By the time Lilly Martinez was 5, her parents were already concerned about her continued rapid weight gain.
They spent the next few years trying to address the issue, both on their own and in concert with medical providers, but keeping Lilly from overeating and teaching her to recognize when she was satiated felt like an uphill battle.
“We had tried everything under the sun, but we couldn’t manage her ongoing weight increase and her blood sugar levels,” her mom, Caroline Martinez, said.
It wasn’t until the fall of 2024, when Lilly, then 8, was referred by her pediatrician, Catherine Kolo, MD, to the UCLA Fit for Health Clinic at Ronald Reagan UCLA Medical Center, that things started to turn around.
Lilly was considered pre-diabetic at that point, Martinez said. And even though she was seeing a therapist and a pediatric psychiatrist, she still struggled with impulse control. She had been diagnosed with attention deficit hyperactivity disorder (ADHD) and was taking medication for it.
“She continued to eat and eat even though she was probably full,” Martinez said. “And when we told her no, you need to wait before eating more, she wasn’t able to. She would do whatever was necessary to satisfy her urge to eat.”
At home, that included going into the pantry or the refrigerator to get more food. At school, she discovered that she could go to the front office to find out which kids had ordered hot lunch but were absent, and she would then eat their lunches in addition to the one she’d brought from home.
Health complications
Although Lilly is on the younger side of the patients they see, her pre-diabetic status is fairly typical, said Vibha Singhal, MPH, MBBS, director of the UCLA Fit for Health Clinic and director of Pediatric Obesity at UCLA Health.
The clinic opened in the early 2000s but has expanded since Dr. Singhal came on board in the fall of 2024.
In addition to the behavioral lifestyle changes that had previously been the main focus, the clinic now offers pharmacotherapy and bariatric surgery. These changes are in keeping with the 2023 weight treatment guidelines from the American Academy of Pediatrics, which were developed as best-practice recommendations to help address growing rates of youth obesity and the resulting health complications.
The clinic includes three pediatricians, including Dr. Singhal; a pediatric surgeon; a bariatric surgeon; nutritionists; a social worker; and a psychologist.
About one in five kids in the United States has obesity, which presents short-term risks for musculoskeletal issues, high blood pressure and Type 2 diabetes, as well as longer-term risks for cardiac disease, Type 2 diabetes and other health issues.
Without treatment, teenagers with severe obesity have a 90%-95% chance of obesity as adults, Dr. Singhal noted. Obesity is also considered a significant risk factor for Type 2 diabetes, which accounts for up to 95% of all diagnosed cases of diabetes in adults, so managing weight is considered key.
“Unfortunately, the rates of Type 2 diabetes in youth have doubled in the last decade, and most of this increase is related to obesity,” Dr. Singhal said.
In addition to boosting the risk for diabetes and the likelihood of adult obesity, childhood obesity can worsen asthma, obstructive sleep apnea and other health complications.
Dr. Singhal described obesity as a “complex, multifactorial, multisystemic disease.” Lifestyle modifications remain a key part of the clinic’s approach, and having other specialists meet with the patient as well, during the initial visit – and as part of regular follow-ups – is equally important, Dr. Singhal said.
“The psychologist evaluates whether there are any behavioral barriers to implementing the changes,” she said, “as well as whether there are any mental health concerns. Anxiety, depression, ADHD, autism – really, any neurodivergence – can all play a role.”
In some patients, these conditions haven’t yet been diagnosed, while in others, their medications may not yet be sufficient, she noted.
Regular monitoring of patients’ blood sugar markers, which are used to diagnose pre-diabetes and diabetes, helps clinicians assess whether their treatment plan is effective or may need modifying.
As a pediatric endocrinologist, Dr. Singhal also looks for underlying causes such as thyroid problems, growth-hormone deficiency or other hormonal issues. Genetic tests can reveal whether patients have specific genetic mutations that increase their risk for developing obesity, she noted; if this is the case, specific medications can sometimes be prescribed.
Some of the newer glucagon-like peptide-1 (GLP-1) medications for weight loss are approved by the Food and Drug Administration for patients 12 and older, Dr. Singhal noted. GLP-1 is a hormone released by cells in the intestines that affects hunger and appetite.
The clinicians pay close attention to the patient’s psychological state to ensure that the medication isn’t used as part of unhealthy weight loss behaviors. This includes assessing whether the patient has a personal or family history of eating disorders, and continuing to meet with the patient regularly to monitor their progress.
Yet another option, generally for patients 12 and older, is bariatric (weight loss) surgery.
With both surgery and GLP-1 medications, clinicians emphasize the need for ongoing adequate nutrition, which can suffer when food intake goes down.
“We have to be very cognizant of setting goals and expectations that this is for health reasons, not cosmetic reasons or size reasons. Making sure there aren’t body image issues is a big part of our assessment,” Dr. Singhal said.
“If there are any mental health concerns, that’s how the visit starts. Then depending on the patient’s needs, we assess what’s most suitable, including psychotherapy and pharmacotherapy. It could be just one. It could be two. It could be working up to a surgery. It’s very much a team and a family decision.”
Dr. Singhal characterized the clinic’s role in working with the patient’s existing doctors as collaborative. She cited depression as an example, noting that some antidepressants and mood stabilizers can cause weight gain. “If so, I reach out to the original prescribing team to see if they can switch the medication,” she said. “I don’t manage the change of the medication, but I do identify the issue.”
The clinic generally treats patients up until age 21, but some patients, particularly those with neurodevelopmental issues, may remain with the clinic past that point, Dr. Singhal said.
Plan tailored to Lilly
To prepare Lilly for her first appointment at the Fit for Health Clinic, Martinez explained to her that her blood sugar was on the higher side and that as a family, they needed more help managing it so that she could remain healthy.
It was a long meeting, Martinez remembers, and included a pediatrician, a social worker and a psychologist to map out a course of treatment. “The providers were very understanding,” Martinez said, “and really took the time to explain to Lilly what was going on.”
Together, they devised a multipronged approach that included helping Lilly make healthy food choices and build awareness of her body’s signals when she was eating, which included slowing down while eating to allow herself time to register the sensation that she was full.
They also focused on practicing healthy eating, “as a family, together, to help support her in her new lifestyle,” Martinez said.
At regular Zoom follow-up visits, the clinic team worked with Lilly and her parents to assess her progress and adjust the treatment plan.
From a medication standpoint, this included lowering the dosage of her ADHD medication, which had been increasing her anxiety, and slowly increasing the dosage of an antidepressant she’d begun taking.
Lilly also subsequently started taking a blood-sugar medication prescribed by her doctors at the clinic. “That really was a game changer in terms of controlling both her blood sugar and her appetite,” Martinez said. “I noticed that her appetite went down dramatically, to a healthy level.”
Lilly was also referred to a UCLA Health allergist and to the UCLA Pediatric Sleep Clinic, where she underwent an overnight sleep study. She was diagnosed with obstructive sleep apnea and had her tonsils and adenoids removed. Afterward, Lilly stopped snoring and seemed to be sleeping better overall, Martinez said.
Meanwhile, Martinez focused on finding exercise activities and healthy foods that Lilly enjoyed. Lilly has three younger siblings and another one on the way, so Martinez also knew she needed to be realistic.
Food-wise, that meant swapping out fast food for less-processed food and switching from less nutrient-dense foods to more nutrient-dense ones. “We found foods that she liked and made them fun to eat, like apples spread with peanut butter and sprinkled with chia seeds,” Martinez said.
During the initial months, she met frequently with the clinicians to continue to finetune the approach, such as adding more protein to help Lilly feel full.
Adjusting Lilly’s medications took time, Martinez said, but by June of 2025, they’d found the right combination, which includes two ADHD medications, an antidepressant and blood-sugar medication.
Martinez also participated in Fit Mind, a virtual video program created by the clinic to help patients learn to slow down while eating and be mindful of their body’s signals of hunger and fullness. With younger patients like Lilly, the video program is completed by the parent, Dr. Singhal said, while adolescents typically complete the program themselves.
Ongoing relationship
Martinez plans to have her second child, who is now 7, seen at the clinic as well, as he appears to have similar weight issues.
Lilly, now 9, will continue to be seen two to three times a year until she finishes puberty, Dr. Singhal said, and most likely will be seen annually after that.
“Puberty is a time when we see a lot of weight changes,” she said. This can bring about insulin resistance, so Lilly’s blood-sugar levels will continue to be monitored.
Lilly has “responded beautifully” to the blood-sugar medication, Dr. Singhal said, adding that Martinez reports that her appetite is better, as is her impulse control around food.
A year after Lilly’s first visit to the clinic, Dr. Singhal said, “she looks like a different person.”