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Monday, January 25, 2016
In the past 30 years, childhood obesity has more than doubled, increasing the number of children with potential for short- and long-term health issues. Clinicians in MGHfC’s Raising Healthy Hearts and Pediatric Gastroenterology and Nutrition Program and are working to eliminate these budding hazards by providing specialized care and treatment options for overweight and obese children and teens.
A study recently published by Lauren Fiechtner, MD, MPH, director of nutrition for the Division of Pediatric Gastroenterology and Nutrition and Elsie M. Taveras, MD, MPH, chief of the Division of General Pediatrics and director of Pediatric Population Health Management is creating a healthier future for the next generation. Dr. Fiechtner discusses the role food access plays in the health of children in obesity intervention treatments while answering commonly asked questions.
Q: How do you determine if a child is overweight or obese? Clinicians calculate body mass index (BMI), a measure which takes into account a child’s weight for their height to determine if the child is overweight or obese. We plot this on standardized BMI growth curves. If a child’s BMI is greater than or equal to the 85th percentile, then we consider them to be overweight. If a child’s BMI is greater than or equal to the 95th percentile, we consider them to have obesity. Q. Can obesity be prevented?Obesity has a genetic link and can be attributed to family history. However, a healthful diet without processed foods and sugary beverages, as well as adequate physical activity and enough sleep early in life may prevent childhood obesity.
Q: Is there a standardized course of treatment for obesity? There is no standardized course of treatment but an overall healthful lifestyle approach has been shown to be effective, including focusing on improving a child’s diet, physical activity and sleep.
Q: What has your most recent research told you? Previously, we investigated if distance to a supermarket was associated with a child's body mass index (BMI). We then looked into whether the distance would impact how children performed in a behavioral intervention, thinking that those who had access to a more healthful neighborhood and food may be more successful in getting to a healthier weight. The intervention included computerized clinician support in the electronic health record and either a family self-guided family intervention or a health coaching intervention, which included an interactive text-messaging program.
We found that children who were in the intervention who lived closer to large supermarkets were more likely to eat more fruits and vegetables. They also had a lower BMI and improved their overall health more than those living farther away. These results suggest that having access to a healthful neighborhood and food can improve a child’s BMI.
Q: Were you surprised by these findings?We expected the distance from grocery stores to have a greater impact on children's sugary beverage intake. These beverages, such as juice and soda, contain a high amount of calories and have been linked to weight gain in previous studies. In the Raising Healthy Hearts Program we recommend parents limit these beverages as a first change because it can have a large impact in getting their child to a healthier weight. Q: How can parents ensure that their children have access to fruits and vegetables?Often families need to travel far distances to get to the closest supermarket. Also, many families face time and financial constraints making the behavioral and dietary changes we prescribe difficult to fulfill. Maximizing frozen fruits and vegetables purchases or fruits and vegetables that do not perish as quickly is important to ensure children always have access to these staples in their homes.
More importantly, policy makers should consider ways to ensure all children have access to healthier neighborhoods including incentives for building supermarkets in low-income neighborhoods and decreasing the costs of fruits and vegetables.
While designing obesity behavioral interventions, we as clinicians need to account for the neighborhoods families are living in. This could help identify why certain children are more successful than others in getting to and maintaining a healthier weight.
For more information about the Pediatric Gastroenterology and Nutrition Program and Raising Healthy Hearts and its services, visit the group’s website here.
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