Category Archives: Obesity policy
James Perrin, MD, FAAP, began a one-year term as president of the American Academy of Pediatrics (AAP) in January. A professor in the department of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, Perrin received a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research in 1997.
Human Capital Blog: Congratulations on your new role as president of the American Academy of Pediatrics! What is your vision for the organization?
James Perrin: We are focused on addressing three main areas, which have really driven a lot of our thinking and, more importantly, our activity and change in the last several years.
First, we are working to help pediatric practices take on more community-based interventions to help young families raise their kids more effectively. There is a tremendous growth in the number of chronic diseases among children in four major areas: asthma, obesity, mental health, and neurodevelopmental disorders. We recognize these are not classic health conditions; they arise from and within communities, and both their prevention and their treatment are really community-based endeavors, as opposed to office-based activities.
Our second, and highly related priority, is an increased focus on early childhood development. We have understood the tremendous importance of early childhood for years, but there is now so much more science behind it. We know a lot more about how negative experiences and toxic stress can affect child development and how it can affect brain growth and neuroendocrine function. On the positive side, we also have more knowledge about the importance of reading to children, increasing language in the home, and other early-childhood interventions.
Thirdly, we have a better understanding of the tremendous impact of poverty on child health. Almost a quarter of American children live in households below the federal poverty line, and almost 45 percent live in households with incomes less than twice the federal poverty line. So a large number of American children are poor or near poor, and we know that poverty affects essentially everything related to child health. It makes those four categories of chronic conditions—asthma, obesity, mental health, and neurodevelopmental disorders—more prevalent and more serious, and it affects children’s responses to treatment. Lower-income kids with leukemia or cystic fibrosis, for example, have higher death rates than kids with the same diseases who are middle class. It’s impossible not to see on a daily basis how poverty affects child health.
Justin List, MD, MAR, is a Robert Wood Johnson Foundation/VA Clinical Scholar and primary care general internist at the University of Michigan. His research interests include community health worker evaluation, social determinants of health, and improving how health systems address the prevention and management of non-communicable diseases.
Recently, the Robert Wood Johnson Foundation announced a shift from its focus on health care toward building a “culture of health.” As a buzz phrase, “culture of health” carries promise to transform how Americans think about health, but it carries a risk to mean so many things as to dilute its meaning. For example, I saw a recent picture on Twitter where two people anonymously answered “what does the culture of health mean to you?” with “feeling guilty for not taking a sick day.” If we think of the culture of health as a web of health experiences, that answer might be best placed somewhere along an outer ring of the web. But what would be at the center of the phrase’s web of meaning?
To start, a culture of health goes beyond the health care system and incorporates every day experiences and choices people make that affect their health. Building a culture of health means not only looking at clinics and hospitals under the microscope but also looking more closely at how our communities impact health. The culture of health concept offers every person in America a larger vision and momentum for changing how Americans experience health, and it requires everyone’s participation to make change happen.
As a physician, I struggle with what role my colleagues and I play in building a true culture of health. Recent obesity statistics may suggest we’re not so effective. Obesity rates fell for children ages 2 to 5 years old since 2003-2004, according to researchers from the Centers for Disease Control and Prevention. Meanwhile, obesity rates remained essentially unchanged for most other age groups and even higher in women in over 60. From the health system side of the equation, why might that be?
The health care industry is not in the healthiest state when it comes to weight, according to a study published in the American Journal of Preventive Medicine. Analyzing data from the 2010 National Health Interview Survey and adjusting for confounding factors such as race, gender, and smoking, researchers identified two industries—public administration (36%) and health care and social assistance (32%)—as having significantly higher-than-average obesity rates.
Long work hours and hostile work environments were among factors that contributed to higher obesity rates, researchers found. Within the health care industry, obesity rates were lower for health care practitioners and for workers in technical occupations than they were for health care support occupations (such as home health aides and nursing assistants), “suggesting that the impact of working conditions on obesity may be especially harmful for lower-income workers,” the researchers wrote.
Out of 20 industries in the study, real estate workers had the lowest obesity rate, at just under 20 percent.
Janet Tomiyama, PhD, an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2009-2011), is director of the Dieting, Stress, and Health (DiSH) Lab at the University of California-Los Angeles. She was recently named the 2013 recipient of the Early Career Investigator Award from the Society of Behavioral Medicine.
Human Capital Blog: First, congratulations on receiving the Society of Behavioral Medicine’s 2013 Early Career Investigator Award! What does this award mean for your current research and for your career?
Janet Tomiyama: Thank you! Of course, as I’m fighting my way toward tenure, this kind of recognition is really key to my career. I am trained as a social psychologist, but this award was from the field of behavioral medicine. It shows that my work has interdisciplinary appeal, that people in the medical field find it important. It shows me that I was on the right path in trying to broaden my training through the RWJF Health and Society Scholars program and trying to incorporate aspects of medicine and population health. Getting recognition from a field that’s not my own means a lot to me.
HCB: What specific work did the award recognize?
Tomiyama: I was recognized for a paper about racial disparities in chronic psychological stress and body mass index (BMI) among girls between the ages of 10 and 19. Of all the many, many health disparities out there, the disparity in obesity between Black and White girls in adolescence is one of the biggest. I wanted to tackle a big disparity, and I thought stress had something to do with it. I completed the research during my time as an RWJF Health & Society Scholars fellow.
Human Capital Blog: You argue in your book that the focus on the “obesity epidemic” obscures a deeper, more important question: How has fatness come to be understood as a public health crisis at all? How do you answer that question?
Abigail Saguy: It’s multilayered. On the deepest level, the fact that we perceive obesity as a public health crisis is related to the fact that fatness, or corpulence, has become an undesirable social characteristic. It has not always been that way, and it is not that way everywhere even today. In many places and times in history, being heavier has been considered a positive social characteristic, particularly in times and places where food is scarce. This is why, in certain contexts, women or girls are fattened up for marriage; there, the woman’s fatness symbolizes the wealth or status of their families.
Human Capital News Roundup: Television ads for statins, advanced nursing education, treatment for gunshot wounds, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:
In a piece about the growing need for advanced nursing education, Nurse.com interviewed a group of nurse leaders working to fulfill a recommendation from the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, which calls for doubling the number of doctorate-level nurses by 2020. Among those quoted: Christine Kovner, RN, PhD, FAAN, co-principal of RWJF’s RN Work Project; RWJF Executive Nurse Fellows alumna Jane Kirschling, RN, DNS, FAAN; and Susan Bakewell-Sachs, RN, PhD, PNP-BC, program director for the New Jersey Nursing Initiative, a program of RWJF and the New Jersey Chamber of Commerce Foundation.
Nurse.com and Infection Control Today report on an RWJF-supported study that finds hospitals that have higher percentages of nurses with baccalaureate degrees have lower rates of postsurgical mortality. The study, published in the March issue of Health Affairs, stems from the Future of Nursing: Campaign for Action. Read more about the study.
“I recently traveled to Singapore, where I met with other doctors and told about being the emergency department (ED) doctor at the University of Colorado Hospital the morning of the Aurora theater shootings on July 20, 2012,” RWJF Clinical Scholars alumna Comilla Sasson, MD, MS, FACEP, writes in an op-ed for the Denver Post. “One thing dawned on me as I spoke: I had seen more gunshot wound victims in that one night than these doctors will see in their entire careers.” Read a post Sasson wrote for the RWJF Human Capital Blog about the Aurora theater shootings, and learn more about her experience talking to the national news media afterward.
February's RWJF Clinical Scholars Health Policy Podcast Focuses on Philadelphia's Fight Against Childhood Obesity
In this month’s RWJF Clinical Scholars Health Policy Podcast former RWJF Clinical Scholar Donald Schwarz, M.D., M.B.A., (University of Pennsylvania, 1985-1987), Philadelphia Health Commissioner and Deputy Mayor for Health and Opportunity, discusses his work combating the childhood obesity epidemic in Philadelphia, touching on that effort’s controversial soda tax. In his conversation with podcast series host, Matthew Press, M.D., Schwarz also talks about the impact of health care reform at the city health level, and the learning curve required to transition from a career in academia to government service.