Specialised clinic goes effectively past way of life modifications to tackle childhood weight problems

By the time Lilly Martinez was 5, her mother and father have been already involved about her continued fast weight acquire.

They spent the following few years making an attempt to deal with the difficulty, each on their very own and in live performance with medical suppliers, however protecting Lilly from overeating and educating her to acknowledge when she was satiated felt like an uphill battle. 

“We had tried everything under the sun, but we couldn’t manage her ongoing weight increase and her blood sugar levels,” her mother, Caroline Martinez, mentioned.

It wasn’t till the autumn of 2024, when Lilly, then 8, was referred by her pediatrician, Catherine Kolo, MD, to the UCLA Fit for Health Clinic at Ronald Reagan UCLA Medical Center, that issues began to show round. 

Lilly was thought-about pre-diabetic at that time, Martinez mentioned. And despite the fact that she was seeing a therapist and a pediatric psychiatrist, she nonetheless struggled with impulse management. She had been recognized with consideration deficit hyperactivity dysfunction (ADHD) and was taking treatment for it.

“She continued to eat and eat even though she was probably full,” Martinez mentioned. “And when we told her no, you need to wait before eating more, she wasn’t able to. She would do whatever was necessary to satisfy her urge to eat.” 

At house, that included going into the pantry or the fridge to get extra meals. At college, she found that she may go to the entrance workplace to search out out which youngsters had ordered scorching lunch however have been absent, and she or he would then eat their lunches along with the one she’d introduced from house.

Health issues

Although Lilly is on the youthful facet of the sufferers they see, her pre-diabetic standing is pretty typical, mentioned Vibha Singhal, MPH, MBBS, director of the UCLA Fit for Health Clinic and director of Pediatric Obesity at UCLA Health. 

The clinic opened within the early 2000s however has expanded since Dr. Singhal got here on board within the fall of 2024. 

In addition to the behavioral way of life modifications that had beforehand been the primary focus, the clinic now affords pharmacotherapy and bariatric surgical procedure. These modifications are in step with the 2023 weight remedy tips from the American Academy of Pediatrics, which have been developed as best-practice suggestions to assist deal with rising charges of youth weight problems and the ensuing well being issues. 

The clinic consists of three pediatricians, together with Dr. Singhal; a pediatric surgeon; a bariatric surgeon; nutritionists; a social employee; and a psychologist. 

About one in 5 youngsters within the United States has weight problems, which presents short-term dangers for musculoskeletal points, hypertension and Type 2 diabetes, in addition to longer-term dangers for cardiac illness, Type 2 diabetes and different well being points. 

Without remedy, youngsters with extreme weight problems have a 90%-95% likelihood of weight problems as adults, Dr. Singhal famous. Obesity can be thought-about a big danger issue for Type 2 diabetes, which accounts for as much as 95% of all recognized circumstances of diabetes in adults, so managing weight is taken into account key.

“Unfortunately, the rates of Type 2 diabetes in youth have doubled in the last decade, and most of this increase is related to obesity,” Dr. Singhal mentioned.

In addition to boosting the chance for diabetes and the probability of grownup weight problems, childhood weight problems can worsen bronchial asthma, obstructive sleep apnea and different well being issues. 

Dr. Singhal described weight problems as a “complex, multifactorial, multisystemic disease.” Lifestyle modifications stay a key a part of the clinic’s method, and having different specialists meet with the affected person as effectively, in the course of the preliminary go to – and as a part of common follow-ups – is equally necessary, Dr. Singhal mentioned. 

“The psychologist evaluates whether there are any behavioral barriers to implementing the changes,” she mentioned, “as well as whether there are any mental health concerns. Anxiety, depression, ADHD, autism – really, any neurodivergence – can all play a role.” 

In some sufferers, these circumstances haven’t but been recognized, whereas in others, their drugs could not but be adequate, she famous.

Regular monitoring of sufferers’ blood sugar markers, that are used to diagnose pre-diabetes and diabetes, helps clinicians assess whether or not their remedy plan is efficient or may have modifying.

As a pediatric endocrinologist, Dr. Singhal additionally appears for underlying causes resembling thyroid issues, growth-hormone deficiency or different hormonal points. Genetic assessments can reveal whether or not sufferers have particular genetic mutations that enhance their danger for creating weight problems, she famous; if that is so, particular drugs can typically be prescribed.

Some of the newer glucagon-like peptide-1 (GLP-1) drugs for weight reduction are accredited by the Food and Drug Administration for sufferers 12 and older, Dr. Singhal famous. GLP-1 is a hormone launched by cells within the intestines that impacts starvation and urge for food. 

The clinicians pay shut consideration to the affected person’s psychological state to make sure that the treatment isn’t used as a part of unhealthy weight reduction behaviors. This consists of assessing whether or not the affected person has a private or household historical past of consuming issues, and persevering with to fulfill with the affected person recurrently to observe their progress. 

Yet another choice, usually for sufferers 12 and older, is bariatric (weight reduction) surgical procedure.

With each surgical procedure and GLP-1 drugs, clinicians emphasize the necessity for ongoing ample vitamin, which might endure when meals consumption goes down. 

“We have to be very cognizant of setting goals and expectations that this is for health reasons, not cosmetic reasons or size reasons. Making sure there aren’t body image issues is a big part of our assessment,” Dr. Singhal mentioned.

“If there are any mental health concerns, that’s how the visit starts. Then depending on the patient’s needs, we assess what’s most suitable, including psychotherapy and pharmacotherapy. It could be just one. It could be two. It could be working up to a surgery. It’s very much a team and a family decision.”

Dr. Singhal characterised the clinic’s function in working with the affected person’s present medical doctors as collaborative. She cited melancholy for instance, noting that some antidepressants and temper stabilizers may cause weight acquire. “If so, I reach out to the original prescribing team to see if they can switch the medication,” she mentioned. “I don’t manage the change of the medication, but I do identify the issue.” 

The clinic usually treats sufferers up till age 21, however some sufferers, notably these with neurodevelopmental points, could stay with the clinic previous that time, Dr. Singhal mentioned.

Plan tailor-made to Lilly

To put together Lilly for her first appointment on the Fit for Health Clinic, Martinez defined to her that her blood sugar was on the upper facet and that as a household, they wanted extra assist managing it in order that she may stay wholesome.

It was a protracted assembly, Martinez remembers, and included a pediatrician, a social employee and a psychologist to map out a course of remedy. “The providers were very understanding,” Martinez mentioned, “and really took the time to explain to Lilly what was going on.” 

Together, they devised a multipronged method that included serving to Lilly make wholesome meals selections and construct consciousness of her physique’s alerts when she was consuming, which included slowing down whereas consuming to permit herself time to register the feeling that she was full. 

They additionally targeted on working towards wholesome consuming, “as a family, together, to help support her in her new lifestyle,” Martinez mentioned. 

At common Zoom follow-up visits, the clinic workforce labored with Lilly and her mother and father to evaluate her progress and modify the remedy plan.

From a medicine standpoint, this included reducing the dosage of her ADHD treatment, which had been growing her anxiousness, and slowly growing the dosage of an antidepressant she’d begun taking. 

Lilly additionally subsequently began taking a blood-sugar treatment prescribed by her medical doctors on the clinic. “That really was a game changer in terms of controlling both her blood sugar and her appetite,” Martinez mentioned. “I noticed that her appetite went down dramatically, to a healthy level.”

Lilly was additionally referred to a UCLA Health allergist and to the UCLA Pediatric Sleep Clinic, the place she underwent an in a single day sleep research. She was recognized with obstructive sleep apnea and had her tonsils and adenoids eliminated. Afterward, Lilly stopped loud night breathing and gave the impression to be sleeping higher general, Martinez mentioned. 

Meanwhile, Martinez targeted on discovering train actions and wholesome meals that Lilly loved. Lilly has three youthful siblings and one other one on the best way, so Martinez additionally knew she wanted to be real looking.

Food-wise, that meant swapping out quick meals for less-processed meals and switching from much less nutrient-dense meals to extra nutrient-dense ones. “We found foods that she liked and made them fun to eat, like apples spread with peanut butter and sprinkled with chia seeds,” Martinez mentioned.

During the preliminary months, she met often with the clinicians to proceed to finetune the method, resembling including extra protein to assist Lilly really feel full.

Adjusting Lilly’s drugs took time, Martinez mentioned, however by June of 2025, they’d discovered the suitable mixture, which incorporates two ADHD drugs, an antidepressant and blood-sugar treatment. 

Martinez additionally participated in Fit Mind, a digital video program created by the clinic to assist sufferers be taught to decelerate whereas consuming and be aware of their physique’s alerts of starvation and fullness. With youthful sufferers like Lilly, the video program is accomplished by the father or mother, Dr. Singhal mentioned, whereas adolescents usually full this system themselves.

Ongoing relationship

Martinez plans to have her second little one, who’s now 7, seen on the clinic as effectively, as he seems to have related weight points.

Lilly, now 9, will proceed to be seen two to 3 instances a yr till she finishes puberty, Dr. Singhal mentioned, and most certainly might be seen yearly after that. 

“Puberty is a time when we see a lot of weight changes,” she mentioned. This can result in insulin resistance, so Lilly’s blood-sugar ranges will proceed to be monitored.

Lilly has “responded beautifully” to the blood-sugar treatment, Dr. Singhal mentioned, including that Martinez experiences that her urge for food is healthier, as is her impulse management round meals. 

A yr after Lilly’s first go to to the clinic, Dr. Singhal mentioned, “she looks like a different person.”