Just six months after launching the Pediatric Lifestyle Medicine Program at Kaiser Permanente and the Mid-Atlantic Permanente Medical Group, Christina Brown, MD, a pediatrician and board-certified obesity medicine specialist, has already seen remarkable changes in her patients’ health and well-being.
“I have one teen whose hemoglobin A1C went from 6.5 to 5.8 in just five months of us working together. It was unreal,” Dr. Brown said.
Another patient lost 20 pounds after committing to a personalized plan he and Dr. Brown developed together.
“He’s stronger, more confident and truly empowered in his own health. That shift in mindset is just as important as the weight loss,” she shared. “These teens are choosing their health habits and how they are going to spend the rest of their life.”
For Dr. Brown, these early successes reinforce the importance of addressing obesity during adolescence, which is a pivotal time when lifelong habits and health trajectories are still taking shape.
As the prevalence of childhood obesity has more than tripled in the past four decades, Dr. Brown wanted to help change that trend. The Center for Healthy Weight and Lifestyle Medicine at Mid-Atlantic Permanente Medical Group launched the Pediatric Lifestyle Medicine Program to help address these needs, with Dr. Brown as the first physician providing this care. This physician-led initiative helps eligible teens with obesity lose weight while building realistic, sustainable habits to carry them through adulthood. It took countless meetings with the IT team, health educators, dietitians and others to create the resources, questionnaires, notes and smart sets used for the program.
The Mid-Atlantic Permanente Medical Group is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine. Doctors with the Mid-Atlantic Permanente Medical Group exclusively see Kaiser Permanente members.
While lifestyle medicine has traditionally been associated with adults, intervening during formative teenage years can have an even more significant impact. Research shows that having a high BMI as a teenager can increase your risk for certain cancers, heart attacks and other diseases in adulthood, reflecting metabolic damage already underway in adolescence.
“This work needs to start in pediatrics because we have the opportunity to change a child’s entire health trajectory,” said Dr. Brown. “We are saving lives and improving the quality of life for these kids now and in the future. … It has been the most meaningful part of my career so far.”
Going beyond wellness visits
The goal of the Pediatric Lifestyle Medicine Program is to flip the script on the standard pediatric wellness visits by empowering teens to play an active role in their health.
“In a traditional doctor’s appointment, it tends to be focused on ‘eat your vegetables’ and ‘exercise more,’” Dr. Brown explained. “There’s some back and forth, but it tends to be very prescriptive. Then at the next visit, the patient has gained 20 to 50 pounds, and it’s very frustrating for both the patient and the doctor.”
Instead, the Pediatric Lifestyle Medicine Program centers on a personalized approach that considers each teen’s goals, lifestyle and readiness for change.
Currently, the program is available to teens 15 to 18 years old who have obesity, along with an additional condition such as sleep apnea, prediabetes, diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD) or polycystic ovary syndrome (PCOS). As the program grows, Dr Brown is also helping train primary care physicians across Mid-Atlantic Permanente Medical Group on the latest advances in pediatric obesity medicine, expanding access to care for more patients.
One of the most important eligibility factors, however, is motivation.
“They have to be ready and willing to commit. It can’t just be that their parents want them to do it,” explained Dr. Brown. “We spend a lot of time one-on-one with the teen. So, if they are just going to sit there saying, ‘I don’t know what I want to focus on,’ or ‘I don’t care,’ this may not be the right time for them to join the program. Maybe in six months they will be more ready to make a change.”
To get the most out of the program, patients need to reliably attend appointments and be open to trying new approaches to build healthy habits.
“You have to be willing to hear some things you may not want to hear, ready to engage and open to making a change,” she said.
That openness goes both ways. Dr. Brown approaches the program as a partnership with her patients.
“I start with listening and getting to know them. Then I ask permission to offer some advice,” she shared. “A lot of teens come in vulnerable and kind of raw. So, I meet them where they are.”
This can vary as some teens “come in really excited and motivated and some come in crying, upset and stressed,” said Dr. Brown.
Treating the whole person
Before entering the program, teens are encouraged to fill out an extensive pre-visit questionnaire that explores their medical history, as well as social and emotional challenges. The questionnaire asks patients to reflect on past attempts at weight management, diet history and family context. In some cases, the responses help identify potential medical issues.
“Some children have had obesity since they were 3, 4 or 5 years old, which can suggest an underlying genetic obesity syndrome,” noted Dr. Brown. “In those cases, we may involve genetics specialists.”
From there, Dr. Brown works with each patient across several pillars of health, including nutrition, physical activity, sleep, stress and social connections.
“I explain to them that if you’re not sleeping well or your stress is really high, you’re not going to feel like exercising or taking care of your health,” she said. “You have to think about all the aspects together because they all affect each other.”
Dr. Brown also emphasizes the importance of assessing social and emotional challenges for teens navigating obesity.
“I was shocked to see how many teens isolate themselves due to bullying, anxiety or depression that they’re experiencing related to obesity and social pressures,” said Dr. Brown. “When I asked one of my patients what her goal was, she said she wanted to be able to go back to school and not be bullied. It breaks your heart.”
Setting achievable goals
With a clear picture of each teen’s lifestyle and challenges, Dr. Brown works with them to develop goals using the SMART goal framework, which includes goals that are specific, measurable, achievable, relevant and time-bound.
“We create these patient-driven goals together by figuring out what their priorities are,” noted Dr. Brown. “We follow the SMART goal pattern, so their goals are relevant, time bound and really specific.”
Depending on each patient’s readiness, Dr. Brown typically focuses on two goals at a time. Some patients are ready to take big swings, while others prefer baby steps. For example, one patient’s starting point was simply adding a 10-minute walk once a week into their routine.
She then encourages teens to notice how these changes affect their sleep, stress levels and energy.
“I teach them to be really mindful of those things to help them decide to go a bit further with their goals,” she explained.
Establishing healthy eating habits
Food habits naturally play a major role in many patients’ plans. Dr. Brown explores not only what teens eat, but also when and how they eat. Challenges can range from skipping meals to high-calorie beverages to disordered eating patterns such as bingeing and purging.
While food tracking is optional, Dr. Brown often recommends it as a starting point.
“Tracking your meals at least part of the time helps you recognize patterns,” she said. “You notice that you may be having a high calorie snack after school or that you’re drinking more calories than you realized in specialty coffee drinks.”
She also examines routines surrounding meals.
“We ask questions like, ‘How often do you skip breakfast?’ because we know that people who eat breakfast are able to manage their appetites better,” she said, “Or ‘Where do you eat your meals?’”
These behavioral patterns often reveal important and achievable opportunities for change.
Collaborating with other specialists
Because obesity is a complex condition, Dr. Brown collaborates closely with other physician specialists across Mid-Atlantic Permanente Medical Group.
For instance, when a patient begins weight-loss medication, she connects them to a dietitian to ensure they are getting enough protein and fluids. And, if a patient is struggling with disordered eating or other mental health challenges, Dr. Brown refers them to behavioral health specialists for additional support.
Notably, sleep medicine has become one of the program’s most important partnerships. In fact, nearly every patient that Dr. Brown has referred to sleep medicine has tested positive for sleep apnea. While sleep apnea is typically associated with obesity in adults, it can often be overlooked in kids.
“Most of these kids don’t have the classic symptoms of sleep apnea, such as snoring or hypertension. But their parents may say, ‘He’s lazy, unmotivated and napping all the time,’” explained Dr. Brown. “Then we figure out they have sleep apnea and are not getting enough oxygen to their brain while sleeping. So, they’re actually not lazy at all. They have a medical condition we need to treat.”
Patients also have access to health coaches who provide telehealth support to help them stay motivated, focused and accountable between appointments.
Physical and emotional benefits
Even in its early stages, the program’s impact has been clear. From a behavioral health perspective, many patients report a positive shift in their social and emotional well-being.
“We are helping them build their confidence and self-esteem and empower them,” said Dr. Brown.
Further, the health improvements extend far beyond the immediate results. For instance, Dr. Brown noted that helping teenage girls reduce obesity today can significantly influence their future reproductive health.
“If you have obesity when you become pregnant, you have a higher risk of having a baby with a higher birth weight, which causes so many issues … including gestational diabetes, hypertension and a higher risk of needing a C-section,” she shared. “It is hard to even predict the impact this will have for the future of these teens.”
Other long-term health improvements among patients thus far include:
- Improved lipids, which reduces their risk for heart disease.
- Lowered hemoglobin A1C, reducing their risk for diabetes and prediabetes.
- Improved FibroScan results, indicating improvement in fatty liver disease.
- Improved PCOS symptoms, including normalization of menstrual cycles.
Expanding the vision
While the program is still in its early stages, Dr. Brown is encouraged by her patients’ progress and hopes to expand pediatric lifestyle medicine beyond her own clinic.
She has been hosting educational programs to help other physicians integrate lifestyle medicine into their practices and approach childhood obesity with the same clinical rigor they apply to other chronic conditions.
“Physicians need to educate themselves about the new generation of obesity medications and examine their own biases. Obesity deserves the same evidence-based, proactive treatment we give conditions like hypertension or asthma,” she said. “The most dramatic health care impact is in pediatrics because changes in children can last a lifetime and impact generations to come, and that’s why this work is so exciting.”
For Dr. Brown, the program ultimately represents something larger than weight loss alone. It’s about giving teens the tools, confidence and support they need to reshape their health and their future.
