Helping Communities Reduce Childhood Obesity

She felt self-conscious when she participated in physical activities. She was always teased about her size. She said she ​“felt sad” every day about her weight.

She was 8.

Dr. Sarah Armstrong, director of Duke University School of Medicine’s Healthy Lifestyles clinic, hears those stories all too often. North Carolina has one of the highest obesity rates in the country, and Armstrong sees the epidemic of childhood obesity firsthand.

In 2006, she helped launch Healthy Lifestyles for children and adolescents and has since developed a community-based wellness program for its participants. She and her team are now focused on replicating that community effort in other areas.

The goal is to reduce obesity, improve health and prevent chronic disease among vulnerable children in the Carolinas. Nearly $750,000 in funding from The Duke Endowment is supporting the work.

A Safe Space

The model links a health care clinic with a recreation center and promotes community collaboration to deliver family wellness programming.

In Durham, it’s called Bull City Fit, and it serves low-income and uninsured children who have already developed obesity. Participants join through the Healthy Lifestyles clinic, a one-year intervention for children with a body mass index (BMI) over the 95^th percentile.

When the program got underway in a makeshift gym at a children’s hospital, organizers were surprised that so many families signed up.

“Kids told us this was the only place they could be active and not feel awkward or self-conscious, and their parents echoed that,” says Armstrong, a pediatric physician. ​“We were offering a safe space where families could exercise and learn together and get motivated about behavior changes.”

Bull City Fit is now housed in space provided by Durham Parks and Recreation. Local groups help with programs and staffing. The Healthy Lifestyles clinic provides medical expertise. Children and caregivers come for supervised exercise classes, cooking and gardening demonstrations, and support groups. Best of all, it’s free.

“There’s a public perception that obese children are simply overweight and that’s their problem,” Armstrong says. ​“But many of these children have high blood pressure, high cholesterol, and type 2 diabetes. There’s a serious underlying medical component to what we do.”

Quality of Life

In North Carolina, 28 percent of high school students and 22 percent of children entering kindergarten are overweight or obese. Nationally, one in six children are obese; the number climbs to one in four among low-income and minority families.

Since Bull City Fit began in 2012, more than 5,000 children and parents have participated. Each night, as many as 40 families show up to play games, try a sport, or learn new tips for healthy eating.

“Creating an environment where you can play soccer and not be self-conscious and actually get the ball and score a goal and have your team supporting you instead of judging you is a really special thing,” says Lauren Sibley, program coordinator.

Six-year-old Jana agrees. ​“It doesn’t matter if you can run fast or if you are young or old,” she says. ​“Everyone works together and has fun together.”

“The staff keeps cheering me on so I can do it,” says Karol, 11. ​“It makes me want to come every day.”

Armstrong and other researchers have completed a randomized controlled trial to determine the effectiveness of this integrated model of obesity treatment. Results are promising, and will be published soon.

“This is so much more than getting children to lose weight,” Armstrong says. ​“This program helps communities and families create healthier habits — both now and throughout life.”