exercise, she has been able to maintain normal blood sugar levels, and has also managed to decrease her once-
elevated cholesterol level.
"It is amazing how well some of the kids do when they have the motivation," says Savoye-Desanti. "They can't benefit from the program if they are in it because a parent has forced them to take part. They have to really want to make changes in their lives that will help them become healthier.
Savoye-Desanti admits that even some children who have the motivation to lose weight and change their dietary habits face an uphill struggle.
"Sometimes, parents will continue to have tempting foods in the home, even though their children are trying to avoid eating them," she says. "The dynamics of the family also play a role in how well these kids will do in the program. Since family situations can have such an impact, a social worker, Sylvia Lavietes, is an important member of our team, and we work with the entire family of each child to promote better health in the home."
Throughout the program, Bright Bodies staff members monitor the weight and percentage of body fat in each of the young participants to gauge their improvement. At the end of the session, prizes such as CDs or books are awarded to the children who have lost the greatest amount of weight or the greatest percentage of body fat. Children who have done well in their original 12-week session but who can benefit from additional assistance and support are welcome to re-enroll for a subsequent session.
"We know that 12 weeks very often isn't enough time for many of the kids, some of whom have lived years of their lives with poor eating habits," says Savoye-Desanti. "At the end of the 12 weeks, some of our participants are just beginning to feel positive about themselves and the changes they are making. Some of the children who enroll in consecutive sessions have been in the program for over a year."
For Savoye-Desanti and other Bright Bodies staff members, seeing the children apply what they have learned through their sessions brings great satisfaction.
"I'll hear the kids repeat some of the things I've taught them, or encourage each other in ways that we helped to encourage them," comments the nutritionist. "Sometimes, it's what they hear from their own peers that makes the most difference."
The School of Medicine's program is now being duplicated as part of a study in the city of Bridgeport coordinated by dietititan Gina Barbetta and exercise physiologist Tarja Cannon at the Charles Smith Center.
For the Yale-based sessions, participants pay for the program on a sliding-fee scale basis, and some insurance companies cover the entire cost.
Just feeling better about herself has made the challenges of the Bright Bodies program worth the time and effort Shauna Harrington puts into it, the teenager says.
"Joining the Bright Bodies group was one of the best decisions I could have made," she wrote in "Rock Bottom." "It has made a real difference in my life. Since I have been in the program, I have lost a significant amount of weight and am proud of all my accomplishments. For me the best thing about the program ... is the people I have met. The friends that I have made at the program are the best friends in the world."
For more information on the Bright Bodies program, contact Mary Savoye-Desanti at (203) 737-4384 or via e-mail at mary.savoye@yale.edu.
-- By Susan Gonzalez
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