Sep 24, 2013

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Dr. Cindy Gellner: Hi, I'm Dr. Cindy Gellner. I'm a pediatrician at the University of Utah's Westridge Health Center.

Interviewer: Let's talk about childhood obesity for a second, one of your passions.

Dr. Cindy Gellner: Right.

Interviewer: Why is childhood obesity one of your passions?

Dr. Cindy Gellner: Just because I see a lot of it. It's a big, growing problem nowadays. We see a lot of kids who are overweight and actually kids that are normal weight seem really, really skinny but they're actually normal. We have such a high prevalence of childhood obesity now that it's just something I started doing routinely and then I did a project about it and it's just been something that I've been the specialist for at this clinic for the past three years.

Interviewer: Childhood obesity. Do you think that's one of the most important things facing our children today?

Dr. Cindy Gellner: It's one of the biggest problems that we're facing in child's health, yes.

Interviewer: Why is that?

Dr. Cindy Gellner: There's a lot of theories going around. The biggest one is you don't have PE in school as much as you used to. In neighborhoods there's a lot of places where kids can't go and play as much as they used to. Foods, obviously there's a whole lot more variety for foods out there and quite often it's expensive to eat healthy. So a lot of people can't afford to eat a lot of the healthy foods that would be better for the children.

Interviewer: We know childhood obesity, for those that have it, it's a threat. How prevalent is it among our children?

Dr. Cindy Gellner: A lot of kids. I would say in my patient population there's probably about a third of my patients who actually meet the criteria for childhood obesity.

Interviewer: Have you noticed that increasing over the years?

Dr. Cindy Gellner: I have, yes.

Interviewer: How do I know if my child is obese? Is there a definition?

Dr. Cindy Gellner: There is. The hard thing is, when you think about adults you think about obesity as having a body mass index of 30 or higher, and a body mass index is actually a math formula that takes height and weight into consideration and so for kids you can't just say a body mass index over 30 because it's going to change based on the gender of the child and the age of the child.
So on the graphs that we do for all children over age 2, there's a body mass index chart when we do a visit and we check their height and we check their weight. If a child is between 85th and 90th percentile on the body mass index we start talking about how their weight is starting to creep up there. Let's talk about ways that we can bring it down into a more healthy range.
Kids that are in the 90th to 95th percentile or even the 95th to the percentile we're like, okay, we really need to start talking more seriously about it because they are getting into the overweight categories. Children who have a body mass index above the 99th percentile for their age and gender technically meet the criteria for childhood obesity.
Genetics plays a big part of it too. You've got to figure out is the child obese because that's their genetic makeup, or are they overweight and they just have other risk factors like too much television, things like that.
So it's not as cut and dry as just saying, yes, your child is overweight and this is what we need to do. But we do have a lot of things that we can tell them that these are things that you can do to help increase the chance that your child is going to be a healthy weight and to help your child be healthy on the inside as well, which is what we strive for.

Interviewer: All right. So let's talk about this for a moment. A parent brings a child in and you determine that they're obese. What's the first step then?

Dr. Cindy Gellner: In the program that I do we have a very long conversation about weight. They'll actually come back for a consult with me, and if the child is old enough, usually we say over 10 but I've done it in younger kids as well, we'll check for their cholesterol, we check their sugars, we check their thyroid, although it's very rare that the kids actually have a true thyroid problem, and we just check to see what their overall health is. I've caught kids who have liver abnormalities because there's fat in their liver already.
So we do that and then we sit down and we find out: what is your lifestyle like at home? What are your eating habits? Do you eat regular meals or do you graze all day? Does your family eat together? Do you eat enough fruits and vegetables? You're supposed to have five servings of fruits and vegetables a day.
Do you watch a lot of television? You should have two hours or less of screen time, and that includes television, computers, video games, Facebook, things like that.
There's a lot of kids that are emotional eaters. They get stressed out or they're bored and they will sit and just eat even though it's not meal time and they're not hungry but they're bored so they reach for something to eat.
Then kids don't get a lot of exercise. During the summer you have a lot of outside things that they can be doing and during the school year a lot of them have PE or they'll walk to school, but they should have a cumulative of one hour of activity a day.
Then the biggest thing I find is kids are just shocked when they find out how many calories are in juice in soda. I actually have a chart that I give them where a soda and juice are actually called liquid candy because a 20 ounce regular soda has as much calories and sugar as a candy bar.
So they don't realize all this stuff. They don't realize the portions they're eating and they don't realize this until you sit down and you talk with them about their individual habits at that time and then they're like, "Oh, wow."
We just choose one small change to make at every visit because it takes about a month of them doing a particular change before it actually becomes part of their routine and then we just slowly see how they're doing. I do pick up a lot of kids that have insulin resistance where they have a lot of sugar in their body and their pancreas is just overloaded.
They can't make enough insulin for their body to use to get all the sugar that they eat turned into energy and whatever sugar is left over gets turned into fat. There's a lot of kids that have that. There's a lot of kids I find with high cholesterol at a young age, so we do have a lot of discussions about all that.

Interviewer: So it's more than just being overweight. You need to eat less, you need to get out and move around more. There are a lot of other factors it sounds like.

Dr. Cindy Gellner: Exactly, there are.

Interviewer: That's kind of an old-fashioned way of looking at it.

Dr. Cindy Gellner: Right.

Interviewer: All right. So after that first consultation, how often do you see those steps solving the problem, letting them know how many calories they're actually consuming, looking and seeing if they're stress eating, how much screen time they're getting?

Dr. Cindy Gellner: Right. Again, the child comes up with one goal. They can ask for my input, they can ask for their parent's input, but the bottom line is they're in charge. Giving them the autonomy to make these choices actually helps improve the outcomes.

Interviewer: So you give them that one goal and you see them a month later?

Dr. Cindy Gellner: Yes.

Interviewer: And then, generally, 90 percent of the time the problem is solved?

Dr. Cindy Gellner: Nope. No, no, no. We see them every month and if they have a slip-up, it's like, okay, don't get discouraged. Let's see where we can tweak things. We keep on them because quite often just having that reinforcement of, "You're doing a good job," or, "You know what, it's okay. It's the holidays. We all understand," and just say, "Okay, how can we get you back on track?" just having that support system there, the parents and the kids really respond to.

Interviewer: All right. So what are some other factors and we'll talk about these in future podcasts that might play into it? Kind of tease us, if you will.

Dr. Cindy Gellner: Genetics is huge. There is a lot of diabetes, high blood pressure, heart disease, things like that going around.

Interviewer: That you might miss in the first initial screening?

Dr. Cindy Gellner: Well, actually, we talk about that in the first initial screening. We ask about family history because that is such an important thing. You can change your eating habits, you can change your activity, you cannot change your genetics.

Interviewer: Okay.

Dr. Cindy Gellner: As much as some of us would like to, we cannot change that. But there are ways that by doing things on a more healthy level you can actually prolong or reduce the chance of you actually having those chronic diseases.

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