Dr. Mike Dedekian (Guest): Thanks, Melanie. Thanks for having me. This is great to be on with you. I think the statistics are really overwhelming for a lot of us. About 30 percent of kids—depends on the study that you look at—about 30 percent are struggling with their weight, either in the overweight category or in obese category. We’re really worried about that because we know that kids are at risk for diseases as they get older, and we know that if you do something about it when they’re young, it has a long impact and is a great investment in health to start at a young age.
Melanie: Now, is it true, Dr. Dedekian, that as an endocrinologist, you’re seeing diseases, kidney diseases and blood pressure problems, hypertension, in children that we never really saw before in children? Diabetes and things, type 2 used to be adult-onset, and now you’re seeing it in children, young children.
Dr. Dedekian: That’s right. That’s exactly it. And I think you hit the nail on the head. We used to call it adult-onset diabetes, and that doesn’t work anymore. We call it type 2 diabetes because it can really present at any age. And you’re right again that as a pediatrician, we weren’t trained originally to deal with these diseases that we usually think of as adult-onset and we are seeing them in young kids. Perhaps even scarier is that weight, more and more, is understood as a symptom, not necessarily a cause of all these things. We are all in the same boat of metabolic risk, if you will. We really emphasize with kids that it’s not so much in number of their weight that we’re looking at, but we’re looking at behaviors and health and trying to protect the health that they have rather than just looking at a number on a scale.
Melanie: Tell us about the Countdown to Healthy Me program at Maine Medical Center.
Dr. Dedekian: The Countdown clinic is what we call a multidisciplinary clinic. That means I have a whole team around me, which is great. We have myself; we have a couple of other doctors there with different specialties in pediatrics. We have a social worker. We have two wonderful dietitians, a medical assistant, and we have connections to other folks out in the community, including physical therapists who help our kids exercise. At the Countdown clinic, I always tell patients at the beginning that they are in the driver’s seat. They are the ones who are going to determine what we’re going to do, what we’re going to talk about. We’re, of course, going to move them along and give them suggestions and nudge them in the right direction, but parents and kids really run the show in terms of how long they want to be at Countdown, how many visits they want to have, what they think is helpful, what they think is less helpful. We try to make sure that kids always feel good about coming to Countdown. They’re never going to get in trouble for telling us anything. Again, we don’t look at that number of weight and pass judgment about it. We’re always trying to make sure that kids and families are feeling great about making some positive, healthy changes in their life. We have all kinds of ways of doing that. It depends on what the family is ready for and what your kid is ready for. That’s what we help you with and help you identify.
Melanie: As a parent, it’s important that we stress health over weight loss or being thin, and I understand that. How do you work with parents, Dr. Dedekian? Because some parents are in denial a little bit. If their child is overweight, they think that maybe it’s just extra growing. How do you deal with parents and get them on board with this?
Dr. Dedekian: Well, that’s a great question. I think we focus the conversation on health and try to look into the future a little bit. And that is a hard thing for kids—and grownups, too, as well. We all like to think of the here and now. It’s hard to see down the road. We try to look ahead into the future a little bit and use that as motivation. We will explain to parents, too, that weight gain in childhood is normal—to a point. That’s what kids are supposed to do. They’re growing in height. They’re supposed to be gaining weight. But sometimes, what I’ll do is show a growth chart and demonstrate that height is going up really well but weight is going up faster than height. If that continues now, we know there’s a high risk of that continuing to be a problem into adulthood. I think most parents understand that, especially when we can show them on a growth chart where their kids are, how they’re doing. Usually, they’re growing beautifully in terms of height, but it’s that weight that’s increasing a little bit faster than it should.
Melanie: As the parents are generally the ones shopping for food, Dr. Dedekian, give us your best advice for healthy eating, because getting your child healthy means getting the whole family healthy. So it’s something, really, families can do together.
Dr. Dedekian: Absolutely. That’s why we always like to work with families in the Countdown clinic. In fact, we encourage as many family members to be there as want to be there. We love to see moms and dads and grandparents and whoever else is in the home with kids. Because it is a family effort. We make a big deal about food rules in the house being the same for everybody. You can’t just have a certain kid that needs to eat in a certain way and other kids can do whatever they want. It really has to be the same for everyone. Healthy eating is complicated. It doesn’t have to be, but there’s so much messaging out there that’s contradictory about what’s good for you and what isn’t good for you. We try to boil it down to some very basic things about proper portion size, cutting down on carbohydrates a little bit, and eating a lot of fruits and vegetables. For many families, it’s really simple things that are going to make the difference. For a lot of kids that we see, just cutting out sweet drinks, soda and juice, and whatever else has sugar in it, that alone for a lot of kids is all they need to get back on track. We really try to focus on basic things. We don’t tell people to eat weird stuff or go on strange diets. We talk about food that everybody knows about and try to boil it down to some very simple and practical things that every family can do.
Melanie: Well, a tougher thing for parents these days also, Dr. Dedekian, is that schools are cutting gym and recess in favor of academics, and we know that kids need to get their beans out. They need to be running around. How do you encourage exercise, again, for the whole family to help that child in the Healthy Me program, really take control of their physical activity and get up off the couch and stop playing video games?
Dr. Dedekian: Right, that’s probably one of the hardest things we work with families on. And one of the great programs that we partner with is called Fit for Me, which is run out of a whole series of physical therapy offices in the area. We have found that a lot of kids need a little extra TLC when it comes to exercise. They need a little bit of one-on-one attention to do that. We work with our colleagues in physical therapy to make that happen, and we find for a lot of kids that is the jumpstart to really get them going. We, of course, always encourage families to be active together and try to learn a little bit more about what they like, where they live, what kind of resources are nearby that maybe they could take better advantage of. It really depends on the individual family, and we come up at the end of the visit with a prescription of exercise and some really specific suggestions about what families should try to work on together. It can be hard in Maine, especially in the cold weather months, to get out there, but I always say there’s plenty of snow to be shoveled and played in and plenty of leaves to be raked and played in in Maine. So we’re lucky we have the great outdoors here in Maine accessible to most of our families. Usually, there’s a way to make it happen. Doesn’t have to be running a marathon. I love when kids are out and working in their neighborhoods or mowing a neighbor’s lawn or just getting outside. And walking the dog can sometimes be enough. There’s always ways to make activity happen, and we help families explore those ways and figure out what’s going to work for them.
Melanie: Dr. Dedekian, in the last few minutes, please, your best advice on the childhood obesity epidemic we’ve got going on in this country and what parents can do to help their children in the Countdown to a Healthy Me program at Maine Medical and why parents should come to the Countdown to a Healthy Me program at Maine Medical Center.
Dr. Dedekian: Well, I would say the most important thing I feel like for families to know is don’t be afraid. You can do it. Making these positive changes is definitely possible. It sometimes seems scary at first, but you can do it. You can get that junk food out of the house. You can encourage your kids to drink more water and be more active. It can be done. We are in a food culture in America that unfortunately works against us. I think one of the most specific pieces of nutrition advice we have for families is to watch those carbs. Americans, all of us, we eat way too many carbohydrates. We work with families on identifying what those are, cutting them down, not putting them on an Atkins diet, but cutting those carbs down or adding healthy carbohydrates back into the diet. And that too is another very effective strategy to help get weight back on track. I would say, why come to Countdown? You bring your child to Countdown if you’re concerned about their health and protecting that health as they get older so that they’re healthy and happy adults, not needing a physician when they grow up, or needing only well visits at a physician’s office when they grow up. That’s the best reason to come to Countdown. It is the time to do it. If you wait until you’re 40 and 50 years old, it is tough. But working with younger kids, that’s where we have a real opportunity to make a big impact and a lasting impact that’s going to carry forward with them as they grow up.
Melanie: Fantastic information on the Countdown to a Healthy Me program at Maine Medical Center. You’re listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening and have a great day.