ISaturday mornings are quiet, and as a pediatrician who's had a busy week, it's the perfect time to relax at the kitchen table with a big mug of coffee and mull over the many test results. That is to say. Your electronic health record inbox from the previous day. I may not be setting a good example of work-life balance. But clinic days are filled with seeing patients, teaching residents, and answering questions from the care team. Saturdays are the only time I can focus on patients and their families and not rush them too much.
Most of the labs I was preparing to share with my family had their body mass index (BMI), an imperfect but useful measure of weight for height and age, rising to dangerous levels. It was related to screening tests that are sent to children if they have a child. It can cause problems with blood sugar levels, cholesterol levels, and liver function. Discussing weight in the pediatrician's office is complex and must be done carefully, but more than 1 in 4 children ages 10 to 17 on Medicaid meet criteria for obesity. Our role is to inform families and help them advocate for their health.
The next list of family members to call included the mother of a cheerful 10-year-old girl. We'll call this girl Mindy. When we were in the office earlier in her week, I showed her mother that Mindy's skin on the back of her neck had darkened slightly after hearing her lung sounds. . That color change indicates that her body may be producing extra insulin to keep blood sugar levels at normal levels. The same insulin was causing some of her skin cells to grow. I called on Saturday morning to tell them the test results confirmed this. Mindy's blood sugar levels were indeed in the pre-diabetic range.
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Mindy's mother expressed understandable sadness over the phone, but quickly resolved to find healthy activities for her child. What she said next was heartbreaking. “I work two full-time jobs, so I can't afford to have her learn sports.” she told me” You can't give your child the opportunities they want. That's not fair. The odds are extremely high for us. ”
I stopped and took a breath. In a short sentence, Mindy's mother expressed what her data showed about health disparities and the link between those disparities and economic opportunity. She has a seemingly insurmountable wall that is not her or her daughter's fault.
But it was Saturday, so I had time. So I answered: “You're 100% correct. Are you near your computer?” She replied making sure the kids were in a safe place before heading to the computer. I tried to match her determination when she said she was ready. “Let's think about this together.”
I spent the next 30 minutes googling.
“I believe the state health department recently announced free swimming lessons. Let me check.” i said. “Oh yeah, I heard that it's available at several YMCAs, but let's find the closest one to hers. Why don't you call that number sometime this week?”
“Oh! There are some non-profit organizations that help pay for participation in school sports, so let's look for them. Hmm, it looks like we don't have any openings for this year yet, but I hope they do soon. ”
“See what sports and summer events are happening in your town.”
“There are great programs out there for families to learn about healthy eating and exercise together. Oh yeah, it might not fit into your busy work schedule or it might sound far away, but please give me your contact information.” Sho.”
Mindy's mother ended the call with new options and ideas for activities for her child. She thanked me and we discussed plans to check in at the office in a few months. In fact, this Saturday morning conversation was probably one of the most important and fulfilling conversations I had that week. Because we were finding solutions to help ambitious families develop healthy habits for their children's futures.
However, this conversation was only made possible by a combination of lucky factors. Mindy's mother was tech savvy and could browse her website in English, Google her with me, and had time on a Saturday morning. And even if those stars aligned, there was no promise that the potential programs we found would be a fit or funded. This call never solved the fundamental problem of access to lifestyle interventions and activities for America's children.
The latest obesity treatment guidelines from the American Academy of Pediatrics have garnered attention in the press as they discuss treatment options including medications and surgery. But one key element of these guidelines that hasn't made as much headlines is that families learn about nutritious meal preparation, exercise, sleep hygiene, and healthy habits through multiple sessions and participate in the lifestyle. It was an intervention in style. Mindy's mother was interested in this type of intervention, but would she be able to access this intervention, which we found was 30 minutes away by car and often overlapped with her work schedule?
Mindy's mother is right. As it stands, it's unfair. But we can make effective prevention more readily available to our nation's youth and families. More local, state, federal, and insurance funding is needed to increase the availability and accessibility of lifestyle intervention programs. Additionally, Mindy's mother was willing to wait several months to apply to the nonprofit organization. perhaps You can receive support to participate in school sports. Perhaps school sports should be covered by medical insurance. Or, even better, make sports available to all kids for free. Certainly, we need to improve access to sports, activity, and lifestyle interventions for families across the United States.
I hope that someday these preventive interventions, if put into practice, will reduce the number of Saturdays spent calling families about their child's blood sugar and cholesterol levels. When that day comes, families like Mindy's will already have the opportunity to learn, play, and grow about health as a family.
