IIt’s a quiet Saturday morning, and as a pediatrician I’ve had a busy week, which means it’s the perfect time to relax at the kitchen table with a large cup of coffee and browse through the many lab results that have been released. Electronic health record inbox from the previous day. I may not be setting a good example of work-life balance. But days in the clinic are filled with seeing patients, teaching students, and answering questions from our nursing team. Saturdays are the only time I can give my patients and their families my undivided attention and not be in a rush for answers.
Most of the labs I’m prepared to share with families are related to the screening tests we send children if their body mass index (BMI) (an imperfect but useful measure of weight for height and age) is elevated enough to possibly This can cause problems with blood sugar, cholesterol levels, or liver function. Discussing weight in the pediatrician’s office is complex and should be approached with caution, but since more than one-quarter of Medicaid-insured children ages 10-17 meet obesity criteria, our role is to help inform families and advocate for their health.
Next on my list of families to call was the mother of a bright and lively ten-year-old girl I’ll call Mindy. When we were in the office earlier this week, after listening to her lung exam, I showed her mother the slight darkening of the skin on the back of Mindy’s neck. This color change indicates that her body may be producing extra insulin to keep her blood sugar at normal levels. The same insulin also caused some of her skin cells to proliferate. I called everyone Saturday morning to tell everyone that the lab results confirmed it: Mindy’s blood sugar was indeed in the prediabetic range.
read more: Weight bias is a problem in health care.This is what a doctor can do
On the phone, Mindy’s mother expressed understandable sadness, but that quickly turned to determination to find healthy activities for her children. What she shared next was heartbreaking. “I had two full-time jobs, but I couldn’t afford for her to play sports.” she told me“. I can’t let my child have the opportunity she wants. It’s not fair. The odds are stacked against us.”
I paused and took a breath. In a few words, Mindy’s mom expressed what the data shows us about health disparities and their connection to economic opportunity; that some seemingly insurmountable barriers are not her or her daughter’s fault.
But it was Saturday and I had time. So, I replied, “You’re 100% right. Are you near a computer?” She replied that she would make sure her children were in a safe place and walked to her computer. When she said she was ready, I tried to match her determination: “Let’s figure it out together.”
We spent the next 30 minutes Googling.
“I think the state Department of Health recently announced free swimming lessons, let me check,” I said. “Oh yeah, it says they’re at some YMCA, let’s find the one closest to you. Maybe try calling that number during the week?”
“Oh! There’s a non-profit organization that helps pay for school sports registration fees, let me find it. Well, it doesn’t look like applications are open yet this year, but hopefully they will be soon.”
“Let’s see the sports and summer activities in your town.”
“There is a great program for families to learn healthy eating and exercise together – oh yes, this may conflict with your busy work schedule and may sound far away, but let me give you their contact information.”
Mindy’s mom ended the call with new activity options and ideas for her kids. She was grateful and we discussed plans to check in at the office in a few months. The truth is, that Saturday morning conversation was probably one of the most important and fulfilling discussions I had that week, as we look for solutions to help motivated families build healthy habits for their children’s futures.
But this conversation happened because of a lucky combination of factors: Mindy’s mother was tech-savvy enough to browse English websites, we could Google together, and I was available on a Saturday morning. Even if the stars align, there’s no guarantee that any potential projects we identify will be matched or funded.This call in no way solves the fundamental problem of access to lifestyle interventions and activities for America’s children
The American Academy of Pediatrics’ latest obesity treatment guidelines have caused a stir in the media because they discuss treatment options, including medications and surgery. But a key element of these guidelines that doesn’t make the headlines is lifestyle intervention, in which families learn about and engage in nutritious food preparation, exercise, sleep hygiene and healthy habits together over multiple sessions. Mindy’s mom was interested in this type of intervention, but would she be able to get one that we found was 30 minutes away and often overlapped with her work schedule?
Mindy’s mom is right: right now, it’s not fair. But we can make effective prevention more accessible to our nation’s young people and families. We need more local, state, federal, and insurance funding so that we can increase the availability and accessibility of lifestyle intervention programs.Additionally, Mindy’s mother plans to wait a few months to apply for a nonprofit so she can perhaps Get support to participate in school sports. Maybe school sports should be covered by health insurance—or better yet, free for any kid to play.Of course, we must improve access to sports, activity, and lifestyle interventions for families across America
I hope that one day, once we put these preventive interventions into practice, I can spend less time calling families on Saturdays to check on my kids’ blood sugar and cholesterol levels. When that day comes, families like Mindy’s will have the opportunity to learn about health, play, and growth as a family.