Wednesday, July 14, 2010

a growing problem

it's a big deal
i saw 4 new patients yesterday (an admit, a consult, and two outpatients). and 100% of them were morbidly obese. the most impressive tips the scales at more than 4 times the weight of moi.

excuse the less-than-splashy graphic -- this was the only image i could come up with that doesn't exploit some poor obese child or make light of what i feel is a sad and serious subject.

i am not going to give specific ages as i'm terrified of revealing anything that might be considered patient demographic information, but remember -- i'm in pediatrics.

2 of the 4 have insulin-dependent type 2 diabetes (the other 2 were working on it). 2 have fatty liver disease. 3 have high blood pressure. all 4 have unfavorable lipid profiles. i realize that since i'm in endocrinology and i'm talking about patients in the hospital/clinics, there's a selection bias towards patients with mucho complications.

but it is still rather horrifying. and i have a lot of thoughts on how we counsel these children and their families -- unfortunately, i don't think there is a lot of good evidence on effective ways of doing so, and i'm not sure what our success rates are. i do know that it is something i will be doing for the rest of my career, and it is probably the most critical issue in pediatric public health (maybe OVERALL public health?) in america today.

i will definitely write more about this in the future. if you work in health care, what have your experiences been treating and counseling obese patients? any sage advice for me?

the gradebook
thanks for supporting my personal pep talk in yesterday's post. i feel like i'm dealing with a lot during the current transition, and it can seem overwhelming when the pager seems to be on overdrive!

still. remember this?

it's my list of goals for the month! i think i had some good ideas, but let me just say that the past week of focus on #2: managing big projects fell 100% flat.

and i think i know why: really, i had no plan or clearly defined goal in that resolution at all! my dilemma is fitting in all of the projects and studying that i need to be doing on a regular basis, and my solution to this challenging situation was sort of a nebulous 'just figure it out.'

TONIGHT, on my final day of this HP week, i am going to concentrate on this and actually work out a realistic, doable plan; to hold myself accountable, i promise i will unveil this plan tomorrow! we'll just call this make-up work for extra credit . . .



workout: 30 minutes elliptical (10 as warmup, 20 after weights) levels 9-12; 30 minutes lower body/mixed strength training session (SSU-inspired)

cooking: leftovers SMORGASBORD! and, tcby.

late night pages: only one medical call . . . and it was about my 3 year old niece!! don't worry, she's okay.


  1. RD here - I see obese kids ALL the time. My advice - don't ask the kid to make any changes without also asking the same of parents. At a young age, it's the lifestyle of the FAMILY that must change; you can't put it all on the child. The parents are responsible for offering healthy choices and being good role models. I have seen kids who feel singled out because "my parents put me on a diet" - this only leads to poor confidence and likely rebellion.
    Also - when it comes to behavior change, focus on baby steps. With sedentary people, you can't start preaching the "60 minutes a day of activity" without freaking them out. Baby steps.
    Also, have resources for them - books, websites, programs, other healthcare providers (RD, perhaps in the area?). This is such a longterm issue, one doctor visit will never fix it all.
    Good luck! You can email me if you want for more specific resources if needed.

  2. Clinical Social Worker here- Ditto on all that Elizabeth said, however in my opinion, when someone is 100+ overweight- there is usually an underlying emotional issue. I mean we are not just talking 20lbs overweight due to poor eating/exercise habits! The impact that being morbidly obese has on a child is all encompassing and I don't know how you would go about suggesting it, but I think therapy could really benefit this population. After all.... its like the saying's not just what you are's what's eating you!

  3. So sad! It's such a complex issue of why and how our children are getting so fat. I would encourage you to refer patients to see an R.D. because they are trained to deal with these issues. P.S. I'm not an R.D. but I'm working on an MPH in nutrition.

  4. Anonymous5:57 PM

    The best thing you can do is refer them (and the parents) to an RD, and possibly to a counselor/psychologist if needed (which it usually is).

  5. atilla11:22 PM

    thanks for the help with Gaux-Gaux..Their pediatrician, friend, neighbor actually came over and made a housecall instantly qualifying her for New York Doctor of the year!!