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:

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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. 

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.

Beyond willpower: Three TEDMED talks on how to fight obesity

What’s the best way to combat our national obesity epidemic?

To preview the issues behind our live online Great Challenges conversation about obesity this Thursday at 1 PM EST, we’ve collated three recent talks on the topic, a running theme of which is: It is immensely difficult for any single person to tackle the health issue of obesity alone.

How can America lose weight?
The CEO of Weight Watchers, David Kirchhoff, says America’s obesity crisis isn’t about people eating too much; it’s about our “obesogenic” environment. Beating it will involve lots of collective willpower.

Why can’t America “weight” any longer?
John Hoffman, vice president of HBO documentary films, and Judith Salerno, executive officer of the Institute of Medicine of the National Academies, talk about the HBO documentary The Weight of the Nation, why obesity is indeed a health crisis, and why it demands action on a national scale.

If we can’t cure the patient, can the community do it?
Mark Hyman, MD, best-selling author and chairman of the Institute of Functional Medicine, relates a story of how a stringy chicken in Haiti led to a revelation about using social networks to combat chronic health issues, one community at a time.

Great Challenges live online event Thursday: Can we manage our obesity crisis?

 

This week’s Great Challenge conversation: Can we manage our obesity crisis?

Join the Challenge Team at 1 PM EST on Thursday, December 6 to watch a Google+ Hangout, share your thoughts with other viewers, and ask questions of Team members that they’ll answer in real time.

They are:

 

James Zervios – Director of Communications, Obesity Action Coalition

 

John M. Auerbach – Director of the Institute on Urban Health Research and Distinguished Professor of Practice at the Bouve College of Health Sciences at Northeastern University

 

Christine Ferguson – Strategic Initiatives Advisor, STOP Obesity Alliance; Professor, The GWU School of Public Health and Health Services

 

Rebecca Puhl – Director of Research and Weight Stigma Initiatives at the Rudd Center for Food Policy & Obesity at Yale University

 

Maya Rockeymoore PhD – President and CEO, Global Policy Solutions

 

Dan Callahan – Senior Research Scholar and President Emeritus, Hastings Center

 

Scott Kahan, MD, MPH – Director, STOP Obesity Alliance

 

To get started, follow the TEDMED Google+ Page or @TEDMED #greatchallenges on Twitter.

What’s really causing our obesity epidemic?

What are the top 10 contributing factors to our nation’s struggle with obesity?

TEDMED’s Great ChallengesTeam Leaders, who address the problem every day from their top posts in advocacy, academia and public health, had varied perspectives on what’s causing this vast, relatively recent, and growing health threat.

A big part of the issue is that we oversimplify the problem, says Joe Nadglowski,  President of the Obesity Action Coalition. Gaining or losing weight is not just a matter of calories in, calories out, he says, but a matter of what does get consumed, and when.

Professor Christine Ferguson of the School of Public Health and Health Services at George Washington University, pointed out that interventions for children’s health may be the most effective way to stem the tide of obesity, and that working at less than peak health impacts our workforce and hence, our economy.

Dan Callahan of the Hastings Center pointed out industry influence as a factor, including resistance to resistance to regulation and taxation of unhealthy food and beverages, and large restaurant and sugared beverage portions.

Maya Rockeymoore, President and CEO of Global Policy Solutions, singled out portion sizes and the easy access to high-fat and sugary foods as causes, while adding that for many neighborhoods, access to healthy food was also a major barrier.

And Rebecca Puhl, Director of Research and Weight Stigma Initiatives at the Rudd Center for Food Policy & Obesity at Yale University, added agricultural policy, commodities pricing and the built environment to her broad-view perspective on the issues.

Click here see their full responses and comments from the rest of the team members on the Great Challenge of obesity.

Fake food and the obesity crisis

How much of our nation’s obesity crisis is driven by an overabundance of processed food — and a lack of access to the real stuff?

In a new video series co-produced by TEDMED and Fenton Studios, and filmed at TEDMED 2012, Tracie McMillan, author of “The American Way of Eating” and David Ludwig of Boston Children’s Hospital sat down with Lisa Witter to discuss the issue.

What do you think contributes most to the obesity crisis? Share your thoughts and ask our team of thought leaders on the TEDMED Great Challenges website.