Common Sense Nutrition toward fighting an epidemic…Amidst a global pandemic

By: Tami Dolphens, MPAS, PA-C
Nebraska Home Pediatrics
Creighton University PA Program
Omaha, NE

A CNN article published early in the New Year confirms the fear that many of us have had for months. 

Those of us tasked with keeping our young patients healthy from COVID are struggling to keep them healthy in general. 

As noted by Dr. Edith Bracho-Sanchez in the attached article, “The pandemic created the perfect conditions for kids to gain weight, and they have.”

Complications from childhood obesity include a number of organ systems, including:

  • Cardiovascular – Hypertension, Dyslipidemia
  • Gastrointestinal – Non-Alcoholic Steatohepatitis, Cholelithiasis, GERD
  • Endocrine – DM Type 2, Acanthosis, PCOS, low levels of Vitamin D, etc.
  • Orthopedic – Blount’s Disease, Slipped capital femoral epiphysis, Advanced Bone Age
  • Respiratory – Sleep Apnea, Asthma
  • Psychologic – Depression, Anxiety, Low Self-esteem, Bullying

As mentioned in my previous blog, obesity is a preventable illness, and prevention begins early. 

For decades, primary care providers have worked to counter habits that promote obesity in late childhood and into adolescence. Just as we were making headway, the pandemic threw us into a tailspin. Rates of compliance with well-child checks have plummeted across the country. According to preliminary data from the Medicaid & CHIP Data Snapshot, 1.7 million fewer vaccinations were administered from March to May 2020 than in the previous period in 2019. Providers have turned to the use of telemedicine visits to close the gap. 

Medicaid & CHIP preliminary data show delivery of telehealth services to children increased by over 2,500% from February to April 2020.

In my personal opinion, telehealth still doesn’t compare to a face-to-face conversation, asking a child to tell you about their favorite foods or listening to a mother describe her feeding struggles. Perhaps you educate families while showing them a growth chart, remeasuring a blood pressure that was high, or pointing out physical exam findings such as acanthosis nigricans, to a mother who only thought it to be “dirt on the skin”. 

Nutrition education regularly offered at well-checks was working! Childhood obesity rates were beginning to slow; even the rate in toddlers was showing a plateau for some patient populations. Albeit slow, there was at least a glimmer of hope that a generation of children could be saved.

In response to this old (but new) crisis, the American Academy of Pediatrics has released interim guidance on Supporting Healthy Nutrition and Physical Activity During the COVID-19 Pandemic. The provider’s role has expanded from educating families on healthy habits and lifestyles to assessing for barriers that prevent having a healthy lifestyle. 

While present for years before, food insecurity, disordered eating, and having no access to safe physical activity have reached epic proportions. My presentation during GAPA’s Summer Conference, Pediatric Track, will review these interim guidelines and discuss how they can be applied to the ever-changing approach to the obesity epidemic.

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