Weight and see: Children's obesity clinic expected to make difference in families' lives
by Cameron Steele
csteele@annistonstar.com
Jul 29, 2012 | 8025 views |  0 comments | 18 18 recommendations | email to a friend | print
Gabriel Omans, 8, weighs himself. (Anniston Star photo by Trent Penny)
Gabriel Omans, 8, weighs himself. (Anniston Star photo by Trent Penny)
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Gabriel Omans wants to run faster, play harder, make the teammates in his youth baseball league proud. The 8-year-old Anniston boy has high hopes for next season: racing around the bases, running faster than people who used to leave him in the dust.

But at 4-foot-4 and 130 pounds, Gabriel is obese. His weight slows him down, his mother Lisa Omans says. It keeps him from running fast, Gabriel says.

“It keeps him back … and I know it’s not healthy for him,” Lisa Omans, 47, said as she and Gabriel sat in the living room of their Anniston trailer on a recent morning. “But he’ll eat and 10 minutes later, he’s like, ‘I’m hungry! I’m hungry!’”

It’s a struggle for Omans — trying keep the pounds off her growing, omnivorous son. But she’s hoping that an Anniston pediatrician’s plans for a local children’s obesity clinic will help Gabriel get back to a healthier weight — and help her learn techniques for keeping Gabriel fit in the process.

“I would love for my baseball players to see me be skinnier than last year,” Gabriel agreed. “I would like to be shortstop.”

New clinic

Gabriel’s pediatrician, Dr. Lewis Doggett, has for years wanted to open a clinic to address the growing problem of childhood and teenage obesity in the Calhoun County area. Now, with the support of other doctors in his practice, Anniston Pediatrics, and nurse practitioner Linda White, it finally looks like the clinic will become a reality. Doggett hopes to get the clinic up and running by the end of the summer.

The Children’s Hospital in Birmingham runs a similar clinic, but local health care providers say a number of factors prevent local kids from participating in that program. It’s hard to encourage parents to make the road trip, they said, and there’s often a waiting list to get into the program.

“So we had a vision for setting something for this community, starting something on our own here,” Doggett said.

Preliminary plans for the local program include providing educational and medical support classes for area children and families who struggle with weight issues. Doggett said the clinic will be open to children as young as four and as old as 18 and will offer education components for parents, too.

That’s important, pediatric experts say, because if parents are overweight, it’s more likely their children will be, too.

“You have to elicit from the kids what they are willing to change, and then the same things from the parents,” said Dr. David Collier, director of the Pediatric Health Weight Research and Treatment Center at East Carolina University’s Brody School of Medicine.

For that reason, “this is going to be an immense project,” Doggett said.

Necessary clinic

Nevertheless, it’s one that Doggett hopes to have started within a couple of months. It’s important to get it working, White said, because the problem of childhood obesity isn’t going away. In fact, it’s growing: A recent study by the Centers for Disease Control and Prevention show obesity rates in Alabama high schools are among the highest in the nation. That study concluded that 32.8 percent of Alabama high schoolers were overweight or obese.

Locally, Anniston Pediatrics has tried to keep track of the number of its overweight or obese patients. During a study the group did two years it ago, it found that 36 percent of the 70 kids who came in for checkups were either overweight or obese. And only one parent had said she was concerned about her child’s weight prior to the check-up. That cemented in White’s mind Anniston’s need for a pediatric obesity clinic.

“I never dreamed I would be doing cholesterol levels on 4-year-olds,” White said. “We’ve got to make a change, to teach the parents how to lead by example.”

Parental concerns

Omans wants to try out the clinic for her son — and not just because of the effect it could have on Gabriel’s performance and self-esteem in baseball. She doesn’t want him to end up with major health issues later in life. She doesn’t want to see him go down the same road as his 19-year-old brother, who — at one time — weighed 360 pounds at 6-foot-4.

It’s nearly impossible to distinguish Gabriel from the pictures of his brother, Michael, when Michael was Gabriel’s age.

“They look so much alike that Michael calls Gabriel his ‘mini-me,’” Omans said. “But I don’t want Gabriel to weigh what Michael did.”

But she also doesn’t know how to help Gabriel help himself. One minute on a recent morning at his home, the Weaver elementary school student is talking about how he’d like to lose weight. The next, he’s eating a large bowl of cereal as he says plainly: “I don’t care what I do!”

Omans noted that Gabriel isn’t a couch potato. He likes to ride his bike and play outside. But the family doesn’t have a working vehicle at the moment. And it’s less expensive for Omans, who has a job in the Weaver elementary lunchroom, to buy hot dogs, chips and frozen French fries for dinner than it is fresh vegetables that Gabriel says himself he doesn’t eat.

“I want him to thrive. You want them to eat healthy,” Omans said. “I know when he loses the weight, he’ll be able to do things better.”

Motivational interviewing

The clinic will originally be set up as an after-hours effort located at the office of Anniston Pediatrics. It will include group sessions with a dietician, a nutritionist, exercise education and counseling using a technique that Doggett calls “the heart of” the clinic: motivational interviewing.

This technique focuses on open-ended questions and conversations designed to lead patients to make conclusions about their lifestyles, then learn to make their own choices about how to become healthier. For example, motivational interviewing could — through those open-ended discussions — encourage Gabriel himself to make the connection between eating vegetables and snacking less with baseball performance and running faster. Meanwhile, counseling sessions with his mom would help Omans learn about what kinds of foods to keep in the house and techniques for handling Gabriel’s hunger cravings.

And that’s information Omans said she could use.

“Right now, I’ve been telling him to drink a glass of water” when he’s hungry in between meals, Omans said.

Success and motivation

Motivational interviewing is a tried-and-true method in 12-step programs that help treat alcohol and drug addicts, according to medical experts.

“Basically, you can’t just tell somebody with a chronic lifestyle disease to change something, and they’ll go do it,” Collier said. “Motivational interviewing is about negotiating, meeting people where they are, looking to promote small, sustainable change.”

Studies are beginning to show that motivational interviewing can be successful in treating pediatric obesity, too, according to Collier and other pediatric obesity experts. The technique is used at the clinic at Children’s Hospital in Birmingham, according to Judith Thomason, the Birmingham program manager. It’s also a key component of Collier’s clinic at the Brody School of Medicine in North Carolina.

There, about 50 percent of the children who go through the clinic and continue to follow up with doctors see modest improvements in Body Mass Index scores, Collier said.

Training and costs

In the coming weeks, a nutritionist from Birmingham will train Doggett and the others involved in the local effort in proper motivational interviewing techniques.

Doggett said he and other doctors already use motivational type techniques in regular check-ups, but the training will help to ensure they are getting it right.

“You really have to be their support person,” Doggett said of the overweight and obese children — and their families — the new clinic aims to serve. “But you do need to pin them to what they want.”

In addition to training, Doggett said he still has to hammer out the costs for the clinic and reimbursement details with insurance companies. He hopes for the clinic to cost nothing for families whose children are recommended for the treatment by their primary care physician, because many of his clients already are on Medicaid and don’t have much extra money to spend on extra care.

Running the clinic out of Anniston Pediatrics' existing office space will help keep costs down, Doggett said. And finding out how to best code the treatment on insurance forms will also help doctors get reimbursed for their services at minimal cost to patients.

“The cost can’t be prohibitive,” the Anniston pediatrician said. “We don’t want any barriers.”

Although Doggett hasn’t set an official opening date for the clinic, he estimates there will be six group sessions for the pilot program, starting sometime in late summer or early fall.

Omans said her son will be among the kids in that first group. Gabriel seemed excited about the idea, too.

“I would love to run faster than some of the kids now,” he said.

Star staff writer Cameron Steele: 256-235-3562. On Twitter @Csteele_star.

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