The HAND Pathway: Erasing the Stigma Surrounding the Obesity Epidemic

The HAND Pathway: Erasing the Stigma Surrounding the Obesity Epidemic


Obesity is a condition that is associated with having an excessive amount of body fat, defined by genetic and environmental factors. Obesity is, in fact, an epidemic, and while over the last decade rates have slowed, it is still a major health concern in need of attention and awareness. More than 35 percent of people in the United States population are obese, including about one in three or 17 percent of children and teens. A child is considered obese when their Body Mass Index (BMI) is greater than the 95th percentile for their particular age.

Among children, obesity causes a broad range of health effects, some of which are even life-threatening including shortness of breath, bone and joint issues, heart disease, stroke, high blood pressure (hypertension), type 2 diabetes, and elevated cholesterol levels. There are also psychological effects from struggling with weight including low self-esteem, negative body image, and depression. Often, this can leave a child feeling hopeless, depressed, unmotivated, and in need of help.

According to research, being overweight and obese results from multiple factors, but an energy imbalance plays a significant role. The body needs a certain amount of energy (calories) from food to keep up with basic life functions. Body weight tends to remain the same when the number of calories eaten equals the number of calories the body uses or “burns.” Over time, when people eat and drink more calories than they burn, this results in weight gain. Many factors contribute to this, including genetics, eating habits, how and where people live, attitudes and emotions, life habits, and income (socioeconomic status).

Many kids are spending less time exercising and more time in front of the television, computer, phone, tablet, or video-game console. With today's fast-paced world, and not enough time in the day, families have fewer free moments to prepare nutritious, home-cooked meals. From fast food to electronics, quick and easy is the reality for many of us today, which influences bad habits. Preventing kids from becoming overweight means making the right choices, for example, the way your family eats and exercises, and how you spend time together. Motivation and positive attitude are key.

Despite the significant action taken so far to keep lowering the rates of obesity, much more needs to be done. It is clear that obesity is a major public health threat in countries around the world. In order to continue making strides towards significant change, all areas of society, must get involved and engage in a “health in all policies” approach within government, schools, media and businesses. In other words, with the right policies and strategies in place, the alarming statistics regarding this epidemic can decrease significantly, immensely helping the lives of those affected.

The solution to this obesity problem sounds deceptively simple, however, it is not without the right resources. That is where the HAND Pathway, developed by Endocrine Kids, comes into play.

Nurse Practitioner Mary Ann Cherenzia explains how the HAND Pathway was developed with the mission of motivating children to lose weight, simultaneously raising awareness, in an attempt to erase the stigma surrounding obesity.

1. What is the Health and Nutrition Direction HAND Pathway?

The HAND Pathway (Health and Nutrition Direction) is a health and nutrition approach developed by Endocrine Kids to manage weight gain and obesity in children and adolescents.  We provide a customized approach to help our patients, and their family, reach health and weight goals. We address all aspects of weight concerns – medical, social and psychological. Our goal is to provide guidance and support to assist our patients in achieving lifelong health and wellness goals. Of course, with children, it must be a fun and positive experience so we incorporate fun incentives and lots of positive motivation!

2. The HAND Pathway has multiple elements, why was it chosen to structure it in this way?

There’s never just one reason for weight gain or one approach to weight management that works for everyone. To achieve health goals, we knew it would be crucial to address multiple areas of care. This sometimes involves lab testing, dietitian evaluation, psychological assessment or treatment of underlying medical conditions that are contributing to weight gain. We also make it a point to really get to know our patients and come up with an action plan that works for them and their family. If you don’t address all the contributing factors to weight gain, then success is difficult.

3. The HAND Pathway is NOT a program, why?

We feel that health and nutrition require more than just a prescribed number of visits to the office.   Here at Endocrine kids, we believe that having a pathway for our patients to follow means that changes will be life-long and not just for the duration of a program.  The HAND Pathway can be individualized to the needs of each of our patients and families. Some may need more frequent follow-up, and others less, to achieve their goals. The HAND Pathway works with you each family to set and reach goals at a pace that is effective.

There is not a ‘one size fits all’ approach to obesity as is often seen in weight programs. Every diet and exercise plan does not work for everyone. The Hand Pathway takes a goal-oriented approach based on the patient’s physiological needs, that may include individual exercise plans and targeted nutrition plans, for example, calorie or carbohydrate reductions.

4. As found through research, diet programs don’t usually work for everyone, as 97 percent of people regain what they lost. Therefore, what is different about the HAND Pathway?

The difference is the HAND Pathway is helping our patients and families create their own goals that they feel are attainable. This sets our patients up for success. We provide our patients with the opportunity to meet one on one with our dietitian to create a diet plan that works for them. Our HAND patients meet with medical staff to evaluate for medical causes of weight gain. The approach is complete and completely individualized.

5. Obesity is an epidemic, and a huge topic of conversation nowadays. Why is it especially prevalent in kids? As 35 percent of people are obese and 17 percent of those are children, what do you think people can do to raise more awareness?

Childhood obesity has been on the rise for many years. This happens to coincide with the rise in high fructose corn syrup consumption in the United States. In addition, electronic device use is on the rise and our neighborhoods are more sprawled out. As a result, children don’t go out to play as often as they used to. On top of that, we have a fast-paced society that encourages people to eat convenience food – often not the healthiest choices.

These are just a few of the reasons for the epidemic, and it will require many solutions. Over the last decade, the rate of rise in obesity has slowed. This has occurred as local and national leaders have taken the initiative to make the curbing of childhood obesity a priority and as more clinics, like the HAND Pathway Clinic, are made available to families.

6. Do you believe that motivation and encouragement is fundamental to the success of weight loss/weight management?

YES!! Here at Endocrine Kids, our HAND Pathway provides the encouragement that our patients are looking for to help them achieve their health and nutrition goals. We offer fun incentives to our patients to help motivate them too!

7. What do you believe is the key to a balanced diet and good nutrition?

The key to a balanced diet and good nutrition is finding the foods that you find appealing and that work for you to manage weight gain. It’s also important to realize that any permanent change takes time and commitment. There are no quick fixes and that’s OK. Making the best nutritional choice most of the time (note, not ALL of the time) will lead to long-term success.

8. What advice would you give to a child or parent who is feeling discouraged?

Our suggestion is to focus on “non-scale victories.” It’s vital to focus on the achievements that aren’t related to numbers. Developing healthy behaviors is a lifelong commitment and making small attainable goals, will be motivating and set you up for success.  Helping kids lead healthy lifestyles begins with the right resources and parents who lead by example.

Working together is crucial. Endocrine Kids we believe that success comes from a family-centered team. 

If you would like to be a significant part of raising awareness about obesity, visit To learn more about the HAND Pathway call Endocrine Kids at (248) 347-3344 or request an appointment online.