There is an insidious enemy on the rise, and while underlying issues are varied, there are strategies aimed at reducing the incidence of childhood obesity. According to the American Pediatric Association, the United States leads the world in cases of childhood obesity. Despite having one of the best healthcare systems in the world, many U.S. citizens, especially children, live on a diet full of fast food and highly processed foods. Sadly, these food sources are inexpensive and readily available in contrast to more natural, whole foods. Quality food sources are often more expensive and less available to families trying to make ends meet. It is important for healthcare teams caring for families to take action to limit consumption of unhealthy fast and highly processed foods. Knowledge and support can redirect and lower the trajectory childhood obesity is taking in the U.S.
ASSOCIATED HEALTH CONDITIONS
As a medical assistant working in pediatric cardiology, I work with many case managers. In our practice, we see an enormous number of young children diagnosed with heart-related diseases and conditions such as hypertension, hyperlipidemia and hypercholesterolemia. These serious health conditions, if not treated properly, lead to severe illness and an overall decrease in quality of life as these children grow into adults. In most cases these diagnoses are the result of a diet that regularly includes unhealthy foods. Obese children’s diets typically include highly processed foods high in calories, sodium and/or fat. According to the Centers for Disease Control and Prevention, childhood obesity is strongly related to psychological problems such as anxiety, depression and low self-esteem. These and other psychological problems associated with obesity can lead to a child being bullied by peers and even adults. Additionally, many children come to our practice with pre-existing conditions such as diabetes and asthma, further impacting their overall health status. Childhood obesity and unhealthy eating habits follow most children into their adult life, putting them at higher risk for heart disease, which remains the #1 cause of death in the U.S. today.
South Florida, which comprises Miami-Dade, Broward and Palm Beach counties, is a very diverse region that is host to many cultures and ethnicities. According to the 2017 National Immigration Council “Immigrants in Florida,” about 20.2% of Florida’s population is made up of immigrants. While childhood obesity is certainly not confined to children of immigrant families, there are cultural variables affecting a family’s ability to acquire knowledge of and provide access to a healthy diet for their children. Since many immigrant families are undocumented, an additional layer of complexity is added to an already difficult situation. Undocumented mothers or fathers find it difficult to secure a job that pays enough to buy their children healthier food. It’s a sad fact that immigrant families often lack access to quality, affordable, readily available food sources. It is apparent that the quality of food chosen by many U.S. citizens, especially those at a lower economic status, is a public health crisis. It has been suggested that the Food and Drug Administration severely limit or even ban the sale of high lipid, high-carb, and high fructose corn syrup foods. It would be helpful for the price tag on natural whole foods to become more affordable and available to lower economic families.
TEACHING AND SUPPORTING A HEALTHIER LIFESTYLE
An essential first step is when a child is identified as high risk for obesity; it is important for “someone” to get involved. This could be the school nurse, the payer case manager, the primary care physician or in our case as the pediatric cardiologist to refer to one of our support partners.
Simple steps can be taken toward education and support to help families change behaviors. Below are listed several key areas that can positively impact a child’s overall health status, and assist in lowering his/her risk of developing obesity.
Exercise: As we all know, kids are packed with loads of energy! If we create an active, welcoming environment, children can be persuaded to put down their phones and electronic games and join in on some exercise disguised as fun! Bike rides, a traditional one-on-one game of catch, brisk walks around the neighborhood and participation in on-line exercise activities are all opportunities to exercise safely despite recent restrictions based the COVID-19 pandemic. Since some children are too young to do many of these activities unsupervised, the case manager should encourage parents to commit to their children’s health and lead by example. Kids love a challenge, and they love to feel included. Exercise can be fun for the whole family, and it is certainly part of a healthy lifestyle!
Snacks: Another tip a case manager can offer families is to avoid buying unhealthy snacks for home consumption. Parents should be reminded to avoid grocery shopping while hungry themselves, avoiding temptation based on their own snack desires. According to KidsHealth.org, a well-timed healthy snack can be helpful in providing children a boost of energy to hold them off until the next meal (Gavin, M.D, 2015). Healthy nutritious snacks include cheese, fruit, veggies, nuts, peanut butter and low-fat yogurt. It is also important for a case manager to remind parents snacks should not be used to reward good behavior. Snacks are integral to a healthy diet and not used as a bargaining tool.
Cooking: As we know, children tend to be picky eaters. Oftentimes, an interest in cooking will precipitate increased interest in healthy eating too. A case manager can suggest that families initiate cooking time together at home. Children can learn to understand package labeling in making wise food choices. Children love to feel included, and by involving them in the cooking process, they may become creative and even develop their own recipes. Every cooking lesson supports time together and the development of an appreciation for a healthy diet.
There is no single or simple “fix” for childhood obesity due to the many variables at play. Hopefully the simple steps described here can serve as guidance for case managers to assist in the development of a healthier lifestyle for children and the families that care for them.
• Facts and figures on childhood obesity. (2019, September 23). Retrieved from https://www.who.int/end-childhood-obesity/facts/en/
• Gavin, M. L. (Ed.). (2015, July). Snacks (for Parents) – Print Version – Nemours KidsHealth. Retrieved from https://kidshealth.org/en/parents/snacking.html?view=ptr&WT.ac=p-ptr
• Immigrants in Florida. (2017). American Immigration Council. Retrieved from https://www.americanimmigrationcouncil.org/research/immigrants-florida
• Obesity-Update-2017. (2017). Retrieved from https://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf
• Ogden CL, Carroll MD, Fakhouri TH, et al. Prevalence of Obesity Among Youths by Household Income and Education Level of Head of Household—United States 2011–2014. MMWR Morb Mortal Wkly Rep 2018;67:186–189. DOI: https://www.cdc.gov/mmwr/volumes/66/wr/mm6650a1.htm.
• U.S. Census Bureau QuickFacts: Miami-Dade County, Florida; Broward County, Florida; Palm Beach County, Florida; Florida. (2019). Retrieved from https://www.census.gov/quickfacts/fact/table/miamidadecountyflorida,browardcountyflorida,palmbeachcountyflorida,FL/PST045219