Sudden inspiration hit pediatrician Anne Van Garsse last year while she was strolling through a local department store.
Van Garsse, who has been practicing in Lawrence for 10 years, wanted to help families struggling with obesity. She called a friend, dietitian Shannon Jones, and the two joined forces to start a pediatric and adolescent weight management clinic.
They opened the clinic in July, and since then they have seen about 30 patients ranging in age from 5 to 19. Both Van Garsse and Jones put their other business on hold to run the clinic every other Tuesday at Van Garsse’s office, 346 Maine. Their professional relationship began three years ago, back when Jones opened her business, Simple Solutions, focusing on nutritional counseling and weight management for all individuals.
“When Shannon was first starting her practice, she invited me to meet with her and discuss how she would be helpful to a pediatrician for patients with weight issues,” Van Garsse said. “From that meeting I started referring overweight pediatric patients. She is private pay, so it limited the amount of patients I could refer to her. This is just not a one-visit solution.”
Shortly thereafter, Van Garsse spent an afternoon observing and speaking with her medical peers at the weight clinic managed by Children’s Mercy Hospital in Kansas City, Mo. She refers some extremely obese patients there.
“But if we can do the preventative care here in Lawrence, then that frees up more of their time for more severe cases,” Van Garsse said.
In her practice, Van Garsse begins having conversations with patients and their families when a patient’s body mass index is in the 85th to 95th percentile range. The BMI is an approximation of an individual’s body fat based on height and weight. At the clinic, one of their top goals for patients is to have their height catch up to their weight and their weight stabilize, which will lead to a decrease in their BMI.
“We work together to create behavior change and lifestyle changes in the family with the hopes that we instituted enough positive and simple changes for their height to grow into their weight. Once they become an adult, we no longer get to take advantage of the ability to grow into their weight,” Jones said. “If all of a sudden, because of lifestyle changes, they are no longer gaining weight each year while continuing to get taller, we can prevent these kids from being overweight or obese adolescents and then an adult.”
For Jones, using her motivational interviewing training and nutritional assessments allows her to “determine the family’s readiness to change and for them to come up with ideas on their own. If the family comes up with the ideas on their own they will have a better chance to stick with it. They own it.”
The patient and family are typically seen monthly and work on achieving one goal a month.
“We are giving them tools to help break down their goal and be successful. The family picks the goal and they don’t move on until they are ready,” Jones said. This goal may be increasing their amount of physical activity, reducing the amount of sugared drinks, or increasing their intake of fruits and vegetables. “We adapt to the family. … One of our goals is to help the family move towards healthy habits.”
At a session in February, the mother of a 9-year-old patient shared her thoughts about the program.
In addition to her child being overweight, the other alarming discovery was her child’s high cholesterol count. “As a parent, that is scary to find out your child has higher cholesterol than you do,” the mother said.
The mother admitted while meeting with Jones that they have slipped on their goals since their previous visit but said they have talked about plans to get back on track.
“We sat down together the other day and talked about eating healthy again and what are some ways we can do this and what are the healthy things we can eat,” the mother said. “We are also planning our activity chart together, which has walking and dancing in the living room. We are going to turn on music and boogie down.”
This is just what Van Garsse advises.
“We counsel the parents to discuss healthy lifestyles at home,” she said.
She and Jones encourage families to celebrate achieving goals by instituting a reward system based not on food but on fun activities.
“This encourages physical activities and family time,” Van Garsse said.
“I personally feel the obesity increase is the result of two main things: calories the kids drink and the sitting they do in front of the TV,” she said. “There is less activity now in a child’s day, and kids also start drinking fruit juices and eating snack crackers at such an early age. That is not 100 percent bad, but we get them in a habit of thinking their stomach has to be full.”
Van Garsse also acknowledged the role of genetics in children’s weight.
“No doubt predisposition plays a part, but that does not mean you do not have control of how you live your life,” she said.