Dr. Michelle Levitt isn’t asking her patients in Akron Children’s Healthy Active Living program – formerly the Healthy Weight Clinic – to do anything she doesn’t already do. If practicing what you preach earned you gold stars, she’d have a very full reward chart.
As the pediatrician who oversees the medical component of the clinic, Dr. Levitt takes medical histories, performs physical exams, orders labs and offers up a healthy dose of encouraging words for her patients and their families.
“One day I found myself on the couch eating a bag of chips and watching an infomercial for P90X and thought what am I doing?” she said.
Board-certified in obesity medicine, she is part of the multidisciplinary team that spends 1 day a week seeing patients between the ages of 2 to 17 who have been referred to the clinic due to childhood obesity.
“We want to capture them while they’re young so we can help them establish healthy habits,” Dr. Levitt said.
In addition to Dr. Levitt, the healthy weight clinic team includes includes dietitians, youth fitness specialists and psychologists. Their patients are allotted 8, 2-hour appointments where they spend 30 minutes with each provider getting structured modules of education on 6 healthy topics.
Patients generally come in once a month. The first appointment is strictly an intake appointment that covers the child’s health and nutrition history, physical activity and a change assessment questionnaire.
The parent’s role
“For the younger kids it’s about the parent’s willingness to change – to role model healthy habits and to protect the home by controlling what kinds of foods they bring into it,” Dr. Levitt said. “It’s no different from protecting your child from anything else. We need to protect them not just from the medical consequences of being overweight, but from the social and psychological consequences as well. Older kids usually have a little more drive to do this on their own, because many of them have already encountered the negative social effects.”
Nine-year-old Giovanni recently came in for his 8th and final visit. Giovanni has stabilized his BMI and dropped a few inches off his waist.
“You look great buddy!” she said. “You did everything you needed to do and I’m really proud of you.”
The sweet-faced 3rd grader smiled.
Dr. Levitt and Giovanni’s mom review the family’s plan for keeping him active and sweating throughout the summer months.
“I like to recommend martial arts as a way to keep kids active,” Dr. Levitt said. “Studios generally offer a varied schedule, you can pick a time convenient for you and it’s something that’s ongoing and progressive.”
Although she has 9 patients scheduled for this particular day, the “no show” rate in the clinic can be as high as 50 percent.
“I don’t think families always see the medical urgency behind childhood obesity and all the other problems it can lead to,” Dr. Levitt said. “If they did, they would be here.”
Having spent 15 years in private practice and 2 years in endocrinology, Dr. Levitt joined the healthy weight clinic in 2014. Before it opened, pediatricians referred their overweight patients to either endocrinology or sports medicine’s future fitness clinics.
Dr. Levitt left endocrinology in 2014 to merge with sports medicine and offer 1 program instead of 2 parallel options. She now spends 1 day a week in the clinic and half a day doing shared medical appointments.
Shared medical appointments
“Shared medical appointments are about goal setting and accountability, although there is an educational component, too,” Dr. Levitt explained. “We have to be ‘out of the box’ with our interventions. This concept is a little more dynamic and offers lots of opportunities for sharing information and asking questions.”
Families come on Thursday mornings for a 90-minute block of time. They get to check in privately with Dr. Levitt to go over any medical concerns. The rest of the time is spent participating in brief exercise periods, learning about nutrition and sharing success strategies with each other.
“The big focus is on having fun so families are excited about being healthy,” she said.
This week’s shared medical appointment focused on raising awareness about the surprising amount of sugar in soft drinks, Gatorade, lemonade and fruit juices.
“It’s eye opening when you see something labeled 100% apple juice still contains 12 teaspoons of sugar,” Dr. Levitt said. “You’re better off just eating the apple.”
On the path to better health
Dr. Levitt’s next patient is 5-year-old Quaveon.
Quaveon’s body mass index is in the 99th percentile for his age, which has caused him to suffer from sleep apnea, pre-diabetes, high blood pressure and dyslipidemia – putting him at higher risk of heart disease.
Mom tells Dr. Levitt that Quaveon will spend this summer training for next year’s Special Olympics.
“That is going to be a great start on the path to getting him healthy and strong,” Dr. Levitt says. “If he can get some of the weight off, there will be less stress on his kidneys, liver and heart.”
Mom informs Dr. Levitt that she is the 20th doctor visit they’ve had this month.
“The drive behind what we do, and if we’re successful, could mean being able to cut back on the number of specialists he sees,” his mom said. “Step 1 is getting him off sugary drinks and eating more fruits and vegetables.”
Together they review the 5-2-1-0 handout that suggests 5 servings of fruits and vegetables, 2 hours or less of screen time, 1 hour of physical activity and zero sugary drinks per day.
Although the acuity of every patient is different, the goal is empowerment and teaching kids and their parents how to sustain healthy lifestyles.
“We can only do so much and it can be frustrating when families don’t get it,” Dr. Levitt said. “But when they do, it’s exciting to see a whole family get healthy and know that you played a role in empowering them to do that.”
Ten-year-old Madison couldn’t wait to tell Dr. Levitt she’s lost 4 lbs since her last visit.
Dr. Levitt asked Madison about what she’s been working on that has helped her feel successful.
“I’m trying to spend more time outdoors getting hot and sweaty,” Madison said. “I’m also choosing healthier snacks – like more veggies.”
When Madison shares an album made by her mom titled “My Year in Sports,” it becomes evident that she is a busy little girl with softball, cheerleading, basketball, volleyball and twirling.
Mom tells Dr. Levitt that Madison had recently been suffering from some exercise-induced asthma flare-ups. They reviewed Madison’s asthma action plan and Dr. Levitt suggested talking to their pediatrician about adding an inhaled steroid to their treatment protocol.
They also talked about Madison’s sleep habits because sleep is a big component in overall health.
“Sleep, exercise and nutrition are the triad to health regardless of a person’s age,” Dr. Levitt said.
After delivering a few well deserved high fives to Madison, Dr. Levitt reminded the family they could access her through MyChart with any questions or concerns that cropped up before their next appointment.
With her positive approach, sunny disposition and willingness to dish out the hugs, there’s no doubt she means it.