Childhood obesity and chronic illnesses that result from being overweight

Our national health status is in imminent danger from the effects of a condition that most population health experts acknowledge is out of control.

I am speaking of obesity — and, in particular, its increasing prevalence in American adolescents and children.

Almost every study that has been done concerning obesity shows a correlation with soda consumption. As a result, some states and municipalities have tried to implement initiatives that make it more difficult (or expensive) for people to purchase sugary soft drinks.

Even President Obama has “weighed in” on the topic. He was quoted as saying that such initiatives were worth putting on the table as Congress debated healthcare reform.

I have asked guest columnist, Diane Abatemarco, PhD, MSW, associate professor and director of doctoral programs here at the Jefferson School of Population Health, to react to the initiatives that have appeared in the national media and to share her experience with an innovative program aimed at reducing childhood obesity — a program that engages physicians and features “carrots” as well as “sticks.”

Dr. Abatemarco worked with the innovators of the program to implement and evaluate it at three family medicine centers in western Pennsylvania.

Those in positions to fashion health policy should take note.

Dr. Abatemarco writes:

In March of this year, the mayor of Philadelphia proposed a tax on sweetened beverages such as soda, energy drinks, and bottled teas. Months later, the mayor of New York sought federal permission to bar the city’s 1.7 million food stamp recipients from using food stamps to buy soda or other sugared drinks.

Whether you agree with these controversial legislative actions or not, public health professionals and researchers agree that obesity among the nation’s youth is an epidemic.

More and more children, ages 9 to 12, have health issues related to overweight and, while most children see their pediatrician or family physician yearly, there has been no decrease in the rate of weight gain among children.

The real question before intervening with children and their families is “Whose job is it to tell parents that their child is overweight, obese, or morbidly obese?”

Researchers have found that some physicians are uncomfortable bringing up the subject of children’s weight because, quite often, the parents are overweight as well.

Other physicians may be reluctant to discuss the topic because they do not want to make their patients feel uncomfortable.

Adding to the problem, we have yet to figure out how to deliver educational messages about nutritional alternatives to typical inexpensive fast foods.

But interventions such as Fitwits MD have shown promise in the pilot phase of testing.

Developed by researchers Kristin Hughes, at Carnegie Mellon University, and Ann McGaffey, MD, of the University of Pittsburgh, and directed at physicians, Fitwits MD is a brief educational intervention that includes physician tools, children’s games, food recipes to share with parents, and tips to help change family behavior.

Pilot data showed that the 50% of physicians and residents who adopted the intervention used it for the majority of well-child visits.

Qualitative data from the participating physicians showed that the tool facilitated discussions with the child and the family regarding weight, BMI, nutrition, and exercise.

Participating physicians reported that spending a few extra minutes on the subject seemed to make a meaningful contribution to the child’s and family’s welfare.

The physicians also reported personal feelings of confidence and competence.

The intervention also changed physician beliefs about why patients are overweight and about patients’ resistance to making needed behavior changes.

In post-intervention interviews, participants reported that the real barriers are the lack of convenient places to buy inexpensive healthy foods and the lack of safe environments for children to play and enjoy physical activity.

If we are to turn the tide on childhood obesity and chronic illnesses that result from overweight, we need more brief medical interventions that include appropriate health literacy and easy-to-adopt behavioral changes.

Clinical transitional research can be used to inform practice change as the science of nutrition and excessive weight gain is translated to “real life” experiences.

The bottom line is that, if we want to move healthcare toward holistic prevention, we must assist primary care physicians in taking on these important issues without overburdening or overextending the office visit.

Fitwits MD is part of a larger project designed to change the way we think about nutrition, exercise, and portion size. Featuring characters that embody healthy foods (Fitwits) and nonhealthy food choices (Nitwits), the project has school and community components as well.

Originally published in MedPage Today. Visit for more health policy news.

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