Imagining a culture of healthier childhood

TEDMED speaker and pediatric endocrinologist Louise Greenspan has been a co-investigator in a uniquely comprehensive longitudinal North American study following young girls through puberty. We asked her to design a fantasy health intervention with unlimited resources. Here’s her vision:

Image courtesy of Shutterstock

We all know the expression, ”It takes a village to raise a child.” My fantasy intervention is based on that concept, however it expands on what the village is and what it provides. Today’s industrialized societies have fractured the extended family, resulting in most parents not having support from their own elders in raising their children. Many young parents don’t have the basic knowledge they need to support their growing families in healthy ways. While concepts about child rearing naturally change between generations, there is still a lot to be learned from those who have gone before us.

I’d love to support an intervention that provides education and assistance to families beginning from the moment they find out they are pregnant. The idea would be to start with pregnant mothers, by providing nutritional education and enhanced psychological and educational support, regardless of socioeconomic status. This education would take place in classes with members of the neighborhood who are also pregnant, thus building community.

After delivery, new parents would be encouraged to breastfeed and learn how to nurture their babies by visiting health workers who could come into the home. As the children grow, these home health workers would provide assistance and education to parents on how to feed their children, how to support their developing brains, and also how to discipline them. This way, parents could learn the facts they need to know, as well as start to develop a healthy authoritative approach to setting limits with their children. These trained workers would be available for parents to turn to for advice, to supplement the way some of us were once able to turn to our mothers and grandmothers for advice (but with the latest in knowledge and skills). The health workers would also set up support groups for families who live near each other or hold groups and classes as well.

At age 3, all children would be offered high quality preschool with a healthy lunch provided for all, and the parental support and education could continue, informed by these community schools. Parents would learn how to deal effectively with the challenges presented by their ‘threenagers’ and other toddler challenges. At entry to elementary school, the support and education would be augmented so that it would also be provided directly to the children themselves while also continuing with their families. All kids would have weekly lessons in cooking and healthy eating, and be active participants in growing and preparing healthy food at their school as part of the curriculum. Parents and guardians would participate in sessions about how to feed their children healthfully, assist their children educationally, as well as continue to be given tools about how to effectively parent their children.

Health Education would be taught to the children directly, starting in kindergarten with practical life skills, including cooking. In the early grades, the education might focus on the importance of eating a healthy balanced diet and on getting enough physical activity and sleep. As the children age, lessons would include classes on their body and health, with puberty education starting in third grade, separate from sex education, which could start in sixth grade. In third and fourth grade, children would learn about puberty and the body changes that will start and happen to everyone over the next few years. In middle school, kids would continue to discuss puberty, but would now have discussions about sex and sexuality. In high school, these topics would be discussed in more depth. The lessons learned about cooking, healthy eating, and exercise would continue throughout these years. There would also be age-appropriate mindfulness-based stress-reduction education through all of the grades, with an emphasis on this in high school. Parenting assistance and education throughout these years would reinforce these concepts and would perhaps also focus on how to enforce healthy sleep habits and limitations on screen time. The outcomes examined in this intervention would include rates of childhood obesity, early puberty, and psychological and educational diagnoses issues across the socioeconomic spectrum.

Could an intervention like this help reduce childhood health care disparities? Could it reduce parental stress and anxiety? Might it lead to more teens heading to college, thus reducing educational disparities? It is my dream to be able to study the effects of such a holistic, longitudinal, health education intervention. My hunch is that it could be game-changing.

Louise Greenspan is co-author of the The New Puberty: How to Navigate Early Development in Today’s Girls. Learn more by watching her TEDMED talk, “Weighing the causes of early puberty.”

Zoobiquitous Medicine: Q&A with Barbara Natterson-Horowitz

Barbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, offered an unusual perspective on how human patients, including those suffering from mental illnesses, can be helped by applying insights from animal health. We caught up with Barbara to learn more about how her Zoobiquity idea improves understanding of ourselves and the natural world.

Zoobiquitous Medicine. Barbara Natterson-Horowitz at TEDMED2014. Photo: Sandy Huffaker for TEDMED.
“When I see a human patient, I always ask, ‘What do the animal doctors know about this problem that I don’t know?'” Barbara Natterson-Horowitz at TEDMED2014. [Photo: Sandy Huffaker for TEDMED.]

What motivated you to speak at TEDMED?

After 20 years of practicing cardiology taking care of patients with heart attacks and high cholesterol, I was thrust into the world of veterinary medicine. Seeing my human patients as human-animal patients completely changed how I practice medicine and understand health and disease. Insights from this species-spanning approach to medicine can benefit human and animal practitioners and patients alike. It’s thrilling to introduce this approach to physicians, psychologists, dentists, nurses, etc. and watch their viewpoints transform; the exposure at TEDMED led to a collaboration between a celebrated human breast cancer physician studying a mutation that causes breast cancer in women with a veterinary oncologist working on the same mutation that causes breast cancer in jaguars and other animals!

Why does this talk matter now?

Animals and humans get basically the same diseases. From heart failure, diabetes and brain tumors to anxiety disorders and compulsions, the challenges we face aren’t uniquely human. Discovering why, where, and how non-human animals get sick reveals crucial but hidden clues to human health and illness. For instance:

Breast cancer: When beluga whales began dying of breast and colon cancer in the St. Lawrence estuary, a parallel epidemic of breast cancers in women was discovered in the same region. This species-spanning breast cancer outbreak was ultimately linked to toxins from local aluminum smelting plants.

Obesity: Medical insights into obesity — which challenges physicians and veterinarians alike as animal and human patients are becoming more fat — are generated by a zoobiquitous approach.  Awareness of worsening obesity in domestic and wild animal populations challenges us to consider environmental factors including endocrine disrupting chemicals,  antibiotics, and even climate change as contributors to the “plurality of obesity epidemics.”

Infectious disease: The majority of infections that could create human pandemics come from animal communities. From Ebola to West Nile Virus, SARS to H1N1, some of most worrisome threats to human health and survival are encountered first by veterinarians and animal experts. If we fail to pay attention to these experts and miss out on the opportunity to collaborate, we lose crucial information and increase unnecessary risk for human populations.

How do you see your work fitting into species-survival, wildlife preservation and conservation?

Zoobiquity emphasizes the interconnectedness of animal and human lives and ecosystems. Animals can be sentinels of disease in humans. When horses in Venezuela start to die, it can mean equine encephalitis may threaten local human populations. When cormorants and crows get sick with West Nile virus in Queens and the Bronx, elderly and immunocompromised patients may also be at risk for the virus. On the other hand, humans can be sentinels of disease in animals. Human outbreaks of Brucellosis often lead to identification of sick and suffering animals. The detection of lead poisoning in a child often leads to exposure and disease in local wildlife. Bringing practitioners of animal and human health together encourages the transfer of information from the world of human medicine that is vitally relevant and important to wild animal populations.

What do you hope for the legacy of Zoobiquity? 

Zoobiquity Conferences have now been held across the US and internationally. At these events human health practitioners including physicians, nurses, dentists, psychologists and others come together with animal health practitioners including veterinarians, behaviorists, nutritionists and others to discuss the shared diseases of their different species. I’ve heard some veterinarians joke, “real doctors take care of many species.” Bringing the comparative approach to the human medical community has the power to transform how physicians, nurses, psychotherapists and others understand disease, their patients and the environmental and evolutionary factors that link us all together.  I hope Zoobiquity is successful in bridging the worlds of animal and human health, ecology and evolutionary biology.

Check out our archived Facebook chat with Barbara about species-spanning medicine. 

Preventing childhood obesity: It’s never too early to start

What’s the best way to prevent children from becoming obese?

While theories abound, one thing we’ve learned so far: It’s never too early to start.  A New England Journal of Medicine study last week showed that children who are overweight in kindergarten are much more likely to become obese teenagers. Other recent research suggests risks begin in the womb, and include a mother’s weight gain, blood sugar levels and smoking habits.  Risks may even stretch back generations; the great-grandchildren of a group of rats exposed to DDT had higher levels of fat and weight gain than progeny of those not exposed.

TEDMED 2013 speaker Peter Attia, an MD who conducts what his organization, NuSI, considers the most comprehensive research on the causes of diet-related diseases to date in adults, says that factors likely to trigger children to become overweight in the first place may indeed be present at birth, and are tough to surmount.

Does a typical school lunch contribute to food-related diseases?

Does a typical school lunch contribute to food-related diseases?

“Genetic factors aren’t as likely to explain changes over relatively short periods of time. The epigenetic factors – genetic factors turned on by environmental triggers – may have a lot to do with a mother’s eating behaviors while a child is in utero.  [Studies so far] certainly suggest that the quality of a mother’s diet plays a role in a child’s susceptibility to obesity and insulin resistance,” Attia says.

And these influences are only likely to grow along with a child, he says.

“There’s a whole host of systems and structures that got that child to be where they are; they’re probably related to socioeconomic status, education, and what the child consumed for the first five years of his or her life. All of those factors aren’t going to go away,” Attia says.

Communities are scrambling to catch up, and many are looking at the school environment as a logical start point. In TEDMED’s Google+ Hangout last week, Great Challenges team members and special guests discussed measures schools are taking to educate kids about good nutrition and ensure that they receive it on school premises. They include efforts to help schools procure locally grown fresh food for cafeteria lunches; on-site gardens where children harvest and study the science of food; and nutrition education and cooking classes. (Watch a video of the insights shared here.)

Will these interventions happen quickly and go far enough? Attia has hypothesized that foods high in sugar — juice, soda, candy bars, sugary cereals, and sauces — are prime culprits of diet-related illnesses like type 2 diabetes and fatty liver disease.  And right now they’re commonly available in cafeterias and on school property.

The fast rise of these ills in children – as many as seven million cases of fatty liver disease in the U.S. – should be a wake-up call that vast changes are needed, starting with improved medical research on their causes, Attia says.

“Do we honestly want to continue reiterating the same dogma for the next 30 years that says ‘Just eat less and exercise more, and if you have the right moral fortitude you’ll be fine?’

“It’s been a scientific and policy failure in adults. All you have to do is look back when the mantra started, and look at how many people were obese, and how many had type 2 diabetes, and follow through on the amount of spending that’s gone to propagating that message, and compare that to the numbers today,” he says.

What’s happening to kids also reinforces what Attia expressed in his TEDMED talk:  That we mistakenly attribute obesity and its related diseases to a failure of personal responsibility.

“ ‘People who are obese and diabetic are morally corrupt.’ We don’t come out and say that, but that’s the implication. ‘These are bad people. These are lazy people who lack discipline.’

“But do we really believe that children are morally bankrupt, lazy, slothful entities who just choose to be gluttonous?  We have a hard time believing that for a five-year-old,” he says.

Stacy Lu

N is for Nutrition: Can schools help prevent childhood obesity? An online live event

What kind of role can and should schools be taking to help keep kids at an optimal weight?

Image courtesy of The Kitchen Community

Image courtesy of The Kitchen Community

According to a Kaiser Permanente survey published last summer, some 90 percent of Americans expect schools to take the lead in any community effort to reduce childhood obesity. This makes sense, after all – the vast majority of school-age children spent most of their waking hours at school, and most partake of school lunches. Further, the Centers for Disease Control pointed out in a report about how schools can promote kids’ health, research now shows that a healthy body is critical to a healthy mind. In our age of winner-take-all standardized testing, no stone can be left unturned.

For those and other reasons, a growing number of schools are taking part in a drive to do just that. Fresh, nutrient-filled food is increasingly on the menu. The Federal government has stepped in by instituting new standards for school lunches. Education about good nutrition and its relationship to a healthy body weight is on the rise.

Can school gardens harvest health?

Some schools are going a step further by growing fresh edibles on school grounds, and asking kids to help harvest them. The movement had a visible beginning some 17 years ago when chef Alice Waters started her Edible Schoolyard project in Berkeley, Calif. Research so far suggests that “garden-based learning” may increase students’ knowledge of nutrition and promote healthy eating habits, as well as teaching team-building skills and an appreciation for the environment.

Image courtesy of The Kitchen Community

Image courtesy of The Kitchen Community

A number of local and national initiatives have, er, sprung up with plant-based missions.  The Kitchen Community, an initiative based in Boulder, Colo., makes the school garden the basis of an outdoor classroom that includes benches and artwork.

“It’s fundamentally changing the built environment and using that as a catalyst towards experiential learning and imaginative play. We know that will raise test scores, and we know the impact will be profound on what kids eat and how they eat,” says Travis Robinson, Managing Director.

So far, Kitchen Community has helped create 155 school and community center “Learning Gardens” with an additional 11 community gardens across the U.S. Installing the Gardens, however, isn’t an inexpensive or quick endeavor, and involves much involvement with school and community facilities managers.

Cheryl Moder, director of the San Diego County Childhood Obesity Initiative, says the group takes a policy, environmental, and systems approach to obesity prevention, working to improve access to healthy, fresh food and promote physical activity.

The Initiative’s work with school gardens allowed community members to help with gardening, and in some cases to have plots on school property.

“It helps increase the sustainability of school gardens.  All too often once the project champion leaves the school plot goes fallow,” says JuliAnna Arnett, who manages operations and food systems for the Initiative.

The group works with partners in multiple sectors to prevent and reduce childhood obesity through a variety of strategies, including healthy and local food procurement for hospitals and schools, while also focusing local efforts around two overarching strategies: Reducing consumption of sweetened drinks and increasing safe routes to healthy places.

How are efforts like these making a difference? Join this week’s live online Google+ Hangout this Thursday at 2pm ET to discuss these issues and more. Tweet questions to #greatchallenges and we’ll answer as many as we can on air. Participants include Great Challenges Team Member, Melissa Halas-Liang, and our guests for this discussion: Cheryl Moder and JuliAnna Arnett from the San Diego County Childhood Obesity Initiative, Travis Robinson from The Kitchen Community, and Laura Hatch from the Alliance for a Healthier Generation. Amy Lynn Smith will return as our moderator.

NYC doctors can now prescribe fruits and vegetables

An apple a day might keep the doctor away, but she won’t mind – she might even write a prescription for it.

As reported by the New York Daily News, Two New York City hospitals, Lincoln Medical Center in the Bronx and Harlem Hospital in Upper Manhattan, are launching what’s called The Fruit and Vegetable Prescription Program (FVRx). It aims to help overweight children and their families access fresh fruits and vegetables to counter obesity and related diseases.

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FVRx works like this:  Doctors and nutritionists assess a patient’s eating habits and prescribe produce as needed. Kids and their parents are given “Health Bucks” to use to purchase produce.

“A food environment full of processed foods full of fat, sugar and salt is contributing to obesity, diabetes, heart disease, stroke, cancer, and other chronic diseases,” said New York City Health Commissioner Dr. Thomas Farley, in a press release. “The Fruit and Vegetable Prescription program is a creative approach that, with the inclusion of Health Bucks, will enable at-risk patients to visit any of our 142 Farmers Markets and purchase the fruits and vegetables that will help them stay healthy.”

The program is coordinated by Wholesome Wave, a non-profit based in Bridgeport, CT, that aims to seeks to provide locally-sourced whole foods to underserved communities. The organization has programs in 28 states and the District of Columbia with more than 60 partners implementing subsidy and incentive programs for businesses and consumers.  A similar program started in 2010 in Massachusetts has reportedly met with success.  The U.S. Food and Drug Administration also has had a Farmer’s Market Nutrition Program for women, infants and children since 1992.

As Rebecca Onie of Health Leads pointed out in her TEDMED 2012 talk, it’s difficult for families facing hardships to have the basic resources necessary to heal from illness or even to maintain wellness. Health Leads works to connect patients in need with appropriate social services. Its work stems from a growing awareness of the major role social determinants play in health.

On Thursday, September 19th, TEDMED will host a Google Hangout related to the issue of consumer behavior and food purchases. Stay tuned for more information on when to tune in, and visit TEDMED.com to learn more about the Great Challenge of coming to terms with our national obesity crisis.

Live event Thursday: What can adults do to reduce childhood obesity?

This week at TEDMED, we’ll be focusing on a Great Challenge with perhaps the biggest impact on future health: reducing childhood obesity.  Some 17 percent – 12.5 million – of kids in the U.S. are obese. How did we get here, and what can we do about it? Watch Judith Salerno and John Hoffman talk about “The Weight of the Nation” at TEDMED 2012 – and join our live online event this Thursday at 1 pm ET.  Moderating the discussion is Sally Squires, former Washington Post nutrition columnist and Director of Health and Wellness for Powell Tate. Visit TEDMED’s Google Plus page for details.  Ask questions of our group of health leaders on the topic – they may answer them on air.

The challenge of child obesity — for adults

About one in five kids in the U.S. is obese, which carries not only current health problems but a greater risk of issues like diabetes and heart disease later in life. Early intervention is key, particularly as kids are less set in their ways than adults, so it’s easier to change their behaviors and teach them new concepts.

Yet children don’t have the power over their lives, decisions, and lifestyles that adults have (parents and adults make many decisions for them and have the power to enforce certain behaviors).

Social institutions have more impact on kids than on adults (like church, YMCA, and especially school — including school lunch programs, mandatory gym classes, possible nutritional education, etc.).

Given all the factors, what’s the best way to go about reducing childhood obesity?  Who  should lead the charge? Have you seen strategies that work, first-hand?

Clearly, this is a complex issue that needs collective wisdom to address. Join the discussion about childhood obesity and ask questions to health leaders on the issue at the new interactive website, challenges.tedmed.com.

Note to parents: The Strategies to Overcome and Prevent (STOP) Obesity Alliance and Alliance for a Healthier Generation recently released “Weigh In: Talking to Your Children About Weight and Health,” a research-based online guide that helps prepare parents for tough conversations about weight and health with their kids. View the guide at www.WeighInOnObesity.com.