Eleven years ago, Dr. SungWoo Kahng moved to Baltimore with his wife to join the staff of the neurobehavioral unit at the Kennedy Krieger Institute. Kahng became so engrossed in his work, treating some of the most severely autistic children in the country, that at first he didn't notice when he started to pile on the pounds.
"Quite honestly, I was a slug," says Kahng, now 41, who began thinking about his weight when he had trouble walking up two flights of stairs. "I stepped on the scale and I broke the 200-pound mark—I had never weighed 200 pounds before in my life. I said, 'Holy crap, I've got to do something about this.'"
Kahng enlisted his wife, who had also been looking to lose weight, and constructed a plan to begin eating better and increasing their physical activity. They shopped for healthier foods together, encouraged each other, and both took up running. Within a year, Kahng lost 50 pounds and his wife lost 40. Five years later, they've both kept the weight off and they've each run a marathon.
After he lost the weight, Kahng had an epiphany.
"What we did was basically what I do for a living every day," he realized. "In looking back upon the changes in my lifestyle, I noticed that we're using the same techniques, the same procedures that we use upstairs with the kids in our unit. So, I said, 'Why can't we start doing some of this work with kids with a more common problem?'"
Out of that realization came the Healthy Kids program, a free 10-week weight loss program for obese children in downtown Baltimore. The keys to the program are family involvement—parents must come to every meeting and do a weigh-in along with the kids—and creating an environment more conducive to healthier behaviors, just like Kahng does with his autistic patients.
"My training is with applied behavioral analysis," Kahng explains. "ABA is designed to identify why people are engaging in negative behaviors and then use that information to develop a program to increase more appropriate behaviors and to decrease inappropriate behaviors. The key principle is reinforcement, providing access to preferred events before engaging in whatever the specified behaviors may be."
As applied to obese kids, that means figuring out what triggers kids to eat unhealthy food and avoid exercise, and creating an alternate environment where other choices are possible, and rewarding kids when they make healthier choices.
In the two years since Kahng initiated the program with help from Kennedy Krieger and several of his graduate assistants, 27 families have gone through Healthy Kids, and many of them have seen significant, lasting results. The key, Kahng says, is getting total commitment from the families.
"You have to make it a team effort, so it's not just the child doing it, it's the parent and the child, and maybe the siblings too, helping themselves," he says, adding that for all but one of the families who have been through the program, the parents were overweight as well. "The families that really commit to the program, they do very, very well."
Two years ago, when Tekerra Mickles was 10 years old, she weighed 150 pounds, about twice as much as someone her height and age should weigh. Her pediatrician, concerned about the possible onset of type-2 diabetes and other health problems, suggested that Tekerra and her family attend the Healthy Kids program at Kennedy Krieger. Tekerra's mother, Tamika Mickles, was hesitant, but signed up for the program to help her daughter.
"I thought it was just going to be like a diet," says Mickles, who also struggles with her weight. "I thought they were gonna make us eat cottage cheese and all kinds of food I hate."
The mom was relieved to find that the program doesn't include strict requirements of what participants can and can't eat. "They gave us a book that talked about all kinds of different choices we could make when we go shopping," she says. "I didn't realize it was going to be a program for the whole family."
Mickles says her younger daughter Tyonah, who was 8 when Tekerra started Healthy Kids, has never been overweight, but she got involved in shopping for and cooking healthier food, too. Even the kids' father, who doesn't live with them, would participate when he was with the children.
"It's easier, because the child doesn't feel singled out," says Mickles. "We weren't buying special food for that child. She didn't feel isolated."
In order to give as much specialized attention as possible, Kahng and his team only allow three or four families into each 10-week session. They also make it as easy as possible for families to participate, hoping that it'll encourage them to be committed. Not only is the course free, but Kennedy Krieger also provides free parking and holds the sessions in the evenings so that working parents can attend.
At the beginning of every weekly session, each family meets individually with Kahng or one of the other facilitators to weigh in and go over weekly goals (generally a half-pound per week for kids and a pound per week for adults) and discuss individual issues with food choices or exercise options. After that, the kids get together in one room and the parents in another. While the parents go over things like portion size and strategies for grocery shopping, the kids get a more hands-on lesson, which often includes trying new foods like kiwi and sushi.
"We still eat kiwi and mango," says Mickles, citing two foods her family tried for the first time during the class. "I can't get into sushi though."
One of the biggest challenges is finding ways for families to increase their physical activity. Most city schools have drastically cut back on their physical education programs or cut them altogether, and few low-income families have the space to run around near their homes.
"There's not a lot of green space, and that's really a challenge for a family living near Hopkins," says Kahng. "We talk about making easier lifestyle changes, like walking to work, walking to school, simple things like using the stairs instead of the elevator—we don't want people to have to join gyms."
The Mickles family started taking long walks around the neighborhood after dinner and on weekends. "It was really great for us," says Tamika. "We were seeing a lot of different things and meeting a lot of new people while we were walking." Mickles, a Pre-K teacher's aide at Bay-Brook Elementary-Middle in South Baltimore, even engaged a group of her coworkers and students to start a walking group during their lunch hour.
The family's hard work paid off. Tekerra initially lost 15 pounds and, now 12, she has grown five inches and weighs a more healthy 160 pounds. Mickles initially lost 30 pounds, but has gained some of it back. "Some of that weight that got lost, I found it," she cracks.
The biggest barrier to eating better, she says, is the cost. "Eating healthy is so expensive," she says. "I mean, why do white meats cost so much more?"
Kahng says the question of economics comes up a lot during the sessions, and he doesn't really have a good answer, except to do the best you can.
"Parents often ask us, 'How do I get those healthier foods?' It does tend to be more expensive, and it's definitely not as convenient as a lot of the processed foods that are also cheaper. Unfortunately, that's really beyond the scope of our program," he says. "Our goal is to get parents and kids to make the healthier choices from what you have available to you."
Down the road, Kahng hopes to expand the program and partner with schools and other community organizations, where it could have a much broader impact.
"The key is just finding a way to motivate these families, to nudge them just a little bit further," he says, adding that the child obesity has gotten a lot more attention nationally, thanks, in part, to Michelle Obama's attention to the issue. "We want to change these unhealthy behaviors before kids have had a long history with them, so they can live long, healthy lives."