Obesity is a prevalent health problem for children in the United States. Nearly one in five children are affected by it. For Black and Hispanic children, that rate is one in four. Public health experts have given a lot of attention to the issue over the years, and one recent study by the UMass Chan Medical School has demonstrated some promising intervention techniques. The study was conducted among socioeconomically disadvantaged communities in Worcester and had health workers meet periodically with parents to discuss their children's weight, diet and physical activity.
Dr. Milagros Rosal, professor of population and quantitative health science and co-director of the Prevention Research Center at the UMass Chan Medical School, was one of the study's authors. She's also Imoigele P. Aisiku chair in health equity and diversity. She spoke with GBH's All Things Considered host Arun Rath about the research. This transcript has been lightly edited.
Arun Rath: Before we dive into the study, tell us a bit more about how big a problem obesity is among children today. I'm wondering if, as was the case with adults, it's been worse since the pandemic?
Dr. Milagros Rosal: Well, yes, obesity in children has become a considerable problem and this is something that has been going on over quite a few years. As you mentioned, it did get worse with the pandemic. We have a crisis in this country and one that we should all be concerned about. Children are gaining excess weight. A large proportion of children, as you pointed out, especially children from minority backgrounds and children from under-resourced communities.
Rath: Just on an individual level, what does obesity mean for a child?
Rosal: That's a very good question and one that sometimes we don't think about very much. Obesity has tremendous consequences, some short-term and some long-term for the individual child, for the families, and society at large.
At large, we are seeing more and more something we didn't see before, which is that now children are developing diseases of adults. Type two diabetes is one example of it. It used to be unheard of that a child would be diagnosed with type two diabetes, but now children as young as 9 and 10 years old are receiving this diagnosis. Obesity is related to diabetes, cardiovascular disease, some cancers, high blood pressure, high cholesterol, breathing problems like asthma, sleep apnea and joint problems. Children who are obese have a very high chance of growing up and becoming obese adults and then these consequences are obviously very serious.
Obesity also has consequences for children in terms of mental health, depression, low self-esteem. They are more likely to be bullied. Their quality of life is compromised.
And at a larger scale for society, the consequences are enormous. There is an increased cost of health care and low productivity associated with the inability to work and disability and, frankly, early mortality.
Rath: So, tell us about the study, what it found about what techniques worked to fight this.
Rosal: We developed this intervention with the help of parents and it consisted of two in-person sessions and two follow-up calls per year, over a period of two years, and these sessions were conducted by a community health worker. Community health workers are people from the community that understand the culture, can address issues of health literacy and can speak the language of the communities. We developed this intervention, and it was delivered by these community health workers in English and Spanish.
The intervention sessions consisted of the community health worker talking with a parent or guardian of the child and coaching them, giving them brief advice about a healthy child weight and giving them key messages about reducing sugar-sweetened beverages, reducing high-calorie snacks, reducing screen time and increasing fruits and vegetables and physical activity. Then, the community health worker would ask the parents what goals they have for their kids in terms of health behaviors. They were able to define the goals and the community health worker would help them with making a plan to achieve that goal for their kids or for their families. And at the end of the session, the community health worker would discuss a plan for following up to see how the goal of the family and the plan to achieve it had worked out, and help with problem-solving any challenges. They had to understand what worked and what didn't, and why.
Rath: It sounds like there's this whole suite of very specific, particular things that can be done and that work. Now, is it possible to scale it up so that could be used for many more parents and children? And what would it take to scale it up enough to have the impact that it should have?
Rosal: Absolutely. And that is the beauty of this program, that it is a very simple program and relatively easy to implement and integrate by community organizations that may be interested in doing this type of work. There are many programs out there in the community to help families prevent obesity, and pretty much the intervention, as I mentioned, is delivered by a community health workers — somebody who can be trained from the community, who understands the community and understands the resources available. Part of what the plan involved was to help families identify resources for implementing their plan. For example, if it was increasing activity, what are the parks in the area where families could go and bring their kids and to participate in activities or to walk together? And it could be that the families needed food assistance and the community health worker would be able to help families with that. So, any organization that is interested in delivering this type of intervention would certainly be able to do that. It is not very complicated to integrate into an organization.
Rath: Dr. Rosal, thank you so much. It's been great talking with you and nice to hear about solutions to a big health care problem.
Rosal: Thank you very much.
