Reversing the impact of the pandemic on childhood obesity [PODCAST]

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“With schools closed, children spent hours upon hours sitting in front of a screen for instruction and homework. Non-academic screen time increased as well, with parents needing to work from home and thus relying more on screens to occupy the children. Parents also were unable to police screen time as much as they had in the past. Much built-in physical activity of school was removed: from the simple act of walking between classes to recess to physical education to field trips.

I have started wondering what would happen if we approach the obesity crisis like we approached the pandemic? By using the strategies that were used to “stop the spread,” I believe we can reverse this trend of burgeoning childhood obesity rates.”

Teresa Fuller is a pediatrician.

She shares her story and discusses her KevinMD article, “Reversing the impact of the pandemic on childhood obesity.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/follow. Today on the show we have Teresa Fuller. She’s a pediatrician. Her KevinMD article, which we’ll talk about today, is titled “Reversing the impact of the pandemic on childhood obesity.” Teresa, welcome to the show.

Teresa Fuller: Thanks, Kevin.

Kevin Pho: We’ll get to the article in a little bit. First off, briefly share your story and journey to where you are today.

Teresa Fuller: Well, I’ve been practicing for years. Initially, I practiced acute care medicine. I was a hospitalist for about 10 years, and then about 10 years ago my focus in pediatrics really changed to more of a preventive care focus, as I developed an interest in integrative and holistic medicine, and I was interested in how that applied to pediatrics.

So I would say that over the second half of my career, I’ve been working more in primary care, both in traditional practices and once in a holistic, integrative practice. Currently I’m in a traditional practice, and I try to incorporate a holistic approach to their health care for my families.

Kevin Pho: So when you talk about a holistic approach to pediatrics, tell me what that would look like.

Teresa Fuller: For me, what I focus on mostly is nutrition. I try to really empower my families with information about healthy eating and a healthy lifestyle, especially for kids: really just a general healthy lifestyle of exercise, getting outside, getting outdoors, overall healthy eating, and just, you know, a positive home environment.

Kevin Pho: So it sounds like a lot of that can also be applied in a traditional pediatric practice. What more can you offer in a holistic practice that you can’t offer in a traditional pediatric practice?

Teresa Fuller: Really, to me, it’s mostly the same thing, because as pediatricians, that’s always our focus, a healthy lifestyle. The only difference, I would say, is the training that I had in learning more about some of the specific ways that nutrition impacts health, how nutrition impacts our psychology, and how nutrition and nutritional supplements can help. I would just say that I have some more formal training in that, but you’re right, this is what pediatrics is all about.

Kevin Pho: All right, and we’re going to talk more about that in your KevinMD article titled “Reversing the impact of the pandemic on childhood obesity.” Now, for those who didn’t get a chance to read your article, just walk my audience through it and share the story of why you decided to write it.

Teresa Fuller: I think the article was initially motivated by my observation that during the pandemic, my patients were gaining weight at dangerously high rates. I did some research and found out that this was actually an observed trend all over. It turns out that while the prevalence of childhood obesity was already high at 19 before the pandemic, in the two short years since the massive shutdowns of schools and activities, the childhood obesity rate took another leap, to a current prevalence of 22 percent.

That’s not too hard to understand, because with schools closed, there was an increase in sedentary activity, an increase in consumption of unhealthy food choices, an increase in non-academic screen time, etc. So I thought about what it would take to reverse this damaging fallout from the COVID-19 pandemic, and it occurred to me that some of the same strategies that were effective in the pandemic for stopping the spread of the COVID-19 virus can also reverse the childhood obesity trend.

Kevin Pho: So what are some examples of that? You’re seeing that increase in the prevalence of childhood obesity from 19 to 22, so tell me some of the things and strategies that we can use to help reverse that.

Teresa Fuller: Yes. What I did in the article is list five strategies that we use. I basically compared what we did in the COVID-19 pandemic to how we could use those same strategies. So I listed five, and there are probably more, but these are the ones that I came up with.

I started by recommending that we stop placing the burden of childhood obesity on individual responsibility. I say that because when we look at the pandemic, we didn’t leave the strategies up to individuals. We didn’t say, “It would be nice if you wear a mask or if you shut down your business.” We mandated some things, because we recognized that in order to really stop the spread, we were really going to need to have a public health response. Basically, that’s what I think would work for childhood obesity as well.

Most of the time, we are telling our parents and our families, you know, “We need to increase fruits and vegetables in your diet, and you need to increase exercise, and you need to decrease screen time.” That’s true, and we need to do that. But I think that if we mandated some things, just like we did in the pandemic, and in this case it would be things like, you know, school phys ed programs and school nutritional programs, some of that is done, but not nearly on the scale that it needs to be, this would make a big difference if we made it more of a nationwide effort.

Another thing that we did, for example, is we instituted actionable, simple steps in the pandemic. What was the message? It was the three W’s: Wear a mask, wash your hands, watch your distance. Of course, we actually know what the actionable steps are for weight control. We know it’s, you know, healthy eating, exercise, and limiting screen time. We know that’s what it is, but we really need to systematize that as much as possible.

Not only should we tell our patients that, but we should saturate the environment with that information. By that I mean just like in the pandemic, when that message was everywhere. It was on posters, it was on billboards, it was on TV commercials. I think the message should be there everywhere children go, encouraging them to make healthier food choices, and encouraging them to exercise, take the stairs, or, you know, go ride your bike for 30 minutes, or things like that. Everywhere that they touch, that message should be there.

And not only should the message be there, but the tools need to be there, because with the pandemic, we didn’t just say, “Wash your hands.” There was also hand sanitizer. You know, there were hand sanitizers everywhere. When you walked into the store, the hand sanitizer was right there. I think we could do something similar for kids, so that, like I said, everywhere they touch, there should be opportunities for healthy eating and exercise. We shouldn’t have food deserts, for example. Healthy foods should be accessible in all of the places where they are, and physical activity opportunities should be abundant, you know, even outdoor free things like parks. Safe parks, safe playgrounds, things like that would make a big difference.

And finally, one of the other things I suggested was the investment of money, because all of these things are great, but it takes an investment. We did invest quite a bit in making sure that people were protected during the pandemic. We invested in the vaccine. We invested in free testing for anyone who needed it and made it accessible. I say we should do the same thing, you know, make an investment in these things that we need for a healthy childhood, for reducing weight. It takes investment to have these safe spaces that I talked about. Physical activity opportunities and removing food deserts take an investment from our government. So that’s the approach that I was suggesting in the article.

Kevin Pho: I want to go back to your first point about relieving individual responsibility as it relates to childhood obesity. As you know, during the pandemic, there was a lot of pushback to some of these mandates. You do live in America, where people do value their individual rights and freedom. Do you see any potential for pushback whenever something is mandated, especially as it relates to childhood obesity?

Teresa Fuller: Yes, absolutely. I think there would be a lot of pushback. I think we’ve seen the pushback. If you go back to the Obama administration and you think about how Michelle Obama tried to, not even mandate, but really push for healthier foods in schools, and push for the Let’s Move movement, and there was a lot of pushback. So I do anticipate that.

But I think we’re talking about things that we pretty much can all agree on. We can all agree that we don’t want our children to be at risk for chronic illnesses. We don’t want them to be at risk for diabetes and, you know, high blood pressure and heart disease and all of these things. What we really are asking for is not so much mandates that impose on families, but more mandates that allow the children’s environment, like the schools, to have things in place.

I really think it would be hard to argue that we should mandate physical activity in schools. We do have it mandated, but for example, at a lot of schools that may only be one semester, or one year out of the four years of high school. But we could mandate that. This is America, and there’s going to be pushback, but I think overall we could probably agree on those types of things.

Kevin Pho: We’re talking to Teresa Fuller. She’s a pediatrician, and her KevinMD article is titled “Reversing the impact of the pandemic on childhood obesity.” Teresa, I think that a lot of these are policy goals that we absolutely should pursue. But in the exam room, as a primary care doctor yourself, I’m sure that you know that there’s a lot of time pressure on pediatricians. So what are some high-yield things that they can do in the exam room to help reverse that trend of childhood obesity?

Teresa Fuller: Yes, I agree. I experience that every day. You have your well-child care visit, and you’re trying to address so many things. You’re trying to address so many health issues. So in the exam room, we definitely want to, you know, make it as easy as possible. We want to give parents very simple, actionable steps.

So one thing that I recommend, and that I try to do, is to have things written down so that it can be a simple handout. Some years ago, an example that I really liked was the prescription for exercise, where you actually give them a written prescription with some ideas. You can let them know what’s in their own neighborhood. You know, many times people are coming to pediatricians who are pretty close by, and so we can let them know what the parks and the locations are in their own neighborhood that would be accessible, because parents are worried about their children being safe as well. So try to find those resources for parents.

Once you gather all of that together, you know, being simply able to hand it out or talk about it for two minutes or so, and following up on those things, having them come back, “Let’s see how you’re doing with this. How’s the week going?” Those types of things are simple. They do take time, but they can be done in a pretty systematic way.

Kevin Pho: And my final question: Any take-home messages that you want to leave with the KevinMD audience?

Teresa Fuller: I would say that, you know, a lot of clinicians are very involved in public health, and I think more of us need to be. I need to be. Because I think what we’re seeing, as we’re seeing children in our practices daily, as we just talked about, and we’re trying to counsel our parents and our patients to make these healthier choices, is that we also want to advocate for local and federal governments to make this easier for families.

And so, as we get involved in public health and push our governments to make public health a priority, and to make these changes in the schools and the environments that our children find themselves in a priority, I think we can make a difference as clinicians, not just in our exam rooms, but also on the larger scale.

Kevin Pho: Teresa, thank you so much for sharing your time and insight, and thanks again for being on the show.

Teresa Fuller: Thank you, Kevin.

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