Michael, 9, careens through the gymnasium of Celentano School in New Haven and laughs at the luxury of having all that space to himself. Soon enough the gym will be crowded with friends playing basketball with such intensity that every trip down the court ends in a jump ball. His family is the first to arrive for tonight’s session of Bright Bodies, a weight management program for teens and children. If you think that means “diet,” think again.
“Dieting doesn’t work for adults. Why would we think it will work for children?” asks Mary Savoye-Desanti, a registered dietician and research associate in the Yale School of Medicine’s department of pediatrics.
Bright Bodies is the brainchild of Savoye-Desanti and Yale Medical Group endocrinologist Sonia Caprio, MD. Their strategy favors moderate, permanent changes over time. It teaches families to make healthy food choices and engages kids in appealing exercise.
Type 2 no longer rare
Caprio recalls when type 2 diabetes, caused by obesity, was called “adult onset diabetes.” Type 1 diabetes, which has no relation to weight, was called “juvenile diabetes.” Obesity was so rare in children that kids didn’t get type 2. Today 17 percent of 2- to 19-year-olds are obese, according to the Centers for Disease Control and Prevention.
Around 2000, Caprio saw her first cases of type 2 diabetes in children. “The longer the duration of diabetes, the greater the potential for complications,” she explains. “So Mary and l looked into developing a program to deal with overweight.”
The epidemic of obesity is drawing national attention as well. President Barack Obama created a Task Force on Childhood Obesity, which recently came out with recommendations that range from promoting breastfeeding to re-examining how food is marketed to children. Childhood obesity has become a signature issue for First Lady Michelle Obama.
Taking the program into the community
Originally Bright Bodies was based at Yale-New Haven Hospital. Moving the sessions into a New Haven public school helped the program take on a less clinical feel and service more families. The children do a weight and height check-in when when they arrive, but they soon seek out the gym – or the monkey bars. Many are referred to the program from pediatricians in New Haven and surrounding communities. To participate, children must be in the 95th percentile for body mass index, a weight-to-height ratio, and be aged 7 to 16.
Michael came to Bright Bodies at his pediatrician’s suggestion, but he had his own motivation. “I came so I could lose weight because I don’t want to be… ,“ he looks up at the ceiling in search of the right word. “Chunky.”
This is his second time through the 12-week program. It is recommended that kids repeat it at least once to keep their weight loss on track. Depending on their weight goals, some kids have been in the program over a year.
“He lost a lot of weight and he seemed more active,” said Michael’s mother, Katia. Michael is also eating better, as is the rest of the family. “Lots of meals have changed,” says his mother. “Portion size has changed. We cook everything on the grill now.”
Patients keep the weight off
The program includes nutrition classes. Katie Marotto, a dietetic student, fields questions from a roomful of curious teens. “Is mayonnaise bad, because I like that on everything?” Marotto suggests a healthier alternative made with olive oil. She gives them the skinny on fat-free ice cream—so high in carbohydrates that you might as well enjoy the real thing in moderation—and extols the virtues of whole grain pasta.
Outcome measures of a large randomized study have shown that Bright Bodies kids lose weight and that the weight stays off when researchers check in at 12 and 24 months. A small pilot study followed 15 children who had pre-diabetes, high blood glucose levels that are a precursor to type 2 diabetes. After working with Bright Bodies, all 15 lowered their glucose levels out of the danger zone. Now Yale Medical Group endocrinologist Robert Sherwin, MD, will lead a study to see if those results hold for a larger group.
Caprio heads the national Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study to look at different treatments for type-2 diabetes in adolescents. Her research examines everything from the effect of obesity on the liver to how high-fructose corn syrup affects the brain. While much of her work involves treating young people with weight issues, she stresses that obesity is far easier to prevent than to treat and urges parents to keep an eye on weight gain even in very young children.
Fighting a toxic environment
“We’re fighting against a toxic environment,” she adds, a reference to the high-calorie, low-activity modern lifestyle.
Bright Bodies families are up for the fight. Winnie Dixon resolved to stop purchasing fishsticks and limits the sweet tea that her 8-year-old granddaughter, Makayla, loves. Exercise is a problem, because Dixon doesn’t always feel safe letting her grandchildren outside. Bright Bodies provides a safe environment for her granddaughter to obtain physical activity in her community.
To contact Yale Pediatric Endocrinology, please call 203-764-9199.