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Healthy Lifestyles Program

One in three children in North Carolina are overweight and suffer health problems, poor quality of life, and social isolation. The Healthy Lifestyles Program seeks to answer this challenge by offering caring providers, family-centered treatment programs, highly trained educators and researchers, and strong community partnerships.


Obesity-related co-morbid health conditions are the second leading cause of preventable death, following tobacco use. One-third of children and adolescents in the United States are overweight or obese, and the dramatic rise in the prevalence of pediatric obesity has been predicted to lead to a decline in overall life expectancy. Obese children are at high risk for dyslipidemia, hypertension, and type 2 diabetes mellitus. Obese children are also more likely to suffer from obesity as adults. Given the large number of children who are overweight or obese, there is an overwhelming need for effective treatment for overweight and obese children.

5-3-2-1 Almost None!!

5: Fruits and vegetables English [PDF, 302KB] Spanish [PDF, 44.7KB]
3: Structured meals English [PDF, 63.7KB] Spanish [PDF, 28.5KB]
2: Hours or FEWER of "screen time" English [PDF, 215KB] Spanish [PDF, 183KB]
1: Hour or MORE of being active English [PDF, 111KB] Spanish [PDF, 92.6KB]

 



Treatments

The foundation of Duke's Childhood Obesity treatment is lifestyle modification, called "Healthy Lifestyles Basics." Through individual and group visits with medical, dietary, physical therapy and behavioral specialists, families learn the skills and knowledge needed to live a life of healthy eating and active lifestyles. There is no one solution for everyone, so treatment is individualized for the child and family’s specific needs. More than 5,000 families have received care from the Healthy Lifestyles clinic, and those who complete approximately one year of treatment show a significant drop in body mass index, body fat percent, blood pressure, and cholesterol, as well as an increase in self-esteem and nutritional knowledge.

Some patients come to clinic having attempted nutrition and activity programs before, with limited success. For these patients, and those who do not succeed with the standard intervention, we offer advanced treatments including specialized diets, pharmacotherapy and surgical options for qualifying adolescents.

Diet
The Staged Transitional Eating Plans (STEPS) diet was designed by Duke Healthy Lifestyles faculty specifically for children. Through three very carefully designed “steps,” we will provide guidelines, meal plans, recipes and intensive support to help you achieve an optimal diet for your family. The general progression of the STEPS diet is (1) low sugar (step-1), (2) high fiber (step-2), and low sodium (step-3). Patients remain on each step for approximately two months before transitioning to the next step. 

Medications
Currently, only one medication is FDA-approved for the treatment of obesity in adolescents (Orlistat, Xenical). However, newer medications approved for adults may be used to assist adolescents with weight loss in specific circumstances (Qsymia, Lorcaserin). 

Surgery
For teens aged 14 and older who have attempted weight loss for at least six months in the Healthy Lifestyles Clinic, and who have significant health problems as a result of their obesity, may be eligible for gastric bypass surgery. This program is offered in conjunction with the Duke Metabolic and Bariatric Weight Loss Surgery Center of Excellence. If you are interested, please check first with your insurance plan to verify that it is NOT an excluded benefit in patients under the age of 18.

The Healthy Lifestyles Clinic

Healthy Lifestyles is a one-year, family-based intervention for children with a body mass index (BMI) over the 95th percentile. Click here to enter your child’s birth date, height and weight to see if he/she qualifies. You can schedule an appointment by contacting us directly or through a referral from your child’s pediatrician by calling 919-620-5356.

First Appointment
Your first appointment will be a half day session on a Monday, Wednesday or Friday morning. We will learn more about you and your specific goals, obtain screening labs on children aged five and older  and provide health, nutrition, and physical activity counseling in a group session with other families. Please bring your child fasting (nothing to eat or drink except sips of water for at least eight hours prior, or midnight the night before the visit) to this appointment. If your child is not appropriate for a group setting for any reason, please call the Healthy Lifestyles Program Coordinator at 919-620-5394 to discuss.

Return Appointments
Following this initial visit, you will be scheduled to return within two weeks to meet with your individual Healthy Lifestyles team which will include a medical provider and a registered dietician specializing in childhood weight management. You will be offered the option of meeting with a pediatric physical therapist and a mental health provider specializing in eating behaviors at any time during the year-long intervention. All services are provided on-site. You will make your plan for the frequency of visits over the one year treatment, which will be determined by your child’s health needs and by what you feel will work best for your family. Some people prefer more intense, frequent visits; others feel they need time to work on changes and would rather have fewer appointments. Regardless of your decision, we require all patients to return one year after they start the program to evaluate progress and plan next steps. 

Children will earn incentive prizes at each visit for setting goals and working to achieve them.

Fees and Payment
Healthy Lifestyles visits (medical, dietary, and physical therapy visits) are billed to insurance. Mental health visits are not charged to insurance at this time, so there will be no co-payment or diagnosis in the child’s medical record. Your financial responsibility will be minimized as much as possible, however, Duke University Medical Center does not have the ability to waive co-payments, deductibles, or non-covered services. Duke Patient Resource Management Organization will investigate your insurance plan after the group visit if you decide to enroll in the one-year program. We will inform you of any financial responsibility that might be associated with the individual medical, dietary, physical therapy or mental health visits. If you have questions or concerns, please call the Customer Service Center at 919-620-4555 or 800-782-6945.

Community Outreach Programs

These programs advocate within Durham and the surrounding communities to prevent disease, promote health, and provide opportunities for healthy food access and active living. We partner with many local organizations to move toward our shared goal of a healthy tomorrow. Please contact Julia Wacker (julia.wacker@duke.edu) with any questions about our advocacy projects. A few of our signature programs include:

  • Bull City Fit. Bull City Fit was founded in 2012 and is a community-based exercise program for teens (12-18) and their adult workout partners. It is located at Edison Johnson Community Center on Murray Avenue in Durham (adjacent to the Museum of Life and Science). In 2013, Bull City Fit will begin enrolling children aged six and older. Bull City Fit is free, open only to Healthy Lifestyles Clinic families, and involves a wide variety of programming, including fitness instruction, dance, sports, moderated peer support group sessions, gardening, cooking classes and more.

  • Healthy Lifestyles Girls on the Run. Healthy Lifestyles Girls on the Run is a character development program for girls ages 8-12 years. Healthy Lifestyles has partnered with the Triangle Girls on the Run chapter to host its own Girls on the Run team, open only to Healthy Lifestyles participants. Twelve-week sessions are held twice a year and culminate with a 5k fun run and celebration.

  • Community Awareness and Education Programs. Healthy Lifestyles conducts community awareness and education programs throughout the Triangle, including school and preschool teaching, a childhood wellness-promoting media campaign, and appearances at large community events, such as health fairs and the North Carolina State Fair.

Physicians and Staff

Physicians

Name Areas of Special Interest
Sarah C. Armstrong, MD Comprehensive treatment of childhood obesity
Michelle L. Bailey, MD Community and family education on effective strategies to help children, adolescents, and young adults optimize health and well-being by supporting healthy lifestyle habits related to factors such as nutrition, physical activity, sleep, and relationships; teaching positive stress management, while building essential life skills
Michael S. Freemark, MD Pediatric endocrinology; hypothalamic-pituitary dysfunction; disorders of growth, thyroid function, and sexual development; diabetes mellitus; insulin resistance; celiac disease in diabetic children, hyperlipidemia
Alex R. Kemper, MD, MPH, MS Supervise residents in the provision of well-child and acute care; coordinate research activities to improve the quality of care received by children and their families
Caren Mangarelli, MD General pediatrics and adolescent medicine, childhood obesity

Staff

NameAreas of Special Interest
Dorothy Conrad, RD, MPH Eating disorders in children and teenagers.
Jenny Favret, RD Dietician specializing in eating disorders in children and teenagers, including binge eating disorder and bulimia. Extensive experience and success in helping overweight children and their families.
Amy Fryt, BS Bull City Fit coordinator, Healthy Lifestyles data manager.
Andrea Hartzell, PT Fitness evaluations and design of exercise programs for children.
Meryl Kanfer, MSW Clinical social worker providing individual and group counseling services for patients and families with disordered eating patterns, family stress, and emotional problems.
Martha Nelson, PA Physician assistant in general pediatrics specializing in family-based childhood and adolescent obesity care.
Katie Ollendick, PT Fitness evaluations and design of exercise programs for children.
Julia Wacker, MSW, MPH Director of Community Outreach specializing in community resources to support a healthy and active lifestyle for children, adolescents, and their families. experience and success in helping overweight children and their families.
Lisa Watson, PNP Nurse practitioner in general pediatrics specializing in family-based childhood and adolescent obesity care.
Kimberly Yancey Program Coordinator
Nancy L. Zucker, PhD Research focused on developing novel treatments for individuals with eating disorders and children who struggle with weight management; integration of family members into effective treatment strategies.


Clinic Hours and Location

Duke Children's Primary Care
4020 N. Roxboro Street
Durham, NC 27704
Tel: 919-620-5356 or 1-866-530-5356
Fax: 919-471-6930
Appointments: 919-620-5356

Hours: 
Monday - Friday, 8:00am - 5:00pm


Appointments and Contact Information

To serve our patients and referring physicians, faculty physicians covering pediatric weight management are always on call to answer questions and provide consultation.

  • For new and return appointments, please call 919-620-5356 or email us at healthylifestyles@duke.edu.**
  • For urgent calls during business hours, call the divisional office at 919-620-5394 or 866-530-5356.
  • For urgent calls after business hours, on weekends, or on holidays, please call your primary care provider.
  • For physicians requesting consultations or making referrals, please call the division office at 919-620-5356 or 866-530-5356 and speak with Kim. You may also contact the Duke Consultation and Referral Center at 800-MED-DUKE (800-633-3853) or fax a referral form [PDF, 216KB] to 919-471-6930.

Referrals

Referrals are accepted from providers, but family members may also call directly to set up an appointment. Please call 919-620-5356 or 1-866-530-5356 to schedule an appointment.