1. An Approach to Healthy Lifestyle
10 Steps to a Healthier You: Pearls from the Pediatric Healthy Lifestyle Center
An Approach to Healthy Lifestyle
Patricia Barreto, MD, MPH
Norma Molina RDN
Karina Perez, MS, RDN

2. Pediatric Healthy Lifestyle Center History
Founded in 2003
Part-time pilot
Full-time specialty practice 2006
Department of Pediatrics

3. Pediatric Healthy Lifestyle Center (PHLC)
PHLC serves
Families of children ages 18 months to 19 years
Overweight (BMI > 85%) or obese (BMI >95%)
Referred from their primary care providers

4. Pediatric Healthy Lifestyle Center Vision
“Promoting Health and Fostering Healthy Lifestyles for Santa Clara County’s Children and their Families”

5. Pediatric Healthy Lifestyle Center Mission
“To provide high-quality, family-centered, community-linked preventive care,
lifestyle management and medical interventions
for children and youth at risk for Type II diabetes and other lifestyle related conditions”

6. Pediatric Healthy Lifestyle Center
PHLC Recommendations are based on
Expert Committee Recommendations Regarding the Prevention, Assessment and Treatment of Child and Adolescent Overweight and Obesity*
*Pediatrics Vol. 120 Supplement December 2007 p. S164-S192

7. PHLC: Focus on fostering behavior change
Dietary Intake
Breastfeeding for the first 12 months or longer
Limit or eliminate consumption of sugar-sweetened beverages
Eat the recommended quantities of fruits and vegetables
Physical Activity
Limit television and screen time to no more than 2 hrs/day
Remove television and other screens from children’s bedrooms
Moderate to vigorous physical activity for at least 60 minutes a day
the following evidence-based areas (See 10 Steps to a Healthier You): 

8. Pediatric Healthy Lifestyle Center
Eating Behaviors
Eat breakfast every day
Limit eating out, especially at fast food restaurants
Have regular family meals
Foster a healthy relationship with food by focusing on appropriate feeding dynamics at mealtime

9. Pediatric Healthy Lifestyle Center
Evidence-based recommendations with additional ‘pearls’ from our PHLC practice
‘10 Steps to a Healthier You’ framework
See posters and brochures

10. Focus on balanced growth
The PHLC Approach
No focus on weight
Focus on balanced growth
No diets
Focus on eating healthy
foods
No “exercise”
Focus on fun physical
activity and play
No deprivation
Focus on habits that fit
the individual family and
that the child and family
enjoy

11. PHLC Philosophy/Approach ABC’s
Asset-based
All families/communities have strengths that can facilitate success
Belief that families want to be healthy
Need tools, skills, support, and resources to make changes
Community-linked
Relationships with community resources are vital to treatment/intervention

12. PHLC is Family Focused Focus on changes for the entire family
Take pressure off child and reduce conflict and anxiety in the home
Child does share age-appropriate responsibility

13. Building Capacity in the Community to Implement Healthy Lifestyles
Currently PHLC see and treats children AFTER that have developed a medical condition related to their lifestyle
We help families adopt a NEW lifestyle by provide education, resources and facilitating lifestyle skills
“In order to provide more primary prevention for childhood obesity in Santa Clara County, the Healthier Kids Foundation of Santa Clara supported PHLC staff in developing a pilot training program designed to enhance the capacity (skills) for implementing healthy lifestyle behaviors among “upstream audiences”, or populations that have not yet developed BMI >85%.

14. Collaboration with Healthier Kids Foundation of Santa Clara County
Collaborated to design a curriculum
help families develop skills to establish and maintain a healthy lifestyle habits
BEFORE children develop a medical condition related to their lifestyle
Building capacity in the community
Primary prevention

15. Building Capacity in the Community to Implement Healthy Lifestyles
Curriculum presents evidence-based recommendations for the prevention and treatment of obesity (WHAT)
Practical approaches to implementing the recommendations (HOW)

16. Collaboration with Healthier Kids Foundation of Santa Clara County
The pilot included an evaluation
to assess the impact of the training on healthy lifestyle behaviors
Assess PHLC messaging for audiences that have not been referred to PHLC

17. ‘10 Steps to a Healthier You’ curriculum
3 8-hour training sessions were held with participants.
Training sessions were designed to be interactive and experiential.
Overall, the participants gave the training session high evaluation scores
(see first five evaluation class report).

18. ‘10 Steps to a Healthier You’ curriculum
Participants mentioned the following experiences as being high impact:
“Back to basics” concept

19. Who’s Healthier? ¿Quién es más saludable?
Ask – how can you tell? ASK the group

20. Hábitos Impacta la SaludTV
Video Games
Computer
Habits Impact Health
Hábitos Impacta la Salud
Snacks Bocadillos
Drinks
bebidas

21. ‘10 Steps to a Healthier You’ curriculum
High impact experiences:
Modeling healthy food and beverages
tasting water with cucumber/mint (no sugar)
experiencing a meal without any processed or packaged foods

22. ‘10 Steps to a Healthier You’ curriculum
High impact experiences:
Seeing the amount of sugar in common beverages
Demonstrated with the amount of sugar per beverage measured out and displayed/discussed
including sodas, sports drinks juices

23. ‘10 Steps to a Healthier You’ curriculum
High impact experiences:
Seeing the amount of fat in common packaged snacks

24. ‘10 Steps to a Healthier You’ curriculum
High impact experiences:
The concept of “trick foods”:
highly processed foods
added salt, sugar and fat
promote cravings
lack nutritional value and fiber
do not satisfy hunger
compete with fruit and vegetables

25. Unhealthy Processed/Packaged Snacks Bocadillos Procesados
Now let’s look at….
What surprises you about what you see? 25 25

26. ‘10 Steps to a Healthier You’ curriculum
High impact experiences:
Experiencing through role-playing the thoughts and feelings of a child
that is told they cannot eat more
pushed to eat more than they would like to eat
Role play reinforces concepts of the division of responsibility
(of the healthy options presented).?????

27. ‘10 Steps to a Healthier You’ curriculum
Quantitative evaluation found statically significant decrease:
amount packaged/processed foods offered to children (crackers),
amount of juice served to children
decrease in inappropriate pressure to eat vegetables
Due to the role playing

28. ‘10 Steps to a Healthier You’ curriculum
Next Steps:
Modify/update ‘10 Steps to a Healthier You’ curriculum and roll-out
schools
clinics
community centers