'I literally would tell my patients, ‘You need to eat better. Consider things like avocados and kale.' And my parents would literally just stare at me, ‘Where am I going to get that? Like, where am I going to afford to buy that?’'
. Volunteer professor of pediatrics at the University of Cincinnati. Community Partner with The Center for Better Health and Nutrition at Cincinnati Children’s Hospital., mother of 9, an emotional support aide in Milwaukee public schools. She lives in a food desert., grandmother of a 13-year-old with obesity in Washington, D.C. She works with children and adults with developmental disabilities.MEGHNA CHAKRABARTI: Dr.
So there's, you know, many, many complications and long-term chronic consequences of being obese. Kids who are obese grow up to be young adults who are obese, who grow up to be adults who are obese. So it's really important that we can identify this and address it and really reverse it. Prevent it, ideally, in childhood.
CHAKRABARTI: Yeah. Now, you mentioned the new guidelines that have just recently been released by the American Academy of Pediatrics. That is the reason why we're doing this show today, because it's the first ever set of guidelines that the American Academy of Pediatrics has put out to physicians and clinicians about how to help treat children with obesity in this country.
HANNA-ATTISHA: Absolutely. It's a major factor. And we really have limited resources to be able to properly address it. You know, we notice this as an issue, you know, years ago in our practice, and we've tried to do preventative things. We moved our pediatric clinic to the second floor of a farmer's market. I mean, it's the only clinic that I know that's co-located in a farmer's market, to try to, you know, preventively address this issue.
CHRISTOPHER BOLLING: Thank you, Meghna. It's really truly a pleasure to be here and also to be here with Mona, who's a bit of a rock star in pediatrics for everything she's done in Flint, really. CHAKRABARTI: So for you, in your personal experience, it sounds like it wasn't necessarily that central of an aspect of how you treated children in your practice 30 years ago. Or should I say, was it? Versus how central the issue of being overweight or obese was in your practice upon your retirement?
But we spend billions, trillions of dollars addressing things like hypertension and diabetes and chronic disease in all these chronic diseases. But, you know, if we spend a little more on preventing this, making sure kids do have access to healthy foods and they do have that economic stability to be able to provide for their families and transportations and, you know, safe places to play. So, you know, this is touched on in the guidelines, which is fantastic.
It's important for pediatricians to take the time like they do with their families, to talk about nutrition, to talk about activity, to talk about healthy lifestyles.HANNA-ATTISHA: It's very hard for some patients, you know, And in my community, we have a child poverty rate that exceeds 50%. I tell my patients, you know, I used to tell my patients naively, you know, eat healthier, like just go and buy, you know, fresh apples and, you know, kale, all these things.
Our families face so many hurdles in life, and it's virtually impossible, as Mona said, to go ahead and make a kale salad. How would they even know how to do that, for starters? So it's a discussion and it's something that we have to meet parents where they are. We have to help them figure out ways that may be better. You know, we don't want perfect to be the enemy of good here. We want them to be able to do things that they can do and to partner with them.
BOLLING: So and that's a good place to sort of step off into what these clinical practice guidelines really address. So the first step in these guidelines is really to evaluate and assess kids, where are they on their growth curve, what is this excess weight potentially having? What kind of effect is it having on their health? So that's the first step and that doesn't apply to everybody. We're talking about the kids who are already suffering from obesity.
Like I'm seeing obesity prevalence is 19% amongst children in America's lowest income groups, and then it drops down to 10% in the highest income groups. So, you know, when we say for the places who can do it, are the kids who most need this kind of help living in the places that can't do it? Well, okay. We've talked to family members who have children in their families who are obese, and one of them is Star Simmons. She works with children and adults with special needs in Washington, D.C. and she's also a grandmother. Her 13-year-old grandson has several health challenges, including being severely overweight.
SIMMONS: So when I walk down in the produce section of my supermarket, you see lettuce. I definitely tell you about this. Try to get a bag of salad. You see brown lettuce, yellow tomatoes. We went in the grocery store the other day and I couldn't even find a good tomato at all. CHAKRABARTI: So that's Star Simmons, a grandmother and a special needs worker in Washington, D.C. area schools. Dr. Mona, I'd love you to respond. Love to hear you respond to this, because again, it just links back to that listener who has the not uncommon critique, a critique of get some personal discipline here.
Sorry, I'm having trouble articulating today, but that underlying system is the food system and the environment that we're all living in. So we're going to come back to that. But Dr. Bolling, I guess we have to touch that third rail here. Why did the American Academy of Pediatrics even go so far as to recommend surgery for children at younger ages who are suffering from obesity?
BOLLING: Well, certainly we know that intervening early is desirable and being able to prevent kids from getting to severe obesity is very important. However, we know there are a lot of kids that have genetic reasons, have other causes for their severe obesity. And we have kids that are in those situations. So I look at it very much from my individual patients.
So, for example, Bich-May Nguyen is a family doctor and professor at the University of Houston. And we reached out to ask her what she thinks about the guidelines. And she likes what she sees on paper, but she wonders: CHAKRABARTI: So, Dr. Bolling and Dr. Mona, I would like you to listen along with me because I cannot help but still dwell in this mental and intellectual space about, in a sense, what a tragedy it is that we've come to the point in this country where the American Academy of Pediatrics has to go so far as to put surgical options in its guideline guidelines for, you know, a disease that was basically nonexistent amongst children, some, you know, 50 years ago.
EARL BUTZ: I probably said it. I said a lot of things when I was secretary, and I expect I did say it, but it was the market who dictated the farmers plant fence row to fence row. Prices were up, exports were good. And the market dictated, expand your production. They not only planted fence row to fence row, they tore out the fence row. I can't even find the fence rows out there. Now I guess that's because of large tractors and large combines.
And in 1977, Indiana's Manchester College held a remarkable debate between Earl Butz and Wendell Berry. Now, Berry was the well-known writer, activist and farmer who just published The Unsettling of America, a scathing critique of American agribusiness. And in the debate, Wendell Berry described the changes he'd seen in his home state of Kentucky as agribusiness bought more and more farmland.
A young graduate student from Purdue and I stopped out here at McDonald's a while ago to get our supper. A third of the meals eating outside the home. That's all in the 17%. That means we got 83% as a nation left to do something else with besides feed ourselves. This is the very basis of strength in America. Never forget it.
LEE: Even with the healthy foods, they're more expensive than the unhealthy foods. You know, you can go to the store with $100 and buy a whole bunch of unhealthy food, have access to unhealthy foods, the abundance of that. But then you get the fruits and vegetables that everything is just upcharge and is really expensive.
BOLLING: Well, first of all, we need to advocate for our patients who are sick currently, and we definitely want to help those children who are suffering from obesity at this point. And that is absolutely essential to the American Academy of Pediatrics. Mission is for the health and welfare of all children. So your other statement about, you know, do we need to address these things?
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