Ava Brandys' troubles with weight began as an infant when she started to gain three pounds a month on a typical eating schedule.
Alarmed, her pediatrician ordered a battery of tests starting at 9 months old. As Ava grew, results continued to show that her key health indicators were normal.
New York fares better than four of every five states when it comes to the percentage of children deemed obese, but the numbers remain high enough to cause concern.
“Years went on and we kind of took a break from everything because we just weren’t getting answers,” said her mother, Kristy Paradowski.
Ava, then 13, weighed 330 pounds by last school year, when doctors discovered she had hypertension, prediabetes and sleep apnea. They prescribed a CPAP machine to help her breathe better at night.
“Our biggest concern was what was going to happen to her blood pressure,” her mother said. “Is she going to have a stroke? Is she going to have a heart attack?”
People are also reading…
Her pediatrician referred Ava to the Healthy Weigh program at John R. Oishei Children’s Hospital in Buffalo. As a result, she started her freshman year at Lancaster High School this month 100 pounds lighter – and a whole lot happier.
“Coming in here, I just wanted answers,” she said.
The Healthy Weigh clinic sits in the Conventus medical office building, alongside Oishei Children’s. It opened Dec. 30, 2014. Its first child patient, in his mid-teens, weighed 550 pounds.
Staff has since treated patients as young as 2 saddled not only with excess weight but related health conditions.
“We only operate on teenagers who have complications of obesity, so we tell them, ‘We’re fixing your hypertension, we’re fixing your sleep apnea. Oh, and by the way, you’re going to lose weight, too,’ ” said Dr. Carroll “Mac” Harmon, program surgical director.
The clinic sees children of many backgrounds from across the region, as well as northwest Pennsylvania, said Sara Armstrong, a registered dietitian who helps lead Healthy Weigh.
The staff also includes a pediatric nurse practitioner, psychologist, social worker, endocrinologist, occupational therapist and physical therapist – focused on body composition, not weight.
It helps parents and children with simplified, structured meal planning with real, whole foods. Regular exercise is stressed, along with personalized attention to good sleep, mood, habits and coping strategies.
Bariatric surgery is offered as part of the program, but only about 10% of patients end up getting it, said Harmon, also chief of surgery with Kaleida Health and the Division of Pediatric Surgery in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.
Behavior change is emphasized, surgery or not.
During the first meeting with program staff, parents typically say their child’s blood pressure and blood sugar alarms them most, the pediatric surgeon said. “The teenager oftentimes says, ‘I don’t like my clothes choices, I can’t keep up with my friends, I get tired before they get tired.’ ”
Treatment plans fall into place over time. The program, which takes health insurance, requires those interested in surgery to spend six months in treatment before it's considered. Team members help decide if patients and their families will benefit – and are committed to staying at a healthier weight.
Most of Harmon’s pediatric surgical days involve fixing hernias, taking out appendixes and gall bladders, and helping address trauma and birth defects. He does one or two bariatric surgeries a month.
“We have two buckets of patients,” he said. “They are here because they want to figure out how to eat right and exercise better. Some of them have a genetic predisposition to obesity. Of all the patients we see, only a handful are interested in surgery or we find would be a good candidate."
One reason doing surgery on teens was so controversial at the start was the definition of a teenager: “Someone who’s noncompliant,” Harmon said.
“There’s a lot of lifestyle changes that have to occur after surgery,” Armstrong said. “We need to know that they’re dedicated to and capable of sustaining for a long period of time, so in addition to getting to know all of us, it’s important for us to know that they can adhere to those changes long-term to ensure success.”
The Healthy Weigh team commits to these young patients, too, by insisting patients continue to keep touch as they move into their 20s and 30s.
In the early years, the clinic mostly saw teenagers who struggled with weight. Not anymore.
“We’ve had success with kids under 5,” Armstrong said. “When you come to us, we’re able to help families make changes that last a long time and prevent children from having these issues as they get older.”
Almost all obesity is a combination of genetics and environment, Harmon said. Most obesity is more tightly tied to learned behaviors in the home, school and community, he said, “but we all know people that we tell, ‘How can you eat that much all the time and be so skinny?' ”
Fewer than 6% of people have a single gene mutation that disrupts leptin, the hormone that tells the body it’s full while eating. Through the clinic, Ava Brandys, now 14, learned she has two gene mutations that play a role in her eating habits, though their power is somewhat less pronounced.
Her mother took her to five nutritionists over the years who put her on a variety of eating plans, including a 900-calorie-a-day diet. By kindergarten, all sweets, including chocolate and birthday cake, were out of bounds.
As she gained weight, interactions with peers during elementary and middle school became less frequent.
“People would notice that I was there, but they wouldn’t try to interact,” Ava said.
Things began to change when she started Healthy Weigh last fall. She lost 25 pounds by the time it became clear that with her genetic predisposition gastric sleeve surgery was an option she could take. Deliberations often talking with teens and parents who have been through the procedure at Oishei Children’s.
“It was more mentally that I had to prepare myself,” she said, “but I knew that I wanted it.”
She went through surgery on Feb. 22. She has lost 75 pounds since. She continues to visit with Healthy Weigh staff once a month to update the treatment team about her food and activity choices and assure that surgical risks including acid reflux and abdominal pain haven’t been bothersome.
They haven’t – and she is off the CPAP machine and her prediabetic medicine. Today, she said, salad, chicken and two protein shakes make up the staples of her diet. Three workouts at the gym in the apartment complex where she lives with her mom also set a healthier tone.
“It’s not just about the weight, it’s the blood pressure and the blood sugar and blood lipids and the liver function and the sleep apnea,” Harmon told her during a visit to the Healthy Weigh clinic last week. “From a surgeon’s perspective, I’m really pleased with how you’ve done. We want you to keep working, so that means keep coming back.”
Success and good counsel drive her to do so, Ava said.
“I have more energy. I’m able to do more activities and exercise. I feel this helped set me up. It was a huge relief, knowing that something could be done.”
Last spring, she made the National Junior Honor Society and joined the Lancaster Middle School Student Council. She hopes to achieve more academic success and take on more activities in her freshman year at Lancaster High.
“You can tell she wanted this just by the results that she was able to get in six months,” her mother said. “She’s so happy, and I’m so happy to see her smiling.”
Learn more about the Healthy Weigh Program through your child's pediatrician, at ochbuffalo.org/care-treatment/healthy-weigh or by calling 716-323-2000.