Healthy Lifestyles, Bright Bodies

Alex, a sweet, soft-spoken, thoughtful 9-year-old, began gaining weight during the pandemic-related school closures in 2020. By fall 2021, his condition had become serious. Alex – whose name has been changed to protect his privacy – was diagnosed with obesity, pre-diabetes, and fatty liver disease. 

Alex and his parents were referred to the Healthy Lifestyles Clinic at Zuckerberg San Francisco General Hospital (ZSFG), where UCSF pediatricians provide treatment for children with overweight and obesity. The family met with a pediatrician, a nutritionist, and a physical activity case manager, who secured Alex a scholarship for swimming lessons through San Francisco Recreation and Parks. 

Two years later, Alex’s weight had stabilized, and his pre-diabetes and fatty liver disease had resolved. Amy Beck, MD, a UCSF pediatrician and co-director of the Healthy Lifestyles Clinic, says Alex’s physical and emotional transformations have been enormous. “He has so much more confidence and enthusiasm for movement now. He really seems to love it. It’s been great to witness.” 

The Power of Prevention 

Beck was a fourth-year medical student doing a rotation in emergency pediatrics when the power of prevention hit home. 

“I remember thinking that we’re really fixing these kids,” she recalls. “We’re fixing this kid’s ankle. We’re fixing this kid’s pneumonia. But then I started realizing that half the patients I saw were at high risk for diabetes. I had this feeling that we were addressing the things we knew how to fix but not these harder issues.”

As a pediatrician, my job is to set children up for a healthy future.

That was Beck’s “aha” moment. She recognized that the challenges many of her patients were facing might not affect them today but could reduce their quality of life – or even its length. “As a pediatrician, my job is to set children up for a healthy future,” she says.

In 2014, Beck joined the UCSF faculty as a pediatrician and co-launched ZSFG’s Healthy Lifestyles Clinic to offer evidence-based strategies for treating childhood obesity in underserved children and their families and change the course of the diabetes epidemic.

The Social Determinants of Health

The children referred to the Healthy Lifestyles Clinic with obesity tend to exhibit four major health complications: pre-diabetes, fatty liver disease, high blood pressure, and obstructive sleep apnea – conditions that have long-lasting repercussions for the patient’s health and generate significant costs for the health system every year.

Beck says that structural challenges – often called "social determinants of health" – underlie many of the health conditions that her patients experience. Food, income, and housing insecurity; language and cultural barriers; and limited access to physical activity all play roles.

"If you’re food-insecure, processed foods are just more affordable than fresh fruits and vegetables, meat, fish, even dairy products,” she says. “And there’s a strong connection between the intake of processed food, weight gain, and all these other complications."

Income level also plays a part in access to exercise. “Even for a highly resourced parent, registering for sports programs can be super overwhelming. It’s all online. It’s time sensitive. And it’s expensive. If you need a scholarship, there is a huge amount of paperwork. So, if you’re a parent who doesn’t have an office job or doesn’t have access to a laptop during the day, it’s really tricky.”

Bright Bodies

In 2021, the Healthy Lifestyles Clinic launched the Bright Bodies program to provide more hands-on support for exercise and nutrition. Patients participate in fun, intensive physical activities outdoors and learn about healthy dietary changes. Clinic staff members also work with parents to help them enroll in CalFresh, access other food resources, and apply for scholarships to physical activity programs.

Alex and his family were regulars at Bright Bodies and took advantage of several Recreation and Parks classes, which Beck credits as instrumental to his recovery. “We see so many patients like this,” she says. “Patients lose weight, their blood sugar normalizes, their liver inflammation improves. For some, like Alex, the benefits go well beyond what we can measure. Kids learn to swim or join a basketball team – activities with physical but also far-reaching social benefits.”

According to the US Preventive Services Task Force and the American Academy of Pediatrics, intensive health behavior lifestyle treatment programs like this should be the standard of care for obesity prevention. But due to funding constraints, ZSFG is among the few hospitals in the nation offering them.

The intensive case management offered through the Healthy Lifestyles Clinic and the Bright Bodies program are funded entirely through a variety of short-term grants. When these grants expire, Beck’s team has to stop offering popular resources like food vouchers for fresh fruits and vegetables and scholarships for sports programs – resources that have become a lifeline for patient families.

"We are always looking for opportunities to get this work funded because the impact is so clear," Beck says. "We see huge benefits for these kids. This is the kind of prevention work I’ve always been excited about."

For more information about how you can support the Healthy Lifestyles Clinic and Bright Bodies, please contact Amy Beck at [email protected] or (415) 476-3368.