“I’ve always felt different – larger – and that somehow, it’s my fault.”
Many teens attending the SickKids Team Obesity Management Program (STOMP) share similar feelings. Societal messages make them feel responsible for their size. They are made to feel weak and inadequate, for if they were strong, they would be “normal.” They feel excluded. Some actually feel targeted. A patient once told me that while eating a granola bar on the subway, a stranger asked, “Do you really need that?”
The pressure these teens face to achieve an acceptable body size combined with social marginalization often propels them into various states of anxiety, depression, disordered eating, binge eating, and suicidal ideation. In fact, obesity and mental illness are so frequently combined that they constitute an epidemic within an epidemic. To further complicate the situation, the medications prescribed for the treatment of some mental health issues can lead to unstable eating behaviour and weight gain. Such complex issues and interactions, especially among teens, cannot be managed by weight management strategies alone.
Consequently, mental health providers are being incorporated into thoughtful weight management programs around the world. In this vein, the SickKids Team Obesity Management Program (STOMP) was launched in 2009 as an outpatient intervention with a strong mental health component. Physicians, mental health providers and the rest of the interdisciplinary team work collaboratively with patients and their families to develop a contextualized treatment plan in support of healthy eating and active living.
While this traditional outpatient intervention works for some patients, for others, the situation is so complex that more intense strategies must be developed. Similar programs are required in the management of other eating disorders like anorexia and bulimia. In order to meet the needs of these patients, a collaborative effort was mounted between STOMP, the SickKids Psychiatry Acute Inpatient Day Hospital and Emergency Care Program (AIDE), and the SickKids Eating Disorders Program.
With support from the Medical Psychiatry Alliance, these programs were afforded the resources to combine expertise and to develop a comprehensive day treatment program for teens whose complex physical and mental health issues, including eating and weight issues, cannot be managed in the traditional outpatient setting. The combined AIDE/STOMP Day Treatment program, which is the first of its kind in Canada, was launched in the summer of 2016 and integrates mental health treatment with specialized programming about healthy eating and active living.
The goal is to provide a specialized, holistic approach to overall health for these vulnerable teens who might otherwise be lost to the system. Even though the program is in its early days, the first group of patients we have seen through this holistic approach have shown meaningful gains, which gives us hope that we are on the right track to providing the kind of care these youth and their families need.
Dr. Elizabeth Dettmer is a Staff Psychologist and Mental Health Lead with the SickKids Team Obesity Management Program. She is also Project Investigator at the The Hospital for Sick Children's Research Institute, and Assistant Professor of Paediatrics at the University of Toronto.