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It was a quiet Saturday morning, and as a pediatrician who had a busy week, that meant it was the perfect time to cozy up with a large mug of coffee at my kitchen table and make my way through the many lab results that had come into the electronic health record inbox since the previous day. I may not be setting a great example of work-life balance. But clinic days are filled with seeing patients, teaching trainees, and answering questions from our care team. Saturdays are the only time I’m able to give patients and their families undivided attention and no-rush answers.
Most of the labs I was preparing to share with families were related to screening tests that we send for children if their body mass index (BMI), the imperfect but helpful measure of weight for height and age, is elevated to a point that it may be causing problems with blood sugar, cholesterol levels, or liver function. Discussing weight in pediatrician’s offices is complicated and should be undertaken with care, but with more than one in four Medicaid-insured children 10-17 years old meeting criteria for obesity, our role is to help inform families and to advocate for their health.
Next on my list of families to call was the mother of a bright and bubbly ten-year-old girl who I’ll call Mindy. When we were in the office earlier in the week, after listening to her lungs, I showed her mother the slight darkening of the skin on the back of Mindy’s neck. That color change was a sign that her body was likely creating extra insulin to keep her blood sugar at a normal level. That same insulin was also causing some of her skin cells to proliferate. I called that Saturday morning to share that the lab results had confirmed this: Mindy did indeed have blood sugars that put her in the pre-diabetes range.
On the phone, Mindy’s mother expressed understandable sadness that quickly transitioned to determination to find healthy activities for her child. What she shared next was heartbreaking. “I’m working two full-time jobs, and I can’t afford to enroll her in sports,” she told me.” I can’t let my child have the opportunities she wants. It’s not fair. The odds are stacked against us.”
I paused and took a breath. In a few short sentences, Mindy’s mom had expressed what data have shown us about disparities in health and their links to economic opportunities; there are seemingly insurmountable barriers that are not her or her daughter’s fault.
But it was Saturday, and I had time. So, I replied, “You are 100% right. Are you near a computer?” She responded that she would make sure her kids were in a safe spot and then headed to her computer. When she said she was ready, I tried to match her determination: “Let’s figure this out together.”
We spent the next 30 minutes Googling.
“I think the state department of health announced free swimming lessons recently, let me check,” I said. “Oh yes, it says they are at some YMCAs, let’s find the one nearest to you. Maybe try calling that number during the week?”
“Oh! There’s a non-profit that helps with school sports enrollment fees, let me find it. Hmm, it seems they aren’t open for applications yet this year, but hopefully they will be soon.”
“Let’s take a look at your town’s sports and summer offerings.”
“There’s a great program for families to learn about healthy eating and exercise together—oh yes, that may conflict with your busy work schedule, and sounds like it may be a far drive, but let me give you their contact information.”
Mindy’s mom ended that call armed with new options and ideas for activities for her child. She was thankful, and we discussed a plan to check in at the office in a few months. The truth was, this Saturday-morning conversation was probably one of the most important and fulfilling discussions I had had that week, because we were finding solutions to help a motivated family set up healthy habits for a child’s future.
But this conversation only happened because of a combination of lucky factors: Mindy’s mother was tech-savvy and could peruse English-language websites, we could Google together, and I had time on a Saturday morning. And even when these stars aligned, there were no promises that any of the potential programs we found would be a match or had funding. This phone call was in no way a solution to the underlying problem of access to lifestyle interventions and activities for children in the U.S.
The latest guidelines for the treatment of obesity from the American Academy of Pediatrics made a splash in the press because they discussed treatment options that included medications and surgery. But key elements of these guidelines that didn’t make as many headlines were lifestyle interventions, where families learn about and participate in nutritional food preparation, exercise, sleep hygiene, and healthy habits together over multiple sessions. Mindy’s mom was interested in this type of intervention, but could she access the one that we found that was a 30-minute drive away and often overlapped with her work schedule?
Mindy’s mom is right: currently, it isn’t fair. But we can make it easier for our nation’s youth and families to have access to prevention that works. We need more local, state, federal, and insurance funding so that we can increase the availability and accessibility of lifestyle-intervention programs. Furthermore, Mindy’s mother was planning to wait a few months to apply to a nonprofit to be able to maybe receive support to enroll in school sports. Perhaps school sports should be covered by medical insurance—or, better yet, they should be freely available for any child. Certainly, we must improve access to sports, activities, and lifestyle intervention for families across the U.S.
I’m hoping that one day, once we have put these preventive interventions into practice, I can spend fewer Saturdays calling families regarding their children’s blood sugar and cholesterol levels. When that day comes, families like Mindy’s will have already had access to opportunities to learn about health as a family, to play, and to thrive.
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