CVAHEC Student Project Reports

Stacy Strouse
Freeman Scholar Program 2006

This summer I worked with Dr. Heidi Zvolensky, a pediatrician at Mousetrap Pediatrics, St. Albans, Vermont, on a summer program focused on helping young women live healthier lifestyles. Within Franklin County, VT, we selected families in which there is a child having difficulty managing her weight, as indicated by a high body mass index (BMI). Our motivation for selecting children from this population came from recent studies indicating that a high BMI is a major risk factor in the development of health issues such as type II diabetes mellitus, high cholesterol, high blood pressure, and arthrosclerosis.1 We decided to work with young women because weight and appearance is a delicate issue with many girls and we wanted a chance to clearly convey to children and their parents that the reason for concern about the child's weight is health and not appearance.2 We set out to accomplish this by focusing on nutrition and physical activity, and not on the child's weight or weight loss. When children or their parents inquired about weight, we gave them honest answers: a healthy, well-rounded diet, paired with regular exercise, would be of benefit to their health. Our stated goals for the program were to (1) provide additional education and resources about nutrition and fitness, (2) show the families how to utilize the resources around them for a fit and healthy lifestyle, and (3) above all, have fun improving their health.

After contacting a list of interested participants, we received commitments from three of the families. The girl's age's ranged from 9 1/2 to 14. The four week program involved working 2-3 days a week with each young woman in the program and her parents. The focus of the meetings was to teach the child and parents the importance of good nutrition and physical activity. In addition to teaching, we also participated in at least a half hour of physical activity during most meetings. We tried to limit the activities to something that was easy for children to do by themselves, or for their parents to do with them. Throughout the four weeks, I received guidance from Dr. Heidi Zvolensky, the children's pediatrician; Linda LaShure, a nutritionist at FAHC; and Mary Chiappinelli, a middle school nurse.

During our first week I focused on connecting with each of the kids and their parents, making sure I knew what their goals were for the next couple of weeks. I let the families know whay my goals were and suggested some of the planned activities. There was a wide range of ages, so adjustments were made in order to keep everyone's interest. At the end of the meetings we would assess how things were going and discuss the focus of our next meeting. I had each of the girls keep a food and exercise log in order for both her and me to become aware of her eating and fitness habits.3,4

The nutritional focus of the second week was reading food labels. This was an activity that both the children and the parents became interested in. After running through the basics of what to look for, we went through the household cupboards together, talking about what foods were good choices for meals and snacks, and why. After going through a similar exercise with their food and fitness logs we would pick small goals for the week. Some of the goals were to eat a whole grain cereal for breakfast every morning instead of a sugary one, try to limit pizza to only 1-2 meals a week, and try to eat breakfast every morning. All of the girls tried to exercise on the days we did not meet. During this particular week, we also tried to get our heart rates up during our physical activities, and I explained to them the benefits of such cardiovascular activity.5 For example, if a walk was the activity of choice, we would pick a point to walk briskly to, and then a point to recover to, and would repeat the exercise until our walk was finished. The girls responded very well to this, and made it into a game.

During the third and fourth weeks, I made trips to the grocery store with one of the mothers and her daughter, as well as with one of the older girls alone. This was an amazing experience as we went through picking not only the foods that they wanted, but discussing why they decided not to choose some of the foods they had previously. In addition to food label comparisons, we did price checks, and found many of the generic brands were as good for you as the name brand, and cost less. During these weeks we also talked about disease states that some of the girls were showing signs of, and others that ran in their families. Two of the participants were aware of having high blood pressure, and one of them also had high cholesterol. Another one of the girls had a family history of type II diabetes mellitus. Some of the conversations on our walks were centered on understanding what this history meant, and how making lifestyle changes now could create positive differences in their health later on in life.

Behavioral changes are very difficult to make. My hope was that by working directly with individual children and their families, by addressing where and how life changes could be made, and by helping them follow through on those changes, positive improvements were being made for their health. I also wanted this to be a fun and positive experience for the children and their families, one in which they would be able to take away a better understanding of the importance of life-long healthy eating and fitness habits.

Acknowledgements:

This program is funded by the Freeman Medical Scholars Program in conjunction with the Champlain Valley Area Health Education Center (CVAHEC).

References:

1. Marks DB, Marks AM, and Smith C. Basic Medical Biochemistry: A Clinical Approach. Lippincott Williams and Wilkins: 1996.
2. Duncan J. Pediatric Overweight Prevention and Intervention Toolkit. Vermont Management Care: 2004.
3. My Pyramid Website: http://www.mypyramid.gov/
4. Northwestern Medical Center: Fit Family Coalition of Franklin and Grand Isle Counties Resource Guide for Promoting Healthy Weight; 2004.
5. Silverthorn DU. Human Physiology: an Integrated Approach (Third Edition). Pearson Education, Inc with Benjamin Cummings; 2004.