Patient Care

Genetic testing

For children who develop very severe obesity early in life, or those who have developmental disabilities, we are able to test for genetic causes of obesity.  All patients who receive genetic testing will be offered free genetic counseling to explain the results.  In some cases, there may treatment options identified through testing.

Disordered eating

Evaluation and treatment of obesity should only be done in supervised settings where we can recognize and address early warning signs of disordered eating.   Our team will carefully assess the child’s relationship with food to ensure a healthy and positive experience with eating over a lifetime.  We will never recommend dieting or restrictive eating practices, which are known to place children at risk for eating disorders.  

Mental health

The journey to healthy living depends on children and families having a solid foundation for emotional support.  We offer testing and treatment for common mental health conditions that may be identified, and will refer to a specialist as needed.  

Health issues related to obesity

We will carefully evaluate your child for the health issues known to come with extra weight.  This is tailored to each individual child based on family history, risk factors, and personal medical history.  It will include testing for diabetes, blood pressure, cholesterol, and a condition called “fatty liver disease.”

Social drivers of health

We understand that some people have more barriers to healthy living than others.  These barriers might include difficulty speaking English, not having enough food to make healthy choices, transportation issues, and financial stress.  We will respectfully allow all families to share these barriers, and where possible, we will work with you to help find solutions.

Intensive health behavior and lifestyle treatment (IHLBT)

This is what we offer all children and families.  Our treatment team will meet with you and your child regularly either in clinic or by telehealth to help track progress, monitor health, provide nutrition ideas or new physical activities, support mental and emotional health, and help you set and stick with lifestyle goals.  In addition, we offer all Healthy Lifestyles patients a 1-year free membership to our community-based program, Bull City Fit. This website also provides over 50 cooking classes and exercise routines developed by our team for you and your family.

Medications

For children 12 and older, or for children with a diagnosed genetic cause for obesity, we offer physician supervised medications that can help reduce hunger, cravings, and food-seeking behaviors.  When used alongside our lifestyle supports, this can help teens who may have more weight to lose, or who may be developing early health problems that come with excess weight.  Medications that we use, currently approved by the FDA, include (for children aged 12 and older): Saxenda (Liraglutide), Wegovy (Semaglutide), and Qsymia (Phentermine/Topiramate).  We also use additional medications for children who have obesity and diabetes, including: Glucophage (Metformin), Victoza (Liraglutide), and Ozempic (Semaglutide).  We may also use off-label medications to help those children who have excess hunger or food-seeking behaviors.

Surgery

Duke is the only weight-loss surgery program approved for adolescents aged 14 and older in North Carolina.  We have been continuously accredited as a center of excellence by the Metabolic and Bariatric Surgery Quality Improvement Program since 2009.  The path to surgery typically takes 6 months or longer, and requires comprehensive evaluation and multiple visits to ensure the safest and best outcome for teens.  Patients under age 18 and all patients insured by NC Medicaid are required to start with the Healthy Lifestyles clinic.  Please visit the following website for more information: https://www.dukehealth.org/locations/duke-center-metabolic-and-weight-loss-surgery-durham-clinic