**This article comes courtesy of the May 2012 issue of School Nurse News**

Recently, there has been an effort through media and advertising campaigns to shock adults out of their denial about the state of our children’s health and the rise in childhood and adolescent obesity. School nurses have known for a long time that children and adolescents are suffering. Overweight and obese students turn up at the school nurse’s office with complaints that shouldn’t be coming from 13-18 year-old students.
“My legs are killing me. I can’t go to gym today.”

“I can’t get to my class on the third floor, because I can’t breathe too well.”

“I forgot my diabetes medication. Can you call home?”

“I hate this school. Kids give me a hard time and call me ‘fat.’”
The national focus on the anti-obesity issue has been mainly on the home, the food and beverage industry, as well as the controversial topic of school lunches, but a largely overlooked and powerful resource is the school nurse.

At fitsmi.com, a unique web community for teenage girls struggling with weight issues, we’ve learned a lot about how adolescent girls think. We have come to the conclusion that some of the standard approaches of helping teens get on a healthy track don’t work. Why? Teens are at the age when they don’t want to be told what to do, they’re
more concerned about what their peers think of them, and they want to be independent. Girls, in particular, are very conscious of body image, an extremely emotional issue.

According to a recent study published in the journal Pediatrics, teens can take control of their own health given the right tools and guidance.
“Most clinic-based weight control treatments for youth have been designed for pre-adolescent children by using family-based care. However, as adolescents become more autonomous and less motivated by parental influence, this strategy may be less appropriate.”
Enter the school nurse. These professionals are in a unique position and in the right place to help. When students come to them with problems directly related to their size, it’s one of the best opportunities to step in.

How?

It’s time to get creative about how we treat overweight and obesity in children. They are, after all, faced with life-threatening
issues. If gone unchecked, obesity can progress to diabetes, heart ailments, asthma, and even depression—each of which can be deadly.

School nurses know the daunting challenges in communicating with teens on such a sensitive subject. They cry out “I need help…but don’t help me!” Innovative strategies to reach them are needed.

Starting the Conversation

Sometimes it’s not about talking, it’s about listening. If a teen girl expresses concern over her health and weight, you
should tell her that you admire her for being aware and that she’s not alone. In addition to the support she will get from
you, there are resources outside the school, including a web community where she can find additional ways to attack
these problem issues, and can also get peer support, can start setting goals on her own, and even have fun.

What more can be done?

Engage the student:
*  Download tips on topics such as “Being Thin vs.Being Healthy.”
*  Start a fitsmi Change Me Challenge. The fitsmi Change Machine allows girls to set small daily
goals and stay on track for healthy and sustainable change. Create a group of girls who are up for the
challenge. For more details go to fitsmiForMoms.com.
* Create your own fitsmi Stars group. Girls look to their peers for inspiration. Take for example 16 year-old
fitsmi Star Denise Campbell who took on the challenge to get healthier against difficult odds and is now
inspiring other girls. There are potential success stories in every school.
* Get others on board. The school counselor might be able to facilitate schedule changes in a girl’s
school day to make time for her to access nutrition  and exercise information.

Engaging the School Community

We applaud school nurses who are going the extra mile to enlist the help of school administrations and parent groups
in a concerted fight against obesity.
*  Speak to school administrators about offering healthy alternatives at lunch and for snacks. Encourage the
school to make healthy snacks available throughout the day so that when students have free time and also feel
hungry, they don’t just rely on chips and candy bars.
* Offer to speak to the parent-teacher organizations in your school about general health concerns, including
adolescent obesity. Enlist their help in creating outreach programs around the subject.
* Make sure that plus-sized teens are featured positively on photos/images/posters in your office
as well as in classrooms.
* Talk to physical education teachers about ways in which overweight teens can feel more comfortable and
engaged in phys ed class and afterschool sports.
* Engage faculty to become healthy role models at the school – eating a healthy lunch, walking around
the campus, or going to afterschool sports events when convenient.
* If your school has one, talk to the health teacher about how to address obesity/exercise/nutrition in the
classroom without further stigmatizing overweight kids or making them feel uncomfortable.
* Show the principal, faculty and administration the Yale Rudd Center video on weight bias in schools.
* Lobby your school administration to make sure students have enough time to eat. It takes a lot longer
to eat a salad than a slice of pizza or a container of French fries. It’s easy to overeat if you’re rushed and
cramming food in your mouth on the run.
* If you don’t have one, work with your school’s leaders to create a school garden. Engage kids in afterschool
clubs in growing vegetables for the school’s lunches. School gardens are known to get kids and teens eager
to try, and, eventually, like more vegetables. If they can’t be integrated into the school lunch program,
let kids take them home or cook them in family and consumer science classes.

It’s time to combine forces and take action. The staff at fitsmi.com is happy to speak to anyone who has a
question or finds our programs interesting and useful. We hope to make many new partnerships through the school
nursing community, as we add more tools to the toolbox, such as our new and affordable group coaching services.

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Want More Information about fitsmi? Check out the fitsmi fact sheet (pdf 504 KB) and take a video tour (1:33 min.)::::::::::

“Having a great day!! Going dress shopping later! Can’t wait. Lost 16 lbs.”
“Thank you for everything. I lost the weight I wanted thanks to fitsmi.com. That is why I told my friends with weight problem about this site. I’am now a healthy 110 pounds for my height. Thank you so much, you don’t know how happy am I”
“this website is a blessing from God!”
“fitsmi is like facebook but with real people! i love it!”
“Hello Fitsmi Staff! I am very happy that I am a member at Fitsmi!! It’s a great way to meet new people and new friends!! Thanks for all of your support! !”
“i think it’s all great. You have a great program going here”

“I think this site is really interesting and I’m sure it’s something I’ll be using quite a bit. I looove the changes! Being healthy is really about making changes to your lifestyle, and I love the fact that we can keep track of those changes on here! I’ll definitely go in the message boards sometime! I like making new friends
who I can really relate to.”

“I am so happy I finally found a site with support and its free lol yay!!!!!!!”
“Thanks so much. I hope to meet new people too. I am sorta getting the hang of the site, just exploring for now, then the real work shall start. This site will definitely help me tons <3”
“I’m so excited fitsmi is a great website and is very helpful!!!”

“well im new here and im starting to think this might hlp me lots”

“this article so gets me”

“Hi! I came on this website the same reason why steph came on On caloriecount.com, someone suggested that this was a good website so I decided to check it out. I really like the site so far and I’m hoping it’ll get me motivated to get into shape!”
“This site looks awesome, I’ve wanted something like this for ages! ”

“I couldn’t believe it when I found this website, it’s perfect. In the couple of weeks I’ve been on here I have learned so much. Today is the first day of my weight loss journey, and fitsmi has really helped. During lunch I was amazed! I had my final exams today and got back home around 1. I was starving and my mom had some food ready for me.
I decided to use a smaller plate for my meal. After seeing the new food pyramid thing I made a mental note and arranged my plate that way. I had some pasta, chicken, carrots and broccoli, and some whole wheat bread. I went down to my basement to watch some tv while I ate. I began to eat and decided to eat slower than I normally do.
I took me about half an hour to finish eating and I didn’t even clear my plate, I was so full! I couldn’t believe those tips worked, usually I would have ate double the amount! Thank you fitsmi. I feel it in my gut that this summer will be the summer I will succeed.”

“Thanks so much! this is a great website. This website is SO inspirational. I appreciate it.”
“AHH, thank you! As cheesy and corny as this sounds, fitsmi has opened a whole new perspective to me. It’s amazing :O !”
“I just wanna say that this website is awesome, and extremely helpful. iv’e struggled with being over weight and having a low confadence for as long as i can remember. So thank you.”
“I love Fitsmi I’ve even made a few new friends who can relate to how I feel. … I’m ready to apply myself and make the CHANGE”
“I LOVE THIS SITE!!!”

So far, we’re impressed with the three years of research and the wide variety of expert voices who chime in at the screening we saw. The documentary takes a long hard look at environmental factors contributing to obesity — our country’s food production and food industry for one, as well as food-marketing to kids, and the over-availability of cheap processed foods.

Overall, the Weight of the Nation aims to highlight a national epidemic which it says threatens the fate not only of overweight individuals but the country itself.

We’re eager to know what you think! And hope you’ll be glued to the screen along with us starting TONIGHT, May 14 (Parts I & II) and tomorrow, May 15 (Parts III and IV) on HBO. If you don’t subscribe to HBO, you can watch online starting May 14 at 8pm EST for free!

Meanwhile, here’s the trailer:

fitsmi.com, our sister site for teen girls struggling with their weight, is working on a new product: affordable, online group coaching. Girls will attend live webinars with professional coaches, track healthy changes online, and get peer support 24/7 from home or a mobile device. Interested? We’d love your input on a few key questions. Please add your email at the end so we can get in touch with you when the product is ready (later this summer)!

It’s simple.  Encourage your teen girl to use the fitsmi Change Machine (it’s free and all she has to do is register on the site).  She can set her own (realistic) goals and make small, attainable changes around what she eats and how she moves.  These small changes add up to big results so encourage her to stick with it for at least a month.   Celebrate her success with a small reward…going to the movies, getting a manicure, buying some accessories or even splurging for new workout clothes.  And then encourage her to keep going…

If she needs a little extra motivation, Denise Campbell, one of our fitsmi Stars will inspire her!

And here’s our gift to both of you for getting started:  Download fitsmi’s Top Twenty Get Healthy Tips For Teens

1.  Wellspring Camps (2004), 12 different locations; ages 11-18; 1100 campers per summer.  NY location is a girls-only camp (and only location which is ACA accredited).  Wellspring takes CBT approach to weight loss seriously with 2 individual and 2 group sessions per week.  Claims that “70% of campers maintain or continue to lose weight at home.”  Interactive online program for self-monitoring and discussion boards for campers year round.  Best parent support with 2-day workshop, published guidebook.  Minimum stay 3 weeks, full-priced tuition is $5995; if parents attend the family workshop and fulfill continuing care requirements, there is a rebate of $1,000.  Up to an additional $1500 may be reimbursed by some health insurance policies.

2.  Camp Shane, Catskill Mountains, NY; ages 7-25; 550 campers per summer. A co-ed family-run camp with claim to fame of being the oldest weight loss camp (42 years!).  Known for a relaxed, fun atmosphere.  Menu includes healthy versions of kidfriendly foods like pizza, burgers, nuggets.  Some CBT offered; “At Home” booklet and newsletter for families and special rate to join Dr. Dolgoff’s online weight loss program after camp.  Minimum stay 3 weeks ($3600); financial assistance and a new Nikki Blonsky scholarship available. Mixed reviews from campers – kids seem to either love it or hate it.

3.  New Image Camps (1991), two locations, Florida and Pennsylvania; ages 7-19;  400 campers per summer, ACA accredited.  Boasts a well-trained staff and individualized programs as well as top-of-the-line facilities.   No CBT offered; au contraire:  “we are not a clinic where your child will be placed in endless therapy sessions.”  After-camp “Strive!” program with daily emails and some personalized feedback.  Minimum stay two weeks, $3150.

4.  Camp Kingsmont (1967), the “first weight loss camp in New England” in Amherst, MA;  ages 9-18; 200 campers per summer, ACA accredited.  Camp Kingsmount focuses on developing self-confidence as a basis to make lasting, fundamental changes in life.  A new 2010 “Connections Program” in partnership with UMass’s Psychological Service Center sounds promising, with a “heavy reliance on cognitive therapy.”  Offers group CBT 1xweek; individual sessions “offered.” Minimum stay two weeks, $2495.

5.  Camp Pennbrook (1976), Pennington, NJ; girls only ages 8-21; 150 campers per summer.  Family-owned camp promotes a sense of “sisterhood” and takes advantage of its proximity to NYC with at least one trip to see a Broadway show.  Boasts mature staff, many of whom are in nutritional/educational fields, and top-notch facilities.  Parent’s Visiting Day teaches families how to prepare for their daughter’s successful return home.  ACA accredited.  Minimum stay 2 weeks, $1990.  ACA

6.  Camp Jumpstart (2003), southern Missouri; ages 9-17; 80 campers per summer.  Prides itself on being a “healthy lifestyle camp” blending “camping, fitness, nutrition, health education and leadership training together for positive youth development.”  CBT group sessions and workbook provided.  Post-camp self-monitoring on interactive “Jump Zone” website.  Minimum stay is 4 weeks for $3,695.  Scholarships available.

7.  Camp Shining Stars, (2003), Wilson, NC; ages 12-18; 70 campers per summer.  A non-profit, co-ed camp located on Barton College campus and founded by Ira Green, founder of Healthy Kid’s Foundation.  Author/actress and frequent guest on Oprah, Stacey Halprin, teaches drama.  95% campers lose more than 8% of their body weight.  If camper doesn’t lose at least 7% of their total weight, camp will refund $2,000!  Minimal, informal CBT.  Parent workshop.  Minimum stay is 3 weeks, $3250.

Other weight-loss camps to consider:

Adventure Chicks Tahoe, California.  Single-sex, minimum stay 1 week, $1,950.

Camp Kaizen, NE Vermont, girl-only, non-profit camp run by husband and wife team Nick and Cindi Bollettieri.  Minimum stay 5 weeks, inquire for price.

Active Challenge, Ontario, girl-only outdoor adventure camp for ages 12-18.  Minimum session 3 weeks, $2966.

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Related topics:

What to look for in a weight loss camp.

Abby Ellin, former fat camper, cuts loose on why she remains “deeply, passionately conflicted” about fat camps.

Susan Basso, Mom to Scotty on “Too Fat for Fifteen”, explores her son’s time at Wellspring Academy.

Photo courtesy of choicecamps.

Ms. Weiss proceeded to put Bea on a yearlong Weight Watchers type of diet and, in the article, is quite frank about what she did to keep her 7-year-old on track. After one year, Bea lost 16 lbs.

“I once reproachfully deprived Bea of her dinner after learning that her observation of French Heritage Day at school involved nearly 800 calories of Brie, filet mignon, baguette, and chocolate,” Weiss writes.

While we appreciate the honesty from this mom (because it is often a “taboo” subject and this article has brokered a national debate – let alone a book deal!), we feel compelled to offer our own fitsmi For Moms advice.

• Weight loss alone does not automatically translate to short- or long-term physical, mental or emotional health.

• A doctor should help a parent understand whether their child is overweight or merely on a normal growth curve for their age and body type, i.e. will they have a growth spurt and grow out of it? Have they always been at a relatively higher weight than their peers and this is a healthy norm for them? (According to Ms. Weiss, Bea’s pediatrician was involved.)

• If you need to take action, work under the guidance of a doctor or certified nutritionist. Getting the help of a dedicated professional can take the pressure off of parents trying to figure it out for themselves.

• DO NOT MAKE A CHILD FEEL BAD ABOUT THEMSELVES. Be supportive. Feeling better leads to empowerment to do the right things.

• Be a role model. When our children see us eat right and exercise, they have a better chance of gravitating towards good habits themselves.

• Never embarrass a child – especially publicly – with any comments about their weight or food choices.

• Don’t single out your overweight child for special foods or smaller portions than the rest of the family. Ideally the whole family should be eating the same healthy diet.

• While parents can control the food environment of younger children more successfully, older children and teens really need to “opt in” and commit to better health on their own.

Parenting isn’t easy…and parenting a child who struggles with their weight is a tricky business. Many parents are in the position of trying to help their child on their own for many reasons, including protecting their child from being taunted about their weight. But no one should go it alone. Working together on solutions is key because in our desire to help our kids, we often make mistakes.  Together we can come up with positive strategies for lifelong health.

Hope these tips help.  Want to share yours?  We’d love to hear about your experience.

Dr. Kerri Boutelle, an associate professor of pediatrics and psychiatry at the University of California (and on the advisory board of fitsmiForMoms), and coauthor of the study said, “We looked at things such as parenting skills and styles, or changing the home food environment, and how they impacted a child’s weight.”

“The No. 1 way in which parents can help an obese child lose weight?” Boutelle continued. “Lose weight themselves. In this study, it was the most important predictor of weight loss.”

The study involved 80 parent-child groups with overweight or obese children between the ages of 8-12, who participated in a five-month weight loss program. Recently published in the Obesity Journal, the study suggests that clinicians should focus on encouraging overweight parents to lose weight themselves in order to make the biggest difference for their child.

What do you think parents and families can do to shrink the unhealthy influence of this media onslaught targeted at our kids?

When one family member loses weight, tensions can rise, but it's an opportunity for all.

By now almost everyone has read or seen something about the controversial new ad campaigns in Georgia and elsewhere intended to shock our country out of denial regarding the obesity crisis in the U.S.

If you’re on this site, you may already be a concerned parent who doesn’t need a campaign ad to spur them into action.  Now what?  What’s our role as parents?  Can teens manage their weight and get healthier on their own or do we need to shadow them like we did when they were learning how to walk or ride a bike?  Are you sure you want fries with that?  Did you eat any vegetables today?  Whoah, watch the portion size on that entree…and did you check out the fat and sodium?  Have you really been sitting on the couch all day while I’ve been gone?

The headline from a recent Time Magazine article discussing recently released research on overweight teen girls asks,

 “Do Teen Weight Programs Work Better Without Mom or Dad?”

Good question and we think the answer is somewhere in the middle.

From the study:

“Most clinic-based weight control treatments for youth have been designed for pre-adolescent children by using family-based care. However, as adolescents become more autonomous and less motivated by parental influence, this strategy may be less appropriate.”

In other words, teens can almost resent our help which is counterproductive if we’re worried about them being overweight and/or unhealthy.

What we see every day on fitsmi.com is that once teen girls are pointed in the right direction, they want to take the reins on their own health and how they feel about themselves.   For example, the fitsmi Change Machine helps them set their own personal goals and stay on track whether they’re at home or on the go.  They can make small changes every day that add up to big changes in their lifestyle…and they can talk and support each other.

This is not to say that parents shouldn’t be involved.  Quite the opposite. Kids who eat healthy meals and exercise with their family, do better.  It’s also important to engage the child’s pediatrician in building a positive plan.   In short, a family’s support can only help, but if a teen takes ownership of his/her health and weight, there’s a better chance for long-term success.

Not every child needs a helicopter mom, but we don’t know one child, including teens, who doesn’t need an advocate and loving role model.

When late-night hunger hits, few people have the motivation to prepare a home-cooked meal – especially if there’s a 24/7 fast food restaurant nearby. But late-night snacking on nutritionally-poor food full of sugars and saturated fats leads to lower energy levels in the morning, not to mention potential weight gain over time if this becomes a habit. Fortunately, there are plenty of healthy and filling snacks to give your teen the late-night brainfood and energy burst she needs, all from the comfort of your own kitchen.  All it takes is a little planning ahead and shopping to make sure the right stuff is at hand!

Yogurt/fruit dippers – combining Greek yogurt (which has half the carbohydrates and 1/3 the fat content of normal, sweetened yogurt) with seasonal fruits leads to a sweet and sour combination that’s out of this world. Lately I’ve been eating my yogurt with pomegranate seeds. They’re rich in antioxidants and provide an awesome crunchy kick.

Baked tortilla chips and salsa – What is salsa but a spicy salad? (Try saying that six times in a row.) Chunky salsas pack a lot of vegetables and flavor into a small space, with very few added calories. Try making it yourself at home for an extra flavorful (and healthy!) experience. Tortilla chips are normally fried in corn oil, which can really pack on the calories and fat. But there are tons of commercial brands (Tostito’s is probably the best known) that now carry baked chips, ensuring you get your nacho fix without all the unwanted extras.

Panini-style turkey sandwich – The keys to this sandwich are lean meats and whole grains – both are great for your heart. The fiber and protein will also keep your teen full for a long time, which is great for keeping away those evening hunger pangs.  A smear of chutney or mustard will kick up the taste.

Chocolate dipped bananas – A great alternative to that pint of Haagen-Daaz! They’re simple to make too. Simply melt a bar of high quality chocolate on a stovetop, dip whole bananas until they’re evenly coated, then leave in the freezer for about an hour. I like to stick skewers in the ends and eat them like popsicles.