Mind-body connections: How Michigan experts treat childhood obesity by supporting mental health

Three years ago, Christine Hudson and her three daughters were at a routine medical visit when the doctor pulled her aside for a quiet word. "She put her arms around me and said in the nicest way, 'I need you to look after your kids,'" says Hudson. "At that time, my youngest was 4, and about 170 pounds. My older daughter was almost 400 pounds. All I could do was cry."

Hudson, who lives in Detroit, didn't recognize how much weight her daughters, Aron, An'tinique, and Angelea, had gained. "Through my eyes, they were just my kids," she says.

With 32 percent of Michigan kids aged 10 to 17 overweight or obese, our state ranks 19th in the nation in childhood obesity rates, according to the Data Resource Center for Child and Adolescent Health. Overweight children face increased risk of type two diabetes, high blood pressure, and heart disease. The longer kids are overweight, the more likely they are to remain overweight into adulthood. Childhood obesity correlates with an increased risk of bullying and depression, as well as poor educational performance, according to a report by The State of Obesity.  

Experts blame childhood obesity on many factors, the simplest being surplus calories coupled with a lack of physical activity. But some Michigan experts are now recognizing that for certain kids, being overweight is more about mental health than it is about a simple caloric formula. 

Complicating matters even more, overweight kids may not even be the ones with the mental health condition. Parents and adults living in the home who suffer from trauma, anxiety, depression, and other mental health challenges can create an environment that leads to obesity in children. 

In other words, a parent's mental health can impact not only their own weight, but the weight of their kids, too. 

Weight loss programs tend to encourage exercise and low-calorie foods, which equates to a steep learning curve for parents who grew up eating a less healthy diet or who have restricted access to fresh fruits and vegetables. But traditional programs rarely address the underlying stressors families experience.

That's why some Michigan stakeholders are providing kids and their families holistic programs that focus on behavioral health to achieve long-term success in reducing childhood obesity.

A behavioral health approach for families

Raised on fried food, pork chops, cakes, and pies, Hudson knew she needed to scrap her decades-old food mindset and start over. The question was how. 

Finding little success with programs that prescribed healthy meals but no education in preparing them, Hudson asked her doctor for more comprehensive support. She connected her to Fit Kids 360, a weekly comprehensive group program for 5- to 17-year old kids and their families. Developed in Grand Rapids and specially adapted for the needs of Detroiters, the program is run by Wayne Children's Healthcare Access Program (Wayne CHAP), and funded by the Children's Hospital of Michigan Foundation, the city of Detroit Health Department, the Michigan Health Endowment Fund, and other stakeholders. 

"We are not a weight loss program, but a behavioral health program," says Krista Siddall, director of programming and operations at Wayne CHAP. "We ask families to put their scales away for eight weeks, and focus on more physical activity, fewer sugary drinks, less screen time, more home-cooked meals, and more sleep."

Krista Siddall

For eight weeks, families work with registered dietitians, social workers, and exercise specialists. Open to Wayne County kids by physician referral, the program just completed its 13th class, and has recently developed culturally-competent curriculum for Spanish-speaking families. Since beginning five years ago, it's served about 1,800 kids and families. 

Sessions specifically address feelings, communication, positive self-messaging, bullying, and social media. Parent sessions focus on discipline and family communication. 

"Some kids have had suicide attempts, so we make sure they are connected to doctors, hospitals, and mental health facilities," says Siddall. "We talk about eating, hunger scales, hoarding food, and choices." 

In the Fit Kids 360 program, children get matched with mentors - Courtesy Fit Kids 360

Collectively, Hudson and her girls have dropped 150 pounds, and return to the program each year to participate in an annual 5K run. "We changed the way we eat, and what we bring into the house. We learned a bunch of information that we had no idea about," says Hudson. "The girls take turns choosing new foods to try. Our motto is, 'You don't have to like it, but everyone has to try it.'"

Stress and trauma contribute to poor health

Recognizing the prevalence of trauma among Detroiters, and knowing its potential negative impact on health outcomes, Fit Kids 360 incorporates screening for adverse childhood experiences (ACEs) in the parents who attend. Studies show that adults who have experienced abuse, neglect, and household challenges as children are at greater risk for disease, disability, and early death. 

"The population we work with lives in high stress environments, in communities that deals with poverty, alcoholism, substance abuse, and incarceration," says Dr. Teresa Holtrop, executive director of Wayne CHAP. 

Dr. Teresa Holtrop

Administrators assess program effectiveness through a number of metrics, like positive change in BMI and diabetic A1C scores, but also the resiliency levels of the families who attend. 

"We use a questionnaire to give us resiliency scores, and they are higher than we expected them to be," says Holtrop. "We wonder if those who are able to get it together to come to Fit Kids are those who have some resilience already."

More data will help determine whether pre-program efforts might help those who are less likely to succeed. 

Group support, successful outcomes

Across Michigan, organizations emphasize behavioral health to help stressed families cope. Healthy eating is the focus at ShapeDown, an eight-week program that has served 2,000 families over 25 years at St. Joseph Mercy Health System in Ann Arbor, Brighton, and Canton. 

"We focus on health, and the wellness factors that it takes to change behaviors," says program coordinator Beth Darnell. 

Families meet individually with diet, exercise, and behavioral specialists to assess medical history, mental health concerns, and family relationships. A driving objective is to improve kids' self-esteem and self-confidence.

Stress is also an essential topic. "We adopt stress management activities, talk about communicating feelings and needs, and how to say no to things that aren't good for you," says ShapeDown behavioral specialist Kerry Minshew. "With help, kids are less likely to turn to food to relieve stress." 

Ultimately, families support each other in a group environment, troubleshooting problematic eating patterns, family dynamics, teen behaviors, and more.

"I'm amazed at how open families are when they feel supported and are in a comfortable environment," says Darnell.

Rather than count calories and track exercise minutes, ShapeDown families transform negative habits into healthy behaviors by learning to set goals, track progress, reward themselves, and keep each other accountable. Success is measured by lasting behavioral changes that lead to better health for the family. 

"Ah-ha moments can be as basic as the understanding of how much sugar is in pop. Or it can be a teen acknowledging a parent's support," says Darnell. "In our program, that can really be the starting point for ongoing work."

This article is part of "Children of Michigan," a series on the importance of health and wellbeing for Michigan's children. It is made possible with funding from the Children's Hospital of Michigan Foundation.

All photos, except where mentioned, by Nick Hagen.
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