SCOTT SCANLON The Buffalo News
Ava Brandys’ weight problems started as a baby when she started to gain three pounds a month on a typical eating schedule.
Alarmed, her pediatrician ordered a series of tests from 9 months old. As Ava grew, the results continued to show that her key health indicators were normal.
“Years went by and we kind of took a break from everything because we just weren’t getting any answers,” said her mother, Kristy Paradowski.
Ava, then 13, weighed 330 pounds 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.
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“Our biggest concern was what would happen to her blood pressure,” her mother said. ‘Is she going to have a stroke? Is she having a heart attack?”
Her pediatrician referred Ava to the Healthy Weigh program at John R. Oishei Children’s Hospital in Buffalo. As a result, this month she started her freshman year at Lancaster High School 100 pounds lighter — and a whole lot happier.
“When I came in here I just wanted to answer,” she said.
The Healthy Weigh clinic is located in the Conventus medical office building, next to Oishei Children’s. It opened on December 30, 2014. The first child patient, in his mid-teens, weighed 550 pounds.
The staff has since treated patients as young as 2 years old, not only with overweight, but also with related health problems.
“We only operate on teens who have complications from obesity, so we tell them, ‘We’ll fix your hypertension, we’ll fix your sleep apnea. Oh, and by the way, you’re also going to lose weight,'” said Dr. Carroll “Mac” Harmon, program director. surgery.
The clinic sees children of diverse backgrounds from across the region, as well as northwestern Pennsylvania, said Sara Alexander, a registered nurse and registered dietitian who helps lead Healthy Weigh.
The staff also includes a pediatric nurse, 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 emphasized, along with personalized attention to restful 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 at Kaleida Health and the division of pediatric surgery at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences.
Behavioral change is emphasized, surgery or not.
During the first meeting with program staff, parents usually say that their child’s blood pressure and blood sugar levels alarm them the most, the pediatric surgeon said. “The teen often says, ‘I don’t like my clothing 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 includes health insurance, requires those interested in surgery to be in treatment for six months before it is considered. Team members help decide whether patients and their families will benefit — and are committed to maintaining a healthier weight.
Most of Harmon’s pediatric surgical days involve repairing hernias, removing appendixes and gall bladders, and helping to 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 know how to eat well 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, otherwise we would be a good candidate.”
One of the reasons doing surgery on teens was so controversial in the beginning was the definition of a teen, “Someone who doesn’t play by the rules,” Harmon said.
“There are many lifestyle changes that need to take place after surgery,” Alexander said. “We need to know that they are committed to and able to stick with it 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 stick with those changes in the long run ensure success.”
The Healthy Weigh team is also committed to these young patients by urging patients to keep in touch into their 20s and 30s.
In the early years, the clinic mainly saw teenagers struggling with weight. Not anymore.
“We’ve had success with children under the age of 5,” Alexander said. “When you join us, we can help families make changes that will last and prevent children from developing these problems as they get older.”
Almost all obesity is a combination of genetics and environment, Harmon said. Most obesity is more closely linked to learned behaviors at home, at school and in the community, he said, “but we all know people who say, ‘How can you always eat so much and be so skinny?’ ”
Less than 6% of people have a single gene mutation that disrupts leptin, the hormone that tells the body to be full when eating. Through the clinic, Ava Brandys, now 14, discovered that she has two gene mutations that play a role in her eating habits, although their strength is slightly less pronounced.
Her mother took her to five nutritionists over the years who gave her various nutritional plans, including a 900-calorie-a-day diet. In kindergarten, all sweets, including chocolate and birthday cake, were off limits.
As she gained weight, peer interactions during primary and secondary school became less common.
“People would notice I was there, but they wouldn’t try to interact with each other,” she said.
Things started 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 cuff surgery was an option she could take. Consult often with teens and parents who have gone through the procedure at Oishei Children’s.
“It was more mental that I had to prepare,” she said, “but I knew I wanted to.”
She had surgery on February 22. Since then she has lost 75 pounds. She continues to visit Healthy Weigh staff once a month to update the treatment team on her food and activity choices and to ensure surgical risks, including acid reflux and abdominal pain, have not been a nuisance.
They don’t — and she’s off the CPAP machine and her prediabetic medicine. Today, she said, salad, chicken and two protein shakes are the staples of her diet. Three workouts at the gym in the apartment complex where she lives with her mother also set a healthier tone.
“It’s not just about weight, it’s about blood pressure and blood sugar and blood lipids and liver function and sleep apnea,” Harmon told her during a visit to the Healthy Weigh clinic last week. “From a surgeon’s perspective, I’m really happy with how you’ve done it. We want you to keep working, so that means you have to keep coming back.”
Success and good counsel drive her to do so, Ava said.
“I have more energy. I can do more activities and sports. I feel this has helped me. 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 from the results she was able to get in six months,” her mother said. “She’s so happy and I’m so happy to see her smile.”
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.