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Bearings - Fall 2008


It is no secret that obesity is among the most significant health challenges facing children in Maryland and across the country today. Children’s National Medical Center is taking a leading role in the greater Washington metropolitan region to combat childhood obesity through collaboration among its many departments and centers of excellence.

This issue of Bearings will focus upon Children’s National programs, services and initiatives that take a multi-disciplinary approach to the prevention and treatment of childhood obesity.

About Childhood Obesity

According to the Centers for Disease Control and Prevention, more than nine million children between the ages of six and 19 are overweight or obese - a number that has tripled since 1980. The United States Department of Health and Human Services estimates that overweight adolescents have a 70 percent chance of becoming overweight or obese adults. This increases to 80 percent if one or more parents is overweight or obese.

The Trust for America’s Health 2008 report, F as in Fat, estimates 25 percent of adults in Maryland are obese and 13 percent of children ages 10-17 are overweight. The same report estimates 10 percent of high school students in Maryland are overweight and are at risk of obesity. At Children’s National, we see children with complications from obesity that are normally exhibited as an adult, such as diabetes, hypertension, dyslipidemia, liver disease, sleep apnea, and heart disease.

According to a 2005 U.S. Government Accountability Office (GAO) report, the rise in obesity-related health conditions also introduces added economic costs. GAO estimates that nationwide, obesity-related health expenditures accounted for more than 25 percent of the growth in health care spending between 1987 and 2001. In 2000, an estimated $117 billion was spent for health-related expenditures due to obesity, with direct costs accounting for an estimated $61 billion.

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Children’s National’s IDEAL Clinic

Children’s National’s IDEAL Clinic (Improved Diet, Exercise & Activity for Life) [INSERT HYPERLINK] treats children and teens ages two to 18 who are at risk of obesity or who have been classified as obese and develops multidisciplinary management plans for the patients and their families. Patients have access to psychologists, dieticians, and exercise therapists as well as nurses, physicians, and specialists in gastroenterology, endocrinology, cardiology, sleep medicine, psychology, and exercise therapy. The IDEAL Clinic is the only comprehensive multidisciplinary treatment program for children with obesity in the metropolitan region.

After a child is admitted into the IDEAL Clinic, they are followed by specialists intensively for six months, followed by monthly visits for approximately 12-18 months. During treatment, the child may receive dietary, nutritional, and weight management counseling, as well as group health education and physical activity classes. In addition, parents receive individual education to create an environment conducive for the child to manage their weight.

The IDEAL Clinic is part of the Goldberg Center for Community Pediatric Health (Goldberg Center). One of Children’s National’s clinical Centers of Excellence, the Goldberg Center offers a community-based model that focuses on comprehensive primary care, prevention, diagnoses and treatment of pediatric health conditions prevalent in the region. Through the Goldberg Center’s broad scope of services, Children’s National Medical Center’s presence extends into neighborhoods as an integral component of community life in the District of Columbia and beyond.

In 2007, the IDEAL Clinic treated 70 patients and their families. Due to the success of the program, there is an excess of demand for children to be admitted to the clinic. Currently, there is a six month waiting list for treatment.

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Children’s National Launches Obesity Institute

There is no magic pill that will solve the problem of childhood obesity. Of course, healthy eating and exercise are key components to losing weight and leading a healthy lifestyle, but the factors that contribute to childhood obesity are complex and numerous. Home and play environments, family traditions and attitudes toward food, and psychological and social issues all play a role in contributing to childhood obesity.

Children’s National founded a world-class Obesity Institute [INSERT HYPERLINK] to address every arena of obesity in the community. Through the Obesity Institute, Children’s National seeks to reduce childhood obesity using a multidisciplinary approach that draws upon our clinical expertise, as well as research, policy and advocacy partners in the region.

The Obesity Institute’s vision is to be recognized regionally, nationally and internationally as a leader in developing and disseminating best practices for the prevention and treatment of obesity. The Obesity Institute’s aggressive goal is to initially slow, and eventually stop the incidence of childhood obesity within five years in children up to 18 years old. The Obesity Institute will execute the strategies and initiatives to reduce childhood obesity through clinical treatment, advocacy, research of best-practice treatments and genetic composition that leads to greater incidences of obesity and education for medical staff, families, and communities.

Representatives from the Obesity Institute were involved in crafting Children’s policy statement concerning childhood obesity (link on underlined text) earlier this year.

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Meet Dr. Anjali Jain!

Dr. Anjali Jain, a resident of Montgomery County and Children’s National’s representative on Maryland’s Committee on Childhood Obesity (HB 1176), works in the hospital’s Center for Clinical and Community Research. The Center for Clinical and Community Research conducts research that leads to advancements in healthcare promotion and improves the prevention, diagnosis, and treatment of childhood diseases in hospitals, outpatient settings and communities. The center identifies the optimal methods for delivering preventive services and other health care to children and their families, paying special attention to disadvantaged and minority populations.

Dr. Jain has been involved with a number of research and public health projects that will help inform health policies to reduce childhood obesity. These include:

The STOP Obesity Alliance: Dr. Jain served as Research Director for the Strategies to Overcome and Prevent (STOP) Obesity Alliance, which is a collaboration of consumer, provider, government, labor, business, health insurers and quality-of-care organizations united to drive innovative and practical strategies to combat obesity.
The Early Childhood Longitudinal Study (ECLS): Dr. Jain is conducting data analysis from the ECLS, which provides national data on children's status at birth and during early childhood. Dr. Jain is analyzing secondary data from the ECLS to examine the various risk factors that lead to childhood obesity, especially children from particular socioeconomic and ethnic backgrounds.
The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program: Dr. Jain has worked with Medicaid Managed Care Organizations to improve the EPSDT Program in Washington, DC. The goal of this work is to help children and families to receive more preventive care, which includes screening and treatment strategies to control obesity;
Provider Bias: In collaboration with a fellow in Children’s National’s Division of Adolescent Medicine, Dr. Jain is studying bias against obese children among pediatric providers.
The Summit Health Institute for Research and Education, Inc. (SHIRE): Dr. Jain is working with the SHIRE on a collaborative to reduce and prevent obesity among youth in the District of Columbia’s eighth ward. The collaborative is charged with developing policy recommendations, selecting obesity intervention/prevention models and educational materials that could be implemented in family child care homes in ward eight, and recommending an obesity prevention/intervention model for use by caregivers in the ward. The SHIRE is also committed to completing other tasks such as promoting the expansion of available fresh, quality foods in wards seven and eight, participating in the District’s anti-obesity campaign, researching obesity related activities and helping child care providers acquire playground space and physical activity equipment.

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Other Programs Offered by Children’s National

Children’s National is involved in other initiatives to address childhood obesity. These include:

COOL Kids (Combating Obesity and Overweight in Latino Kids) focuses on overweight Latino children, ages seven to 15, who are at risk of developing type II diabetes. This pilot study examines the effect of low glycemic load diets in Latino children, and whether these diets will improve insulin sensitivity and/or reduce body weight. Preliminary data from this study has been gathered, and further research remains ongoing.
Start Early, Start Right is an intervention research study designed to prevent and treat obesity among Latino children ages two to six years with the parents as the primary target of the intervention. The program educates parents about choosing healthier foods, understanding nutrition concepts and portion sizes, and encouraging families to become active together.
Childhood Obesity Summit: Children’s National participated in the District of Columbia’s first citywide Childhood Obesity Summit in September 2007. The summit was a collaboration of multiple organizations to tackle obesity. As a result of the summit, an action plan was developed with five distinct areas of goals and objectives, including citywide prevention, treatment, education, social marketing, and public policy. The summit facilitated education on obesity-related services, messages, and resources provided by organizations throughout the District of Columbia.
NBC 4 Health and Fitness Expo: Children’s National is the largest exhibitor at this annual expo, held in January at the District’s Convention Center. Included in Children’s National’s exhibit is the Kids’ Kitchen, which teaches kids about healthy eating and provides nutritious snacks. In 2007, fitness demonstrations were added to Children’s National’s exhibit.
The Girls Fitness and Nutrition Program (FitNut): Children’s National is a partner with the FitNut program, which is an after-school program for families with middle-school aged girls at-risk for obesity. FitNut helps children to build healthier lifestyles by promoting healthy food choices and proper nutrition, incorporating physical fitness into daily life through safe, structured dance lessons, and developing healthy living take-home strategies for the whole family.

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