As you know by now, obesity affects one in three children. And you also know that obesity is a complex disease brought on by a multitude of societal problems. But did you know that physicians, at the front line of this epidemic, most likely lack education in basic nutrition? The very person a parent is most likely to ask questions like: What should I feed my child? or How much should I be feeding my child?
A few years ago, while I was conducting a practice-based research study to learn more about pediatricians counseling practices of obese children, I learned that pediatricians had no training in nutritional recommendations for children. Moreover, as different organizations, such as the AAP and CDC, were scrambling to send pediatricians toolkits that focused on screening children, especially those over the 95th percentile for behaviors such as overeating, lack of physical activity, and too much screen time, they failed to address the lack of nutritional education among pediatricians. While it is important that pediatricians have tools to identify obesity in children, it is equally important that they are properly educated to counsel parents about what their children should be eating. So then, what should we do now? Millions of children have been identified as obese and in need of basic nutritional counseling. And no one is trained to do it.
Well, actually, there are professionals trained to help - dietitians. However, the dietitians I know have been increasingly frustrated with their role in the epidemic. They are trained to help families, but their efforts have been stymied by lack of reimbursement for services, and many families cannot afford the out-of-pocket expense. So while the pediatricians have been referring obese children to dietitians, the parents simply cannot afford the services. Insurance companies need to acknowledge the important role of the dietitian, especially now that we know, according to a New York TImes article of this week that, "In the mid-1980s, the National Academy of Sciences published a landmark report highlighting the lack of adequate nutrition education in medical schools; the writers recommended a minimum of 25 hours of nutrition instruction. Now, in a study published this month, it appears that even two and a half decades later a vast majority of medical schools still fail to meet the minimum recommended 25 hours of instruction."
To complicate things even more, many dietitians do not specialize in pediatric nutrition. For example, in Upstate New York's Greater Capital District, there are only two dietitians specializing in pediatrics. Our front line responders to the childhood obesity epidemic, pediatricians and dietitians, need training in pediatric nutrition through continuing medical education, seminars and toolkits. And we need colleges and universities to help by adding nutrition education to medical school requirements and by creating a subfield of pediatric nutrition to dietitians' curriculums.
The New York TImes has more on the subject.