Anna Giordano is grateful to a community-based program that supports overweight and obese young patients and their families in making important lifestyle changes that will lead to improved health, stronger bodies, and a better quality of life.

Her son Delaun, aged nine, was a recent participant in the Healthy Outcomes Paediatric Program for Scarborough (HOPPS) in the Greater Toronto Area, a specialty program offered jointly by Rouge Valley Health System (RVHS) and The Scarborough Hospital (TSH), with support from several community partners. HOPPS is funded by Ontario’s Ministry of Health and Long-Term Care at no cost to patients.

The HOPPS team consists of paediatric endocrinologists, paediatricians, a registered dietitian, an exercise therapist, a social worker, and a registered nurse. Patients and their families are seen by a paediatrician at either RVHS or TSH, depending on which is closer for the patient and what co-morbidities (medical conditions) they may have. They are also seen by the HOPPS team at the hospital or at one of the community partner sites: Scarborough Centre for Healthy Communities, TAIBU Community Health Centre, or the Toronto Pan Am Sports Centre (through the University of Toronto-Scarborough campus.) The community spaces offer care closer to home, and a way to work with patients and their families outside of a hospital setting, connecting them with community resources. Since its launch last November, the program has seen 135 patients.

Delaun was referred to HOPPS by his paediatrician at RVHS due to his weight and a diagnosis of sleep apnea. While Delaun has always been active, he was not always eating at home, and he often received large portions of calorie-rich foods at mealtimes and during snack times, particularly in his after-school care. HOPPS gave him the tools to help stay focused on eating well.

“Program staff met with us and came up with creative solutions for Delaun on how to handle challenges when being offered food,” says Anna. “Now, he can continue making healthy choices, no matter where he is.”

For children who are overweight or obese, a lot is riding on learning how to make these healthier choices. Dr. Margaret Gan-Gaisano, a paediatric endocrinologist at RVHS says, “Obesity in children has shown to result in much earlier onset of diabetes, hypertension, hyperlipidemia, and fatty liver, leading to heart disease, stroke, kidney and liver failure, and other conditions. The HOPPS clinic aims to help young patients make healthy lifestyle changes to avoid these preventable consequences.”

Dr. Peter Azzopardi, Medical Director and Corporate Chief of Paediatrics at TSH, adds, “It is estimated that there are 36,000 overweight and obese children living in Scarborough. A key concern for these children and their families has been the lack of access to multidisciplinary clinics that can help to treat the various issues that contribute to unhealthy body weight — including lifestyle. By working together on the HOPPS program, RVHS and TSH are helping to address this unmet need.”

Delaun was referred to the HOPPS group program for patients between the ages of seven and 17, which includes an intensive six weeks focusing on healthy lifestyle modification (see sidebar). His classes were held at TAIBU Community Health Centre, and included fun exercises and physical activity, nutrition counselling, and education on family lifestyle changes. The program helps patients improve their confidence and self-image, and provides them with information on resources for sustaining their lifestyle changes. Post-program, patients are followed by the HOPPS interdisciplinary team for two years.

“Delaun has developed an understanding about food, because of the program,” says Anna. “He makes nutritious choices, including protein and veggies in his diet. He is aware of portion sizes now and what they should look like for someone his age. He knows how to stop eating when he is comfortable, and doesn’t have to eat until he is full. And, he manages his own treat intake; he knows that he doesn’t need a treat every day, and when he does have one, he knows he doesn’t need another later the same day.”

And while Delaun has lost weight by making better choices, Anna’s focus is for her son to be strong and healthy. Delaun has noticed other health benefits as well – his sleep apnea is no longer an issue, which means he is sleeping better, and is not as tired during the day. This, along with an improved ability to breathe better generally, increases his ability to be active. Friends and family are noticing how well he is doing. Anna loves to see the increase in his self-esteem as well.

“Delaun is gaining so much confidence – not only from the weight loss, but because, thanks to HOPPS, he has learned how to do all of this stuff to take care of himself in spite of the temptations, and other unhealthy ideas about food that exist everywhere!”

 Who is HOPPS for?

• HOPPS has been developed for children between the ages of two and 17 who have an elevated body mass index (BMI) and may have complications related to obesity. Specifically, paediatric patients with a BMI greater than the 97^th percentile; or those who have a BMI greater than the 85^th percentile with one or more of the following conditions: pre-diabetes, hypertension, polycystic ovarian syndrome, hyperlipidemia, fatty liver, or sleep apnea.
• In addition to the group program, family-centred counselling with the HOPPS team is available for younger patients between the ages of two and six, also at a community site. The counselling includes discussions for the whole family around lifestyle changes, healthy eating, physical activity, and supports that are available in the community. The frequency and number of weeks of counselling are based on the needs of the family.
• To learn more about HOPPS, please contact the team at 647-461-7030, or HOPPS@rougevalley.ca. To participate in HOPPS, patients will need a referral from their family physician. Referral forms are available at rougevalley.ca/HOPPS and www.tsh.to/hopps, and can be faxed to the central booking office at 416-281-7313.