I came across this video from December. On point about healthy eating. Take a look.
Being thin and being in shape are not the same thing, as evidenced by our slender friends who never get off the couch, and conversely, by every single overweight athlete. Although our weights and where we fall on the body mass index — a measurement of our total body fat based on our height and weight… Continue reading “Are You In Shape Or Just Thin?” »
It’s a grim reality many of us face: Promptly after eating cheese, we become sick. Should we persevere through our love of cheese and a helping of blissful ignorance, or face the fact that we may be lactose intolerant? According to the Mayo Clinic, the most common symptoms of lactose intolerance, when our bodies cannot fully… Continue reading “6 Signs Of Lactose Intolerance” »
WASHINGTON, February 20, 2017 – Childhood obesity is an increasing problem around the world, and a new study suggests genes may contribute to the problem. A new study by the University of Sussex in England has found that parents of obese children may have passed on their obesity genetically, according to Science Direct. The numbers are… Continue reading “Childhood obesity may be inherited from parents” »
What Is On A Pediatrician’s Mind?
Pediatricians have the task of pleasing or appeasing three or more separate persons at any given time of which only one is the patient and the others are parents and siblings (not forgetting the grandparents). Under such circumstances, the challenge, therefore, is to deliver care that society will deem fair to our most vulnerable.
That task also comes with the need to ensure that both the evolving culture of the society as well as psychological and social factors are taken into full consideration when delivering care to children. There is also a thin line between ethics and access to care which we must ensure even within the most constrained systems.
Below are some of the facts at the back of your pediatric practitioner’s mind when he or she asks you those questions in the clinic, on the phone or in a questionnaire. A shorter version of this article is on our Omega Promise blog on Medium. (www.promise.omegapediatrics.com).
Pediatrics is less profitable than other specialties
In being at the forefront of healthcare delivery for children it is interesting how one has to juggle a lot of interloping factors including the economics of health. In February 2016, a large healthcare organization unceremoniously let go of a group of 16 pediatricians. As reported in this article, Pediatrics is less profitable than other medical specialties. Many children are covered by the low-income Medicaid program, which reimburses doctors and hospitals considerably less than private insurers.
According to the CDC Faststats, 3.3% of children under 18 years still do not have adequate health insurance coverage. This number has been dropping from a high of 9.9% in 1997 to 6.6 in 2008 and now down to this 2015 number. However despite this apparently high percentage of coverage (more than 96%), the bulk of reimbursements from care given to children, 42.2% was from public healthcare coverage plans which we know pay much lower than the private insurance. This makes pediatrics as a specialty, a low revenue specialty since most of its revenue comes from government insurance.
Many mothers refuse to act responsibly and thus put their children in danger
Early pregnancy care, prenatal care and first-trimester supervision of pregnancies are still at 75 to 90%. Many pregnant mothers still smoke, take alcohol or use illicit drugs during pregnancy, thus putting the unborn baby at risk. The problems of the infant fall directly onto the pediatrician’s turf and the pediatrician usually is not in a position to influence the public health roots of the problems.
Improved neonatal and prematurity survival makes the job of the pediatric practitioner more challenging
In the United States, there are still a lot of preterm births, low birth weight infants, and prematurity. Though the peak was in 2006 at 12%, it has been falling steadily but the overall incidence of infants born under 2500 grams has remained steady. These are the more challenging infants to take care of especially when these infants need neonatal intensive care prior to discharge. Pediatricians manage these children once they are home with their families unless they have major issues or have to see a specialist in which case they are managed in collaboration with the specialists.
Pediatricians often have to take care of “babies” who have babies
Birth rates among adolescents have been dropping. The latest numbers show a decline of 9% down to 24.2% in 2014. However, it is still a major pediatrician hassle to provide primary care for infants of children, emancipated or not! According to the CDC, “…teen pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children”. “In 2010, teen pregnancy and childbirth accounted for at least $9.4 billion in costs to U.S. taxpayers for increased health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers.”
Breastfeeding is best for the baby but uptake and sustenance remains a challenge
Initiation, as well as maintenance of breastfeeding, have remained a challenge despite supporting legislation and more trained professionals in the lactation medicine arena. The good news is that an increasing number of mothers initiate breastfeeding, the latest numbers put the national score of ever breastfed at 81.1% but that number falls off steeply at 6 months with only 52% still breastfeeding at that time. Despite the numerous advantages of breastfeeding exclusively and the personal health as well as public health advantages of breastfeeding, the numbers remain worse than health indices from resource-limited countries. This suggests that it is the abundance of resources that has been our biggest disadvantage in the breastfeeding space. Other factors include old family traditions and cosmetic misconceptions, especially among the young adults and teens.
Mental health issues fuel most of the pediatric admissions that are not trauma
Hospital admission of children is a rarity, occurring in 2.4% of children in 2010. Overall for children under 17, respiratory illnesses such as asthma and pneumonia were the leading diagnosis as well injuries. However of note is that in children between 13 and 17 years old, mental illness is a top diagnosis on admission.
Trauma kills a lot of children
The cause of death in the U.S. child aged 1 to 24 remains mainly preventable conditions: accidents, suicides, and homicides. Malignancies (cancers), and congenital malformations which children may have been born with also play a role to a large extent in the younger age groups.
Substance abuse is extremely high in adolescents
Substance abuse is very high among adolescents in high schools. In 2011 one report put it as high as 71% of students had had at least one drink. A different report showed that 46% had tried cigarettes. About 40% of high school students have tried marijuana. Other drugs that are a problem include cocaine, heroin, and methamphetamine.
Obesity remains a big problem for us now and for our future
The obesity epidemic is not yet going away. It may never go away. There is much we can do as a planet, but not much can move the needle just from the pediatric office. Society as a whole has to start taking responsibility.
What are your thoughts about pediatric problems and the challenges they face?
Comment below or on our Facebook Page. Please share this article.
Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.
Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.
WASHINGTON – Children with asthma may be at higher obesity risk later in childhood or in adolescence, according to new research published online this week. Researchers from the University of Southern California found that young children with asthma were 51 percent more likely to become obese over the next 10 years than children who did not… Continue reading “Children with asthma more likely to become obese: study” »
We are not doing as well as we should with obesity in this country. It is really a sad case since the United States leads the world in healthcare spending and identification of threats to optimal health, yet we are still losing the battle of the bulge, the Obesity Epidemic.
In the United States of America, we have a lot of physicians and a thriving primary care culture. Many children and a good proportion of adults go to their physicians for routine check-ups everyday. Unfortunately we have become so overnourished that being overweight is the rule rather than the exception. More than one-third (34.9% or 78.6 million) of U.S. adults are obese according to this JAMA article cited by the CDC website while this self-reported obesity map is horrifying.
If our physicians knew enough about obesity, then why is it winning? Why are people not wrestling this scourge down? Knowledge is power. Power to win battles. The understanding of different cancers lead scientists to newer ways of attacking and defeating it. The same has happened in infectious diseases like Hemophilus Influenza and HIV. However, for obesity which we only came around to recognizing as a disease in 2013 (see this long American Heart Association Report if you desire or their recommendations here).
The expectation following the announcement by the American Medical Association that Obesity is a disease was that physicians would pay more attention to the condition and address it in a holistic manner with hopes of reversing the dangerous trend that we are seeing. However there are several reasons why those are tall dreams.
- You do not know what you do not know. The physicians, though well-meaning do not know enough about obesity to meaningfully battle it. Obesity is a complex condition and with the multi-system interactions that are in play, it may take more than defining it as a disease to got it under control.
- Primary care providers already have their hands full. The average family physician or pediatrician is very busy. The specialists working in hospital settings are even more squeezed for time. Reimbursements from payers including insurance companies, medicare and medicaid are not keeping up with inflation. The volume of paperwork and other requirements make it very difficult to take on a new entity.
- Patients feel offended. People feel offended when the issue of their weight comes up in discussion, even among family and friends. It is even worse if it is the physicians and other healthcare providers. Thus in an effort to keep the customer “right” and coming back, the issue of weight is avoided, while the provider manages health issues related to the excessive body fat.
- Patients and providers need a quick fix, maybe an app. Is there an app for that? Can I download something and make it go away? We now want fast solutions for problems. Obesity solutions sell if there is a “fat burn gizmo” as seen on TV. We want the magic diet that will get us ready for the beach in 3 weeks or the ready-made meals that worked for the celebrity we saw on TV. Nobody is ready for the hard work, the grunt work or the multiple office visits and accountability required for both our eating and our physical activity.
- It is big business. Yes it is big business. I will steer clear of the numerous complications associated with excessive body fat and just focus on the “ancillary industries” that have become 800-pound gorillas when it comes to excess weight and obesity. Diet fads, Packaged meals, Food blogs, Exercise programs, Fitness clubs and sports/workout equipment. The list is literally inexhaustible. Too much money is being made in the area associated with body weight, looks and diets. That is the offensive truth. There are so many “experts” in the arena that it is nauseating. Lots of deceit because they want your money.
- It is fueled by big business. Many fingers point to fast foods and soda as the main agents in the overnutrition battle. However, these behemoths have enough lobbying dollars to out-spend the likes of Google and Apple 100-times over.
Thus we should know where the real enemies are and understand that Obesity as an epidemic cannot be handled by physicians alone. The overweight adult must come to terms with the issues at stake and take a meaningful step towards saving us all from another threat to humanity. The story is getting worse as our numbers are now about 40% according to this ABC report today.
Look for a physician certified in obesity medicine (full disclosure I am a Diplomate of American Board of Obesity Medicine and now live in the Atlanta area) and have a discussion with him or her. That is one of the first steps I would recommend if you want to rescue yourself and the rest of the world from the obesity epidemic. As a second step check out this free BMI calculator before your visit to see your obesity physician.