“And at the end of the day, it's important that our interactions with patients give them important information, allow them to be empowered to change whatever behaviors they're motivated to change for the reasons that are consistent with their values.”
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In this episode, Dr. Eliana Perrin discusses the importance of clinicians and caregivers in childhood obesity prevention. She talks about how parents can help their children establish healthy habits from an early age and how clinicians can better intervene to prevent childhood obesity during and beyond the COVID-19 pandemic. Tune in to learn how healthcare providers can better equip parents and caregivers to prevent childhood obesity.
Dr. Eliana Perrin is a general pediatrician, researcher, and expert in childhood obesity prevention and treatment. She focuses on communities that have been systematically disadvantaged. She studies how primary care teams can partner with families to help them engage in healthy behaviors throughout their child’s life. She is a Bloomberg Distinguished Professor in the dept of pediatrics and schools of medicine, nursing, and public health.
Shireen: In this episode, Dr. Eliana Perrin discusses the importance of clinicians and caregivers in childhood obesity prevention. She talks about how parents can help their children establish healthy habits from an early age and how clinicians can better intervene to prevent childhood obesity during and beyond the COVID-19 pandemic. Tune in to learn how healthcare providers can better equip parents and caregivers to prevent childhood obesity.
Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish podcast. Yumlish is working to empower you, to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.
Dr. Eliana Perrin is a general pediatrician, researcher, and expert in childhood obesity prevention and treatment. She focuses on communities that have been systematically disadvantaged. She studies how primary care teams can partner with families to help them engage in healthy behaviors throughout their child’s life. She is a Bloomberg Distinguished Professor in the dept of pediatrics and schools of medicine, nursing, and public health. Thank you, Dr.Perrin!
Dr.Perrin: Thanks for having me on Shireen – an absolute pleasure!
Shireen: So Dr.Perrin, what really drew you to medicine? How did you become involved in pediatric medicine?
Dr.Perrin: Well, like so many, um, folks, I really wanted to help improve people's lives. I've always been fascinated by the doctor-patient relationship and that ability to get to know someone well and by knowing them well, knowing how to keep them healthy, help them get over illnesses. In terms of pediatrics, I've always loved children, um, and helping them grow up healthy is really an honor. I also really love pediatricians. So I'm constantly working with colleagues that are just wonderful people.
Shireen: Lovely. So can you briefly describe to us this, the current state of childhood obesity in the United States? How big is this problem?
Dr.Perrin: Yeah, unfortunately, the rates of childhood obesity are not improving.
We know that about one in five children are obese and the rates of severe obesity are actually rising, and this epidemic hits communities that like you said, in my bio have been systematically disadvantaged the hardest. Unfortunately, we know that childhood obesity often tracks into adult obesity, which is why I, and so many of my colleagues, are actually spending a lot of time trying to prevent obesity.
It's very hard to treat, but all of this is not surprising because we have an incredibly toxic food environment in this country. We’re calorie rich, but nutrient poor food is the cheapest while nutrient rich and calorie rich food is the most expensive. And really often out of reach either financially or logistically for our families with lower incomes. And we have a tough time being active because they're often not safe spaces to play or run, or our days are very scheduled with you, activity breaks. So really it's a perfect storm.
Shireen: How do clinicians generally approach childhood obesity prevention with the parents? Families?
Dr.Perrin: Yeah, no, it's a great question. But in my opinion, clinicians often start way too late in a child's life. So we know from some of our own research, that behavior is like television watching. Juice and sugar sweetened, beverage drinking, et cetera. All of those things start really early way earlier than you think. But there's another reason to start early and that's that if children are newborns, and if we start when children are newborns in a relationship with parents that lets them know that our job is to partner with them, to keep their children healthy, then those conversations go way better throughout the child's life.
If the first time someone engages in a conversation about healthy behaviors or obesity prevention is at age 10. Let's say when a child is already overweight or obese, it's a harder conversation. It's an important one, but it's a harder one. And when we do engage with parents and have conversations, we always like to ask them permission about whether it's okay to discuss this. And then we really work to explore families’ values and desires with regard to any kind of behavior change we're talking about. We also always work to keep the conversation about health rather than weight.
Shireen: You know, what, one of the things I find interesting is that we live in this culture of, you know, getting, you know, immediate results. You, you hear out there 30 days, 30 pounds, and I mean, I've been some, some crazy things out there. What do you say to some of that quick fix?
Dr.Perrin: You know, especially when we're talking about childhood obesity, well, it can be very tempting, but usually so many of those plans are not very healthy and they're not very sustaining and, eating that way or being active that way for a short period of time, isn't nearly as helpful as making small changes that are more sustainable over a long period of time.
Shireen: What improvements, if any, can be made with the provider and patients in that interaction that happens through?
Dr.Perrin: So I always like to share that this is a partnership that we care about children's health and that we want to help the family focus on healthy behaviors and good decisions for that reason. And like I said, even some small decisions can make a big difference. And many of these behaviors that we're talking about can have other positive influences. For example, getting outdoors, being active can certainly help with obesity, but it can also help with mental health and drinking less sugary beverages helps with making sure you have an appetite for foods with better nutrients and it can help toddlers have less diarrhea and it can even help them have better teeth. Drinking more water, eating more whole greens, fruits, and vegetables can help with constipation, which is often a big problem for kids and one that parents come to us about frequently. So there's often more than one reason to adopt some of these healthy behaviors and sometimes different aspects are motivating to different people.
We doctors may care about obesity a lot., but parents may care about constipation or something else. And at the end of the day, it's important that our interactions with patients give them important information, allow them to be empowered, to change whatever behaviors they're motivated to change and for the reasons that are consistent with their values.
Shireen: What, what do you say to this? Cause you know, one of the things that we hear about from the doctor's side is to say, listen, I only have 10 minutes with that patient or their family. I can't go into so much detail. I just don't have the bandwidth because I have to move on to the next patient. What would you say to that as we're talking about this provider-patient relationship?
Dr.Perrin: No, it comes up all the time and, you know, primary care providers are so stretched these days and my hat goes off to each and every one of them. And they are stretched and there are high expectations about all the many things to cover. I find that often easing into this conversation, the way I shared really trying to get at the family's values, their priorities. And actually save time. It's actually remarkable, you know, kind of when you go in there and you say, well, this is what I need you to do. And you know, you're going to get some pushback. And then if you push back to that, suddenly it's a long conversation and not a very pleasant one for anybody. But if you go in and, um, you know, you're really thoughtful about, you know, how can I help this family get to where they want to get to. And listen for just a couple of minutes at the beginning. Sometimes you can make a lot of progress in a very short amount of time.
And, you know, we call this motivational interviewing and there's all kinds of people who really training best practices and motivational interviewing, but it, it really starts with, you know, just being very open, rolling with resistance, finding out about family's values, making sure you have permission for this type of conversation. If you, if you don't take the shortcuts and actually do this, it actually saves time.
SHireen: You know, many children live in disadvantaged environments that make it difficult to eat healthy food, access, safe spaces to exercise. How can healthcare professionals better help parents and caregivers really navigate these toxic food environments?
Dr.Perrin: Yeah, and this is such a big area of my research. And so many of my colleagues, um, we do a lot to try and help parents and pediatricians partner on exactly this. So we talk about pediatricians giving immunizations, right? That's like one of the big things that we do. And I like to say that we need to immunize against the toxic food environment if only we call it right.
But we do still really try to help parents find inexpensive and safe ways to stay active and eat healthy. And much of what we recommend is either free or cheap because our parents, our families that we take care of, they don't have a lot of resources. So we encourage things like tummy time and floor time for infants, you don't need a fancy exerciser. And then as children get older and they're, you know, toddlers or preschoolers, really just going outside and splashing the puddles and playing tag and kicking a ball. And, you know, for older kids, maybe jumping rope inside. In terms of eating, we know that healthy food costs more. It's crazy that it does, but it really often does, but some things we recommend actually cost less. Water is less than juice or fancy sports drinks, and there's no need to buy juice or sports drinks at all.
Making food at home is often way healthier than eating out, which can be really expensive and less healthy. And changing habits, like not eating in front of the TV or serving portions that are the size of the child's fist. These are either budget saving or budget neutral. And I really feel like most of our recommendations have to either be budget neutral or budget saving this year.
Shireen: Dr. Perrin, you advocated that parents should give themselves some grace in worrying about their children's pandemic weight gain because of increased stress and food insecurity at home. How has the COVID-19 pandemic really affected that?
Dr.Perrin: Yeah, I really, um, I'm just very firm in that belief that we have to give ourselves a lot of grace, the entire nation, but certain communities even particularly have been just through so much. And it's only just now starting. To come to light all the many changes in health that are occurring. And we are just now starting to see some research come out on how children's weight has changed as a result of the pandemic. And unfortunately, the news there is not good. Susan Wilford and colleagues published an article in late August that showed that children ages five to 15. So that sort of school age child, um, gained an average of five pounds more during the pandemic period than kids did in a similar sort of pre pandemic reference period. And in looking at the number of children who are overweight or obese, that's that, you know, percentage has changed from 36% to 46%.
So on the one hand, that's really striking. On the other hand, it doesn't come as much of a surprise to pediatricians in the trenches. We're seeing that shift anecdotally. And so many of our patients day in, day out, but that being said, like I said, at the beginning, I get it. It's been a really tough year for so many of our families. And since food is comfort and so many cultures, it's entirely understandable that we all would be eating more and looking for some quick, happy moments of eating tasty foods. I do think that parents need to give themselves that grace, gut also recognize and, and encourage that things like extra physical activity can help with that weight management and the mental health.
So it can actually sort of be that dually focused intervention that maybe sort of recognizes how hard this pandemic has been, but also does something that It's unhealthy weight gain.
Shireen: I want to go back and just clarify something when you said that jump from 36 to 46%. Is that just during the pandemic or is that over another period of time?
Dr.Perrin: Yeah, no, that's, um, sort of what we think has happened with the incidents of obesity. I think the authors had said that it was about a relative increase of about 24%. So, you know, really impressive gains in the number of kids who are overweight or obese during the pandemic.
Shireen: So how can parents best support children's healthy lifestyle? Can you provide maybe specific examples that the parents listening here can apply in their day-to-day life?
Dr.Perrin: Yeah. So the general principle that I like to endorse is to work healthy routines into your life. So all of us have those slings and arrows of outrageous fortune, those things that come up here and there that disrupt our best lead. But the best laid plans needed to be best laid plans. And if parents can work in small, healthy routine changes, then most of the days will be healthier. And the overall effect can be incredibly powerful.
One of our patients, for example, decided she was going to stop buying soda and serve water at dinner. That's just like, it's a simple change. It's a budget neutral or budget saving change or. But it makes such a big difference. She found she saved some money. She actually found the kids. She had been buying caffeinated soda and the kids didn't have that extra caffeine that she felt kept them up. She felt they slept better.
Another one of our families, the mom, took the television out of our child's bedroom. She felt like, you know, they already had a phone in the bedroom to have a TV. It was just like too much screen time. And she felt that that really helped her preteen get more sleep. So small things like that every day can really make a big difference.
We're all gonna have those potlucks, those, you know, pick church picnics, the, you know, whatever. We're all going to have all of them. But if we can work on some small things to our daily routines, keeping our homes as healthy as they can be,
Shireen: Dr.Perrin, you talked about the concept of a budget defecit. I love the concept of that because what is almost implying is that there is a way to eat better, to eat healthier, too. Sort of, you know, at times of course giving into temptation, but even on the side of that, as you're trying to incorporate these habits, it doesn't have to bake the bank. One of the myths that exist around also eating healthy is that I can't afford it., but what I'm hearing from you is that there are ways to get to the other side and, and not break the bank.
Dr.Perrin: I think that's right, Shereen. I mean, I'll be the first to admit it's harder for people who are on tighter budgets to eat healthier. And that is just, you know, kind of how food is priced in this country. And it's super unfair. But, that being said, there are lots of healthy foods that are way less expensive. And you know, in childhood obesity prevention, we think a lot about portion size. And so obviously keeping portions smaller, again, the size of the fist so that it can grow along with the child can mean that we're not buying extra food, unnecessary expenses on food.
Again, water is cheaper than sugar. Sweetened beverages, many physical activity options are free or low cost. You don't need to join a fancy gym. You know, all of those kinds of things are worth thinking about, make sense.
Shireen: Thank you so much for that, Dr. Perry. And I think at this point, we're toward the end of the episode, but this is where I love for listeners to know about how they can connect with you and learn more about you.
Dr.Perrin: Oh, well, it's been a pleasure talking with you. Obviously this area is near and dear to my heart, and I appreciate being able to be on your podcast. I think Yumlish is going to post my Twitter handle and, you know, as my team and I finished studies, we really always work to publish our work if possible, and, and share our results with the media because we really. You know, our work needs to be translated into action as much as possible. Um, so stay tuned. We hope for some exciting work ahead.
Shireen: And until then, we'll follow your Twitter. nd we'll put it in the show notes so folks can follow it there as well.
Dr.Perrin: Thanks so much.
Shireen: Thank you so much for your time, Dr.Perrin. It's been an absolute pleasure chatting with you. I find that childhood obesity is this behemoth of a problem. With the work that research like yourself is doing, I'm hoping we're headed in a very positive direction to word it. And so we will follow your work to stay tuned.
Dr.Perrin: Thank you. Thanks again!
Shireen: And so to our listeners out there, after this episode, head over to our social media on Facebook, on Instagram. And tell us what habit you do every day to stay healthy? Now you may not do it every day. It's okay. We'll give ourselves some grace like Dr. Perron mentioned, but what happened? You try to do every day to stay healthy, head over to our Facebook, our Instagram, and answer that question and with that, Dr.Perrint. Thanks again. It's been a pleasure.
Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.