Teaming Up Against Childhood Obesity

When I graduated from medical school in 1972 and ultimately trained in pediatric gastroenterology, I assumed that the most common problems I would diagnose and treat would be truly digestive diseases-centric. I was particularly interested in underweight, malnourished children. The obesity rate for children was about 5% at that time. Never in my wildest imagination would I have predicted that over the next 40 years the childhood obesity rate would increase fivefold and that many of the children I would soon see would present for conditions related to being overweight and obese.

Fast-forward to 2011. With the obesity rate in children in excess of 30% in some areas of the nation, every one of us is aware that childhood obesity is widely considered to be one of the most serious public health problems facing the United States and other developed and developing nations around the globe. The problem is particularly endemic in urban and some rural population centers, where children's diets are composed of inexpensive but readily available food, coupled with a lack of exercise and inadequate access to preventive healthcare. This multifaceted problem is particularly intractable when coupled with poverty, widespread ignorance about nutrition, lack of access to playgrounds and healthy food, and other societal barriers.

The health and social consequences of obesity are enormous. Children as young as five are being diagnosed with type 2 diabetes, asthma, and hypertension. Dental caries are common, as are sleep disorders and early stage cardiovascular disease. Overweight children miss school frequently, lag behind in schoolwork, and often drop out altogether. Such children tend to be victimized by their peers, or themselves become bullies toward smaller children, and the cycle of violence continues. The problem is particularly prevalent in minority and immigrant communities—the very communities where the population is growing steadily and where much of the future healthcare workforce will be found. These problems are only exacerbated in adulthood, leading to a lifetime of chronic disease, overburdening the health system, and costing taxpayers billions of dollars.

Just as our children did not become obese overnight, the increase in the rate of childhood obesity was not caused by just one factor. And we cannot tackle this vexing problem overnight or in only one way. This problem is not the responsibility of just physicians. Or nurses. Or parents. Or teachers. It is the responsibility of all of us, working together, to ensure the health and well-being of our children and grandchildren.

So how do we begin to work together on the challenge of childhood obesity? Currently, teamwork is not a primary focus of most health professions' education programs in the United States. Regardless of the profession—medicine, nursing, pharmacy, dentistry, social work—students are taught to function independently and they usually learn in silos. I am one of a small but growing group of health professionals and educators who are trying to change that. I believe strongly that all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics.

Even though I am a university president, I am first and foremost a pediatrician and gastroenterologist. I continue to see patients in my weekly President's Clinic. In my clinic, I see firsthand how a truly collaborative approach reaps tremendous benefits. The interdisciplinary team of practitioners and students (from the schools of medicine, nursing, pharmacy, dentistry, social work, and law) with whom I am privileged to work encourages trust and respect among professions, and engenders complementary practice styles and enhanced communication, which results in a shared vision for the patient.

Let us take dentistry as an example of meeting the childhood obesity challenge. According to the Journal of the American Dental Association (JADA), in 2008 at least 70% of Americans visited a dentist the previous year. Visits were most common among children aged 6–11 (83%), followed by 12–17 year olds (80%). A November 2010 cover story in JADA reported that because of their frequent contact with patients, dentists are well positioned to recognize patients who are at risk of becoming overweight and/or developing obesity. ¹ In a survey of nearly 3,000 dentists, half said that they would be interested in providing their patients with obesity-related services.

Similarly, our social workers and lawyers can materially contribute to the prevention of childhood obesity. They advocate, for example, on behalf of our children for obesity-related legislative reforms addressing the built environment or the nature of food and beverages in schools.

Numerous opportunities thus exist for healthcare and healthcare-related professionals to intervene in the war to prevent childhood obesity. Each encounter with a patient or client presents an opportunity for counsel and care. At the macro level, these same professionals can influence the environmental contributors to this epidemic. Interprofessional preparation of professionals to apply their discipline-specific knowledge, skills, and approaches arguably affords us the best chance for ensuring that today's children become healthy adults.