When We Know Better, We Do Better: A Tailored Lifestyle Medicine Approach to Pediatric Obesity Rooted in Health Equity
Lifestyle medicine can have significant impacts on pediatric obesity care when a personalized, culturally sensitive approach is at the core of family engagement and behavior change.
By Erin Brackbill, MD, DipABLM,
and Blakely Amati, MD, FAAP, DipABLM
October 3, 2024
Before discovering lifestyle medicine, our recommendations and those of our resident physicians often sounded like a broken record. Children in our clinic with a body mass index (BMI) over the 85th percentile received generic nutrition and physical activity advice, with clinician-directed prefabricated goals and scheduled follow-ups. Regardless of readiness for change, we’d take the easy route and refer patients directly to our tertiary care obesity center. Families often seemed disengaged and our obesity follow-up visits had high no-show rates.
During Childhood Obesity Month, we want to share what we’ve learned through lifestyle medicine, especially when it comes to behavior change which is often nonlinear. Instead, it involves periods of progress, plateaus, setbacks, and fluctuations. The path and goals are unique to each patient and family, and lifestyle counseling and behavioral change should never follow a one-size-fits-all approach.
Rich Health at The Center for Pediatric Medicine
As General Pediatric faculty at Prisma Health in Greenville, South Carolina, we serve the largest population of publicly insured children in our state, with 38% Spanish-speaking families in addition to other families documenting 28 other languages spoken within their households, at our office, the Center for Pediatric Medicine. Like the rest of the country, during the COVID-19 pandemic, we saw a dramatic increase in the rate of childhood obesity, especially among children most impacted by social drivers of health (SDoH). As two pediatricians certified in lifestyle medicine, we decided to address this gap by designing a bilingual health equity-focused program called Rica Salud, which means Rich Health.
Measuring Success
Rica Salud/Rich Health provides a comprehensive intake visit screening for the six lifestyle interventions or “pillars,” evidence-based mental health screeners, and an assessment of SDOH. This helps providers understand participants’ backgrounds, perspectives, challenges, and strengths. Families participating in Rica Salud/Rich Health engage in monthly visits alternating between clinicians and our registered dietitian. Success is measured in completion of personal goals, not in numbers on the scale.
We address SDoH directly by using local resources, such as making nutrition recommendations that align with SNAP or WIC benefits, as well as connecting families to local food resources including a food prescription program through our Children’s Hospital Food Resource Navigator or our Hispanic/Latino community health workers. Social workers and our medical-legal partners assist with connecting families to resources to address parental substance use disorders, mental health concerns, housing, and transportation insecurity. We provide no-cost ideas for families on how to be active together both inside the home and out in our community, and connect families to local parks, physical therapy, and gyms.
Culturally Relevant Foods are Core to the Program
Our diverse patient population offers a unique opportunity to teach our learners about cultural curiosity in nutrition habits. Our dietitian utilizes culturally diverse recipes, and we’ve partnered with Dawn Hilton-Williams, owner of Herban Eats, LLC, to distribute signed copies of her cookbook “Flava My Plate” to our patients. Dawn is a “vegucator” focused on addressing systemic disparities and prevention of disease through predominantly whole food plant-based lifestyle education.
Transforming Care for Peds Patients in South Carolina
Over the past five years we’ve seen growing interest in lifestyle medicine across our pediatric department, leading to the addition of a lifestyle medicine lecture series for our residents and students, as well as our department naming lifestyle medicine a strategic priority. Interest at the state level led to an opportunity to lead two quality improvement cohorts of practices across the state, “meeting providers where they are” around improving their approach to childhood obesity. The South Carolina Chapter of the American Academy of Pediatrics welcomed this approach and supported the creation of a subcommittee and a state-wide learning collaborative.
As co-chairs of the American College of Lifestyle Medicine (ACLM’s) Pediatric/Adolescent Member Interest Group, we co-authored Beyond the Numbers: A Lifestyle Medicine Approach to Pediatric Obesity, a toolkit that provides guidance for the evaluation and management of school-aged children and adolescents with overweight and obesity using a model embedded in lifestyle medicine.
If you are an ACLM member and a pediatrician or someone who is privileged to work with pediatric and adolescent patients, we invite you to join the Pediatric/Adolescent Member Interest Group. You will be among medical professionals who are passionate about serving children and families through a health-equity-focused lifestyle medicine approach.
Blakely Amati, MD, FAAP, DipABLM
Dr. Amati is a Clinical Associate Professor of Pediatrics at the University of South Carolina School of Medicine Greenville and Medical Director of the Prisma Health Bradshaw Institute for Community Child Health and Advocacy. She is the Community Health and Advocacy Rotation Director and General Pediatrics Faculty for the Prisma Health Upstate Pediatric Residency Program. Dr. Amati is co-chair of the American College of Lifestyle Medicine Pediatric/Adolescent Member Interest Group, a South Carolina American Academy of Pediatrics board member, a member of the SC Department of Health and Human Services Quality through Technology and Innovation in Pediatrics (QTIP) Physician Advisory Group, and SC lead of the Carolinas Collaborative (a coordinated collaborative between the eight pediatric academic institutions and healthcare systems serving as systems change infrastructure in North and South Carolina for innovation, training, research, and advocacy best practices, to drive scalable child public health solutions).
Erin Brackbill, MD, FAAP, DipABLM
Dr. Brackbill (Diplomate of the American Board of Lifestyle Medicine 2019) is a Clinical Associate Professor of Pediatrics at The University of South Carolina School of Medicine in Greenville, SC and Prisma Health Upstate Children’s Hospital. She has extensive prior experience in the field of pediatric obesity and serves as faculty at the resident outpatient clinic, Center for Pediatric Medicine. She was past secretary of the ACLM Pediatric and Adolescent Member Interest Group (MIG), and currently serves as MIG co-chair. Dr Brackbill is also a member of the ACLM HEAL MIG. Her main areas of academic interest are clinical teaching, pediatric obesity, and lifestyle medicine with a special focus on populations disproportionately impacted by the social drivers of health.
