For Kyle Pratt of Scottsdale, the moment of truth came when he saw a picture his cousin posted on Facebook.
It was taken during one of those casual moments that often happen during a family gathering. Kyle and his brother David were sitting at a table. Their older cousin, standing behind them, was swirling his baby boy through the air above them. No big deal.
But it was a huge deal for Kyle, then 14. When he saw the picture, he was shattered.
“I’d never really looked at myself like that,” says Kyle, who turns 16 this month. “I was getting kind of blimpy. Two days after that I stepped on the scale and saw that I was 270 pounds. I was totally shocked.”
He went outside, seeking solace in solitude. He paced around the neighborhood, pondering his situation, praying for answers. With high school looming a year later, Kyle says, “I didn’t want to be the fat kid in the freshman class.”
He walked for two hours. When he came inside, he told his mom, “I’m sick of being heavy. I want you to call the nearest weight loss place or someone who can help me and get me in there as soon as you can.”
Until he hit middle school, Kyle, the second of four children of longtime Arizona broadcaster Dave Pratt and his wife Paula, was an active child whose weight was perfectly average. He started playing soccer at age 4. He played baseball until he was 12. He played basketball for a year.
Then, after switching schools in sixth grade, he became a victim of bullying. It launched a period of anxiety that manifested as panic attacks.
“We wanted him to be able to focus on his academics, so we decided to homeschool,” says Paula, who promptly hired a private teacher, ignoring the raised eyebrows and questions from peers who cautioned her that Kyle’s social development during the critical middle school years was at risk.
“All I cared about was knowing he was safe,” she says.
A doctor prescribed medication to address Kyle’s anxiety. Unfortunately, “the medicine can make you very sleepy, lethargic, unmotivated,” Paula says. “It slows your metabolism down.”
At the same time, Kyle was going through a growth period. As he shot up five inches, the weight gain wasn’t immediately apparent.
“Looking back I wonder, ‘How did I not see it?” says Paula. “But I was so focused on the anxiety issue. My focus was to get him out of those panic attacks.”
Kyle was working out with a trainer, but he continued to gain weight.
“The trainer told me Kyle was really health-conscious, that he was working hard,” Paula says. “He told me that until Kyle got those meds out of his system his metabolism just wasn’t going to snap back.”
Kyle set three ambitious goals for himself as he approached the summer before his ninth-grade year: He wanted to drop the excess weight. He wanted to get off his anti-anxiety meds. And he wanted to get admitted to Notre Dame Preparatory, an academically rigorous Catholic high school in north Scottsdale.
Paula wanted to support her son but was understandably concerned about the prospect of putting a still-growing teenager on a restrictive diet—especially during a time of other stressful challenges.
“I wanted to do it under a doctor’s supervision,” she says. So she talked to her family pediatrician, Vivian Gee Ziltzer, M.D., whose husband, Robert Ziltzer, M.D., specializes in medical weight loss. Paula made an appointment to visit Scottsdale Medical Weight Loss Center, the practice Ziltzer runs with Craig Primack, M.D.
The professional challenge of helping patients achieve long-term weight loss is something Ziltzer and Primack take very personally. Both physicians have parents who suffered from weight-related heart disease, prompting a reassessment of their own lives and habits.
Ziltzer lost his father to a heart attack, so “I have a vested interest in keeping myself healthy,” he says. “We’re not asking anyone to do anything we haven’t done.” A dedicated runner, he often trains for and competes in marathons.
Primack’s father survived a heart attack in his early 50s. For Primack, who was then overweight himself, it was a profound wake-up call. He lost 30 pounds, which he has successfully kept off since 2005. “We have to live the lifestyle we want for our patients,” says Primack, an avid cyclist and runner who has completed one full marathon and several half-marathons.
As partners in internal medicine and pediatrics, Ziltzer and Primack worked with a number of families that were struggling with weight-related issues. Both doctors are board-certified in bariatric medicine, the study and treatment of obesity.
Ziltzer launched the practice in the 1990s (Primack joined in 2001), during the days of Fen-Phen, a combination of appetite depressant/amphetamine that was heavily marketed as a “miracle” diet drug until it was found to contribute to heart valve abnormalities.
“At that time physicians were just starting to understand the tools available for losing weight,” Ziltzer says. “But it was kind of a shotgun approach—just do the diet and exercise or just go to the classes or just use the medications for weight loss.” Taken individually, each of these approaches can bring modest weight loss, he says, “but when combined, the effect is more dramatic.”
They started realizing the need for a comprehensive, long-term approach to effective weight loss that addressed all the factors involved: exercise, diet, medical support and behavioral coaching to facilitate lifestyle changes.
Eventually, “we closed our other practice,” Ziltzer says. “We felt this was where we belonged—where we could make a difference.”
In 2006, they launched Scottsdale Medical Weight Loss Center to provide physician-supervised weight loss programs that include custom diets, meal replacements, education and support.
As they saw their adult patients achieve success they became interested in the growing problem of childhood obesity. They started taking on younger clients and in February formally expanded their practice to focus on children ages 12 to 18. (They sometimes treat younger children but typically find that most are not yet mature enough to undertake the kind of changes required for long-term success.)
“To date, no one has taken a comprehensive approach to childhood obesity: exercise, family-based behavioral education, a specific meal plan, exercise…and put all those pieces together,” Ziltzer says. “We have developed a comprehensive range of kids’ programs that don’t exist anywhere in the Valley, except piecemeal.”
Patients who come into Scottsdale Medical Weight Loss first undergo a lengthy assessment with an office coordinator, who explains the program’s philosophy, answers questions and describes the commitment required to be successful—“so they know what they’re getting into,” Primack says. “Then they assess the child’s level of commitment—is the child involved in the conversation or playing a video game? The best predictor for success is when the motivation is coming from the child, not the parents.”
A complete diet history is taken so that the physicians understand why the weight gain occurred. Questions may include:
• Does the child drink a lot of soda or other sugary beverages?
• Does the child skip breakfast?
• Is the child on any medications that can contribute to weight gain?
• What is the family history in regard to weight and weight-related medical issues?
A thorough physical exam is next. The doctors look for medical problems like insulin resistance, which can be a precursor to diabetes. “If a child is insulin-resistant and you do nothing, you can almost guarantee that child will develop type 2 (adult-onset) diabetes in the next 10 years,” Primack says. “We’re now seeing this disease—which used to strike people in their 40s, 50s or 60s—occurring in teens.”
Questions are asked to determine if behavioral habits or emotional conditions are contributing to weight gain. “Emotional eating is a big thing,” Ziltzer says. “We might ask, ‘Are you hungry when you’re eating?’”
Other contributors include:
• mindless eating (while bored, or watching TV)
• stress eating (to provide temporary pleasure and relief)
• avoidant eating (the child doesn’t want to think about or deal with something difficult)
• eating sugary foods or drinking caffeinated beverages for energy (often because the child didn’t sleep well, or enough, the night before)
Once the assessment is complete, the doctors prescribe a plan of action. Patients are put on a calorie-restricted diet of nutrient-dense meal-replacement products. Some are prescribed appetite-suppressant drugs to help them adjust. They get recommendations for an exercise plan and they are required to take a 12-week series of family-centered classes. Topics include reading food labels, proper use of exercise equipment, recognizing eating triggers, how parents can avoid being the “food police” and more.
When the Pratts went in for Kyle’s initial assessment and orientation, “I thought this was pretty extreme,” Paula admits. “Total meal replacements? An eight-ounce shake?”
But Kyle was eager to give it a try. So she decided to do the program with him—partly to provide moral support and partly because “I needed to lose some weight, too.”
Kyle was put on a 1,600-calorie-a-day diet; Paula’s daily intake was limited to just 800 calories.
Kyle describes a typical day: “Get up in the morning and the first thing you do is have a shake and a bottle of water. Wait three hours then probably have another shake. Work out. Come home and have some [cream of chicken] soup—it tasted horrible, like licking metal. It’s gross.”
The next choice might be a protein bar, which Kyle describes as the closest they got to a treat. (Paula’s take? “It’s waxy.”) The only other items in their food repertoire were bags of protein chips. Both Kyle and Paula were instructed to eat something every three hours and to drink lots of water.
Try to wrap your head around the image of a 6-foot-1-inch man/child being satisfied with a 160-calorie liquid breakfast from a container the size of a child’s juice box. A teenager strictly adhering to his severely restricted diet while friends and siblings eat pizza, pasta, burgers and fries.
How did he do it?
“It was a lot of mental stuff,” says Kyle, whose brilliant blue eyes, calm demeanor and natural grace of movement hint at deep internal reserves. “It took a lot of willpower. My older brother would put Pizza Hut, Dominoes right in front of me to tempt me. Even though I used to love pizza I didn’t have one craving for it because I really wanted to lose the weight. I’d tell myself, ‘It doesn’t matter what I eat. If I’m full, I’m full.’”
“I’m the soft-hearted mom,” Paula says. “I’d think, gosh, one day [of cheating] won’t hurt. But he was so focused. After all he’d accomplished with overcoming his anxiety he didn’t want to give one kid one reason to give him a hard time.”
Kyle also spent a lot of time working out, which would tire him out to the point where, he says, “I really slept a lot.”
His original goal was to lose 40 pounds. Paula gasped when she first heard the number. “I was like, 20 is enough! When people say 40 it sounds like so much. Then when he hit his goal, Dr. Z said, ‘What do you think?’ and Kyle said, ‘I want to lose more.’ At that point he added one meal a week—a free meal of any choice. We’d go to Sweet Tomatoes or Baja Fresh to get a salad.”
Kyle was feeling pretty good. He realized he was no longer hot all the time, no longer subject to profuse sweating. “I took one of those 40-pound bags of water softener salt and carried it around just to see how much I’d lost,” he says.
But he wanted to drop another 20 pounds, which was well within the healthy lower limit the doctors had set for him. “They told me the weight I should be at my lowest,” he remembers. “They’d say, ‘You don’t want to get too crazy here—that turns into anorexia.’”
By the time Kyle started high school, he’d dropped a total of 60 pounds and was still losing.
“I felt a lot more confident, even though I was still one of the bigger kids on campus,” Kyle says. “My brother tells me, ‘You should be proud you’re big’ but I wish I had a smaller frame, like him.”
“What’s really amazing about this program for teens is that if you stick with it, you’re going to lose,” says Paula, who fulfilled her own goal to lose 20 pounds. “At three pounds per month he would have thrown in the towel. This whole generation wants instant results. They want everything now. Once you start seeing it, it’s easy to stick to it.”
“It’s kind of like a rush,” Kyle adds.
On the day Kyle realized he’d lost 70 pounds, his mom put things into perspective.
“You’ve now lost the equivalent of your sister [10-year-old Madison],” Paula told him. “Think about having your little sister around your neck.
Kyle smiles as his mom tells the story. “I’d lost Madison,” he says quietly.
This fall, Kyle begins his sophomore year at Notre Dame Preparatory with the satisfaction of knowing he’s maintained an extraordinary weight loss for more than a year.
Now 6-foot-2, he is still one of the largest kids in his class. But he feels comfortable in his own skin—more athletic, more agile. He’s gotten over early fears of regaining the weight. He knows now that he can indulge one day and cut back the next. That “just working out makes me feel good about myself” and that he enjoys bananas, grapes and apples as much as some of the treats he used to consume.
He’s now 85 pounds less than his starting point. How does he know that he’s finally at the right weight?
“It’s all about self-confidence, self-esteem,” he says. “Right now I feel great. At the 40-pound weight loss I could still see and feel that I was a little chunky. Now I feel really good about myself. I eat whatever I want but I still get the fruits and vegetables in. I still drink a protein shake before I work out. I still get my water in. I read food labels. If it’s over three grams of saturated fat I won’t eat it. I’ve become really fond of fruit—after coming off that diet, the bark on trees would taste good! Right now I’m just maintaining and enjoying life and food. I know as long as I get my workouts in, I’ll be fine.”
His mom sees other changes in her son. “I think he’s more compassionate because of all that,” she says. “I think there will always be a place in his mind thinking ‘that was me.’ I could have been that guy at 40 being 150 pounds overweight.” She predicts he will eventually enter a profession that allows him to help others overcome personal challenges.
Kyle’s Facebook now includes a post showing the “before” photo that so distressed him in March 2010 next to an “after” photo dated October 2010. It shows a lean, handsome, confident young man who has journeyed to the depths of his soul and learned to tap an inner strength he never knew he had. This is a kid who knows himself, who has confronted and overcome the greatest challenge of his life and who is grounded in ways that many adults would envy.
But he’s still a kid—with a great sense of humor. Across the top of the Facebook page he typed, “HAHAHAHAHAHAHAHA…..” -Karen Davis Barr
Charting Kyle’s progress
When Kyle Pratt went in for his first weigh-in at Scottsdale Medical Weight Loss on April 23, 2010, he measured 6-foot-1 and weighed 262 pounds. Of that, 94 pounds (35 percent) was fat mass. His waist measured 44 inches, his hips 50 inches. His BMI was 34.6 (a healthy range is 18 to 24). Here’s what happened after that:
May 20, 2010 (1 month): 245 pounds • BMI 32.3
June 24, 2010 (2 months): 225 pounds • BMI 29.8
July 29, 2010 (3 months): 215.5 pounds • BMI 28.4
Sept. 21, 2010 (5 months): 207 lbs • BMI 27.3
October 20, 2010 (6 months): 196.5 lbs • BMI 25.9
December 21, 2010 (8 months): 187.5 pounds • BMI 24.7
By Jan. 28, 2011, Kyle reached his goal. He weighed in at 182 pounds, having lost a total of 80 pounds. (He has since lost five more.) He reduced his fat mass to 23 pounds (12 percent) and his BMI was a healthy 24. His waist was 36 inches and his hips 44 inches.
The risks of childhood obesity
• Health problems associated with excess weight and obesity include cardiovascular diseases, asthma and chronic lifelong diseases such as type 2 diabetes.
• Children who are overweight have a very high likelihood of becoming overweight or obese adults.
• Today’s children may represent the first generation to experience a shorter life span than their parents.
• Obese children face higher odds of being bullied, no matter their gender, race, family socioeconomic status, school demographic profile, social skills or academic achievement.
—Sources: American Academy of Pediatrics, Scottsdale Medical Weight Loss Center
How to support a child who is ready to lose weight
• Don’t be overly critical. Make conversations about health, not weight.
• Don’t be the “food police.” Instead of saying “no” to foods the child shouldn’t eat, say “yes” to foods the child should be eating—like more fruits and vegetables.
• Don’t restrict a child who’s truly hungry. Find something healthful to offer.
• Do restrict TV time and other sedentary activities.
• Keep plenty of healthy, low-calorie, low-fat, high-fiber foods stocked in your kitchen.
• Avoid buying anything based on simple sugars—whether it’s breakfast cereals, snacks, soda or ice cream.
• Be aware of power messages in television advertising that entice kids to eat unhealthy foods. Talk with your kids about how advertising works to influence their choices.
• Encourage your child to be active for at least one hour a day. That doesn’t mean the child has to be an athlete. The best exercise is one he or she chooses to do—even if it’s just taking the dog for a walk.
• Don’t allow siblings and other family members to eat junk foods in front of the child who is overweight. If they want to eat junk food, make sure it happens out of the house and out of sight of the overweight child.
• Be a good role model. Take time to exercise, eat fruits and vegetables and get enough sleep.
—Source: Scottsdale Medical Weight Loss Center
What contributes to childhood obesity?
• Television advertising that promotes high-sugar, high-fat snacks and fast food.
• Sedentary activities—TV, video games, computers.
• Parents aren’t comfortable sending kids outside to the park or to roam the neighborhood.
• Poor or insufficient sleep, which affects the hormones that regulate appetite.
—Sources: Scottsdale Medical Weight Loss Center, Valley Sleep Center
Childhood obesity by the numbers
• 30.6% of Arizona children are overweight or obese.
• 1 in 3 children and youth (ages 2-19) in the United States is already overweight or obese.
• About 30% of the pediatric population (2-19 years old) has a BMI at or above the 85th percentile.
• 17% of Arizona children are in the 95th percentile or above.
• Children who have a BMI in the 95th percentile or above are clinically obese.
• Kids Health ranked obesity-related health problems first on its 2011 Top 10 Kids’ Health Issues to Watch list.
—Sources: American Academy of Pediatrics, National Conference of State Legislators, Scottsdale Medical Weight Loss Center
AZ Way to Go
An obesity-prevention website created by the Arizona Chapter of the American Academy of Pediatrics Obesity Committee to provide resources to clinicians and families in both English and Spanish. Lots of great printable sheets of information and even stickers.
Arizona Nutrition Network
Online games, videos and activities for children (in English and Spanish) with a focus on health and nutrition. Section for parents (also in English and Spanish) provides information on how nutrition and physical activity can help you and your family.
Baylor College of Medicine has a BMI calculator tool that allows you to plug in your child’s age, height (in inches) and weight so you can determine your child’s percentile rank. According to the site, any child ranking above the 85th percentile should be evaluated by a health professional.
Centers for Disease Control
Offers data and statistics, science-based strategies, policy information and national, state and local programs.
National Heart Lung and Blood Institute (National Institutes of Health)
we can! (Ways to Enhance Children’s Activity & Nutrition) program offers tips on eating right, getting active, tools, resources and more.
Cardon Children’s Medical Center
Fit Kid Challenge is an online summer program for kids. Sign up and receive healthy tips, recipes, fitness challenges and fun facts. You can even win prizes including a vacation for four to SeaWorld in San Diego.
Phoenix Children’s Hospital
Phoenix Children’s has teamed up with Kohl’s to offer a free online game with a Rock Band theme called Kids Rock Stars. As you enter your team’s activity time into the website tracking system, it translates into miles and those numbers then turn into band members on a game board. Kids exercise and play their way through milestones to add band players and advance careers, ultimately playing a sold-out rock concert with their six-member band.
KidShape is a nine-week program designed for children ages 6 to 14 and their families. At least one parent or guardian is required to attend each class with the child. Classes teach kids the things they need to know to be healthy. Cost is $425 for two parents/guardians and one child.