"...Oftentimes we think about good food and bad food. So getting rid of that language, so there's not good food or bad food..." - Dr. Audrey Ross Powell, MD
Shireen: Dr. Audrey Powell is a physician with over 10 years experience in the pharmaceutical industry. She's a Board Certified pediatrician and an internist. She completed dual residences in both Internal Medicine and Pediatrics at the University of Tennessee in Memphis. Welcome, Dr. Powell.
Dr. Powell: Thank you. So glad to have you on with us today. So with that I'd love to learn about what led you into pediatrics. So when I went to medical school, I thought that I would end up being an OBGYN that was my dream. However, the first delivery that I attended, I was more drawn to the care of the baby as opposed to the care of the mom. And so from that point on, you know, I was really interested in pediatrics. And I ended up doing both internal medicine and pediatrics because I wanted to care for families. And that's kind of my story and how I ended up with the interest in pediatrics. Lovely, what changes have you seen within the pediatric space throughout your 20 years in the field? So I traditionally, we've had more of an emphasis on treatment and disease management, as opposed to prevention. And now, you know, we've sort of morphed into more of a wellness and prevention space. That's the biggest thing that I can say I've witnessed over time. What are the health outcomes you've seen more of as a result of childhood obesity, especially given this epidemic of childhood obesity that we have today. So the big concern with the epidemic of childhood obesity is what we're seeing in the adult diseases that we're seeing in children. So years ago, when we thought about childhood diabetes, it was type one diabetes, that is more of an autoimmune type diabetes that we saw in children, but now we're seeing adult diseases, such as hypertension, and type two diabetes, and children. And that's, you know, really serves over the past, some several decades, and at this point, it's a huge concern, because the health of children is the health of a nation. And if our kids aren't healthy, you know, over time, it's really gonna affect our, you know, health as a nation. So what I'm concerned about is, you know, a few things. One is kids who are having adult diseases younger, so they have decreased quality of life, they also have increased costs as far as care, you know, their health costs, decreased productivity over their lifespan. So as these things that, you know, I kind of take into account when I'm thinking globally about childhood obesity, and the other interest with it his children of color, so we know that children, you know, black children, Hispanic children, you know, have more of an incidence of childhood obesity when compared to other children. And, you know, that's something to really think about, because when we know right now, we're in this COVID epidemic pandemic, and we're saying that people of color are more adversely affected. So it starts out, you know, from these diseases that we have, you know, that from childhood going into adulthood. And when you are seeing this, especially, you know, for our listeners here, where we're addressing more of the diabetes and other chronic illnesses, how are you seeing pre diabetes within children? So we're saying, you know, very young children with signs of pre diabetes even before we're doing testing and things like that, we can see, you know, different physical signs, for instance, little four and five year old as young as bad with a camp osis the rash that's the darker pigment on the on the neck, we can see that very young. And we can also see laboratory abnormalities such as increased cholesterol levels, prior to being able to see the increase in blood sugar or glucose glucose levels. So there are signs very early on, especially you know, the weight gain comes first and then we start to see more, the physical and laboratory signs. What do you feel like are the greatest contributors to the childhood obesity epidemic? Well, that's a loaded question. So there are many contributors to it. But what I would think are the biggest things, as far as communities are concerned are number one in families, it's sort of a lot of people will think, well, maybe diabetes is genetic. But oftentimes, it's not really genetics completely, but more of environment, you know, what we're eating, how we're eating, what type of activity we have, you know, what types of things the parents partake in, and then that sort of flows down to the children. So I think that, you know, as we're looking forward, if we can address some of these things with the adults, and then that will allow us to have changes that occur within the family that allows for improved health. What are the things you do to help the patients that you see the pediatric patients that you see develop a healthy relationship with food? So again, as I mentioned, it starts with the families with the parents. So it's a, treating these lifestyle type of illnesses, is a family oriented type of endeavor. So it starts with talking with, you know, the persons who are in charge of the food at home, sometimes it's the mom, sometimes it's the dad, sometimes it's both, and getting them on board with the plan, looking at sort of where we are maybe even taking data where the parents keeps sort of a food log for, you know, a few days or a week or so, and then sort of seeing where we are and seeing where we can tweak and make small changes, because a lot of times, especially you know, we're in January, people have their resolutions, and they have a long laundry list of changes that they want to make. But huge changes like that all at once usually don't last. So we want to make small lasting changes, you know, it's something as simple as dropping the soda and adding in more water, you know, making that as a one step change, do that for, you know, two, three weeks, maybe a month at a time, and then add another small change, add in one extra serving of you know, fruits and vegetables, at each increment making a small change. So it is not overwhelming and so that it sticks, and doing that with the children as well. So with families, I will tell them all, stop everything all at once just doing incremental changes over time, I think is best.
Shireen: How do you recommend creating a positive relationship with food for their children?
Dr. Powell: So you know, oftentimes we think about good food and bad food. So getting rid of that language, so there's not good food or bad food, there's, you know, I think of it as everyday food and special or occasional food. You know, we just got off the holidays during Thanksgiving, from Thanksgiving all the way to New Year's, we have a bunch of Salvatore occasions. And so the types of food that we eat during this time of the year is not food that we eat every day, our say, for instance, when it's the child's birthday, oftentimes will have birthday cake and all types of treats, but that's your birthday is one day. So just emphasizing that, you know, we can have a range of foods, but there's a time and place for everything. So most days, it's you know, our what we call our normal food, which is you know, the healthier nutrient dense foods and then the occasional or special food that way, I think when we do this good versus bad, we sort of kind of set kids up for having an unhealthy relationship with food. But when we couch it as you know, normal versus special or occasional food that you know, is softer, and you know, more palatable.
Shireen: If you will, where does a parent draw the line between encouraging their child to try something new versus forcing them to eat something they don't like?
Dr. Powell: So never force, you know, the thing about forcing is that, that again, sets up sort of a negative view of certain foods for kids. So with any introducing anything new oftentimes, you know, our kids are, you know, they, they've been eating X, Y and Z for so long. So we're wanting to make things healthier and produce more more healthy and nutrient dense food. Oftentimes, there's pushback because they're accustomed to what they like. So introducing things, you know, slowly, you know, one particular food you know, at a time, and if they like it good, if they don't, it's okay, you can reintroduce that same food again, usually it takes anywhere from six to 10 or even more episodes of trying something before kids will start to you know, like or fancy that tastes so I would never force a child I would just introduce things at a random pace and just kind of see how they do and believe it or not, when the parents are eating that same thing. Food and they're eating, you know, you're eating salad over and over and your child notices it, oftentimes, they'll start liking it too. Or the other thing that I wanted to mention is getting kids involved with the food with shopping and food prep and making it having them have a little bit of ownership in it. And you know, that goes a long way to having them try new things and pick up new things as well.
Shireen: What are your thoughts on using food as a reward I was, I was watching something on TV a couple of weeks ago, and I saw the ad. And it pretty much said something along the lines of you know, the parent asking the kid to either broccoli and broccoli gets such such a bad rap. But the parent was forcing their child to eat broccoli, and the child was, you know, not having it. And so they decided to and this was the ad about I think it was French fries, but essentially reward your child, if they finish their broccoli for every broccoli, give them a fry, it blew my mind. It blew my mind. But anyways, having said that, I'd like to get your thoughts on it about using food as a reward, is there a place for it? And if not, what are some alternative methods you would recommend?
Dr. Powell: So in my opinion, and you know, everyone has an opinion there. I think at this point, there's not a good place for using food as a reward because it sets people up, you know, from childhood on with using food in that way. So it's sort of like as an adult, you're trying to stick to your diet, but you know, the chocolates are calling your name, and you're wanting because of your history of having rewards using different things in that way. So I think with children, we set up different rewards that are non food based. So one way is to think of like a token board. So you earn a token for each time that you exhibit good behavior. And then over time, X number of tokens equals a non food items. So for instance, it could be gift cards to like your favorite store. It could be lots of kids like the different games and the AI games and things like that. It could be coupons for that. Or it could be like clothing, or shoes or different things that kids like movies, although we can't do much of that now, but just non food items that kids like doing. And over time, I think that even activity like urban areas, like a trampoline park, places like that, so that we're kind of killing two birds with one stone, we're rewarding. And then we're doing the activity that's, you know, good for us as well.
Shireen: I love tying their word to physical activity because exactly two birds one stone. So it makes so much sense for some of the older children who are beginning to make their own food selections, and may be apathetic or resistant to health conscious choices. How do you instill a sense that nutrition matters?
Dr. Powell: That's a really good one. So when I think about older children, oftentimes they're involved in different activities, they're in sports, they may be in band or cheerleading, dance all these different activities. So tying the idea of good nutrition to performance, you know, in order for you to be the best at whatever you're doing, or whatever your love is, you have to have a good nutritional foundation so that you can perform at your peak. The other thing is emphasizing healthy foods, or healthy choices, and not tying it to body image or weight or anything like that. But just emphasizing health, you know, for the long haul. And looking at it from the standpoint of you know, you're 16 now, but you know, as you go to college and get older, and all these other things that you want to do, your health is your wealth. And sometimes I think those things resonate better with older adolescents.
Shireen: When would you refer a patient to a registered dietician, or when you feel like a parent should consider consulting a registered dietician for the child's nutrition?
Dr. Powell: I think whenever we've pinpointed an issue, whether it be underweight, you know, the child hasn't gained weight well, or they're overweight, or they're having some feeding issues where whether it's, you know, sometimes you know, we're having more children who have food sensitivities, or they also could have sensory issues related to food. So any particular issue that we find it's good to have a multidisciplinary approach. So getting a nutritional professional, a registered dietician involved early on, I think is best because as far as being with a physician, usually, you know, those visits are pretty brief. And having that extra health care provider in place and on the team is helpful, you know, as far as bringing in, you know, more resources, and helping the family where the food concerns are.
Shireen: Ultimately, what do you think will move the needle on childhood obesity? It's a very loaded question.
Dr. Powell: That is a loaded question. So a few things one is making Healthy Food accessible, maybe we hear a food deserts and there are, you know, many places in urban areas but also rural areas to where healthy foods are less accessible. So being able to have, you know, foods more readily available. I mean, there are some places where the corner store or the bodega is the only thing available for food. And there's hardly any, anything that is that, that's not highly processed available. So being able to have those things available will encourage community gardening, even you know, in cities, and in rural spaces, we can do community gardening where, you know, kids grow their own food and you know, are eating the things that they have grown, you know, from their hands, it's really sort of unique. The other thing is getting government subsidies that cover healthy foods, because right now, there are plenty of government subsidies for corn syrup, and all the things that that goes into being able to have those subsidies for, you know, fruits and vegetables and things like that. So it's not so expensive. I mean, the reason we can go into these fast food restaurants and buy, you know, two hamburgers for $1 versus a salad for $5 is because of our government subsidy. So if we can subsidize more healthy food for citizens, the other thing is changing the environment. And like I live in the suburbs, I can walk right outside of my house and there was a park around the corner, there's another Park, you know, about a block and a half away, having neighborhoods where it's accessible, as far as sidewalks and being able to walk safely and being able to exercise together as a family safely. And also making it inviting, you know, so they're different place, spaces where there are, you know, climbing structures and different structures where you can do strength training and, you know, yoga and things outside. So just making it readily available, and also in some of the urban spaces having more bike lanes so people can get around on their bicycle as opposed to if you're going to go to Kroger and it's two miles away, it's easy to bike that if you have a lane to bike safely in. So those are some of the changes that I would like to see to be able to address childhood obesity.
Shireen: With that, Dr. Powell, we're toward the end of the episode. At this point, I'd love for our listeners to know how they can connect with you and learn more about your work.
Dr. Powell: So I am on Instagram as plant powered MD that's the best way to find me. I'm also on Facebook with the same handle plant powered MD and thanks a lot. I really have enjoyed this episode today. And I really appreciate the time that we spent together.
Shireen: It's such a pleasure having you on. Thank you.
Dr. Powell: You're welcome.