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A Pediatrician with a Big Heart

August 21, 2014
 

This week the Inside Track begins a series of interviews with members of the Strategic Advisory Committee of Voices for Healthy Kids, a joint initiative of the Robert Wood Johnson Foundation and American Heart Association, exploring their various contributions to the fight against childhood obesity.

Dr. Stephen Cook’s running joke among his fellow American Heart Association volunteers is to make sure they know that “I’m not a cardiologist, I’m a pediatrician! Sore throats or ear infections, I’m your man.”

But working at the intersection between childhood health and heart health, he has confirmed the key role that pediatricians can play in getting kids started on the right path.

Dr. Cook, a professor of pediatrics at the University of Rochester Medical Center’s Golisano Children’s Hospital, was trained in both internal medicine and pediatric medicine, and he has been working in childhood obesity research for 13 years. In his work with the AHA, including in his current role representing the American Academy of Pediatrics on the Strategic Advisory Council for Voices for Healthy Kids, he has focused on “public health strategies around cardiovascular health,” including addressing food marketing to children and improving physical activity in schools.

“If you’re trying to help people, children or adults who have obesity, it’s really hard to send them back into an unhealthy environment,” he noted.

He offered a quote: “Obesity is a disease that doesn’t have the dignity of other chronic diseases.” The speaker? Child psychiatrist Hilda Bruch—in 1975. Unfortunately, change has continued to move slowly since then.

“The argument is it’s a personal choice, and it really isn’t,” Dr. Cook says, noting that it’s only been a year since the American Medical Association classified obesity as a disease.

On both the policy and research sides, one of his key interests is access to care. For the past year and a half he has been working with two other organizations with which he is active, the American Academy of Pediatricians and the Children’s Hospital Association, to more closely examine referral services—researching what additional steps primary care doctors are taking to prevent obesity.

His growing concern is that “we need the clinical piece for childhood obesity”—multidisciplinary treatment that addresses the full variety of patient needs. But the high costs of such care for children’s hospitals, and the difficulty of getting Medicaid coverage for it, are roadblocks. In a recent study he worked on of clinical obesity treatment at 200 children’s hospitals, only 80 offered sufficiently intensive programs.

Such programs struggle to break even, Dr. Cook noted. Clinical care for children with obesity or at risk of it is, he said, are supposed to be covered without copay under the Affordable Care Act, just as other preventive care such as vaccines or cancer screening. But this isn’t happening: “Everyone’s waiting for someone who’s willing to take the first step.”

Pediatricians are a key piece of the public health advocacy puzzle, he notes. They long have had a particularly high level of engagement in community health, which makes them the perfect ambassadors to promote actions that can reduce childhood obesity.

They also tend to see their patients more regularly given the number of regularly scheduled well-child visits, particularly in early life.

“Pediatricians are ready and willing to do this work around advocacy—[discouraging] marketing to kids, better food in the environment, promoting walking and physical activity for the whole family,” Cook says. “Pediatricians provide that window into the young family population. We have more impact on the family because they get that window of opportunity to talk to parents about everyone’s health. I think it’s a big advantage that we have and a unique opportunity.”

Donna Brutkoski authored this article.

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