Genesis Heart Institute Launches Program to Reduce Heart Disease Risk Factors in Children       (Posted 2/24/06)

When 12-year-old Mitchell Roberts was diagnosed with high cholesterol last year, he managed to accomplish what many adults have tried but failed to do.  He dramatically changed his diet.  He became more active.  He embarked on a healthier lifestyle -- and most importantly -- stuck to it.  

A year later, a graph documenting Mitchell's reduced body mass index does his pediatric cardiologist proud.  

Mitchell's body mass index has decreased from 35.9 to 26.  His weight has dropped from 166 to 130 pounds.  His pants size has fallen from an adult size 38 to an adolescent size 16.  Not only has he lowered his risk for heart disease, he has gained skills he intends to practice for a lifetime. 

"My cholesterol and body mass index are much better now," says Mitchell, now 13, of LeClaire.  "I can play soccer because I have more energy and am not out of breath.  I can go on a 3-4 mile bike ride with my friends - something I couldn't do when I was heavier.  I'm thinner.  Some of my teachers didn't even recognize me when I came back to school after summer vacation." 

His pediatric cardiologist Vickie Diamandakis Pyevich, M.D., hopes to help more youngsters like Mitchell who are at risk for heart disease.  This spring, she and the Genesis Heart Institute will launch a Children's Cardiac Risk Factor Reduction Program - the first of its type in the state of Iowa. 

A Unique Program 
The program, modeled after a successful program developed by the Children's Heart Center in Las Vegas, puts children at early risk for heart disease and stroke in a 12-week program aimed at making lasting changes to their eating and exercise habits.  Rapid weight loss and dieting are not focuses of the program.  To enroll, both child and parent must agree to complete the program together.

For Dr. Pyevich, the program is a positive step against a national epidemic of childhood obesity and an increasing number of children with risk factors for heart disease.  As a pediatric cardiologist, she expects to see children with heart problems caused by congenital heart defects or structural abnormalities of the heart noted at birth.  However, she has grown increasingly alarmed by the increase in preventable heart disease risk factors being diagnosed in childhood. 

"Now, about 20-30 percent of my patients come to me because of shortness of breath, high cholesterol, chest pain, hypertension or high glucose levels.  It's often directly related to childhood obesity.  Statistics illustrate that 1 in 5 kids today is overweight," says Dr. Pyevich, who has an office at the Genesis Heart Institute.  She also is pediatric professor at the University of Iowa and director of the University's Preventative Cardiology Clinic. 

"Our concern is that 80 percent of overweight adolescents track this condition into adulthood, which places them at an earlier risk for heart disease and diabetes.  We know that atherosclerosis -- the process of plaque buildup in the coronary arteries -- begins in the first decade of life.  By identifying high risk factors early and helping patients make appropriate lifestyle changes, then perhaps we can prevent them from having an early cardiac event in their 20s or 30s."  

The Bogulusa Heart Study, the world's most lengthy and detailed study of childhood cardiovascular disease, demonstrated that coronary heart disease begins in youngsters as early at 5-8 years of age.  By that time, it's possible to see the fatty streaks in their arteries that can one day lead to heart attack. 

To combat the problem, Genesis' Children's Cardiac Risk Factor Reduction Program will target children with one or more risk factors for heart disease, including those with: 

• High cholesterol (total cholesterol greater than 170); 
• High blood pressure; 
• Diabetes; 
• A body mass index (BMI) greater than 95th percentile for their age.  (BMI is a measurement of weight in relationship to height.  The American Academy of Pediatrics has recommended that all children and adolescents have their BMI calculated once a year.) 
• A sedentary lifestyle; 
• Congenital heart disease; 
• A parent or grandparent with a stroke or heart attack diagnosed under age 55, and; 
• A family history of a parent with a total cholesterol greater than 240. 

To enter the program, participants first must receive a referral from their physician and undergo a medical evaluation, lab work and an ECG.  Additional cardiac testing may be ordered.  A dietician will interview children and parents to assess their commitment.  Each session will include exercise and fitness activities with an exercise physiologist and individualized nutrition counseling with a registered dietician. 

"The parent and child must agree that this is something they want to do," Dr. Pyevich says.  "If one or both is not willing to commit, then we will suggest it may be better to delay participation."

"The uniqueness of the program - at least what makes it successful on the West Coast - is that involves both the parent and child.  The parent is not expected to drop off the child and come back in an hour.  The parent will stay and participate in 45 minutes of exercise and 15 minutes of nutritional counseling with their child." 

She adds, "It truly is a family affair.  Parents have to be excellent role models.  It would be very tough for a child to sit down with the dietician without involving a parent who does the shopping and cooking.  Parents can also provide the motivation and reinforce what has been learned during that session.  The entire family can benefit from healthier eating and increased activity." 

A Family Affair 
Mitchell's efforts to curb his weight and control his cholesterol have become a family effort.  He lives with his grandparents, Walter and Lee Anna Roberts of LeClaire, who began their weight loss efforts several months before Mitchell more than year ago.  His 16-year-old sister, Breanna also has been introduced to healthier eating habits. 

"Mitchell stuck with his diet even when we fell off the wagon," Mrs. Roberts says.  "When we blew it over the holidays, Mitchell kept his motivation.  We're really proud of him and tell him we wish we could do as well as he has done." 

No longer does the family of four routinely sit down to a plate of 2-3 pounds of bacon or have gravy with every potato.  "Mitchell still eats about anything he wants but weights what he eats and limits his portions," Mrs. Roberts says.  "The other night he wanted French fries with his dinner, but he only ate half of what was on his plate and got up and walked away." 

A newly motivated Mitchell doesn't plan to go back to the former weight that made him feel self-conscious; experience backaches; and forced him to quit playing baseball because his knees hurt. 

More often than not, he chooses fruit, Jello and diet soda over his former favorites - sugary soda, bacon, gravy and fast food.  Nor does he come straight home; grab fattening snacks; and sit for hours in front of the TV. playing video games.  If he eats some of his beloved Doritos, the disciplined Mitchell puts them on a scale and weighs the portion first.  

"Once you accomplish something -- like going from an extra-large shirt down to a small shirt -- you get more motivation," Mitchell says.  "Sure, it's hard sometimes.  I have temptations, especially when I see other kids with candy bars, chips, regular pop - stuff I know I shouldn't eat.  But once you get going, it gets easier after a while.  It feels good to be thinner and to have the energy to do the things that other kids do." 

Dr. Pyevich is proud of Mitchell's success, and hopes the new Children's Cardiac Risk Factor Reduction Program at Genesis will help other youngsters make lasting changes that they will carry with them for a lifetime.  She would like to see the program at heart centers throughout the state. 

Over the past year, she and Genesis Health Group pediatrician Robert Anderson, M.D., immediate past president of the Scott County Medical Society, have been working with Iowa Quad City-school superintendents to promote awareness of the childhood obesity problem.  Both physicians are part of a new initiative to educate children on how to make heart-healthy choices. 

"I feel a responsibility to address this very relevant and very prevalent issue," Dr. Pyevich says.  "As chairman of the Department of Pediatrics at Genesis, this is one way I can make a louder cry that this is a serious problem."

Candidates for the program first need a referral from their physician.  For more information, call Dr. Vickie Pyevich's office at the Genesis Heart Institute at (563) 421-3980.  

-- Story by Linda Barlow, Genesis 

Click here for tips on raising a heart-healthy child