- The Washington Times - Monday, October 11, 2004

With adolescence a notably turbulent time, treating teens and preteens for obesity is an extremely challenging task.

Take the case of Mike, 14, who started gaining weight after kindergarten. In addition, he was prone to an eating disorder called bingeing — eating excessively and uncontrollably — that made him feel guilty, according to doctors treating him at the time. He skipped breakfast and instead ate a lot of fast-food.

Cheryl, now 10, gained excessive weight starting at the age of 7. Instead of exercise, she watched TV. Because of her size, she was teased often at school, which affected her self-esteem, her doctors report.

Mike and Cheryl’s real names have been withheld at their doctors’ request to protect their privacy.

Both children are patients at Suburban Hospital’s Center for Eating Disorders and Adolescent Obesity in Bethesda, the region’s only clinic dedicated to helping overweight adolescents with a comprehensive program involving prevention, diagnosis and treatment.

Mike’s weekly therapy session helped with his emotional issues and control binge eating, but it took eight months for him to lose 14 pounds. Meanwhile, he grew 1 inch, and his self-esteem increased as well, says center director Dr. Tania Heller.

Cheryl needed nutritional guidance rather than therapy. Under direction of the center’s staff, her family’s habits changed — one meal at a time. They began to eat together more often and take walks together in the evening. In addition, Cheryl started taking a packed lunch to school, instead of relying on cafeteria food. She lost 12 pounds and grew 2 inches in nine months.

The results may not sound dramatic, but progress for young people in various stages of growth is measured differently from adults.

“No one believes such simple things can translate into such changes in a kid,” Dr. Heller says. Her staff consists of a psychiatrist, four therapists and a registered dietitian. In addition, an exercise physiologist is in charge of twice-weekly physical activity sessions at Suburban Hospital.

In three years of operation, the center has treated 235 youngsters, just under half for obesity and the rest for eating disorders. (Obesity may or may not be accompanied by an eating disorder.) A little more than 100 patients — an equal number of boys and girls —are in treatment at present.

Ani Toussounian, 16, a center patient for 10 months, is continuing her therapy but is struggling, says her mother, Teri, who adds that her daughter has been overweight most of her life. (Both Ani and her mother gave permission to use her name and discuss her case.)

“I see some change, but it is slow,” Mrs. Toussounian says. “They told me to expect that. It is a total change of behavior. There is a motivation factor. She needs to work things through by herself.”

Mrs. Toussounian learned of the clinic’s existence through an online ad, but most patients are referred to the center by primary care doctors. Dr. Heller, who speaks frequently at school and community events, says she is happiest when young people refer themselves since that usually ensures that motivation is high.

“We find if you start treating them early, the outcome is likely to be better,” says Dr. Heller, noting how frequently an increase in weight produces accompanying life-threatening conditions such as diabetes and cardiovascular problems.

“We worry now this is the first generation to have a shorter life expectancy,” she adds. “If we look at hormonal things, we don’t think they have changed dramatically enough in the past two or three decades to be causing this epidemic. Genetics and hormones play a big factor but they haven’t dramatically changed. So we think it [primary cause] is more lifestyle.”

Not every patient sees every staff member, but work is done as a team with members meeting weekly to discuss cases under their care. Ideally, treatment continues for one year with some patients being given the means to continue self-monitoring at home.

An initial evaluation can take up to three hours, involving a physical as well as a psychological examination, following which a patient and/or the family is given a treatment plan.

On return, a week or so later, the patient — as well as parents and/or a family caregiver — meet with the nutritionist-dietitian to discuss results of the physical tests with the staff doctors. At that point a patient may be referred to the fitness program if that is deemed appropriate.

A demonstration kitchen on the premises contains materials useful for a discussion of food labeling and content. Each patient is given a simple blue booklet called a food journal to record in detail what he eats and drinks each day and the amount of any physical activity.

“Not everyone goes into it [the fitness program] unless it is safe for them,” Dr. Heller says. Someone who is extremely overweight — the center has had youngsters weighing 300 pounds — may have health problems that need attention and would limit or prevent doing any strenuous athletics.

Families who try shaming their child into better habits fight a losing battle, center therapists say. Families involved with appearances will try to control more of what the child is doing — what they wear and eat, therapists warn.

The more that controlling mechanisms are used, the more likely a child is to rebel by eating more or eating secretly and by refusing to exercise, which ends by making the problem worse.

The center takes the opposite tack.

“The better children feel about themselves, the more effective the treatment will be,” Dr. Heller says.

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