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Monday, 24 May 2010

Well Women--Well World

For most of my professional career in dietetics and nutrition, I have worked in university hospitals and tertiary-care settings. In other words, I worked with the toughest cases -- those people that went through primary and perhaps, secondary care, and then, finally, needed to be referred for complicated treatments requiring the skills and resources of state-of-the-art, sometimes innovative therapies. I also specialized in pediatrics -- neonates until late teenage years. It was a wonder for me to see how much of a difference proper nutrition made to the growth and development of babies born highly compromised, as well as to witness how the most complex, rare diseases responded to manipulation of nutrients and diets. If I was skeptical about the role of the dietitian on the medical team before I worked in these settings, as we were often downplayed and outright disregarded by physicians and nurses in those days, well, afterward, I KNEW I added value and had an outright obligation -- sometimes urgent -- in the provision of best care of these compromised patients. I worked long, hard hours. Before long, the doctors -- attending physicians as well as the interns and residents and nurses -- brought me in automatically as patients were admitted. Today, thankfully, in most hospital and health care settings, dietitians are seen as an extremely necessary part of the medical care team and are highly valued and utilized.
In the pediatric wards, the medical team can't downplay nutrition because it's vital for growth and development despite an infant or child having a disease or condition that precludes proper nutrient intake. When I worked in the pediatric hospital, often the docs and nurses were so busy treating surgical or medical concerns that they didn't have the time/knowledge/expertise to BEST know how to nourish their patients, accordingly, so they welcomed my input with open arms. And that was all great UNTIL.....I started to push for more pro-active treatment/prevention of obese and overweight children/teenagers.

Even though, at that time (mid-1980's),the prevalence of pediatric obesity/overweight was less(maybe 1/10-15 children) of what it is today (about 1/3), I thought it was high enough and I KNEW then, that it would rise high and fast, based on my observations on the eating habits of children and what I started to note as a changing environment (family dynamics, foods produced and marketed, burgeoning IT, emphasis on TV and entertainment, safety issues, etc). The docs and nurse practitioners in all specialties referred their obese kids to me because they all got to know that I welcomed the challenge of working with these kids and I had a knack for treating them effectively. In contrast with my colleagues, I LIKED working with obese children. From within the university hospital system and even from the extended greater South pediatric private practices, I was referred all the obese kids. Usually, however, it wasn't for obesity, but for something else -- allergies, hyperactivity, abdominal pain, behavioural problems. But, intuitively, I KNEW that the obesity/overweight/poor fitness/poor eating habits of these kids was probably the REAL problem and origin of some of their secondary symptoms. Not in all cases, mind you, but most.

I designed and developed a protocol for a multidisciplinary pediatric program for the treatment and prevention of childhood obesity and wanted desperately for this university medical center to sponsor this. I was flatly refused from TPTB. Only ONE influential doctor (the VP of the medical school) wanted to push ahead with it and, ironically, he died of a massive heart attack about a week after he agreed to support me in my efforts to get this program executed. At the time, the other directors of the university medical center said they didn't want their center to be known as a 'pediatric fat farm'. Remember, too -- these were the days that doctors didn't even acknowledge that obesity was a key factor in many diseases, even CVD. Before I specialized in pediatrics, I worked in adult hospitals. I often lobbied to get a referral to work with patients who were obese/overweight and who had CVD, Hypertension, sleep apnea, pancreatitis, ulcers/dyspepsia/GERD, myalgias, and other ailments which I KNEW proper dietary manipulation and instruction would improve the outcomes or course of treatment of these patients, and I was flatly refused.

Oh, how the times have changed.

More than 25 years later, I now know that the university hospital and medical center that I worked at, now has a multidisciplinary pediatric obesity treatment program as well as a whole research foundation dedicated to nothing more than childhood obesity.

Ten years ago, I lobbied to get better access THROUGH THE SCHOOLS for kids with obesity or who were overweight or who just needed attention on how to improve their diets and nutritional status. THEN, I was told that this was 'too political' -- education boards would never go for this. The division of the CDC that deals with adolescent and child health refused to undertake the research proposal that I had sent to study the school-dietitian option to try to get data for the evidence (or not) of such a proposal, because they said the CDC didn't take on these types of studies. My own professional organization didn't even respond to me when I had sent the proposal to the person there who was in charge of vetting research proposals. Perhaps, I sent my proposal to the wrong places. Perhaps, I should have pushed more exhaustively and extensively to other agencies. I heartily admit that I was partially to blame for dropping the ball, so to speak, after I felt that I wasn't getting anywhere with the agencies and organizations that I thought, at the time, would be my best bets for getting the project noticed, and executed to some degree. Maybe I could have done more than I did. It does no use to look back. Last month, thankfully, a project is underway to not only get dietitians working with obese/overweight/unfit kids in school settings, but to study and document the results of such access/intervention.

So, at least it took less than 25 years!

So what have I learned from all this?!

Well, NOW, after all this time and after having experienced all the above, I have learned that it is never too late to concentrate on the pediatric population. I am truly happy and totally relieved that the efforts that I had tried to get pushed forward many and several years ago,are NOW just finally coming to fruition, I must not feel rejected or jaded. For some and several reasons, these programs needed all this time to sink in and mature in the minds of TPTB. I am not a powerful person and I never wanted to be. I only saw needs and tried to answer to them. I only feel sad that childhood obesity has reached such proportions. I also feel sad that it took the medical profession so much time in acknowledging the role that diet plays in prevention and effective intervention for so many diseases. But, as I said, better late than never.

NOW, I MUST acknowledge that I feel VERY STRONGLY that if we start to really concentrate on the wellness, fitness, and healthy lifestyles of WOMEN -- this will have a great impact on the wellness, fitness, and health of total populations. Women are mothers, wives, girlfriends, sisters, and, NOW,powerful and influential professionals.
The health of women pre- and during pregnancies has a great impact on the health of offspring-- in the womb, during, and after delivery. It has now been shown that quality of health pre-, during, and after delivery has an impact on the health, wellness, and FITNESS of offspring for their whole LIFETIME!.
Despite more working women, it is still clear that women remain the primary caretakers in the home -- cooking, shopping, and delivering meals. When women have healthy eating and fit habits, the probabilities go up that the whole family does, too.
The eating and fitness habits and opinions of wives, mothers, female co-workers,and girlfriends affect the eating and fitness habits of husbands, children, male co-workers, and boyfriends.

Over the past 20+ years, I have continued to work with the pediatric population as I always have. But,I have also focused heavily on working with women -- educating them, demonstrating what healthy diets look and taste like, enabling them to get motivated and tuned in to healthy eating and fitness, monitoring them, and doing all that I can to make sure they execute and sustain healthy attitudes, cognitions, and behaviours in regards to balanced diets, nutrition, and fitness. Indeed, I have CLEARLY witnessed that when women are well -- their children, husbands, boyfriends, and everyone around them are or get well.

I'm impressed with the campaigns now to tackle the childhood obesity epidemic -- long needed and long overdue.

However, I would also like to see vast and improved efforts on addressing the myriad concerns and needs that WOMEN have in gaining better access to care for dietary/ nutritional, fitness, and overall wellness concerns.

So, right now, in the community setting I work in, I strive to be the practical link from nutritional science to healthy diets and lifestyle habits -- mainly for WOMEN. I strongly believe if I can help WOMEN to understand, to practice healthy dietary and fitness habits, and to change and sustain changes until they master healthy habits, then they are on the right path to wellness. The people around them -- children, husbands, boyfriends, families, co-workers --will do likewise.

WELL WOMEN! The WORLD will be much better off and WELL, as a result!

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