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History and Viewpoint

Reading & grocery store healthy lifestyle programs designed Pilot of Nutrition & Fitness for Life program Headquarters moved to Durham, NC Partnership with Mike Krzyzewski on the Coach K Drive to Fitness
NOV. 2001 FEB. 2002 MAY 2002 JUNE 2002 AUG. 2002 JULY 2003 Jan. 2004
BMC Nutrition & Fitness for Life team created JUMP!, GUIDE and FitNet programs piloted Member of the "Changing the American Diet" meeting

Over my lifetime, I've become very aware of the positive impact of a healthy lifestyle in my own life, amongst my family and friends, and in patients I've worked with in the healthcare setting. Relative to now, when I was teenager I ate poorly, slept irregularly and worried about a lot of modern life's artificial stressors. Fortunately, my parents instilled healthy habits in me when I was a young child, which I later embraced thanks to athletics, enjoyment of physical activities, and an increasing awareness of the impact of my behaviors on my health. Now, when I follow my own advice--which is not easy in America, but possible--I feel great. I am full of energy, positive, friendly and happy. When I don't sleep well, when I am not physically active, when I eat poorly or feel 'stressed,' I get headaches, feel tired and irritable, and am far less social. Most people can relate to this, but, for some reason, we disassociate our basic behaviors-- what we put into our body, and how we use our body-- from how we feel and perform. When we pay attention to these things too much, they just become another stressor. One key is forming good habits, ideally in youth, when your brain is more adaptable. Another key is planning life factors, such as where you work and how you commute, so that healthy living is just an integrated way of life-- rarely stressful, and often fun. The changes I saw in friends I rowed with in college crew were amazing. The altered mindset of some of my family members has been remarkable. Don't get me wrong- living healthy is not Utopia, and there are frustrating days. But, week-by-week, year-by-year, it makes life so much better.

As I traveled to US, European and Australian cities for work, I was shocked at how many children walking down the street were overweight. Its incredible how we just let this happen, right before I our eyes, during the previous two decades. My primary memories of overweight youth in my own childhood include Fat Albert, and the rare classmate. Now, especially in poor inner city schools, it is becoming a dangerous norm. In the adult healthcare setting, obesity is even more apparent. Hard statistics show that people who live healthy lifestyles indirectly fund the management of chronic diseases in overweight and unhealthy behaving patients, who were never instilled with the tools to take self-responsibility for their health during their youth, or who have been bludgeoned by the excess promotion and availability of low-cost short-term pleasures that are now always at our fingertips. We do not need to give up these pleasures in total, but, we do need to strive for balance, and actively seek healthy substitutions which are almost as rewarding in the short-term, and far more fulfilling in the long-term. Obesity is a very noticeable outward problem. Perhaps worse is the more subtle deterioration of mental health documented in more and more youth. In my mind, the rollercoaster of emotions more common in people today is linked to overstimulation and short-term hedonism, without inward reflection or the effective use of the bodies that house our minds.

Given the ability of children to readily learn, or relearn, and enjoy healthy lifelong habits, especially compared with adults, I began focusing on ideas to help youth and their role models make incremental lifestyle changes that will help the next generation.

One initial idea was to distribute children's books to patients that specifically delivered healthy physical activity and eating messages to parents and young children. The other was to provide healthy shopping and physical activity information to parents in grocery stores. Individuals, such as myself, cannot change our habits, but, slight modifications of existing systems (such as grocery shopping) in cooperation with numerous partners can help us comfortably reinvent our lifestyles.

I approached Dr. Barry Zuckerman, chair of Boston Medical Center's department of Pediatrics, and founder of Reach Out and Read, as he seemed an ideal ally and mentor. Boston Medical Center (BMC) lacked a sustained effort to fight pediatric obesity at the start of 2002, but had a massive need and desire to overcome the problem. Childhood overweight has an even higher incidence in the lower socioeconomic and minority patient population BMC serves. One study at BMC showed that 37% of its Haitian children were overweight; Haitian and Hispanic children make up the majority of BMC's high number of overweight children. The majority of children also had indications of insulin resistance (including acanthosis nigricans), and sometimes other co-morbidities such as sleep apnea, chronic hypertension, hyperlipidemia and skeletal problems; low self-esteem and mental problems were also common.

Thus, before focusing on healthy lifestyle promotion projects for all children, those who required treatment were first addressed. With the encouragement and support of Dr. Zuckerman, I pulled together a team along with the leadership of Dr. Caroline Apovian, M.D. and Diana Cullum-Dugan, R.D., to design and pilot a new, multidisciplinary clinic for overweight children, dubbed the Nutrition and Fitness for Life youth weight management clinic. It is now run by the former co-director of the Harvard OWL program, Carine Lenders, M.D., the former director of the Massachusetts Partnership for Healthy Weight, Vivien Morris, R.D., M.P.H., and a member of our Board of Directors, Rishi Shukla.

With the clinic pilot successfully underway, I returned to the original education and grocery store concepts, and began to brainstorm other programs that might cost-effectively facilitate healthy living, and help prevent the development of obesity or depression, in a larger population of children. These project had to be easily replicable in places where lifestyle choices were made and learned, such as grocery stores, restaurants, the kitchen, schools, places of worship and primary care clinics, to name a few. They also had to use an ironic combination of technology, and return to the basics of low-cost physical activity that can be done anywhere, even confined spaces like a small urban apartment. The JUMP! program was piloted, in which doctors handed out jump ropes to children as 'prescriptions for fitness.' The initial stages of the GUIDE program, to help parents Gain Understanding in Diet and Exercise, was begun at America's Food Basket in Dorchester, Massachusetts. Finally, after completing my time at BMC, just prior to coming to Duke, I finished creating the first, low-tech version of the FitNet software which will serve as a backbone for Fitness Forward, by automating the first phase of the diagnostic and guidance process in an entertaining way for individuals, directing them to real physical activity and healthy eating venues in the community based on their own preferences and needs. This tool could affordably reach large numbers of children and their caregivers through multiple channels, in a much less labor intensive way.

Given the economies of scale and the social influence of many large corporations I have researched and worked with as a former business consultant with Mercer, I founded Fitness Forward to become a future nationwide corporation, while retaining the compassion and focus on the individual found in a grassroots non-profit. With the overweight epidemic now including almost 2/3 of Americans, and increasing rates of youth type 2 diabetes and depression, there has never been a greater need for a results-focused, rather than profit-focused, organization that could help many children from all social spheres live healthier and happier lifestyles.

I decided to move to the 'City of Medicine,' and the 'Diet Capital of the World,' to complete MD and PhD work I had begun in Cambridge, England, at Duke. The Center for Living campus at Duke is one of the foremost research centers on healthy lifestyles in the country; many of its faculty now complement the expert advisors of Fitness Forward from Boston and other areas of the country. The flexibility of the Duke curriculum allowed me to dedicate a great deal of planning time to Fitness Forward, and organize a 12 member interim Operating Advisory Board and large group of volunteers, which have initially worked for free to develop Fitness Forward programs and tools.

Our most exciting project to date is the Coach K Drive to Fitness, a program designed to serve as a motivational base for many elementary school children who we teach healthy lifestyles habits to. Mike Krzyzewski approved the design of our program in January of 2004, and we now work closely with the K Lab, Emily Krzyzewski Family Life Center and Durham Fitness Council to ensure that it will be a great success in Durham, which we will carefully track with numerous metrics. We are actively discussing the national potential for such a concept with a number of high-profile partners with global brand recognition.

Fitness Forward is a member of the North Carolina Action for Healthy Kids team, the Durham Nutrition and Fitness Council, the MA Department of Public Health Partnership for Healthy Weight, and recently partook in the Harvard School of Public Health/ Tiax business conference on "Changing the American Diet," with keynote Mark McClelland, commissioner of the FDA. Fitness Forward has put together a highly reputable advisory group that includes Walter Willett, chair of Nutrition at Harvard School of Public Health; Bill Kraus, exercise expert and research director at the Duke Center for Living; Michael Freemark, chief of pediatric endocrinology at Duke and others. I hope that the Board of Directors and incoming staff will help Fitness Forward live by its mission to acheive its vision, and itself serve as a model of intelligent and energetic youth working with respected and passionate mentors, as peers, to to positively reinvent and reinvigorate our lifestyles, for the health and happiness of my family, my friends, my God son Owen and God daughter Emaline, North Carolina, Massachusetts and the nation.



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