Educating Health Professionals

Laura Szadek explains about recommended food serving sizes.

Their biggest concerns should be studying for this week's spelling test and who gets first dibs on the swings at recess. Yet all-too-many of today's children are also dealing with serious medical issues like diabetes and hypertension. That's because obesity and a host of co-morbid conditions aren't just adult health problems any more.

Concerned with the rising incidence of obesity in children, the physicians staffing USC Department of Pediatrics' Healthy Lifestyles program were determined to make inroads on this disturbing trend. While the Healthy Lifestyles pediatric weight loss program has successfully helped hundreds of children, the doctors were acutely aware that the problem was much larger than the program's scope could reach. 

A logical next step was to better equip more physicians to care for children with weight problems. So funded by a grant from the South Carolina Alliance of Health Plans, the physicians and a nurse practitioner created a "traveling fellowship" to educate pediatricians. "The real trick with this epidemic is to empower the primary care provider so that he or she is in charge," said Dr. James Stallworth, an associate professor of pediatrics and one of the four physicians involved with the effort.

The fellowship is offered through one-day workshops, conveniently provided for pediatricians at their practices. Four workshops, which are conducted at no cost, have already been held. The educational components include a PowerPoint presentation for the doctors and their staffs, who are integrally involved in the training. The overview on pediatric obesity includes the latest in management and treatment strategies. A wealth of patient education materials are distributed, including the red light/green light diet, which shows children and their parents which foods to avoid (indicated with a red light) and which are okay to eat (green light).

During the course of the day, the School of Medicine physicians also consult with the pediatricians on selected patients. "We serve as the specialists who can come in and answer questions," Dr. Stallworth said.  Through this process the pediatricians develop a better understanding of assessing for co-morbid conditions, such as insulin resistance and depression, and when referrals should be made to other specialists like endocrinologists. "Caring for these children is a long-term commitment," Dr. Stallworth explained. "The providers have to invest in this and understand the necessity of closely following these kids," he said.

Advanced practice registered nurse Laura Szadek is a committed member of the traveling fellowship team. In fact, her professional relationship with the S.C. Alliance for Health Plans was the impetus behind the creation of the one-day workshops.  "If providers can address childhood obesity and really do something about it, then we can prevent a lot of the related diseases that develop in adulthood," she said. The workshop's preventive approach also stresses the importance of BMI testing and the use of BMI growth charts when working with pediatric patients. "A chubby two-year-old with rosy cheeks is cute, but it may be determined that the child is overweight. If physicians can recognize children who are overweight and obese earlier, then intervention can be started earlier," she said.

Pediatricians and ancillary staff members also learn that managing childhood obesity is a family issue, with parents and children learning how to change dietary and lifestyle habits.  "When you look at obesity within a pediatric perspective, it's not just the child; it's the child and their environment – family and school and extended family. If you don't work on the environment you won't get the effect you want," said Dr. Stallworth.

Dr. Stallworth and Szadek are both optimistic about the potential of the traveling fellowship, which will be scheduled at additional pediatric practices. "There is no doubt that the sooner we start impacting this issue, the better the outcomes are going to be.  We have to get everyone on board to combat this epidemic," Dr. Stallworth said.

Reprinted from Connections newsletter, May 2007

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