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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]



The foundation of childhood obesity treatment is lifestyle modification, called "Healthy Lifestyles Basics." Through individual 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 improvement in labs, 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.

The Staged Transitional Eating Plan (STEPS) diet was designed by Duke Healthy Lifestyles faculty specifically for children. Through three very carefully designed “steps,” we will provide guidelines, sample menus, recipes and intensive support to help you achieve an optimal diet for your family. The general progression of the STEPS diet is: (step-1) very low carbohydrate, (step-2) gradual reintroduction of certain whole food carbohydrates, and (step-3) individualized carbohydrate prescription for long-term health goals. 

Currently, only one medication is FDA-approved for the treatment of obesity in adolescents (Orlistat). However, newer medications approved for adults may be used to assist adolescents with weight loss in specific circumstances. Please ask your Healthy Lifestyles provider for more information.

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 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.

Intake Appointment
Your first appointment will be a two hour morning appointment. The purpose of this appointment is for us to gather data about your child and your family. Please bring your child fasting (nothing to eat or drink except sips of water after midnight). During this intake visit, you will learn about the program from our nursing staff as they gather important medical and family data concerning your child’s health. Then you will meet with one of our medical providers who will screen for any medical comorbidities. Next, our physical therapist will guide you through a fitness examination focusing on strength, balance, speed and agility. Lastly, for children five and older, we will obtain fasting screening labs. 

First Follow-up Appointment
Your first follow-up will be two to three weeks after your initial intake visit. This will be another two hour appointment, and it is where the work begins! You will meet with the medical provider who will review your child’s “Health Report Card”. This will give you an overall view of your child’s health, and together we will come up with a plan to improve it. You will also meet with the dietician to discuss how changing the family’s eating behaviors may improve your child’s health. 

Return Appointments
Your child’s follow-up visits will occur as often as you like. We recommend at least once a month for at least 12 months. During these visits, you may meet with the medical provider, the dietician, the physical therapist, or our mental health provider depending on your child’s and family’s needs. All services are provided on-site. You will make your plan for the frequency of visits 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.

Fees and Payment
All Healthy Lifestyles visits (medical, dietary, physical therapy, and mental health visits) are billed to insurance. 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. Please check with your insurance to make sure these services are covered. 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 Kiah Gaskin (kiah.gaskin@duke.edu) with any questions about our advocacy projects. Two of our signature programs include:

  • Bull City Fit. Bull City Fit was founded in 2012 and is a community-based wellness program for our patients and families. It is located at Edison Johnson Community Center on Murray Avenue in Durham (adjacent to the Museum of Life and Science). 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.
  • 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


Name Areas of Special Interest
Sarah C. Armstrong, MD Comprehensive treatment of childhood obesity
Caren Mangarelli, MD General pediatrics and adolescent medicine, childhood obesity


NameAreas of Special Interest
Annie Apple Bull City Fit Program Coordinator
Dorothy Conrad, RD, MPH Eating disorders in children and teenagers.
Kristi Duke, PT Fitness evaluations and design of exercise programs for children.
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.
Kiah Gaskin, 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.
Andrea Hartzell, PT Fitness evaluations and design of exercise programs for children.
Lisa Honeycutt, LPC, NCC

Licensed Professional Counselor specializing in family therapy with an emphasis in medical family therapy (MedFT), eating disorders, behavioral family systems therapy, parent skills training, and the acceptance and commitment therapy (ACT) model. Interests include health behavior change in families, and using the ACT model with Spanish-speaking/multi-lingual families.     

Chandler Moeller, PNP

Nurse practitioner

Martha Nelson, PA Physician assistant in general pediatrics specializing in family-based childhood and adolescent obesity care.
Heidi Pongracz, PT Fitness evaluations and design of exercise programs for children.
Lisa Watson, MSN, CPNP Nurse practitioner in general pediatrics specializing in family-based childhood and adolescent obesity care.
Kimberly Yancey Program Coordinator

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

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 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.