A generation ago, “after school” was a time when most children looked forward to being outside, running around and playing until they were called inside for dinner. Flash forward to today, when school-aged children, teens and even toddlers spend most of their free time passively sitting in front of a screen. One in three Canadian children is now overweight or obese, and many of them are dealing with a variety of resulting serious health concerns.
As a paediatric endocrinologist at The Hospital for Sick Children (SickKids), Dr. Jill Hamilton has noticed a gradual change in her patient population over the years, as more and more kids show up in her clinic with a condition that was previously known as an adult-onset disease.
“Thirty years ago, Type 2 diabetes was not really a diagnosis in children,” she says. “The landscape is totally different now, and we need to address the changing needs of our patients who face potentially dire outcomes.”
Dr. Hamilton and her team recently launched the Centre for Healthy Active Kids at SickKids to take a more holistic approach in addressing the issue of childhood obesity. The Centre integrates a multidisciplinary team of health care providers offering clinical care, conducting research studies, and leading education in this emerging field.
“It’s a complex path that we’ve taken to get to this point in childhood obesity, and it’s going to take a multi-faceted approach to get out,” says Hamilton, Director of the Centre for Healthy Active Kids and its clinical program, the SickKids Team Obesity Management Program (STOMP). “With the new Centre, we aim to prevent, understand and manage obesity and related disorders with the ultimate goal of improved health, wellness and quality of life for children and youth throughout their life course.”
The Centre’s clinical activities began with the launch of STOMP in 2010. The program was the first of its kind in Canada, offering teens with complex obesity access to a team of health professionals, support groups and, for those who meet specific criteria, bariatric surgery. Throughout the two-year intensive curriculum, teens and their families are followed closely by paediatricians, a nurse practitioner, dietitians, an exercise therapist, a psychologist and a social worker. Open to patients aged 12 to 17, STOMP sees about 50 new patients per year.
STOMP’s latest clinical offering is its Early Years program, a collaboration with Toronto Public Health which serves children aged six months to six years. Launched in 2012, Early Years educates families about nutrition, meal planning and physical activity, and helps instil healthy habits for lifelong health. A unique component of the program is that it features home visits from a Public Health nurse, who can assess a family’s situation and help guide them to better habits at home and in their everyday lives.
“Targeting our interventions to the early-childhood period is critical,” says Dr. Catherine Birken, a paediatrician with STOMP who leads the Early Years program. “If we can identify unhealthy behaviour and risk factors early, we can provide the tools to help change kids’ habits before they become ingrained.”
In addition to these clinical programs, the Centre for Healthy Active Kids is conducting a variety of research projects along the themes of healthy nutrition and physical activity, prevention and treatment of obesity and the physiology of body weight and associated health risks.
Educational initiatives include the development of training opportunities for health-care professionals. Primary-care providers have historically received limited training on how to speak to families about weight-related issues in a way that is empathetic but also effective. This is something Dr. Hamilton and her team hope to change.
Obesity is a complex issue that is influenced by individual, family, socioeconomic, genetic, physiological, environmental and policy factors. In some cases, it is the result of treatment, like steroids, for a medical condition. It could also stem from a brain tumour, like craniopharyngioma, or another serious illness.
Nine-year-old Jan was diagnosed with craniopharyngioma in 2011. Early in his clinical care, he was referred to STOMP, since one of the common complications of the surgery required to remove the tumour is damage to the hypothalamus, an area of the brain involved in weight regulation. As a result, Jan faced a staggering 50 per cent risk of severe obesity.
“When Jan was diagnosed, it seemed like obesity was almost certainly in his future,” says his dad, Kenton Kroker. “That was difficult, knowing the health risks and incapacity that can result.”
Following Jan’s initial surgeries, the Kroker family began working with a STOMP dietitian and Dr. Hamilton to ensure that Jan’s weight would be carefully managed. At first, Jan was placed on a low glycemic index diet to prevent weight gain. When his tumour increased in size last year, and he required radiation therapy, his appetite decreased dramatically, and he needed further changes in his diet to prevent too much weight loss, his dietitian was there to help the family.
While they had always strived to eat well, the family learned to incorporate Canada’s Food Guide into their meal planning. Jan’s dietitian offered them strategies to help them think of food differently and communicate with each other, as well as with teachers, friends and relatives, about Jan’s dietary needs.
Today, Jan goes to school, plays baseball and maintains a healthy weight. He is well-versed in which foods he is able to eat, and looks forward to his weekly “treat days”, when he is able to indulge in favourite foods that are not part of his regular diet.
“Trying to manage Jan’s health challenges around the dinner table was really hard, but that was made an awful lot easier by the STOMP team,” Kroker says. “The program answered the question of ‘what do I need to do?’ In a medical crisis, parents and kids lose agency really quickly. This was something we, and Jan, could take action on.”
For information about the Centre for Healthy Active Kids, including tips and reliable educational resources for families, click here
For referral information for STOMP, click here