Obesity threatened her daughter’s health, so a grateful mother turned to the Children’s Hospital for help


SCOTT SCANLON The Buffalo News

Ava Brandy’s weight problems began as a toddler when she began gaining three pounds a month on a typical eating plan.

Alarmed, her pediatrician ordered a series of tests to begin at 9 months of age. As Ava grew, the results continued to show that her key health indicators were normal.

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“Years went by and we kind of took a break from everything because we just didn’t get any answers,” said her mother, Kristy Paradowski.

Ava, then 13, weighed 330 pounds in her senior year when doctors determined she had high blood pressure, prediabetes and sleep apnea. They prescribed her a CPAP machine to help her breathe better at night.

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“Our biggest concern was what would happen to her blood pressure,” her mother said. “Is she having a stroke? Will she have a heart attack?”

Her pediatrician referred Ava to the Healthy Weight Program at John R. Oishei Children’s Hospital in Buffalo. As a result, this month she started her freshman year at Lancaster High School 100 pounds lighter – and a lot happier.

“When I came in here, I just wanted answers,” she said.

Ava Brandys, from Lancaster, last November shared a photo of her and her mother Kristy Paradowski from a trip to Disney World ahead of her bariatric surgery in February.

Libby March, Buffalo News

dr  Carroll 'Mac' Harmon, Chief of Pediatric Surgery, UB Jacobs School of Medicine and Biomedical Sciences

One reason teen bariatric surgery was controversial more than a decade ago was the definition of a teen: “Someone who is noncompliant,” says Dr. Carroll “Mac” Harmon, Chair of Pediatric Surgery at UB Medical School and Chief of Medicine with the Healthy Weight Program.

Photo courtesy of the University at Buffalo

The Healthy Weigh Clinic is located next to the Oishei Children’s in the Conventus Medical Office building. It opened on December 30, 2014. His first child patient, in his mid-teens, weighed 550 pounds.

The staff has since treated patients as young as 2 years old who were struggling not only with being overweight but also with related health issues.

“We only operate on teenagers who have complications from obesity, so we tell them, ‘We’ll fix your high blood pressure, we’ll fix your sleep apnea. Oh, and by the way, you’ll lose weight too,'” said Dr. Carroll “Mac” Harmon, surgical director of the program.

The clinic sees children of many backgrounds from across the area as well as Northwest Pennsylvania, said Sara Alexander, a registered nurse and nutritionist who helps lead Healthy Weigh.

The staff also includes a pediatric nurse, psychologist, social worker, endocrinologist, occupational therapist, and physical therapist — the focus is on body composition, not weight.

It helps parents and children with simplified, structured meal planning with real, whole foods. Regular exercise is emphasized, along with personal attention to good sleep, mood, habits, and coping skills.

Bariatric surgery is offered as part of the program, but only about 10% of patients get it, said Harmon, also chief of surgery at Kaleida Health and the Department of Pediatric Surgery at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences.

Behavior change is emphasized, surgery or not.

During the first meeting with program staff, parents usually say their child’s blood pressure and blood sugar are the things that concern them the most, the pediatric surgeon said. “The teenager often says, ‘I don’t like my choice of clothes, I can’t keep up with my friends, I get tired before they get tired.'”

Treatment plans evolve over time. The program, which includes health insurance, requires those interested in surgery to spend six months in treatment before being considered. Team members help decide whether patients and their families will benefit – and are committed to maintaining a healthier weight.

Most of Harmon’s pediatric surgical days involve fixing hernias, removing the appendix and gallbladders, and assisting in the management of trauma and birth defects. He does one or two bariatric surgeries a month.

“We have two buckets full of patients,” he said. “They are here because they want to find out how to eat right and exercise better. Some of them have a genetic predisposition to obesity. Of all the patients we see, only a handful are interested in surgery or, in our opinion, would be good candidates.”

Ava Brandy's training

Ava Brandys, 14, works out three times a week at the gym at her Lancaster apartment complex. Her usual training routine includes a 6-minute warm-up on the treadmill, followed by strength training.

Libby March, Buffalo News

One reason teen surgeries were initially so controversial was the definition of a teen: “Someone who is noncompliant,” Harmon said.

“A lot of lifestyle changes need to be made after the surgery,” Alexander said. “We need to know that they are committed for a long time and are able to sustain it. So it’s not only important for us to get to know each other, but also that they can stick to these changes over the long term to ensure success.”

The Healthy Weigh team is also committed to these young patients by insisting that patients keep in touch as they get into their 20s and 30s.

In the early years, the clinic mainly saw teenagers who were struggling with obesity. No longer.

“We’ve had success with kids under 5,” Alexander said. “By coming to us, we can help families make changes that will last and prevent children from having these issues as they grow older.”

Almost all obesity is a combination of genetics and environment, Harmon said. Most obesity is more closely related to learned behaviors in the family, school and community, he said, “but we all know people who we say, ‘How can you eat so much and be so skinny all the time? ‘ ”

Less than 6% of people have a single gene mutation that disrupts leptin, the hormone that tells the body to eat full. Through the clinic, Ava Brandys, now 14, learned she has two genetic mutations that play a role in her eating habits, although her strength is slightly less pronounced.

Her mother took her to five nutritionists over the years, who put her through various eating plans, including a 900-calorie-a-day diet. Up until kindergarten, all sweets, including chocolate and birthday cake, were taboo.

As she gained weight, interactions with her peers became less frequent during elementary and middle school.

“People would notice I was there, but they wouldn’t try to interact,” she said.

Ava and Kristi

“You can tell she only wanted that by the results she was able to achieve in six months,” says Kristy Paradowski, right, of her youngest daughter Ava Brandys, 14, who lost with the help of Oishei Children’s Hospital’s Healthy 100 program to weigh.

Libby March, Buffalo News

Things started to change when she started Healthy Weigh last fall. She lost 25 pounds when it became clear that with her genetic makeup, gastric sleeve surgery was an option for her. Counselors often speak to teenagers and parents who have gone through the process at Oishei Children’s.

“I had to prepare more mentally,” she said, “but I knew I wanted to.”

She underwent surgery on February 22nd. Since then she has lost 75 pounds. She continues to visit Healthy Weigh staff once a month to update the treatment team on her diet and activity choices and to ensure the surgical risks, including heartburn and abdominal pain, have not been bothersome.

They haven’t – and she’s off the CPAP machine and her prediabetic medicine. Today, she said, the staples of her diet are a salad, chicken, and two protein shakes. Three workouts at the gym in the apartment complex where she lives with her mom also sets a healthier tone.

“It’s not just about weight, it’s blood pressure, blood sugar and lipids, liver function and sleep apnea,” Harmon told her during a visit to the Healthy Weigh Clinic last week. “From a surgeon’s point of view, I am very pleased with your performance. We want you to keep working, so keep coming back.”

Success and good advice drive them to it, Ava said.

“I have more energy. I can move and move more. I think that helped me settle in. It was a great relief to know something could be done.”

Last spring she founded the National Junior Honor Society and joined the student council at Lancaster Middle School. She hopes to achieve more academic success and take on more activities in her freshman year at Lancaster High.

“You can tell from the results she was able to achieve in six months, that’s what she wanted,” her mother said. “She’s so happy and I’m so happy to see her smile.”

Learn more about the Healthy Weigh program from your child’s pediatrician at ochbuffalo.org/care-treatment/healthy-weigh or by calling 716-323-2000.


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