lamentations of a community pediatrician

I am tired of hot cheetos. I am tired of juice and kool-aid for toddlers. I am tired of pizza or and wings from the local takeout. I am tired of 1 month olds being given 4 ounces of formula with cereal in it to “help them sleep” and the school aged children drinking milk or chocolate milk with every school meal even though they don’t really like the taste of it. I am beginning to see more and more 200 pound 12 year olds and 80 pound 6 year olds.

It is Well Child Check season in the land of pediatric primary care. As a private practice Pediatrician in Washington, DC I don’t actually eat those foods myself or feed them to my child (though I do love pizza and wings once a month) almost every single patient I see with elevated body mass index or abnormal increased weight gain has had or currently has some part of this in their diet.

I am beginning to worry every day I am in my office about all of the premature heart disease we are going to see in 20 year olds because I now have seen close to 10 school aged children with abnormal lipid panels due solely to their poor diet, I have seen more than my share of toddlers and school aged children with developing Blounts Disease (this is a disorder kind of like deforming kiddie-arthritis where the bones in a part of one or both knees begins breaking down due to excess weight, causing deformity of the knee), I have seen countless young women with metabolic disorder and polycystic ovarian syndrome (think bad cystic acne, hirsutism, abnormal and often heavy periods). I have seen more than my share of rotting teeth due to prolonged bottle use, inadequate teeth brushing, and poor diet high in sugar-laden beverages.

Every day I say or type in my instructions to countless children and parents “no juice, soda, sweet tea, or koolaid, it’s bad for your child’s teeth and behavior” and I cannot tell you the number of children and parents who argue that juice must be good because “WIC (Women, Infants and Childrens Program) gives it to me”. Or the kids that say “I don’t even like milk, but school gives it to me at breakfast and lunch so I just drink it”. Ohhhhh WIC and schools! If only we could divest ourselves of the sugar and milk lobby and give these kids what they need - gasp, WATER! Water, the only drink that other countries, with much lower rates of childhood obesity than the United States I might add, allow in their schools. It literally takes me a several minutes in most visits to share with parents that no juice is definitely not healthy even though it has “vitamins and minerals” and that no it’s not the same as eating a piece of fruit. And no, if your child doesn’t like milk they don’t actually have to drink it and they can just drink water and get their calcium from things like yogurt or cheese. And no, chocolate or strawberry flavored milk isn’t needed because if your kid doesn’t like milk he/ she really doesn’t have to drink it. And yes, the sugar in juice and chocolate milk is just as bad in it as the sugar in soda is and nope I don’t allow my 6 year old to drink juice, soda, sweet tea, or koolaid (except at the random birthday party or when he is with my family who simply won’t listen to me) and nope my 6 year old doesn’t drink cow’s milk. Seriously, I can recite these points in my sleep because I say them every day countless times.

My heart hurts. The ICD 10 codes: abnormal weight gain, childhood obesity, pediatric BMI greater than 95%ile dot the majority of my notes. Cutting out the “juice, soda, sweet tea, and koolaid”, cutting back on the take out, increasing the time outside or dancing and playing, and cutting out the cow’s milk would be enough in most cases to curb this trend.

We had a new neighbor in his mid-30s die of heart disease this summer. His obituary showed a child who has struggled with his weight since early childhood and multiple relatives with obesity. His story includes hypertension and pre-diabetes in his 30s. This story is going to be more frequent if there isn’t major policy and cultural change in America.

Thankfully I have had a handful of success stories and they keep me inspired to share healthy diet and exercise with all because honestly so many of my patients just don’t know. The toddlers who I have done intensive intervention with in my office and referred to our local childhood obesity program whose entire families have adjusted their diets and their weight gain has slowed and can run and play more. The adolescents who have lost weight since their last visit who walk in with their parents who are looking mighty healthy too and tell me about the weight they lost and how they no longer drink sweet tea every day and do take out much less. The mothers who breastfed for a few more months even though it was hard. The families who stopped giving their 2 month olds rice cereal in their formula (of note, the current recommendation is exclusive breastfeeding until 6 months old unless medically contraindicated. No supplemental foods - that includes rice/oatmeal cereal until the kiddo can sit up on his/her own usually between 4-6 months).

So while I lament, I press on because there is so so so much work to do. Now off to find a healthy early morning and I can’t sleep blogging snack for this 4 month old growing fetus of mine.