Shireen: In this episode of the  podcast, Dr. Michelle White discusses the current state of childhood obesity in the United States, including the impact of COVID 19 pandemic, how we got here and where we are headed. She will also talk about how social determinants of health, environmental factors and how caretakers can influence children's weight and overall well-being. Stay tuned to hear what you can do as a caregiver and healthcare provider to prevent and manage 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. Michelle White is a pediatrician and health equity researcher at Duke University. The focus of her work is developing and adapting interventions to eliminate disparities in child obesity, a condition which disproportionately affects children of color and children living in lower income homes. Welcome Dr. White. 

Dr.White: Thank you so much. Shereen. Very happy to be able to talk to you. 

Shireen: Wonderful! Dr. White, what originally drew you to medicine and how did you really become involved in pediatric medicine? 

Dr.White: Well children  just experienced just a whole variety of illnesses and then obviously different developmental stages when they're feeling well and so it's really a specialty where there's never a dull moment. Additionally, as a pediatric hospitalist, I have the opportunity of taking care of children who are sick enough to be in the hospital overnight. Sometimes for several days. And that's really fun for me because you get to see the resilience of children.

 I'm biased, but I do think that children have just this incredible resilience where even though they may go through really challenging injuries, challenging conditions, you know, they're still excited, happy, playful. And when you get to send them home, there's really nothing, nothing like that.

So I feel really blessed to be able to be in this profession where I get to see such diversity and see such resilience. 

Shireen: Can you share a little bit about the current situation of childhood obesity in the United States and where you think it is? 

Dr.White: Yeah. So childhood obesity affects about one out of every five children in the United States.

It's a very common problem. And unfortunately there is a disproportionate impact on certain children, particularly children of color, so black and Latinx children, as well as lower income children. The reason why this is important is because obesity is associated with health outcomes or poor health outcomes.I should say both in childhood and in adulthood. If you have obesity as a child, you're more likely to have obesity as an adult and that's associated with cardiovascular disease, diabetes. So we really have a chance in childhood to intervene often before they’re adults.

Those are some of the reasons why it's important right now. And then in terms of where it's heading. I, you know, I don't have a crystal ball. I would say right now it appears to be headed in a concerning direction because of the COVID-19 pandemic. You know, we do have evidence that obesity rates are changing and not in a positive way.

So increasing in prevalence. And then again, particularly impacting specific communities, The same communities that are disproportionately impacted by COVID-19 are also the communities that are disproportionately impacted by obesity. So it's this horrible, perfect storm. Where, you know, without  intervention and kind of the work of parents and providers and healthcare members.

I think it's a situation where we could see a worsening of child obesity in the United States over the coming year. I hope I'm wrong. I'm a very positive person. But I do know there are a lot of concerns and there's evidence to support those concerns right now. 

Shireen: You know, it was COVID 19 and what we've seen so far and, you know, kids being, adults being affected just as much as you know, children as well. If there's a parent out there, who's listening to us right now, what steps can such a parent take to control and combat childhood obesity? 

Dr.White: So that is a huge question. And one thing that I wanted to say right off the top, um, because I'm happy to summarize that there's a lovely statement that's been put forward by the American academy of pediatrics. And it's written for providers, primarily, but I think it's also written in such a way that parents also could glean. Some good information from it. And so it's called supporting healthy nutrition and physical activity during the COVID-19 pandemic. And if you just kind of Google supporting healthy nutrition and AAP or American academy of pediatrics, you should be able to find it,

In terms of things that parents can do. So I think we have to delve a little bit quickly into how COVID-19 is affecting obesity and how COVID-19 might relate to obesity risk.

So COVID-19 has just disrupted everyone's lifestyle in so many ways. More, you know, more ways than I can, you know, even articulate at once, just turned our routines upside down. And, one of the keys to obesity prevention is, you know, keeping certain routines, whether it's physical activity., healthy, nution, or family meal times. So all of those things, and for many, many families who've been turned on their heads. And so one of the ways where you're seeing the COVID-19 pandemic, intersecting with childhood obesity, which has also been described as an epidemic in the United States is disruption of routines.

So one of the ways that I would advise parents to try to combat that is to try to maintain or create new routines as best you can. Unfortunately, you know, many unfortunately, or fortunately, depending on who you are, you know, your steps were somewhat more stuck at home. Is there an opportunity here to have more sit down meals, with your kids where you get to kind of talk through things and then also you can eat more mindfully than if you're sitting together as a family versus eating alone or eating in front of a screen. There is data to support that.

Relatedly stress is so much higher right now, job loss, you know, the changing mask recommendations, changing recommendations on all the different things. Just the overall stress of having family members affected having family members who may be hospitalized. Stress is related to obesity. I'm sure I'm not the only one who sometimes wants to eat or drink when they're stressed. And so. trying to recognize that. And then if you do feel like you are having significant, like changes in your eating or stress is really severely affecting your health, seeking medical attention for that, or seeking therapy for that.

There's nothing to be ashamed of. We are all under more stress than we ever really imagined that we would be at this particular time. And mental health is so incredibly important. And many therapists, counselors are providing healthcare via telehealth. So there are opportunities to address those issues.

I think the other key piece for parents is also just continuing to seek regular care. Again, tele-health is an option. If you're nervous about going out and, and who isn't really, particularly with children, being unvaccinated, there's reasonable anxiety about going out and taking your kid to the doctor, but we do encourage you to feel comfortable and you feel like there are good safety protocols in place that your pediatrician in-person visits would be great so that your pediatrician can continue to monitor your child’s diet, weight, and overall health. But if you're not comfortable with that, you know, doing a telemedicine appointment is also a good option. And the key is that we don't want, speaking as a pediatrician, you know,  we don't want to lose you during this time. We really want to support you during this time.

And so making sure that we're able to kind of keep touch and if needed, do weight surveillance, some dietary surveillance support, provide some accountability, even in some goal setting. Like that's what we love to do as pediatricians. And so we just want you to continue to feel comfortable reaching out to us in whatever way, whatever way you'd like 

Shireen: anything else from a physician standpoint, to help individuals, their families, that you would recommend? 

Dr.White: So for physicians specifically, I would say, the recommendations are to continue as best you can to screen for obesity. There's a temptation during this time to maybe focus on everything, but obesity. But to just remember that these two medical issues are kind of running hand in hand, Addressing mental health as we kind of talked about a little bit earlier and setting reasonable goals for parents. Those are some of the key things. 

Another important thing that I have not yet mentioned is food insecurity. Food insecurity has become significantly worse during the pandemic. And food insecurity is the inability to know where your next meal is coming from or feeling like you have inadequate funds to get to the end of the month on your paycheck, or if you have snap benefits. So this is obviously something that's worse than during the pandemic. And food insecurity has some connections to obesity. If you don't have access to food, vegetables, healthy foods, less calorically dense foods, that can promote obesity. 

So the other thing, the recommendation for pediatricians is to have resources on hand to refer families to if they are experiencing food insecurity. And of course we won't know who's experiencing food insecurity without screening for food insecurity.

And there are some great recommendations from the American academy of pediatrics regarding their simple food insecurity screening. And then, if the family is screened positive, then sending them, referring them to resources in the community or some pediatric offices even have food on hand.

But just recognizing that that's getting worse and that, that, um, that meaning food insecurity is getting worse during this time. And if that is related to childhood obesity, 

Shireen: Can you speak a little bit more to environmental factors that impact childhood obesity? You mentioned food insecurity. What other environmental factors would you say hurt, you know, hurt the most to the, you know, essentially impact childhood obesity the most, and specifically keeping in mind ethnic and racial minorities?

Dr.White: Yeah so there are many environmental features that are related to childhood obesity. I'm actually in the process of writing a policy statement with my colleagues at the American academy of pediatrics regarding the built environment or the physical environment. It’s the relationship to not just have obesity, but multiple child health conditions and outcomes.

Much of my work has focused on the importance of parks and the  recreational environment and green spaces, sidewalks. These things can be health promoting. It's hard to get physical activity, particularly right now there are many, many gyms and other opportunities for group exercise might be closed.

Having parks and playgrounds is very critical. Unfortunately, you know, we have unequal access to those specific resources. In most places, if you go back to history and redlining, which prevented certain, families and individuals, who are black, or otherwise, or non-white racial groups from buying homes in certain areas. Those areas have over time become what we say is disinvested. So they don't have as much investment in them and they don't have the resources of the built environment such as the beautiful parks and well-kept playgrounds and safe spaces, um, compared to predominantly white neighborhoods. And this has the potential, um, and does exacerbate  disparities in prevalence of childhood obesity. So the proximity and an ability to access these features is certainly one thing that  is really important when we talk about  obesity and obesity disparities. 

The, um, another big one is access to healthy food. It’s in the news every, every now and then, the idea of, the food desert or living in an area where you do not have a grocery store that's close by, where you may not lack access to fresh food. You may only have a corner store or you may have a dollar tree. Again, those situations tend to be clustered in lower income areas or areas where families of color are more likely to live. So the food environment is really key and then there's some evidence that even advertising in neighborhoods of color  is more likely to be advertising unhealthy foods or unhealthy substances such as alcohol and tobacco.

The last kind of big umbrella for the environment and obesity that I would mention is also like the social environment, which I kind of alluded to a bit in the bill in the built environment, but that's the idea of safety and crime and the aesthetics of the neighborhood. It's not just, you know, the lack of parks and playgrounds.

That's often playing a role in who has access to what. There's also the fact that there may be a park, but there may be a high crime rate or just overall that it's not a safe place to go. And again, those perceptions are more likely to cluster in areas where individuals and families of color are more likely to live.

And so that factor is sometimes forgotten, but really, really important because even if the playground was present, it may or may not be considered something that you would want to actually do based on your perception of safety, especially where children are concerned. So those are some of the ways that I would say the environment in many cases has the potential to exacerbate disparities, but also the potential to leverage it, to be leveraged, to help improve disparities If we can make things a bit more accessible for our families, those of color who are also disproportionately impacted by obesity. 

Shireen: You know, it's interesting you mentioned that. Right now in the Yumlish program, we have this one participant. She makes it to the park every single day and sends us a video from the park every single day. Interesting that you mentioned that, because since she has access that’s now her fuel. She'll go out. She'll, she'll take her walk and she'll talk for, you know, 10, 15 seconds, make a quick video, send it over to us. And that's, that's her fuel. Cause she's like, listen, I'm doing this. I'm out there, I'm exercising and it's so powerful that if you create the right environment and you provide that person, the understanding of how that environment can benefit them, you know? It's just almost natural after that, you know? 

Dr.White: Yeah. That's so true. And yeah, absolutely. 

Shireen: Yeah. So I want to shift real quick to the caretaker, do the identities, lifestyles, and situations of caretakers influence their child's weight and health?

Dr.White:  Yeah. So there's a direct correlation between caretakers, health behaviors, and that of their children, whether or not you have children or you have kids that you care for, nieces, and nephews. They are going to do what you do, whether you want to or not. Um, and this is why, uh, obesity treatment is often family-based because we recognize that the child is not in isolation.

The child's health behaviors and outcomes are in many ways a product of the health behaviors that are modeled around them. So  I think that, you know, again, in this context of, of, of stress and, and COVID-19 is this good opportunity for parents to establish new routines such as if you get off, you know, tough day at work, whether it's on the, at home or you are going to work in person and choosing to go for a walk to relax versus, you know, TV or screen time, your child will join you potentially.

So it's a really good opportunity to not just improve your own health speaking from the parental perspective, but also teach healthy routines to your child. So they're definitely related. And, and I, I consider myself, you know, in many ways, not just a kid doctor, but sort of, you know, family doctor, because my job is often to talk to the caretaker as well.

Shireen: And with that we’re around the end of the episode. Dr. White. Any last recommendations that you have for parents, for caretakers to prevent and manage childhood obesity? I can't imagine a parent out there who's not concerned for their child for this. Right? So what, what last recommendations would you have for them?

Dr.White: Yeah, I just, I think the most, one of the more important things is to have a provider that you trust. If you have a pediatrician or a family medicine doctor. But you don't trust them. I think that is a good red flag to move on and establish care with someone else. There's a lot of misinformation out there.

It's kind of the second big point that I make. And that's why it's important to have a provider that you can trust and that person can point you toward trustworthy resources to help you decide what's best for your family. Obesity is a multi-factorial problem and no family, no parent, no grandparents who's taking care of kids should feel that they're having to walk through that alone and unsupported.

So that's my, my biggest advice is to have someone that you trust to provide you with trustworthy information in the medical field. 

Shireen: Makes sense. Well with that, Dr. I thank you so very much for your time. Just before you go, I would love for our listeners to learn, learn more about how they can connect with you and just follow your work.

Dr.White: Yeah, sure. I have a Twitter handle. You can always send me a tweet at Melle Jo MD on Twitter. And it's at M E L L E J O underscore MD on Twitter. And then my email is just simply my first and last name at duke EDU, Michelle dot white at duke EDU. I’m  happy to take any questions or also hear more about how families are continuing to persevere during this.

Perfect. And we'll link all of this in our show notes. So folks can quickly access it with that. Dr. White thank you so very much for your time today. Thank you so much. And for listeners out there,, head over to our social media, tell us what healthy habits have you developed or maintained during the pandemic. And what's your secret to keeping these habits going? Head over to our Facebook or Instagram. And let's start the conversation there again. Thank you so much, Dr. White. 

Dr.White: Thank you.

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.

This episode is part of our series dedicated to national childhood obesity month for the month of September. With this episode and the rest in the series, we hope to increase awareness around childhood obesity and connect you with experts to help you better prevent childhood obesity and support related initiatives.

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