The Department of Pediatrics created the Center for Nutritional Disorders and Obesity (CENDO) in October, 2006 to address the pressing health issues related to obesity in the pediatric population. The Center encompasses diagnostic and clinical treatment of obesity, research initiatives, educational, and community outreach programs related to the prevention, diagnosis and management of childhood obesity. The Healthy Lifestyles Program is Duke's comprehensive clinical treatment program for children, adolescents and their families. Based on the best available scientific evidence, the multidisciplinary team assists families in changing lifestyle behaviors to create a healthier future. Over 1,000 families have been served by the Healthy Lifestyles Team.

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Treatments

About the Duke Children's Healthy Lifestyles Program

The Healthy Lifestyles Program (HLP) is a multidisciplinary referral clinic for the management of childhood obesity in children and teenagers aged 0-22. This highly successful program, in its second year of operation, cares for approximately 500 families per year. Treatment includes an initial screening for the causes and consequences of obesity, an intensive lifestyle intervention phase lasting six months, and a maintenance program that continues until adulthood. For patients who do not respond to lifestyle intervention, pharmacotherapy (medications to help lose weight) and bariatric surgery (weight loss surgery) are available options for selected adolescents. Healthy Lifestyles is based on the latest evidence for creating and achieving realistic goals for optimal weight to reduce risk for cardiovascular disease.

Eligibility

Individuals are eligible for the HLP if they are 22-years-old or younger with a (1) body mass index (BMI) above the 85^th percentile or (2) have crossed two BMI percentile lines on the Centers for Disease Control and Prevention (CDC) standard growth curve, or (3) are 2-years-old or younger and have a weight for their height above the 95^th percentile.  Participation is divided into three stages: a screening visit, an intensive phase, and a maintenance phase. Click on the following link to see if your child is at risk:  http://www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/.

Background

The Healthy Lifestyles Program began under the direction of Sarah Armstrong, MD, in 2006 to address the seemingly intractable but growing problem of childhood obesity based on the best available scientific data. The Healthy Lifestyles Program, which currently serves about 500 families annually, is staffed by four primary care providers, three pediatric endocrinologists, a dietician with certification in pediatric weight management, a clinical child psychologist with extensive experience in disordered eating patterns, a clinical social worker, and a program coordinator.

What to Expect 

Screening Visit:  Prior to this initial visit, the child will be required to have a set of fasting laboratory studies done, as recommended by the AAP Expert Panel on Childhood Obesity.  These tests can be ordered by your doctor, and include: (required) lipid panel, insulin, glucose, ALT and AST; (optional) HbA1c, TSH, urine microalbumin.  Please contact Kim Yancey at 919-620-5394 when your labs are complete as your appointment may be rescheduled for an earlier time.

During the screening visit, we will review your child's history, and take multiple body measurements (including height, weight, BMI, abdominal circumference, basal metabolic rate and percent body fat) of both the patient and the parent or guardian who accompanies the patient.  We will mail you three patient or parent self-completed surveys to complete prior to the visit (the Pediatric Symptom Checklist, Eating Disorder Screening Checklist, and the Pediatric and Adolescent Lifestyle Survey).

The family meets with the medical provider who provides a comprehensive history and physical to identify underlying medical causes of obesity, risk factors for chronic illness, and lifestyle behaviors.  Additional laboratory tests may be ordered based on findings during the screening visit.  An individualized plan is developed for each patient, and patients are referred as necessary for additional services (e.g., mental health, physical therapy or specialists for the care of co-morbidities).  At the conclusion of this visit we will provide you with a "road map" of your child's health and identify the members of your family's Healthy Lifestyles Team, which will be tailored to your individual needs and goals.  Please allow two hours for this initial visit.   

Intensive Phase:  The intensive phase constitutes the next five monthly visits.  Each of these visits is with each of your personalized Healthy Lifestyles Team members.  During this visit, progress is reviewed, previous goals are refined, and new goals are set.  Patients receive "fit kits" and written materials at each visit.  

Maintenance Phase:  These visits are similar to the intensive phase, but occur only every six months until the patient ages out of the program. 

Our patented intervention is called High Five for Fitness^TM and is based on the following five strategies:

1. Rethink your drink! Choose healthy beverages.
2. Minimize screen time! Limit to less than two hours a day.
3. Be active for 60 minutes a day.
4. Sleep for health! Learn how much sleep you need and how to make that a reality.
5. Eat right-sized family meals at home! Learn portion sizes and easy, healthy recipes.

Forms for the First Appointment

Please download and complete the following forms and bring these with you to your first appointment:

Healthy Lifestyles Program Introduction Letter (PDF, 168 KB)
Pediatric Symptom Checklist (PSC) (PDF, 176 KB)
Pediatric Symptom Checklist - Youth Report (Y-PSC) (PDF, 172 KB)
Medical History Form (PDF, 168 KB)

Other Forms

Daily Food Log (PDF, 64 KB)  Tips for Completing the Food Log (PDF, 36 KB)

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Physicians and Staff

Physicians

Name	Areas of Special Interest
Sarah C. Armstrong, MD	Specialize in causes, complications, and treatment of pediatric obesity working alongside local, state, and national leaders addressing the obesity epidemic
Michelle L. Bailey, MD	Special interests include community education regarding health care and relevant social issues including teen pregnancy, substance abuse and mentoring
Robert W. Benjamin, MD	Disorders of calcium and phosphorus metabolism, disorders of sexual differentiation, and congenital adrenal hyperplasia
Caren Mangarelli, MD	General pediatrics and adolescent medicine, childhood obesity
Nancy L. Zucker, PhD	Research laboratory focused on the development of novel treatments for individuals with eating disorders or children who struggle with weight management with particular focus in the integration of family members into effective treatment strategies

Staff

Name	Areas of Special Interest
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.
Julia Whacker, 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.
Kimberly Yancey	Program Coordinator

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Clinic Hours and Location

Clinic Hours:
Monday - Wednesday, 8:30 am to 5:00 pm
Thursday - Friday, 8:30 am to 12:00 pm

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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.**
• 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).

**Please ensure that the following fasting labs (FASTING Insulin, Lipid Panel, CMP, TSH, HbA1c, and Urine microalbumin) are completed before the patient's appointment and faxed to 919-471-6930, Attn: Kim Yancey.

Referrals

Referrals are accepted from providers, but family members may also call directly to set up an appointment. Please call 919-6220-5356 or 1-866-530-5356 to schedule an appointment.

Note: Although the current waiting list for appointments is relatively long, please contact Kim Yancey at 919-620-5394 when your labs are complete as your appointment may be rescheduled for an earlier time.  For additional information about the program, please call 919-620-5394.

 

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