Obesity among kids has reshaped efforts
Health workers creating new programs to reverse the trend
12:00 AM CDT on Sunday, October 1, 2006
By LAURA SCHREIER / The Dallas Morning News
Nurse Marty Strong is not speaking figuratively when she describes some of her child patients as "off the charts."
SMILEY N. POOL/DMN
Nurses Bobbie Malzhan (left) and Marty Strong offer nutritional counseling at Children's Clinic of Richardson, where roughly one in three young patients is overweight.Holding a body mass index chart, the pediatric nurse practitioner points to a spot near the top of the paper, far off the height/weight grid, even above the line that says "Patient's Name." That's what it means to be a 169-pound 9-year-old, she said grimly.
Ms. Strong runs Children's Clinic of Richardson, where roughly one in three of her young patients is overweight – many of them seriously so. "I've got a 6-year-old female with fatty liver disease. And that's not uncommon," she said.
While the nation struggles to stem a growing childhood obesity problem, health workers like Ms. Strong are adjusting to the slower evolution the epidemic has wrought on their professions. Some say they're now treating children whose weight is so extreme that it slows intellectual development, contributes to speech problems and hinders their ability to do simple tasks, such as dressing themselves.
Doctors, nurses and therapists are responding by tweaking old treatment methods, creating new programs and ordering sturdier medical equipment.
"I think everybody's trying to adjust," said Dr. Sandra Hassink, a board member for the American Academy of Pediatrics. The problem is simply too great to ignore, she said.
A report last month from the federal Institute of Medicine echoes Ms. Strong's observations, claiming that one in three American children is obese or at risk of becoming obese. And the problem isn't expected to improve anytime soon. The institute reported that efforts to turn that tide are scattershot, given too few dollars and lack the national leadership needed to speed real change.
Meanwhile, health professionals are looking at adopting or expanding services for children suffering the consequences of being overweight or obese.
Infants aren't immune
Patricia Clinton, president of the National Association of Pediatric Nurse Practitioners, said medical professionals across the country are treating children whose obesity possibly contributes to motor and cognitive delays, in addition to other troubles.
She said pediatric nurses are seeing more weight problems in the very young – including infants. And when obesity starts early, the effects reverberate across that child's development and in later life.
Shannon Anderson, an occupational therapist at Our Children's House at Baylor in Allen, a clinic specializing in speech, physical and occupational therapy, explained how a child's size can hinder learning ability.
Long before children are challenged to read books or memorize times tables, they learn by moving, she said. They gain spatial and sensory intelligence that lays the foundation for later learning. But children who don't move are slow to grasp concepts like "under" or "sticky" because they aren't crawling under tables or exploring their surroundings.
People often don't understand the strong connection between movement and learning, said Barbara Chandler of the American Occupational Therapy Association and an expert in using occupational therapy to help students.
"The more kids move, the better their brains function," she said.
When schools cut back on recess to focus on math classes or take down playground equipment to avoid accident liabilities, they're hurting kids' intellectual growth, she said. For young children, simple activities like playing on a swing set are vital.
"That movement through space, that pumping of the legs, that screaming at other kids, that joy feeds the sensory motor system," she said. "Movement is food for the brain."
Ms. Chandler said more occupational therapists are working with schools on ideas to incorporate movement into curricula – ideas like using games or songs that require kids to get up and move around, or using movement to teach math or geometry concepts.
Dr. Hassink said there isn't much data on the link between obesity and cognitive difficulties, but the available evidence supports anecdotal reports.
One of the few studies done on the subject was released in August by the University of Florida, she said. Researchers there concluded that obesity in toddlers led to lower IQ scores and delayed cognitive development, possibly because of metabolic and biochemical disturbances.
"It shouldn't come as that much of a surprise," she said. Obesity affects everything else in the body – it makes sense that the brain feels an impact, too. "This is just the next wave of understanding the total impact of obesity."
LeighAnn Robinson, a speech-language pathologist at Our Children's House at Baylor, sees the consequences of obesity in some of her patients. She said they can't get the right breath support to speak clearly because they have to inhale every few words.
She also alters treatment methods for some patients because they can't perform actions or explore outdoors to help them learn certain words or concepts. So she uses pictures or demonstrates actions herself.
Clinic's program
At the Children's Clinic of Richardson, Ms. Strong and a colleague have started a program for their young patients – and their families – that offers suggestions on how to put healthier food on the table or get more exercise in their daily lives. Patients return for progress check-ups, and Ms. Strong said the clinic has seen improvements, albeit often small ones, in many of the patients.
The program was started less than a year ago after workers noted a disturbing spike in seriously obese children. And because Medicaid doesn't cover most nutritional counseling, the clinic usually doesn't get paid for the extra work.
"We're hoping to make a little stab at it because it's the right thing to do," she said.
The occupational and physical therapists at Our Children's House at Baylor have adjusted some of their practices as well.
The clinic purchased a machine that measures pulse and blood oxygen saturation levels to make sure the heaviest patients aren't overtaxed by therapy sessions that include walking, stretching, balancing exercises and work to improve muscle strength, said Melisa Smith, physical therapist and clinical coordinator.
Ms. Smith said the clinic recently bought adult-sized gate belts – belts that allow therapists to catch or steady patients – for some therapy sessions because child-sized belts were too small.
Dr. LeAnn Kridelbaugh of Children's Medical Center Dallas said medical professionals are gradually waking up to the fact that they'll have to deal with symptoms of obesity. It doesn't matter if you're an orthopedic surgeon, an occupational therapist or any other medical specialist, she said: "You're going to be seeing overweight kids who have complications from being overweight."
And the health care community is stepping forward to meet the challenge, she said.
More food and exercise programs are starting up. New medical subspecialties are forming, such as doctors who focus on elevated cholesterol or insulin resistance, either for children or adults. Doctors who might have once tiptoed around the word "obesity" for fear of hurting children's self-esteem are gradually being more direct with their young patients.
"It's a slow culture change, but it's beginning," she said. "Everybody's had to change the way they practice to address this."
The Associated Press contributed to this report.
Childhood Obesity Program