“The childhood obesity issue is critically important to me because it’s critically important to the health and success of our kids, and of this nation, ultimately.” – Michelle Obama
As a friend of mine put it, “I wish I could socially distance myself from my refrigerator.” While working to flatten the curve of the Covid-19 outbreak graduations, birthday parties, backyard barbecues, and weddings have all been put on hold for now. Unfortunately, the same is true for all team sports, from baseball games to track meets. Social distancing, working and learning remotely from home translates to many of us spending our free time eating and watching way too much tv. According to The Time Magazine Article, Endless Summer Puts Homebound Kids at Risk for Weight Gain, Andrew G. Rundle, the lead author of a new report in the journal, Obesity, discusses the connection between school closings and childhood weight gain. He states, “while focusing on the immediate effects of the pandemic is a priority, when it subsides one of its lingering effects could be a worsening of the obesity crisis among children.” Childhood obesity rates have been on the rise in America for the past four decades. According to the Strafford County Community Health Improvement Plan, approximately 12.6% of 3rd-grade students are obese in New Hampshire and 15.4% are overweight. Over 15% of New Hampshire’s youth aged 10-17 years are obese.
Overweight and obesity rates for children with disabilities are often much higher. 26% of New Hampshire children, with special health care needs, between the ages of 10 and 17 are obese, as compared to 9.3% of New Hampshire children the same age, without disabilities. Children with mobility limitations and developmental disabilities may be more vulnerable to secondary conditions, such as heart disease, stroke, and type 2 diabetes (Fragala-Pinkham, 2008).
Recognizing the seriousness of this issue for both children and adults with disabilities, staff from the NH Disability & Public Health Project at the UNH Institute on Disability (IOD) applied for and were awarded a grant offered by the National Center on Health, Physical Activity and Disability (NCHPAD). NCHPAD is a public health practice and resource center on health promotion for people with disability. The New Hampshire Innovative Approach to Public Health Grant, addresses the disproportionate prevalence of overweight and obesity among children and adults with disabilities compared to people without disabilities. The project team has been working on this issue with several other partners: Southern New Hampshire Area Health Education Center, Wings and Wheels Consulting Services, Granite State Independent Living, Lamprey Health Care, and the Seacoast Area Public Health Advisory Council.
NCHPAD’s philosophy is about the full inclusion of all people with various disabilities and their family members or caregivers. When community health programs need to be updated or created, people with disabilities must be involved at all levels; development, implementation, and evaluation. NCHPAD also emphasizes the importance of the involvement of healthcare providers, as well as other public health organizations, and the community at large.
My most significant role on this project has been to partner with my colleague Crissie Ferrara to present a training called Working with Families and Children with Disabilities to a group of Nurse Practitioner fellows at Lamprey Health Care. The first half of the presentation covered some basic information about cultural competence and disability. This includes several topics, for example, the social model and the medical model of disability, some simple communication guidelines for speaking about and with someone who has a disability. For instance, when speaking about someone who has a disability, you should avoid language that carries assumptions, such as, “Kathy suffers from Cerebral Palsy.” Rather it should be said, “Kathy has Cerebral Palsy.” Another example would be to say, “Doug is confined to a wheelchair.” It would be more appropriate to say, “Doug gets around using a wheelchair”—Doug actually plays soccer in a powerchair. This segment of the presentation also has information about the prevalence of disabilities in New Hampshire and health disparities.
The second half of the presentation covered the various aspects of a NCHPAD adaptation of BMI², which is an evidence-based practice to address the issue of overweight and obesity in children and adults with disabilities. BMI stands for Body Mass Index. BMI² refers to Brief Motivational Interviewing about the issues of being overweight or obese hence the origin of the acronym. Actually, Brief Motivational Interviewing is counseling that could be used with many other life issues. Our presentation covers open-ended questions, affirmations, reflective listening and summarizing. These are four basic skills used in BMI² to help the client or patient decide on a goal and make positive changes to reach that goal. The training includes discussing scenarios written about children with disabilities. Eventually, the BMI² will be pilot tested for patients with disabilities at Lamprey Health Care.
From where I sit….
Society tells women that we have to be skinny to be beautiful and we know the older we get the harder it is for us to lose weight. A healthy weight is difficult to manage for most people and even more difficult for individuals with disabilities who have physical limitations. Even so we probably shouldn’t use Covid-19 as an excuse for being unhealthy. It’s a very complex issue. I really feel that more integrated exercise programs should be offered to everyone. Starting from scratch isn’t always necessary to make existing programs more welcoming and inclusive. Programs don’t need to be so segregated. Universal Design is the design and composition of an environment so that it can be accessed, understood and used to the greatest extent possible by all the people regardless of their age, size, ability or disability. An environment (or any building, product, or service in that environment). Community Programs should be created using these principles. Curb cuts on the end of sidewalks are a great example of universal design. That said any program that includes people with disabilities can be helpful because we all have to start somewhere. NCHPAD has a 14-week online fitness program that includes lots of exercise videos, food and exercise logs, healthy recipes, and online coaching. I just joined so I will let you know how it goes. By the way it is free, what do I have to lose but a few pounds, hopefully!
