Richard Carmona, MD, MPH, FACS, 17th Surgeon General of the U.S. (2002-2006), said there is "no choice but to act" today to find solutions to the child obesity epidemic and mental health problems in the nation at a forum attended by more than 200 health leaders at the National Press Club. Dr. Carmona made his remarks at "America's Children at Peril: Solving the Child Obesity and Mental Health Epidemics," a forum sponsored by Arizona State University and its College of Nursing & Health Innovation.
"Obesity is embedded as a cause or exacerbating factor in numerous chronic diseases and affects over 9 million children directly," Dr. Carmona said in his opening remarks. "Obesity and mental health issues directly affect our national security and obesity is often the #1 cause for our uniformed services personnel not being retained on active duty." As Surgeon General, Carmona often referred to obesity as the terror within.
Nearly one third of American children are overweight and more than half of this group is obese. In addition to the increased physical diseases associated with being overweight, these children and adolescents suffer from a higher prevalence of psychological problems resulting in poor academic performance, low self-esteem, depressive disorders, and more suicide attempts. Moreover, approximately 15 million children and adolescents in the U.S. have a mental health problem that impairs their functioning at home or at school, but less than 25 percent receive treatment.
Panelists in the discussion on solutions to the child health epidemics after Dr. Carmona's remarks included, Kyu Rhee, MD, Chief Public Health Officer, Health Resources and Services Administration (HRSA); Peter S. Jensen, MD, President, REACH Institute and Professor of Psychiatry, Mayo Clinic; Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FAAN, Dean and Distinguished Foundation Professor in Nursing, ASU College of Nursing & Health Innovation; Marie Morilus-Black, MSW, Director, DC Department of Mental Health: Children/Youth Services; Russell R. Pate, PhD, FACSM, Director, Children's Physical Activity Research Group, University of South Carolina Arnold School of Public Health; Joanne Kenen, Founding Editor, New Health Dialogue blog, New America Foundation; and Madelyn Clark, Youth Advisor, Alliance for a Healthier Generation. Deborah Kotz, Boston Globe senior health reporter and blogger, moderated the panel.
Solutions Start with Primary Care
Several panelists identified changes in primary healthcare as essential to finding solutions to the obesity and mental health epidemics. Drs. Jensen and Melnyk cited lack of screening in primary care practices, inadequate preparation of providers to accurately assess and treat common mental health problems in primary care, and the shortage of mental health providers and systems to treat children as major barriers to improving these conditions.
"The primary care provider must be involved to fix these problems and be reimbursed adequately for their services," Dr. Jensen said. Dean Melnyk called for more integration of mental health with physical healthcare and the need for more dually-prepared nurse practitioners in specialties such as pediatrics and child-family psychiatric mental health to reduce the shortage of providers and provide needed treatment for affected children in primary care and school-based health centers.
Dean Melnyk also said that many overweight children and teens have depression and anxiety orders that need to be addressed when working with them and their families on making healthy lifestyle changes. "Information alone won't usually change behaviors or lifestyles," the ASU dean said. "We are missing cognitive-behavioral interventions as a key element in programs to prevent and treat mental health problems and obesity. Our team's current NIH/NINR-funded study is testing a novel intervention with 800 teens in Phoenix called the COPE Healthy Lifestyles TEEN program, which is integrated in high school health courses and designed to improve the teens' mental health, healthy lifestyle behaviors and academic outcomes. Teachers are trained to deliver the COPE program, which involves helping teens to learn that how they think directly impacts how they feel and how they behave." The program also teaches teens coping and problem-solving skills, goal-setting, and healthy nutrition with 20 minutes of physical activity during each of COPE's 15 class sessions.
Dr. Rhee of HRSA said he was optimistic the Affordable Healthcare Act recognized the need for more primary providers in community health clinics across the nation. The AHA plans for the doubling of providers to 250,000 to meet the needs of more than 19 million patients which will enable providers to spend more time with patients and track key indicators such as Body Mass Index.
Other panel members focused on family involvement and the home environment as solutions to the child health crisis in the United States. Marie Morilus-Black, Director, DC Department of Mental Health: Children/Youth Services, noted a correlation between parents' involvement and prevention and treatment of behavioral problems. "Our latest results (in the District of Columbia) are encouraging in that they indicate a 51 percent increase in parental involvement in our programs," she said. "Parental influence remains high despite what people think and parental involvement has reduced the numbers of children who need help." People with serious mental health conditions live 25 years less than the average American, Morilus-Black said.
Public Health Solution Needed
According to Russell R. Pate, Director, Children's Physical Activity Research Group, University of South Carolina Arnold School of Public Health, a minority of children meet physical health guidelines. "Children are heavily influenced by examples parent model in the home environment," Dr. Pate said. "We have to turn our thinking to one that says being sedentary and overweight is not acceptable. We need a public health solution to influence parenting behavior."
On the other hand, Dr. Jensen cautioned the forum audience that being in a "special group" is often a pejorative to children and teens. The Mayo Clinic professor of psychiatry called for the need to embed healthy thinking in fabric of school programs to change the climate.
Joanne Kenen provided a journalist's perspective to the discussion. She noted that lack of time talking with patients and system flexibility in payment for services were significant provider and patient issues. She added that the food and nutrition environment must change as occurred with smoking tobacco.
Madelyn Clark, 17, Youth Advisor, Alliance for a Healthier Generation said it is important to reach kids who don't fit in by knowing what appeals to them and by emphasizing nutrition and physical education in all schools.
The forum is one of a series sponsored by ASU on key challenges facing the nation.
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