Boy turns tables on mother with special dietitian's help

It started out as a simple question. Third-grader Harry Burgess saw his mother, Marlo, had joined Weight Watchers and asked if he could too.

His mother asked his pediatrician, and instead, he suggested the Medical University of South Carolina’s Heart Health Program for Harry. Now the pressure’s on. Her son, now 12, has had great success and hassles her about getting more active and eating better. 

Marlo smiles. The tables have turned, and she wouldn’t have it any other way.

Her son has been the spark in getting her family on a healthier path. First, they realized how poorly they were eating, she says. “It was a huge eye-opener to find out about all the things you don’t know about. We realized how many calories he was drinking in a day was just huge and how much fat was in things like a slice of pizza that we just didn’t realize.”

Harry nods, enthusiastically. “Yeah, I can’t remember the last time I drank a Coke.”

“Yeah, success,” yells Janet Carter, a dietitian with the Heart Health Program who meets regularly with the family to track Harry’s progress. Within the first six months he was in the program, she watched Harry drop 10 pounds, a significant amount for that age, and he no longer has dyslipidemia, a condition involving abnormal cholesterol levels. Carter knows that will keep Harry from developing a host of chronic health problems down the road. 

One of the recent highlights for Carter was seeing Harry cross the finish line in the last leg of the Charleston Youth Marathon. Marlo says it meant a lot to the family to have her there cheering him on. Carter, who’s known for going the extra mile to help her patients, recently met a milestone of her own. She became the state’s first dietitian to be certified as a lipid specialist with the National Lipid Association, which makes her an expert on cholesterol as it relates to heart disease. 

“The certification exam is not different for doctors, dietitians, nurses, pharmacists and other health professionals, so it is extremely rigorous,” she says of the two years it took to prepare. It was worth it. She has found physicians are more comfortable referring complex cases to her because she understands the complexities of treating such conditions as dyslipidemia of obesity, where a child’s lipid panel is abnormal because he or she is overweight. 

These problems, unless dealt with at a young age, can cause lifelong issues and can be harder to solve in adulthood when lifestyle patterns get set. An estimated 25 percent of children in South Carolina are obese, and that doesn’t include children of a normal weight who have cholesterol conditions.

“We also have become a lipid clinic, which means that we see and treat children with lipid disorders who may or may not be overweight,” Carter says. 

This includes children with something called familial hypercholesterolemia, which is a genetic disorder characterized by high cholesterol levels. 

“This can be pretty serious.  As a dietitian, I work with them on the diet portion of the treatment of these disorders.  Diet may not always get folks to their goal and often medication is necessary, but diet and exercise can always improve the situation.  Sometimes, even in severe cases, it can help them to have success with lower doses of medication, which often means diminished side effects.”  

Heart Health has operated since 2004 as both the weight management program of the Children’s Hospital and the preventive cardiology service of the Children’s Heart Center at MUSC. This design is unique among children’s hospitals and important to the program’s developer and medical director, Melissa Henshaw, M.D. She says the best way to promote cardiovascular health is through lifestyle modification and risk reduction. 

What experts have learned, though, is that it takes more than telling parents to adopt a healthier lifestyle. Heart Health uses a hands-on approach using the collective expertise of the team to help families meet and reach their goals over time, building success in a step-wise, sustainable way.

“Emerging research is confirming the longstanding impact of childhood obesity and dyslipidemia upon the development of cardiovascular disease in adulthood. Heart Health was designed to keep the role of cardiovascular prevention at the forefront of our weight management focus.”

While some of these children will need medication for cholesterol control, lifestyle counseling can have a dramatic impact, especially when introduced during childhood, she says. Carter’s additional training will help the program expand its impact in counseling dyslipidemic families. “Identifying features of the metabolic syndrome and combined dyslipidemia of obesity in our families and targeting cardiometabolic risk factors for improvement, along with weight management counseling, allows Heart Health to have a broader focus than most other comprehensive programs in the U.S.,” Henshaw says.

Carter, who joined Heart Health in 2006, is glad to see the expansion and development of a focused dyslipidemia counseling core. About 10 percent of Heart Health’s referrals are not affected by obesity but have a history of elevated fasting LDL or bad cholesterol, often with a family history of early-onset atherosclerosis. 

Research over the past decade has identified important markers for children and teens that are precursors of cardiovascular disease, Henshaw says. “Many children and adolescents with obesity also have features of metabolic syndrome, including elevated waist circumference, blood pressure, triglycerides and glucose levels, as well as low HDL levels, which has been associated with early-onset cardiovascular disease in adults.”

An interesting obesity-related lipid disturbance, the combined dyslipidemia of obesity (CDO), has been better defined in recent years, she explains. Among children and adolescents with obesity, it is estimated that about one-third have features of CDO. 

While comprehensive lifestyle education remains the core treatment strategy for CDO, MUSC Heart Health will soon begin participating in a novel medical treatment protocol for CDO via the Pediatric Heart Network and the National Heart, Lung and Blood Institute, Henshaw says.

The CDO protocol will study whether statins, which are currently used for elevated LDL levels that don't respond adequately to lifestyle therapy, will also help as an adjunct to counseling to treat CDO in children, Henshaw says. “It will be a milestone study across multiple sites in the U.S. and Canada. It’s very exciting.”

Another development Carter is excited about is Heart Health’s expansion into telehealth. Carter says the problems of obesity and other conditions that put children at high risk for developing cardiovascular disease have to be addressed aggressively. Families need support.

“We have six slots for telehealth patients every Friday and have been able to successfully enroll more kids from outside the greater Charleston area, mainly Georgetown so far, who need our services.”

In the end, it’s the families and kids, such as Harry, who keep her inspired. Carter is careful to prioritize goals in small steps for children to feel successful. 

Harry’s mom, Marlo, says she’s glad the program is designed so that kids tackle a few goals at a time because making lifestyle changes can be overwhelming. “We did do small steps, but they’re also very motivating. I mean, I think they think their job is to inform us, but their job really is to motivate him. Coming back without his star chart filled out, especially when he was younger, was a big deal.”

Marlo says they stuck to one change long enough for it to become a habit. “The biggest thing that keeps him going is that he doesn’t even consider now drinking a Coke or not eating breakfast because that was one of his goals for a long time: to eat breakfast. He doesn’t even have to focus on it because it has become such a habit.” 

Long term, it means Harry will have a better quality life, says Carter.

“There’s been evidence that kids as young as 2 can start to develop atherosclerosis if they have dyslipidemia, so for him that’s huge to get it down at this age. If kids catch this situation before they’re in their early 20s, they can turn around the situation and get their arteries back to like perfectly healthy arteries. Whereas if you catch it later on in your 30s, 40s or 50s, you can improve the situation, but it’ll never get back to perfectly healthy arteries again,” she explains.

“So, for him, to be where he is now, is going to be huge for him.”

For more information about MUSC’s Heart Health Program, contact Carter at 843-792-4717 or e-mail catjan@musc.edu.