The Duke Healthy Lifestyles Clinic has designed a clinic-community care model to treat childhood obesity.
The Duke Healthy Lifestyles clinic, located in Durham, North Carolina, is one of the largest childhood obesity medical treatment programs in the nation, treating nearly 1000 patients annually. To qualify, patients must have reached the 95th percentile of body mass index (BMI) for their age and gender. Many patients, some as young as two years old, suffer comorbidities, such as high blood pressure, type-2 diabetes, or high cholesterol. Designed as a one-year treatment program, patients and their families visit the clinic once a month and meet with a physician, dietician, physical therapist, and mental health provider to set goals and measure progress toward a healthier lifestyle. Healthy Lifestyles uses an interdisciplinary approach, involving a variety of health professionals to address the multi-faceted causes and consequences of obesity.
Healthy Lifestyles meets the highest criteria of childhood obesity treatment in an academic setting, as defined by multiple sources. Specifically, all providers are certified in motivational interviewing, an evidence-based family-centered counseling approach to promote behavior change. Healthy Lifestyles faculty track patient data and have published health outcomes, peer-groups meet regularly, alternate options such as medication trials, a supervised low-carbohydrate diet and a hospital-approved adolescent weight loss surgery program are available to patients. However, the clinical setting is uniquely and universally limited by one important factor: patients cannot learn cooking skills or exercise there. For the roughly 66% of patients in the program who are publically insured, there are limited options for safe, supervised, affordable opportunities for physical activity. For those who do not have the good fortune of having learned food preparation skills from family or friends, making a meal can be an insurmountable challenge, and simple education in the clinic is not enough to teach this life skill. The clinic does not allow patients to grow, harvest, prepare, taste and share many easily available, nourishing foods.
THE CHALLENGE: To provide medically-supervised, environmentally-safe and affordable opportunities for obese children and their families to practice living healthily together.
THE JOINT-USE AGREEMENT AND THE BIRTH OF “BULL CITY FIT”: One of the Durham Parks and Recreation’s (DP&R) community centers, Edison Johnson, is about a mile from the Healthy Lifestyles clinic. In 2011, staff met with the center’s administration to propose a partnership. The mutual benefits of a partnership were quickly realized: Duke had the resources to secure grant funding and donations for much needed equipment not accessible to city parks departments, and the parks department had the space needed to operate the program. We sought the help of higher level administrators at DP&R and Duke’s Risk Management, and drafted a “joint use agreement.” The joint use agreement outlined the specifics of the first-ever formal contract between Duke and DP&R. Those specifics included that Duke Healthy Lifestyles staff would manage the program, as well as train and supervise community volunteers to provide on-site coaching. Healthy Lifestyles staff agreed to apply for grant funding and to seek donations for gently used sporting and wellness equipment, all of which would be donated to Edison Johnson, in exchange for free use of the space at designated times each week. After a 12-month negotiation process to settle on the terms of the contract, the Durham City Manager and Chief of Duke Hospital signed the agreement.
Open four evenings a week as well as Saturdays and Sunday afternoons, Bull City Fit activities focus on the core themes of physical movement, nutrition/ cooking/ gardening skills, and psychosocial support. Activities are designed to be both developmentally appropriate and considerate of the limitations specific to obese children and adults. The parent or guardian and other family members accompanying the child are expected to fully participate alongside their child. Fitness activities include cardiovascular training through swimming, jogging, dance, relay races, and group games, as well as strength and flexibility training.
Julia Wacker holds master’s degrees in social work and public health and is the Director of Community Outreach for the Healthy Lifestyles Program. Ms. Wacker manages Bull City Fit, and together with Dr. Armstrong, initiated the partnership with Durham Parks and Recreation to relocate and expand the program in 2012. Ms. Wacker oversaw the development of the joint-use agreement, and advocated for its approval by both Duke and city officials. Dr. Armstrong is a pediatrician and the medical director of the Duke Healthy Lifestyles Clinic. She is a leading expert on childhood obesity, having managed the multidisciplinary care of over 5000 patients and families since 2006. Dr. Armstrong and Ms. Wacker are members of several national projects aimed at strengthening the pediatrician’s role in community advocacy to reduce childhood obesity, including the Healthy Weight Collaborative of the National Initiative for Children’s Healthcare Quality.