Physician Patricia Riba, who specializes in child nutrition and obesity in underserved communities, treats patients in Santa Ana, Calif., a city where 34 percent of young people are overweight, park space is lacking and nutritional food options are scarce.
At her clinic, Riba works with a team of bilingual assistants, a trainer, nutrition educators and social workers to help families change their eating habits and help overweight kids establish healthier lifestyles. Below, Riba offers a hands-on perspective on the cost of youth obesity and the resources and will required to address it.
Q: Generally speaking, what are you seeing in the exam rooms of your obesity clinic?
A: It’s a frightening thing to look at these kids, knowing there are problems with diabetes along with complications from sleep apnea, liver disease, heart disease. Their asthma is worse if they have obesity. Their future is grim and that’s why I do what I do and it’s what gets me out of bed every day….
Q: Can you speak in more detail about the medical issues you’re seeing?
A: Nonalcoholic fatty liver disease in a 3-year old… this is something we saw in aging men when we studied it in medical school. Now children have this and in 30 years they’re going to need a liver transplant. I’m seeing it a lot in the blood work, and it’s shocking to see it in young children.
Something else is that kids should not snore. If they are snoring, they could be having apnea. We see this more in overweight kids. Kids get their tonsils out and snoring comes back because the weight. … When you have apnea, you don’t get oxygen you’re waking up all night long gasping for air. So kids have difficulty staying awake and concentrating in school. Again, this was an adult problem when I studied it in medical school.
Q: Asthma is complicated by weight?
A: Yes, they find that asthma will be worse if you’re obese. There’s also psychological issues, anxiety, worsening school performance. You’re four times more likely to have impaired school performance if you’re obese. In studies on quality of life, obese children answer the survey questions like kids who have cancer do. There are also joint problems. With diabetes, if you get it at 90, that’s once thing. If you get it and live with it 30-40 years, you are likely to get complications: kidney transplant, blindness. Getting it at a younger age can be devastating.
Q: How do you help kids lose weight?
A: We don’t put any child on a diet. We don’t want them to feel restricted or have forbidden foods. When food is restricted, kids eat more and more and more. We do encourage parents to serve a variety of healthy foods and let the children learn to self regulate. Some kids are pleasers and clean their plate because they think it’s the right thing to do. We want to get the parent out of that equation. I told a family today, I said, ‘It’s between your stomach and your mouth. You need to tell us if you’re full or hungry. Stop eating if you’re full‘… you have to figure that out with your stomach.’
Q: So what is the parents’ role, as you see it?
A: It’s the parents’ responsibility to decide what’s being served, and to offer multiple food groups. Coaxing has a bad effect. Just keep offering variety and make meals enjoyable. Anecdotally we see this working like crazy.
Q: But won’t kids just refuse to choose the Brussels sprouts? That’s what mine do.
A: A kid has to be exposed to a food a number of times, as high as 28, before they‘ll try it.
Q: What are some misconceptions you overcome?
A: A lot of people come in with misinformation about diet and exercise. I’m hearing kids shouldn’t eat at night, but the kids are hungry, and so when they do eat they binge. I had one little boy sticking food into his underwear.
Q: Can you quantify your success rate and what the factors for success are?
A: I think that when parents are able to tell us the barriers [to a healthier weight], we have a good success rate. In the last 2 years, over 55% of my patients have decreased their BMI [body mass index]. Those are some of the toughest patients in Orange County, because we’re dealing with families with no insurance.
Q: You are mainly serving low-income kids. How do means factor into the child obesity equation?
A: Transportation affects a lot of my families, that is, parents working multiple jobs. But I’ll tell you, it’s not like wealth always leads to success. I see [poorer] families dig in, commit to it and it works. I see families with better transportation and where money isn’t as much of an issue and the parents don’t choose to follow through on these directions. Finances do affect patients but they’re not the only barrier.
Q: As to fitness, are organized sports too expensive and time-consuming for some families?
A: It can be expensive and difficult to coordinate getting multiple children to different exercise programs. Even when you get them there, they serve junk food. There’s candy everywhere at my daughter’s swim meets. As a society, we need to commit to a healthier environment for our kids.
Q: Take away the access issues, and sports still don’t work for everyone, right?
A: Moms will tell me, “He won’t do exercise because he gets teased.” That’s why I designed the play yard next to the clinic [which is fenced in and to allow for some privacy].
Q: You offer free exercise classes. How’s that going?
A: The kids are out there sweating, having a blast. Their hearts are racing.
— Amy DePaul