Vital Views

Joe Gaccione 0:01
Welcome to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. Despite awareness campaigns and healthier food alternatives, now more than ever childhood obesity remains a critical issue in the US. The statistics speak for themselves: according to the Centers for Disease Control and Prevention, obesity prevalence is nearly 20% for children and adolescents aged between 2 and 19 and it impacts more than 14 million people. Among that prevalence, the highest rates are among Hispanic children and Hispanic Black children. In fact, the National Heart, Lung and Blood Institute say nearly one in four Hispanic and non-Hispanic black children have obesity. And this isn't just an individual problem, this is a familial and societal issue as well. Joining us to discuss pediatric obesity is Dr. Imelda Reyes, UNLV Nursing professor-in-residence and associate dean of advanced education. Dr. Reyes is a nationally recognized expert in pediatric care, especially in the Latino community. She is-dual certified as a family and pediatric nurse practitioner. Her focus is not just on finding ways to manage childhood obesity, but having more education service opportunities for families to increase prevention and healthier eating habits. Dr. Reyes, thanks for coming in.

Imelda Reyes 1:13
Thank you.

Joe Gaccione 1:14
So, let's start with those stats that we mentioned earlier. It feels like even despite interventions and more advanced science, more advanced health education, obesity is still an issue. Is it, is it genetic, or are there other factors?

Imelda Reyes 1:30
So, there's definitely a lot of factors that go into childhood obesity, I would say the biggest thing are really the social determinants of health and just the choices that people have. So, for instance, when it comes to making good food choices, the healthier food options are sometimes more expensive than, you know, some of your run-of-the-mill like, fast food items that you can get. And, you know, some of our families are strapped for, you know, time and money and the convenience of buying fast food is also there. But when you start to weigh in, like, you know, how much is it to like, have a family salad, you know, and put all the components together versus buying something else and then what if your child doesn't eat it, so then you're left with all this food that no one's, you know, wanting to eat? And so, I think, you know, there is, you know, whether or not you want to say a genetic component to, you know, hormones, and like, just the way our bodies respond to food, you know, that might be a component, but it's really, really those bigger societal, environmental factors that really play into it a little bit better, or a little bit more. And, you know, having that comprehensive holistic approach when we're talking to families about it is just so important because, again, it's trying to help them arm themselves with tools so that they can really combat the issue.

Joe Gaccione 2:52
Why are certain communities more likely to face obesity? Does it go back to socioeconomic status?

Imelda Reyes 2:57
And social determinants of health, for sure, yeah. So, you know, if you live in an area, for instance, where it may not be safe to walk outside, or it's not safe to send your kids outside to play, that's going to weigh in, you know, a lot to like, how much exercise are the kids getting? Versus if you live in a neighborhood where your kids can play outside all day long, and like, you know they're safe. And so, I think that plays a big role. And, you know, just the fact that like, even for some kids, say they're getting breakfast and lunch at school because they qualify for free food, what kinds of food options do they have at school that go along with that? And the schools are faced with the same issue of like, wanting to have food that kids will eat, and then combine that with like, healthy options. It's just, it's such a multifaceted problem and it really requires like, creative solutions, I think to like, really deal with the issues.

Joe Gaccione 3:53
What are the biggest culprits when it comes to the food itself? You mentioned fast food before? Is that probably the biggest negative food option for kids or are there others?

Imelda Reyes 4:03
I mean, we talk about refined foods, and we talk about like these processed foods, and we talk about like, all of the additives that they have, I think that plays into it. Sugar drinks, or sugary drinks, also plays into it. So, you know, whether or not, you know, kids are drinking water? Are they drinking soda? Are they drinking juice? You know, that plays a big role. You know, I've had some families, for instance, that get assistance, right? So they'll get like Women, Infants and Children, WIC coupons, and the coupons have juice on them. And so, you know, I've had this conversation so many times with families where they're like, “But it's on the coupon, so it must be healthy, therefore I buy more,” and I'm like, “No, like, please don't do that. Like, let's try to cut back on that and drink more water.” And so, it's just interesting, like some of the dynamics and you know, some of the things that we as society do to try to help, but at the same time, it's like misleading and like maybe not giving the best kind of example of how to be healthy,

Joe Gaccione 5:04
When parents are having that conversation with their kids, how should they approach it? How should they talk to their child, if they're concerned without, you know, you have to walk that line of being sensitive, but you also need to address the situation? What are some, what are some suggestions you have?

Imelda Reyes 5:19
Really, it's, again, a team approach. So, I find myself, as a pediatric provider and a family provider, really having to like, start the conversation because in the population that I work with, sometimes the idea that a child, you know, are they happy, you know, and they equate that with being healthy, not necessarily like their weight or where their BMI is, for instance. And so, it really makes a difference, when, you know, it starts kind of when they go to do that visit because you may look at a child and they look fine, but then your provider might say, “You know, their BMI is like, greater than 90%, or 95%,” or something. And that's where I think the conversation should start. And then you also need to work with the family to see like, are they worried? Like, does grandma have diabetes or does, you know, grandpa have hypertension or something and really kind of find a way to like, engage the family to say, why is this important and why should we do something? So it kind of takes the load off the parent a little bit, because I think if it's a conversation that starts in an environment like that, it's much easier than the parent identifying it, and then, you know, doing something. The other thing too, is that it's really a family affair. So, you know, if, if there is somebody in the family that's struggling with their weight or happens to be overweight or obese, it has to be a familial, like a family approach to really dealing with the issue because you want to make sure that the child doesn't feel singled out, you know? It's not like they're getting a separate meal, you know, it's like the whole family needs to change the structure. If the kids aren't getting enough exercise, it’s a whole family going out for family walks or something. So, really having a structured approach so that, you know, they don't feel singled out,

Joe Gaccione 7:08
As a health care provider, as a nurse, having those conversations with patients, does, as a nurse, do you have that, for lack of a better word, authority to approach a patient that you think needs to seek, you know, additional treatment for obesity and start that conversation? Is there a delicate line to walk there as well?

Imelda Reyes 7:26
Yes, absolutely. And the approach that you take makes a world of difference. So, I would never, you know, walk into a room and say, “Oh, by the way, your child's overweight or obese,” but, you know, I had like charts in my room, and I would ask the parent like, “Where do you think your child is? Like, do you think they're in the healthy zone? Or do you think they're in the red zone?” Or, you know, where do you think they are? And for the most part, families could identify where identify correctly where they thought their child was, but it really opened up the conversation, because if they would say, “You know, I think my child might be in the yellow or the redzone,” you know, then I was able to like, “Okay, so you identify it, now, let's do something about it,” versus, nothing's worse than walking in and having a provider say, you know, X, Y, and Z, just to your face, you know, and it immediately kind of puts up those roadblocks, where you're now kind of in a confrontational or, you know, kind of relationship versus, “Let me work with you,” and then really looking at, again, those family dynamics to say, you know, are there genetic or not genetic but more chronic disease within the family that you can kind of latch on to, to say, like, “This is what we're trying to prevent, you know, from happening with your child.”

Joe Gaccione 8:38
The other point I wanted to ask was, when we talk about risks for obesity, there are obvious ones that we hear about, we hear about diabetes, we hear about cardiovascular health, but what are some not so commonly discussed risks from childhood obesity?

Imelda Reyes 8:51
Yeah, so that's a great question. So, in kids, one of the things that were, that we were seeing in my clinic was fatty liver. So, something that typically wouldn't happen to a child, or something that we wouldn't see typically in pediatrics, we were seeing more of so, you know, again, like the families would be super surprised, because they would say, “You know, I mean, I've heard of diabetes, and I've heard of hypertension, or, you know, but really, it's happening to my child,” you know? And then when you add in the component that, you know, their livers being affected, that really kind of scared some people. But I think those are the biggest things that you don't expect to hear that in populations other than adults, having high blood pressure or having diabetes, you know, that shouldn't happen to a child.

Joe Gaccione 9:34
Before, we mentioned data from the CDC. Now, that data from the CDC website was taken between 2017 and 2020. I'm curious, if you took that data now, throwing in the pandemic, if those numbers are now exacerbated?

Imelda Reyes 9:48
Yeah, that's a great question. To be completely honest, I haven't looked at, you know, where the numbers are currently sitting at, but I know the pandemic, I mean, that just threw a monkey wrench into so many things. So, you know, whether it's not getting our kids vaccinated in time to, like, you know, having to make do with what you could during the pandemic, you know, I mean, people were really scared to go to the grocery store and, and like you said, you know, maybe people were ordering out more or something, but I think, you know, we'll have to definitely look at the statistics to say, you know, did the pandemic have an impact, and again, now working with trying to get people back to baseline, you know, and trying to really say, “Okay, you know, like, I know, the pandemic is not over, but can we make some adjustments to kind of get us back to some, whatever our new norm is going to be?”

Joe Gaccione 10:34
Like you did what you had to do for that time, but now that things have loosened up a little bit, we can start going back to healthier alternatives. We have a lot of nursing students listening right now, and pediatrics is a common interest for students that they want to get into as a field, as a career choice. How did your nursing path get you to where you are now, focusing on childhood obesity?

Imelda Reyes 10:56
It was interesting. So, I did my nursing degree and then I was really interested in population health and so. I went into public health and that took me on a different ride in terms of I joined the Navy, I was a healthcare administrator, I was doing health care management. And then I found myself really missing nursing, and so I came back to nursing. I worked med-surg with adults, and I loved working with my patients. So, I was working in urban hospital, I saw a ton of chronic disease, so I would have people come in with hypertensive crises, or diabetic crises, or something. And I found myself just really, really drawn to that population, so I thought, “Well, I think I want to work with adults.” And then when I started doing my rotations in my family nurse practitioner program, I, you know, did my first internal med rotation, I really enjoyed it and then I got into my pediatric rotation. And my preceptor looks at me one day and says, “You know, like, I think you're in the wrong specialty,” and I said, “No, no, I'm not,” and she's like, “Yeah, you are,” she's like, “You're really good with kids and you really need to kind of rethink what you're doing.” And, but by this point, I was already halfway through my family nurse practitioner degree. And so, after I finished that degree, I actually went to work for Children's Healthcare of Atlanta as a pediatric nurse practitioner, and I just fell in love with the population. I think working with families and really helping them to develop like, the healthy habits and trying to set them up for success and really doing the education was like what being a nurse practitioner for me was all about. And so, so, it was really exciting. And then, when I was in my practice, I started noticing, I'm like, “You know, so many of my kids are coming in,” and like those statistics that you shared with with us at the beginning, I actually, between my overweight and obese patients, I think I was sitting at like, 33% of my patients were in one of those categories. And I really started looking at like, “How am I approaching this,” and really working with families to kind of, again, address what was going on. And so, I did two studies in my clinic, one looking at parental perception. So, you know, how do the parents perceive their child to be? And often, the parents could either identify that their kid was overweight or obese, or sometimes they would underestimate. And so, what I found is that our providers were also underestimating. So, we weren't actually doing like, the measurements properly. And so, that was, to me, like, fascinating. And so, we put some things into place to ensure that everybody was being measured appropriately, that they were being counseled appropriately. And so, I worked with a strong for life campaign where we were working with patients and providers to really educate everyone kind of, you know, again, holistically to kind of say, you know, whether you're out in the community, whether you're in a clinic, whether you're a family, here are resources for you to deal with it. And so, that's kind of how my story, you know, got me to where, where I was in pediatrics and working with families and that way,

Joe Gaccione 14:00
Something that you mentioned before that I just want to clarify, and we're kind of late in the episode, the difference between overweight and obesity.

Imelda Reyes 14:07
Yeah, so we want our patients to be, so pediatric BMI is a little different than adult BMI. BMIs for adults are kind of like these cut offs, right, depending on how tall you are, this is your weight. For children, it really is a trajectory along like their age. So, there are BMI charts that you know, track it along. And so, a child that's between the 5th to 85th percentile is considered in the healthy range, above 85 to 95 is considered obese, and then above the 95th percentile is when, or overweight, and then above the 95th percentile, you're considered obese. That's where those BMI charts were, they were kind of color coded, you know, like green is where we wanted to be, yellow was kind of cautionary and red was like, “We need to take action,” was really nice to be able to kind of talk to our patients and show them like, “Here's where they should be.” And the big thing with pediatrics and obesity is that we don't necessarily want children to lose weight, so if we identify that a child is, you know, maybe above where they should be, it was really about maintaining their weight but continuing to grow, so that they could kind of outgrow, like, whatever, you know, they were dealing with. And for some kids, obviously, like, you know, they could afford to lose some weight, but for a majority of my kids, it was really, let's just like, try to maintain and keep growing.

Joe Gaccione 15:24
That's a great point because there is healthy weight, you, especially the younger the child is, you need that to grow and support yourself. Social media always gets knocked for body image stereotypes and what people, and I'm using air quotes, are considered, you know, the “ideal” body size, but do you think that has an effect on childhood obesity, as far as maybe putting that image out there? And children, adolescents that might be overweight or obese, it might affect mental health? Do you think that's a factor too?

Imelda Reyes 15:53
Oh, absolutely. So, I would definitely see it with my adolescent patients in that they might come in, and we would start the conversation about like, “Where do you see yourself?” and it was always they wanted to be thinner, you know, and then when you started to, like, probe around and find out, like, “What do you mean?” and it was, “Well, you know, so-and-so on TV, or magazines.” And so, when I was doing like, education with my patients, it was always, you know, I had to like, reiterate these images aren't real, you know, they're edited, they've got teams of people that make them look good. And so, it was always that constant battle to like, find, you know, “What's a healthy weight for you? What's an ideal weight?” And then what are, you know, what are these images that they see that really kind of play into their mental health? And so, yeah, it was, it was hard, you know, it was just a lot of education, again,

Joe Gaccione 16:43
What resources are available for people out there, especially those with lower socioeconomic statuses that may not have the availability of other communities to be able to seek help, seek treatment and prevention,

Imelda Reyes 16:55
Really knowing like, what your resources are, wherever you're living. So like, I recently relocated from Atlanta to Las Vegas. And so, most communities, you know, whether it's a health department or some sort of initiative to like, really deal with childhood obesity, so looking to see like, what's out there, but, you know, I tell parents all the time that, you know, following rules like five-two-one-O for instance, where they're trying to get the five fruits and vegetables in a day, trying to limit their screen time to less than two hours a day, trying to do physical activity, at least an hour, and then not drinking any sort any sugary drinks. That's a really simple message that I think, you know, can help families. But then again, you know, trying to like, if this is something that's worrying you, when you go to see your provider, like what resources do they have available that they might be able to refer you to as well?

Joe Gaccione 17:47
Are there online like, national groups that you recommend?

Imelda Reyes 17:51
Yeah. So, there's, the CDC is a great place to kind of go and see what kind of resources are there for that. Healthy Plate, I love that website, because I think it does a really nice job of trying to message what is considered healthy and, you know, trying, and they don't make it too complicated. I think the food pyramids we used to have in the past were like, really complicated. And now the, the MyPlate is just, you know, it's simple, and it's easier to follow. So, I think resources like that are really helpful for families.

Joe Gaccione 18:20
That is all the time we have. Dr. Reyes, thank you so much for coming in.

Imelda Reyes 18:22
Thank you.

Joe Gaccione 18:23
Thanks for listening out there. Hope you have a great day.