Teens Achieve Success With Weight Loss

Phyllis Poyner (left) elicits a laugh from patient Essie Morgan (right) during an appointment at the center. Morgan lost over 80 pounds.

It began some three years ago when the staff found that increasing numbers of obese young girls were coming into the practice. "With moving around a lot in foster care, no one was keeping up with these girls' weight gain," said Phyllis Poyner, an advanced practice registered nurse at the center and a clinical associate professor. And with body weights greater than the 95th percentile, the teens were already developing obesity-related health problems.

So the nurse practitioners developed a protocol to help these teens. The process starts with conducting lab work on each girl who has been identified as obese. It's not uncommon for the lab testing to identify health issues such as insulin resistance, high cholesterol levels, and/or high blood pressure. When each teen returns to the center for a follow-up consultation, she learns what her particular results mean, such as how insulin resistance can lead to the development of diabetes. "We explain that 'this is what's going on in your life, but that the good thing is that you are young and can turn this around,'" Poyner said.

The nurse practitioners then work with the teens to set up reasonable weight loss goals. For every pound a girl agrees to lose in a healthy manner, she will earn a dollar from the center's discretionary fund when she reaches her goal. "A lot of these kids don't have any money," Poyner said, explaining that the cash serves as an incentive for the girls to make the lifestyle changes needed to shed the excess weight. "Many of them are lonely and have learned to use food as a crutch," she added. Others have lived in environments where adequate food wasn't always available; their overeating reflects a fear of going hungry again.

A chart at the Children and Family Healthcare Center documents the teenagers' progress using a different symbol chosen by each girl. "Jane Doe may have lost 15 pounds, but nobody knows who she is – just that there are 15 moon stickers on the chart," Poyner said.

The girls are seen at the center on a regular basis, depending on particular medical conditions that also need to be followed. Many are started on medication to manage health problems related to their weight such as rising sugar levels, hypertension, and/or depression. One-on-one education is also an essential component of each visit. "You can't teach everything about nutrition in a small amount of time, but we do talk about foods that are high in carbohydrates and calories and encourage the girls to cut back on them," Poyner explained.

The importance of exercise is also addressed. "A lot of these kids don't exercise. Their life is chaotic and in crisis and that's really on the back burner." Poyner said. So after finding out girls' particular interests, the nurse practitioners structure individualized exercise goals. "If a girl likes to dance, we'll tell her, 'turn on your radio and dance – that's going to be your exercise,'" she said.  

As the teens continue to be monitored over time, definite strides are being made. "The majority of our girls have at least been able to stabilize their weight. It used to be that every time they came in they were gaining another ten pounds. Just to be able to stabilize is an accomplishment," Poyner said. Some of the teenagers have lost ten, 20, or in one instance, over 60 pounds, in a healthy way. "When the girls get on the scale and find out that they have lost weight, they see they can have some control over their situation," said Poyner. The teenagers are also learning that lifestyle changes can improve their health status. The results of their lab work, which is repeated every six months, have turned around significantly for some of them.

The nurse practitioners were so pleased with the positive outcomes among the teens that they began utilizing the same approach with both younger and older patients at the center. The key to success, Poyner, has found, is having enough information to make good choices. "A lot of our patients know very little about nutrition. We give them the knowledge they need to empower them to make better decisions on a daily basis," she said. Dispensing this knowledge has become an invaluable tool. "Our patients are discovering that you can turn things around dramatically just through exercise and healthy eating," she said.

Reprinted from Connections newsletter, May 2007

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