August 10th, 2010

A Family Affair

The surplus of specialists and neglect of primary and preventive care in modern American medicine has led to a very sharp focus on individuals, with little regard for families. A perfect example of how this imbalance has detrimental effects at the population level is the childhood obesity epidemic. Many healthcare professionals perceive obesity as an individual health problem, and therapies and treatments have evolved accordingly. Even parents talk about their obese kids as if the problem were a self-inflicted disease process. I submit that childhood obesity is a family problem, and that it should be treated as such.

According to the 2007-2008 NHANES statistics, approximately 17% of kids in the US are obese. Experts appropriately anticipate that this will lead to individuals having cardiovascular complications at earlier ages in the future. It also appears that childhood obesity, via its known health consequences, could trump recent gains in cardiovascular mortality and morbidity. Much of the conversation about this topic has focused on an increasingly liberal use of statins in the pediatric population. In my view, trying to deploy a magic pharmacologic bullet to cure this disease reflects a cultural stubbornness. How about developing a comprehensive family approach that targets the root of the problem?

As a cardiovascular prevention specialist, I have often wondered whether my work would have a greater impact if, instead of having an individual in my examining room, I could have the entire family. What are the family’s eating habits? What is their level of physical activity? How much do they know about healthy behaviors? Do they have access to healthy food, and if not, why? What is preventing family members from adopting a healthy lifestyle? How much time do they spend together, and when they do, what activities are they engaging in?

Every time I see parents who are obese or smoke, I wonder if they know how negative an effect they are having on their kids’ health and future well-being. A family approach to cardiovascular prevention would emphasize the “practice what you preach” principle. We know how to assess cardiovascular risk in adults. Who is assessing the risks to their children? I would hate to see a progressive increase in the number of kids taking cholesterol-lowering medications or any other drug that could have been avoided by sound and solid family lifestyle changes. Is our society that lazy, that incapable of change? I certainly hope not.

I believe there is a role in cardiology for screening programs and multidisciplinary interventions that aim to prevent heart disease in families, not just in individuals. Have you instituted anything of this sort in your practice? What do you think needs to happen before such an approach can be implemented?

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