To Solve Childhood Obesity, We Must Go Well Beyond Medicine

Years ago, I had two patients, Fletcher and Billy. They were not related, but happened to be born at the hospital where I worked, on the same day, with the same serious intestinal birth defect. These two boys underscored for me an important lesson: medical care and health care are not the same thing.

As their surgeon, I was able to correct the problem for both boys. After six weeks in the NICU, each of them went home. Thanks to the world-class quality of American medical care, Fletcher and Billy had the chance to grow up healthy. That’s where their paths diverged.

Fletcher went home to a town with one of the highest median incomes in the United States. His parents were particularly attentive to his nutrition, and had the means to purchase nutritious, organic food. Billy, by contrast, came from a low-income neighborhood. There was no supermarket within five miles of his home. In Billy’s house, groceries came from the dollar store or gas station mini mart. He ate fast food four days a week.

When I saw both boys at their eight-year surgical follow up, the difference caused by their diets was startling: Fletcher was every bit the healthy child his parents had dreamed of, with a normal height and weight. Billy looked good too and had reached a normal height. But at the age of 8, he was unmistakably obese. He arrived to his appointment with a bag of potato chips in hand. He clearly was on a path toward life-limiting issues like clogged arteries, high blood pressure, diabetes and cancer.

Medical care had saved both boys and given them the opportunity for a normal life. But the medical system wasn’t set up to address the factors that overwhelmingly affect health, like access to healthy food, socioeconomic status, education, recreational opportunities and others. After decades of experiencing the rewards of being a surgeon, I wanted to make an impact on all children, not just those with rare diseases, I wanted to deliver a message of a broader definition of health, one that could help more kids like Billy. That’s why I left the OR and joined Nemours Children’s Health.

September is National Childhood Obesity Awareness Month. Explicitly or implicitly, obesity is too often judged as a personal failing — a failure to comply with instructions. But Fletcher and Billy provide a good illustration of the ways our environment sets us up for success or failure. This is especially true for children, whose choices are limited by their circumstances.

Nemours has an incredible Healthy Weight and Wellness Program, offering comprehensive weight management to more than 2,200 patients each year, and doing research to impact many more. But with nearly 15 million obese children across America, we need additional tools in our toolkit.

That is why Nemours is testing new models of care, like employing care coordinators who can connect families with the social resources they need to build health in their children. We are bringing additional expertise into health care by partnering with schools and community organizations, including food pantries.

This is what we mean when we say “Well Beyond Medicine.” We are investing heavily in models of health care that focus on whole child health, whether that’s the kind of world-class life-saving surgery that Fletcher and Billy needed, or the social supports they needed to stay healthy.