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An obesity epidemic is gripping the United States, and a significant percentage of those living with the condition are children. About 1 in 5 (19%) children in the U.S. has obesity and are therefore at higher risk for many other chronic health conditions, such as asthma, sleep apnea, and bone and joint problems. Compared to their normal weight peers, children with obesity are more likely to have obesity as adults, and more risk factors for heart disease, such as high blood pressure and high cholesterol, as well as many types of cancers, and Type 2 diabetes. Children with obesity are also more likely than others to experience social isolation, depression, and low self-esteem.

Eating habits, lack of exercise, heredity, family and home environment, and community and social factors can lead to childhood as well as adult obesity. Other potential factors include:

• too much time spent being inactive
• lack of sleep
• lack of access to physical activity and nutritious foods
• easy access to inexpensive, high calorie foods and sugary beverages

Unaddressed, childhood obesity can become a chronic adult condition that also raises the risks for problems with the digestive system, like heartburn and reflux, as well as non-alcoholic fatty liver disease, or NAFLD, according to Sonal Kumar, M.D., a hepatologist and assistant professor of medicine. Over time, fat in the liver can destroy normal, healthy liver cells and ultimately lead to cirrhosis. “Most people think cirrhosis comes from alcohol use or hepatitis C, but it can come from anything that causes damage to the liver, including fatty liver,” Dr Kumar explains. “Unfortunately, we don't have any medications for the treatment of fatty liver, but we do have good data that shows that losing weight can not only get rid of the fat, but also reverse any inflammation and damage,” she says. “All of these problems stem partly from excess weight. They also really respond to weight loss.”

Yet, when patients have such multiple metabolic problems--diabetes, heart disease, fatty liver disease, or reflux--they require multiple providers which often leads to fragmented care that doesn’t sufficiently address weight loss, Dr. Kumar says. “Often times patients get the blanket recommendation that they should lose weight. But that doesn't work without really a personalized plan or something that really speaks to the patient,” Dr. Kumar says.

To address the strong link between obesity and metabolic diseases and give patients the medical and psychological support they need to overcome obesity, �ձ�avɫ��Ƭ created the Innovative Center for Health and Nutrition in Gastroenterology or ICHANGE program.

The only program of its kind in New York City,  ICHANGE provides an integrated approach to the management of diseases that are related to excess weight and obesity. It brings together gastroenterologists, endocrinologists, cardiologists, and dieticians. “It's a one-stop shop where patients can see all of the providers they need at the same time during the same visit,” Dr. Kumar says. “Having all of these providers work together allows us to give patients a personalized approach to weight management.”

ICHANGE providers will see anyone with a digestive complaint--reflux, bloating, abdominal pain, changes in bowel habits, as well as fatty liver disease--that diet and weight loss could improve. They will first address a patient’s digestive ailments and then design a personalized weight management plan, says Carolyn Newberry, MD, a clinical gastroenterologist and assistant professor of medicine. “We use multiple tools help people manage their weight,” Dr. Newberry says. The program emphasizes dietary change: eating fewer processed foods, increasing fruit, vegetable, and whole grain intake, and exercise. “Our program emphasizes things that are both achievable and realistic for patients,” she adds.

Adds Dr. Kumar, “Weight management does not have to be daunting. At ICHANGE, we work hard across all disciplines to help patients achieve their weight loss goals.”

Because obesity can begin in childhood, parents should help their children develop healthy eating and exercise habits early by:

• Providing easy access to nutritious, low-calorie foods such as fruits and vegetables
• Making sure drinking water is always available as a no-calorie alternative to sugary drinks
• Limiting juice intake
• Helping children get the recommended 60 minutes of physical activity each day
• Ensuring children’s healthy sleep habits
• Being a healthy role model by eating healthy meals and snacks and exercising daily