Treating obesity at ground zero
I found myself in the trenches of the war on obesity in 2000 when I began working as a general pediatrician at a local community clinic in Southern California. I immediately became aware of the day-to-day barriers that my patients were facing and I began to take on the responsibility of making sure that the children I was seeing would not only survive, but also thrive.
Besides treating their ear infections, asthma, rashes, and getting them through their school physicals, I wanted my patients to be safe by wearing helmets and using properly fitted car seats. I wanted them to be developmentally stimulated so they could do well in school. Above all, I wanted them to fulfil their potential to be whole, healthy human beings.
When children presented to me suffering from obesity, a potentially life-threatening condition, I was as thorough and conscientious as I could be. I checked their diets and their body mass index (BMI). I would make the diagnosis of "obesity," and at times I’d even get fancy and point out “acanthosis nigricans.”
As for our plan, my case manager found a 6-week treatment program that geographically was far away from where we were. I referred many patients, but my families often couldn't or wouldn't go. I quickly discovered there were no other doctors in the area treating or even screening for obesity. I had no plan B, which left me with actually no plan at all.
The turning point
Around this time my dad underwent bypass surgery—he wasn't even obese!—and this brought home the harsh realities of cardiovascular disease and obesity. With great resolve I rolled up my sleeves, read journals and books, and went to conferences to speak with specialists, but ultimately it was my patients who taught me how to treat childhood obesity.
One patient at a time, I started to identify the barriers to a healthy lifestyle and worked with each family to overcome these obstacles. Within 9 months, I had 2 boys in 2 different families that each had lost 100 pounds. Flushed with this success, I was hooked. I was treating a disease just as serious as cancer but without expensive and painful surgery or chemotherapy. Even more enticing was the fact that I was treating not just the patient but the whole family, and the whole family was getting healthier as a result. Mom's diabetes would get under control. Grandpa's hypertension would improve. The list went on and on.
One of the boys was interviewed by a local paper and said, “Now I feel like if a bad guy were to chase me, I could get away.” I was shocked after reading that. It had never occurred to me that a 295-lb, 12-year-old could feel so vulnerable. After that revelation, I stopped patting myself on the back and realized that I still didn't have all the answers.
Creating a plan
During my studies at Boston University School of Medicine and my residency at the Children's Hospital of Orange County, California, I had always been impressed by multidisciplinary clinics that treated complex medical cases such as craniofacial abnormalities, cancer, and spina bifida. It was exciting to be part of those rounds with social workers, specialists, pharmacists, and dietitians. The multidisciplinary approach seemed the ideal model to combat complex medical issues.
I turned to my mentor, Dr. Gwyn Parry from Hoag Memorial Hospital in Newport Beach, California, and asked how I could assemble a multidisciplinary team to combat this epidemic of obesity. He directed me to a new funding source from tobacco tax (Proposition 10) revenue in California run by the Children and Families Commission of Orange County.
My clinic wrote the grant, but we made a political decision to de-emphasize my plans to treat obesity because in 2001 obesity, especially childhood obesity, still was not on many people’s radar. Instead, we said that this program was to “help with the safety net for those most vulnerable.” I figured I was already a pediatrician at a community clinic, and it was impossible for me not to screen for food insecurity, socioeconomic stressors, or poor medical or dental access. We got the funding.