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Atlee High School sophomore Karrah Bauserman has gained muscle weight and lowered her body mass index since she began working out at VCU’s Healthy Lifestyle Center. Photo by Kirsten Lewis
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Montrose Elementary School teacher Kate Puschak leads her third-grade class in a Learnercise program that pairs lessons with movement. The students pictured are (from left) Tramil Brown, Aliyah Leak, Kameryn Kelley, Zackary Barton and Taylor Goodman. Photo by Kirsten Lewis
As an overweight child, Karrah Bauserman remembers being singled out and ridiculed by her classmates in elementary school. Often, the bullying would follow her home.
"I had things thrown at me on the bus," the now 16-year-old recalls. "Pencils, notebooks, textbooks, backpacks … any type of school supply, I've had thrown at me." At her heaviest, when she was 13, Bauserman's 5-foot-3 frame carried about 200 pounds.
When she was younger, she couldn't play tag with the kids in her neighborhood or make it to first base during kickball. She played basketball in the Hanover Youth Recreation League, but she would get pulled out of games when she became too out of breath to make it down the court.
"People looked at me like I was being taken out of the game because of my weight," Bauserman says. "I couldn't be as active as my other friends, and I couldn't do what they could, so I felt like I was left out."
By the end of fifth grade, after enduring barrages of name-calling and feeling isolated every day, Bauserman says she started to contemplate suicide.
"The teasing snowballs into a lot of other things," says Suzanne Mazzeo, a professor of psychology and pediatrics at VCU Medical Center and lead investigator for Nourish, a group-based intervention program for parents of overweight children from ages 5 to 11. "The quality of life for treatment-seeking overweight children is worse than [for] kids with cancer undergoing chemotherapy."
In Virginia, more than a third of fourth graders are either overweight or obese, according to the Centers for Disease Control and Prevention. In addition to being at increased risk for weight-related diseases such as type 2 diabetes, high blood pressure and cholesterol abnormalities, studies have shown that overweight children who are seeking treatment to lose weight have higher rates of depression and anxiety than their peers.
"We're at a critical time to address this issue systematically," says Melanie Bean, an assistant professor of pediatrics and psychology who serves as director of clinical and behavioral services at the VCU Healthy Lifestyle Center, a pediatric obesity treatment and research facility that opened in October.
Three months earlier, the Children's Hospital of Richmond at VCU received $1.2 million from the Children's Hospital Foundation to establish the facility, which brings together ongoing childhood obesity research endeavors and provides comprehensive care for children, adolescents and families.
Also in recent months, the Bon Secours Virginia Health System launched an initiative to fight obesity that combines learning and exercise at local schools. Movin' Mania, Bon Secours' incentive-based healthy kids program, was designed and vetted by a team of physicians, nurses, nutritionists and exercise physiologists. Aimed at reaching about 100,000 children and families in and around Richmond, the program brings the educational and medical communities together.
VCU's Healthy Lifestyle Center, located on Parham Road across from the university's Center for Endocrinology, Diabetes and Metabolism, offers assessments by weight management physicians, behavioral psychologists, dietitians and exercise physiologists. It includes a gym equipped with treadmills, free weights and weight machines, as well as a cardiorespiratory testing room where exercise specialists can measure physical fitness improvements.
While patients can receive individualized care at the center — paid for through health insurance or out of pocket — many adolescents are participants in TEENS, an ongoing multidisciplinary treatment and research program that identifies the barriers keeping overweight teens from healthier lifestyles.
"It's a goal-based behavioral approach where we work with the family to start to make changes in the direction toward health," Bean says of the grant-funded, yearlong program that started in November 2003.
TEENS, which stands for Teaching, Encouragement, Exercise, Nutrition and Support, works with children and adolescents ages 11 to 16 years old whose weight is above the 85th percentile for their age, height and gender. Core components of the program include standardized nutrition education for teens and their parents, supervised physical activity, monthly behavioral support services led by psychologists and parent education meetings.
When Bauserman began the TEENS program in August 2011, she couldn't run a mile without walking. She says she wanted to exercise more and change how she ate, but she didn't know where to start.
A few months into the program, Healthy Lifestyles Center exercise program manager Katie Bowen encouraged Bauserman to sign up for the Monument Avenue 10K while she was running on the treadmill. Every couple of weeks, Bauserman would decrease the time she spent walking and increase the time spent running, tacking a few minutes to the end of every run.
After running for 30 minutes, Bauserman did a circuit of bicep curls, kickbacks and shoulder presses. She took pleasure in seeing gradual improvements in her body.
"My calves are like bricks, and my biceps are pretty big," she says.
About 600 Richmond families have gone through the TEENS program since it began, and on average, participants see reductions in body mass index and improvements in blood pressure, cholesterol, insulin resistance, cardiovascular fitness and quality of life.
"One of the biggest predictors of whether a participant is going to be successful is how engaged their parents have been," says Dr. Trey Wickham, associate professor of internal medicine and pediatrics at the VCU Medical Center and director of research at the Healthy Lifestyle Center.
Another program called Nourish grew out of TEENS in 2007. The VCU research program, funded through a $2.5 million grant from the National Institutes of Health, reaches out to parents of overweight children, including through fliers distributed at schools, and attempts to break the cycle of obesity at a younger age.
According to a study published in the American Journal of Clinical Nutrition, overweight children who do not become obese adults have a mortality risk equivalent to that of their thinner peers.
"The rates [of obesity] are just going up, and the older the children are, the more likely they are to be overweight adults," Mazzeo says. "We don't want people to get a fatalistic perspective. [Overweight children's'] mortality rate is the same [as their peers] if they lose weight before they become adults."
Sweat and Learn
In Kate Puschak's third-grade class at Montrose Elementary School in eastern Henrico County, students jump, stomp, stretch and sweat as they sing along to songs about multiplication tables. During instrumental breaks between songs, the 8- and 9-year-olds break-dance on colorful mats gridded with numbers and letters.
"It's important that kids are getting exercise every day, and this program allows them to do that at school," Puschak says of the students' SOL-compliant Learnercise mats.
The mats, distributed to classrooms in Chesterfield, Hanover and Henrico counties and the city of Richmond in September, are an extension of Movin' Mania. The classroom tool encourages learning while moving and helps educators incorporate movement in the classroom. Through guided lessons, students jump, clap, sing and have fun on the mats while learning academic content.
"Anything that gets them up and moving and includes music is ingrained in their brains," Puschak says, adding that she sees her students singing the multiplication songs during their tests.
The mats are distributed along with instructional DVDs, a set of nutrition cards, dice, desk mats and a curriculum guide. At movinmania.com, families also can find recipes, a calendar of local fitness activities and educational computer games focused on healthy lifestyle practices.
"We're at a turning point, especially in third, fourth and fifth grade," says Montrose Elementary Principal Dana Baldacci. "I think this program is going to allow us the opportunity to catch some bad habits before they form. It's a good preventive stopgap."
Bauserman remembers feeling nervous as she approached the starting line on the drizzly March morning of the Monument Avenue 10K.
"I didn't think I was going to run the whole first mile," she says.
Then nearly nine months into the program, Bauserman had lost body fat, gained muscle weight and lowered her body mass index about three points, but the Mechanicsville resident had never before run or walked a full 6.2 miles.
With the support of Bowen and a fellow TEENS participant, Bauserman alternated between running and walking through Richmond's iconic neighborhood. She recalls rounding the final few feet of the race and spotting her family waiting for her behind the Robert E. Lee statue. Encouraged by the cheers of her family and the crowd of spectators, Bauserman sprinted to the finish.
"I crossed over and started crying because I finished," she says. "It made me feel accomplished. I actually did it."
These days, Bauserman looks forward to her hourlong workouts three times a week. The Atlee High School sophomore says eating healthfully and exercising are now lifelong priorities. After graduating, she hopes to study neurosurgery at VCU.
On a late-November evening at the Healthy Lifestyle Center, Bauserman beams with pride as she talks about the lifestyle improvements she's made in the past 15 months. She's wearing athletic shorts, basketball shoes and a T-shirt printed with her school mascot — a size medium, she proudly points out.