On a warm summer day outside of Johns Hopkins All Children’s Hospital, 18-year-old Shaelyn strikes a confident pose for the staff photographer.

Her radiant smile reveals a celebratory mood — and she has much to celebrate. Not only has Shaelyn recently graduated from high school, but she has also hit a major milestone on her journey to better health.

Over the past 2½ years, Shaelyn has lost close to 100 pounds.

Discovering Healthy Steps

Sometimes pain can be a powerful motivator for change — and by the fall of 2020, Shaelyn was hurting.

As the COVID-19 virus played out, extended isolation at home left her less active, sad, lonely and looking for comfort. Increasingly, she found it in food.

“It was really bothering me,” Shaelyn says. “I needed to do something, but at the same time I worried that I would fail. So, I just kept digging the hole deeper.”

Shaelyn’s mother, Sara, was desperate to help her daughter feel better, both physically and mentally. One day at work, she learned about a special clinic offered by Johns Hopkins All Children’s called Healthy Steps.

The program features a patient-centered, evidence-based, multi-level approach to pediatric obesity, including the only pediatric weight management clinic on Florida’s west coast.

At her first clinic appointment, Shaelyn and her mom met Raquel Hernandez, M.D., M.P.H., medical director of Johns Hopkins All Children’s Healthy Weight Initiative in St. Petersburg, Florida. Hernandez is among few physicians who are certified both nationally and regionally in pediatric obesity medicine.

“She was so welcoming and open,” Shaelyn says. “She helped me to see that we would all be working together on this, but they were also going to help me find the courage and confidence to help myself.”

The Journey

In order to help Shaelyn thrive, the Healthy Steps clinical team set out to understand her individual needs and challenges. Collaborating with the patient and her family, the team learned about Shaelyn’s lifestyle, her eating patterns, her activity level and her mental state.

“It isn’t fun or easy for patients to talk about obesity and weight issues,” Hernandez says. “But Shaelyn is such a positive person. She was very honest with us about what she was going through.”

Shaelyn worked with a registered dietitian to learn about healthy meal planning and snacks that suited her and helped her to feel in control. She met regularly with a clinical psychologist who would give her tools to cope with depression and anxiety.

Every patient in the Healthy Steps clinic also receives a comprehensive medical assessment, which includes a screening for weight-related issues such as diabetes and hypertension. Sometimes patients with multiple issues may be offered an approved medication to help with weight loss if they meet medical criteria and after initiating some lifestyle changes.

After her medical assessment, Shaelyn received some sobering news. She learned that she was pre-diabetic. She was also diagnosed with polycystic ovarian syndrome (PCOS) a hormonal condition that made it difficult for her to lose weight.

During her first year with the Healthy Steps clinic, Shaelyn was prescribed a drug called metformin to help her with her PCOS by lowering her insulin and blood sugar levels.

With her own determination and with the full range of clinical services behind her, Shaelyn began to see progress. She was changing her life, taking off the pounds, feeling better about her health.

She was laying a foundation for lasting change.

Bumps In the Road

Anyone who has been on a long weight loss journey knows that success does not come easily, and not without some bumps in the road. By the end of last year, Shaelyn had made significant progress, but despite her best efforts, her weight loss had slowed, and she continued to have weight-related health issues.

That reality was interfering with another health need in her life — breast reduction surgery. Shaelyn’s large breast size had given her back pain since the sixth grade.

“When you are disproportionately large in that way, it can be challenging,” says pediatric plastic surgeon Jordan Halsey, M.D. “It’s like carrying hand weights on a necklace around your neck all day long. That’s a lot of stress on your body.”

But based on her lifestyle and medical plan, Shaelyn needed to continue losing weight in order to lower her BMI (body mass index) to be at optimal health for surgery.

Another factor was worrying her doctor. Her insulin resistance was not responding to the metformin medication she was taking.

Meanwhile, a drug called semaglutide, sold under the brand names Ozempic, Wegovy and Rybelsus was garnering attention, not only for its treatment of type 2 diabetes, but for its weight-loss benefits.

“Appetite is very physiologically regulated,” Hernandez says. “For patients who have a hard time feeling full, all of that is neuro-behavioral. And this type of drug treats that very well. It promotes fullness and decreases the noise in your brain regarding how often you’re thinking about food.”

By early this year, semaglutide was approved by the FDA for treating obesity in pediatric patients ages 12 and older. Hernandez knew there were children in her clinic, including Shaelyn, who might benefit from the drug.

“Obesity is a complicated, chronic medical condition,” Hernandez says. “Effective medication can serve as an important tool for patients and is not ‘the easy way out,’ as some might believe. You wouldn’t tell a child with asthma that using an inhaler is ‘the easy way out.’”

Was it time for Shaelyn to switch medications? Could she handle a weekly shot to start this medication?

Shaelyn wasn’t sure.

“My mom and Nana are in the medical field, so they know about needles,” Shaelyn says. “My mom was like, ‘Oh, it’s this tiny little thing, like a strand of hair.’ I’m like, ‘How long is it?’”

The weekly shot proved to be no problem for Shaelyn. She had common side effects of nausea and diarrhea at first, but soon her body adapted. The pounds began to come off once again.

“Seeing the progress was like the best thing,” Shaelyn says. “It really increased my confidence.”

Another Goal Achieved

On May 18, Halsey performed successful breast reduction surgery on Shaelyn at Johns Hopkins All Children’s. She was thrilled with the results.

It was the culmination of a lot of hard work and dedication over the past two years. Shaelyn's prediabetes has resolved. Her initial symptoms of anxiety have improved significantly. Through her journey with Healthy Steps, she is now in better physical and mental health.

“Everything that has happened has changed her life,” Sara says. “As a parent, you want to see your child happy, and Shaelyn is happy.”

This new graduate has big plans. She’s headed to college in the fall to pursue a major in psychology. She wants to help children and teens cope with life’s challenges, just as she was helped.

“I am so grateful,” Shaelyn says. “It makes me feel like anything is possible.”

Even with markedly improved health, not every day is easy. On the hard days, Shaelyn remembers what her mom has always told her.

You are strong. You are beautiful. You are powerful. You are enough.

These days, she is a believer.