Obesity affects one in five children in the U.S., according to a National Center for Health Statistics 2017 report, and is more prevalent among minority populations. While there are challenges at hand in facing this condition which has lifelong effects on children’s health, the pediatrician’s office is uniquely situated as not only a center of community change, but also the first place where families can access tools for prevention, education, and support.
Causes & Community
Children can find it difficult to develop healthy eating and exercise habits in communities that do not or cannot offer them the resources to develop them. Your pediatric practice has unique insights on the community you serve -- what do you think most impacts the kids struggling with obesity in your area?
You might be thinking of the elementary school’s cafeteria options, the number of fast food chains in the area, or lack of local public space for kids to play. The point here is not to extend blame, but to determine what influences and obstacles families may be facing in their daily lives which can lead to childhood obesity. Once you know the causes, you can get to work on solutions. Some more examples might include:
- Local policies determining what businesses, including restaurants and grocery stores, are available in the area
- The affordability of low-calorie, high-nutrient foods from local stores
- Food insecure households who may be forced to weigh food costs with household bills
- The accessibility of places children can exercise and play, such as parks, playgrounds, or nature trails
- A child’s ability to play or exercise at home, including the safety of their home environment and neighborhood, accessibility to sports, and parental influence
Pediatricians can have great influence on childhood obesity not only via clinical care, but also through community outreach efforts. Once you’ve identified areas for improvement, become a part of efforts towards accessibility and food security by connecting with local programs with similar goals.
By connecting with stakeholders in the community at schools, hospitals, youth clubs, community centers, and faith-based organizations, to name a few, your practice can participate in community-centered change that can help provide kids at your practice the opportunity for healthy habits for decades to come. This change might include simple changes such as school cafeteria or vending machine changes, or larger ones such as the construction of playgrounds in public areas.
For more information about integrating with local systems to prevent chronic diseases such as childhood obesity, visit the CDC’s guide: Community-Clinical Linkages for the Prevention and Control of Chronic Diseases.
Food Insecurity, SNAP, & WIC
Obesity is an interconnected issue with food insecurity, poverty, unemployment, and inconsistent access to healthful food, which makes both community involvement and assistance programs necessary tools for your practice’s efforts in both reducing and eliminating hunger as well as childhood obesity.
As Dr. Steven Abrams, Chair of the AAP Committee on Nutrition, commented in The Independent Pediatrician, federal assistance programs such as SNAP and WIC are not integrated with electronic health records, making the connection between obesity or other nutrition-related conditions harder to connect to their cause -- food insecurity. In the next section, we’ll cover ways your practice can confront food insecurity in your community.
How Your Practice Can Help End Childhood Obesity
Regular well visits are the backbone of making sure a child’s growth is on track and that they’re receiving the nutrition and getting the exercise they need to grow up healthy. Well visits can help you not only pinpoint risks for obesity in individual patients, but help you understand how to best help your patient population as a whole.
The AAP recommends screening all children over the age of 6 for obesity and providing or referring them to appropriate counseling or treatment, defining obesity as “age-and gender-specific BMI greater than the 95th percentile”. Early intervention can help kids change habits, plus reach and maintain a healthy weight.
The screenings, perhaps performed at well visits, should also include questions related to food insecurity, such as “Do you ever worry about running out of food and not having the money to buy more?”
These food insecurity screening questions, as well as more information on connecting your patients to food assistance programs, can be found in the Food Research and Action Center’s Food Insecurity Toolkit for Pediatricians. In it, you can learn about normalizing screens to reduce stigma, training staff, and connecting patients to WIC, SNAP, and other resources.
When your practice has built the workflows to screen and treat obesity consistently, you’ll be able to review your patient population and determine if obesity is rising, falling, or is a widespread enough concern to be addressed with further measures, such as a fitness or nutrition campaign, referral to or consultation with pediatric nutritionists or dieticians, or measures in local policies and resources, as mentioned above.
Effects of COVID-19 on Obesity & Nutrition
Unexpected changes in schedules for many families means that more patients at your practice may be struggling with obesity and/or food insecurity over the course of the pandemic. Your practice may consider screening more frequently for food insecurity and in addition, asking about any concerns families may have in the nutrition patients are receiving at home or at school.
Families of patients who previously received meals or snacks at school or in daycare programs may struggle to replace these meals at home; however, many school districts and communities are delivering meals or groceries to homes. There are also programs that deliver groceries to reduce the risk of grocery shopping for high-risk family members, such as this one for Cambridge, MA residents.
Addressing obesity in children is a nuanced problem, tied to many other factors in a child’s life, such as environment and socioeconomic status. There are many clinical ways to help a child achieve a healthy weight and lifestyle, but in some ways, this is the simplest of a pediatrician’s tasks. More complex is a practice’s response to their communities’ contextual needs -- the social determinants of a healthy weight and lifestyle for kids.
Luckily, from connecting families to available resources to advocating for policies that will help every child get the access they need, there are plenty of ways your practice can help. While your practice is considering ways to address childhood obesity in your community, don’t forget that food insecurity as well as dealing with obesity can be hard on kids’ mental health. To integrate behavioral health at your practice and get kids access to the services they need, check out our ebook on the topic to decide which path forward is the best for your patients and your practice.