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​​​Step Outside the Office to Understand Hurdles to Healthier Lifestyles

Elizabeth A. Donahoo, MD

October 17, 2016​

It's easy to advise patients to eat healthier food and exercise more. But it's not always simple to understand the many roadblocks to achieving these critical health goals, particularly for families dealing with poverty.

As part of the AAP Section on Physician Trainees FACE Poverty initiative, I recently teamed with a group of residents from various institutions in Baltimore to create and execute an advocacy project focused on healthy eating and physical activity. Working with children of mothers on government assistance who participated in a city program offering weight-loss support, wellness education and group exercise, we gained a deeper understanding of some of the challenges families may face in making healthy lifestyle changes, as well as the role community can play in helping to overcome them.

Similar to most of the nation, obesity and its many related health risks are on the rise in Baltimore. To combat this trend and eat healthier, a family needs ready access to fresh produce and other nutritious food. But as I learned working with these families, many of whom live in one of the city's "food deserts," access is a major hurdle.

​ ​"When you spend your food stamps on healthy foods, it is gone quickly," said one of the mothers."​

 One mother told us how she needed to take two buses to get to the market -- all while juggling two children under the age of three. Many others chimed in on how they wished they had a market close enough to walk to.  Another barrier is the cost of fresh produce.

"When you spend your food stamps on healthy foods, it is gone quickly," said one of the mothers. Together we brainstormed ideas like a community garden or finding a sponsor for a farm share program, but we still are struggling on how to address these perennial issues facing lower income neighborhoods. For now, we bring in produce for the lesson weekly and try to send home any extras. 

It is frustrating to be reminded of these barriers, because the families we work with truly are interested in living healthier lifestyles. Despite this frustration, the mothers said they enjoyed the sense of community working toward that goal, meeting weekly and being held accountable to try to be fit.

"I was blown away by the children's willingness to try things I did not enjoy until I became an adult, like kale salad.​"

The children also seemed to enjoy the program. We strive to make the lessons fun, imagining 'veggie superheroes' and playing games such as trying to guess the fruit or vegetable in a brown bag by touch alone. It turns out, kids like to play with their food AND eat it. I was blown away by the children's willingness to try things I did not enjoy until I became an adult, like kale salad. If I praised a child for sampling the cucumber, suddenly several children were telling me how much they enjoyed the cucumber slices.  Mothers tell us their kids were now requesting bell peppers for snack time. The children are always eager to get to the gym after the lesson for their physical activity time.

As our project progressed, our budding community of health seekers bloomed.  The children saw that weekly community of mothers, not just their own mothers, as a connected support system.  They readily heeded encouraging words to try a something new – or to settle down when more vegetables were ending up on the floor than in their mouths during our games – from their own mom or any other in the room. As we became part of this community, too, we realized additional benefits.

One of the community leaders who helped promote the program told us he loved having young physicians to serve as positive role models for the kids.  He always asks the neighborhood children what they want to be when they grow up, he said, and usually hears "teacher," "correctional officer" and additional figures the children regularly see in their community.  He was now hearing "a doctor" which he attributed to our weekly presence with the children.

As pediatricians advocacy comes in many forms. But for me, this was an important reminder to keep stepping outside the office and back into the community. 

​Editor's Note: This is part of a series of "AAP Voices" blog posts exploring issues addressed by the FACE Poverty campaign spearheaded by AAP's Section on Pediatric Trainees.​

​​Ab​out the ​​Author


Elizabeth A. Donahoo, MD, is a pediatrician in Lutherville, MD.  She recently completed her training at the University of Maryland Medical Center in Baltimore, MD, and continues to enjoy volunteering with the advocacy project, B'More Fit for Kids.   ​


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