Healthy Weight Starts With Healthy Eating Habits

Healthy Weight Starts With Healthy Eating Habits

Community Health’s Initiative to Stem Childhood Obesity

Community Health Pediatrician Dr. Judy Nelson has been taking care of children in Rutland County for over 30 years watching them grow from newborn infants, all the way through to adulthood. She has observed a theme with growing concern – an increasing number of children who are struggling with their weight and the associated medical impacts. “We have such extreme obesity,” she said.

In the US, one in five children have been identified as obese. And according to data from the Robert Wood Johnson Foundation’s “State of Childhood Obesity” project, 14% of Vermont youth ages 10 to 17 have obesity, giving Vermont a ranking of 28 among the 50 states and Washington, D.C.

A study released in September 2020 by the Trust for America’s Health, “The State of Obesity: 2020” reports that obesity rates for children ages 2 to 19 more than tripled, from 5.5 to 19.3 percent between their 1976 and 2018 studies. “Children who are overweight or who have obesity are more likely to have obesity as adults, making interventions at an early age essential,” the report said with researchers focusing “specifically on the first 1,000 days of life as a critical time to encourage healthy nutrition.”

“It’s unbelievable really, the amount of obesity in young children,” said Dr. Nelson. “Obesity can lead to liver problems and type 2 diabetes in kids which we nearly never saw before. And social stigmas too,” she said. “One study says a teenager with severe obesity suffers as much socially as a teenager with cancer.”

Dr. Nelson and Community Health Pediatrics have begun an initiative sponsored by the American Academy of Pediatrics Institute for Healthy Childhood Weight and Bright Futures campaign called “Optimize Infant and Toddler Feeding for Obesity Prevention.” It focuses on the very beginning of childhood, the infant to two-year-old group, documenting growth patterns, identifying eating habits and providing resources and education for parents “to foster healthy behaviors and healthy weight in children.”

“This program encourages parents to delay solid foods until six months and to breast or bottle feed on demand, not having babies finish the bottle and let the baby have control over how much it eats,” said Dr. Nelson.

She has found that parents are introducing unhealthy foods like sugary drinks and snack foods within the first year which sets the stage for food selections that could cause children to become overweight. “This program works with children under two because by nine months most kids have their eating habits established,” she said.

The 19-week quality improvement project includes five stages:

• assessing early growth and obesity risks
• Identifying concerns from parents
• supporting good food selection and diet
• supporting parental strategies that foster healthy lifestyles
• supporting favorable outcomes for key determinants for social health

Among the key determinants is food insecurity. “One in seven children has food insecurity,” said Dr. Nelson. “In the current environment, people don’t have the money to buy as many vegetables as they used to because vegetables have gone up in price more than other food products. It’s harder for people on a lower income level to get all of the healthy foods they need.” The social determinants include asking if families are are worried that food will run out before the next paycheck; if they are at risk of being homeless; if they were living in a safe environment; and if they have support systems of family and friends.

The “The State of Obesity: 2020” report also addressed food insecurity saying it “leads to worse health outcomes, is linked with lower quality diets and higher healthcare costs in certain situations and tracks with higher levels of obesity in many populations.”

Community Health’s care managers, care coordinators and social workers are familiar with and are a great resource for nutritional needs when families have barriers to affording healthy foods and are experiencing food insecurity. The Community Health staff provides families with local connections to organizations like 3SquaresVT, Women, Infants and Children (WIC) program, the Vermont Farmer’s Food Center Pharmacy Program (a Community Health community partner) and local food pantries such as the ones provided at BROC, Rutland County Parent Child Center and the Rutland Community Cupboard.

Community Health Pediatrics has supported the 5-2-1-0 program that gives families a roadmap for eating healthy:

• 5 fruits or veggies per day
• 2 hours maximum of computer screen time
• 1 hour of exercise
• 0 sugary beverages and limited amounts of juice

“The fast food and soda industry has taken a toll on our kids,” said Dr. Nelson.

Adolescent children at Community Health Pediatrics are often referred to special healthy living programs at The C. Everett Koop Institute at Dartmouth and the UVM Medical Center in Burlington, but the travel distance is an obstacle. Dr. Nelson said she’s looking into the possibility of establishing this type of program in the Rutland area to encourage participation from adults as well as children.

“We try to be realistic with what changes older kids will make, like asking them to give up soda. For the little kids, parents are in control, so we are encouraging healthy habits, to steer them in the right direction,” she said.

Marissa Benson, RN, a member of the team leading the obesity initiative, said the data gathered helps them to track the progress, one of the main elements in the quality initiative. “We ask certain questions and document and see how it’s affecting obesity and may be preventing it.” Working within the American Academy of Pediatrics program, Community Health Pediatrics providers will monitor a baby’s growth noting the weight-to-length ratio and assess early obesity risks including the weight gain of new moms during pregnancy. They will also document people’s concerns and address them.

“Broaching the topic with parents is really important,” said Dr. Nelson. “Obesity is a chronic illness, and we need to treat it like a chronic illness. We’ll document the successes and what didn’t work and try new ideas like keeping exercise and food diaries.”

There are about a dozen practices across the country participating in the current program, and the American Academy of Pediatrics has involved over 125 practices in the obesity initiative, providing resources and references, and ideas for Community Health’s program.

Community Health’s initiative began in February. “Our goal is to help all our patients,” said Dr. Nelson.  “For patients who aren’t receptive to the idea, at least we put the idea in their head that it’s great thing you can do for your kids.”

Judy Nelson, MD has specialized in adolescent medicine and pediatrics in Vermont for over 30 years, joining Community Health in 2011. She earned a Bachelor of Arts in biochemistry from Harvard University, a medical degree from New York University, School of Medicine in New York City and completed her residency at the University of Florida, Shands Teaching Hospital in Gainesville.

Marissa Benson, RN, received a Bachelor of Science in nursing from Castleton University where she minored in biology. She joined Community Health after graduation in 2018.