New U, Play Strong, Ounce of Prevention – PediaCast 297

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Dr Stacy Fischer, Dr Amy Sternstein and Certified Athletic Trainer, Travis Gallagher join Dr Mike in the PediaCast Studio for a round-table discussion on the prevention and management of childhood obesity. Included in our conversation is a trio of programs from Nationwide Children’s: New U, Play Strong, and Ounce of Prevention.

Topics

  • Childhood Obesity
  • Obesity Prevention
  • Weight Management
  • Healthy Nutrition
  • Physical Activity
  • New U Program
  • Play Strong Program
  • Ounce of Prevention Program

Guests

Links

 

CONTACT DR MIKE – Ask Questions, Suggest Show Topics

CONNECT NOW with a pediatric specialist from Nationwide Children’s – Referrals and Appointments

 

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It is October 8th, 2014, Episode Number 297. We're calling this one "New U, Play Strong, and Ounce of Prevention". I want to welcome everyone to the show.

So we have a round table discussion today on a trio of programs from Nationwide Children's Hospital. The goal of these programs is to prevent and combat childhood obesity, to encourage healthy nutrition, and to educate and provide opportunity for children, teenagers and their families to engage in safe, age-appropriate and fitness-appropriate physical activities.

0:01:16

Now, I realize that majority of my audience is not in Central Ohio, because we have listeners from just about everywhere. So why should you care about our Healthy Weight programs here in Columbus? Well, in the course of talking about these programs , I suspect that we'll provide lots of great take-home nuggets, just bits of information on healthy nutrition and physical activity that you can apply today, and for every member of your family.

So stick with us, even if Nationwide Children's is not your local children's hospital. Now, for those of you in our service area or reasonably close to Central Ohio, of course, you want to stick around too because you might just be interested in participating in one of these programs. And you might be surprised to learn your insurance company might even help pay for them. Of course, we're not guarantee any particular insurance plans will or will pay for these services, but just in general, some programs and companies do.

0:02:15

So we'll talk about that, and we'll get to all the details on these programs. And then, our usual fashion, I have some great guests in these studio to help me talk about these things. Dr. Stacy Fischer is one of our Sports Medicine doctors and no stranger to the program. Travis Gallagher is a certified athletic trainer in Nationwide Children's, and Dr. Amy Sternstein is physician with our Center for Healthy Weight and Nutrition. We'll do formal introductions on the other side of the break.

First, though, I want to remind you about our 700 Children's Blog. You can find it at 700childrens.org. Recent topics, the dangers of caffeine powder. Kids are using it but they really don't understand the danger. It's not like drinking coffee or an energy drink. In fact, a single teaspoon mixed in to a beverage represents a frighteningly large overdose and can easily lead a child to the hospital, or even the morgue. So be sure to check that one out – The Dangers of Caffeine Powder.

0:03:11

And then, the enterovirus D68, I know those of you in Central Ohio and other places in the Midwest are tired of hearing about it, frankly. But if you live in an area where the virus is just beginning to rear its head, be sure to check out our post, written by yours truly, on the facts as we know them surrounding enterovirus D68.

By the way, the flu has the potential to be much worst, even deadly. So, if you and your child haven't had your flu shots yet this year, it's very important that you get that taken care of. It's the time of the year to do it.

And then, the future of robotic surgery, a high-tech article for technology geeks out there. As it turns out, Nationwide Children's is on the cutting edge of robotic surgery, and yes, the pun was intended, not my best.

So head over to 700headchildrens.org for our 700 Children's Blog, for those and lots of other stories.

0:04:04

Quick reminder, PediaCast is your show. If there's a topic you'd like us to talk about or you have a question for me, or you want to point us in the direction of a journal article or a news article, it's easy to get in touch, just head over to pediacast.org and click on the Contact link, and you can submit your question that way.

Also, I want to remind you, the information presented in every episode of our program is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

All right, let's take a quick break and I'll be back. We'll introduce our guests and we'll talk about these programs to help kids be healthier. It's all coming your way, right after this.

[Music]

0:05:27

Dr. Mike Patrick: All right, we are back. Dr. Stacy Fischer is a Sports Medicine physician at Nationwide Children's Hospital and an assistant professor of Pediatrics at the Ohio State University College of Medicine. She recently joined me to talk about the female athlete triad that was back in Episode 285. She returns today to talk about childhood and adolescent obesity and more specifically, the roles nutrition and physical activity play in preventing and treating this common problem. So welcome back to PediaCast, Dr. Fischer.

Dr. Stacy Fischer: Thank you.

Dr. Mike Patrick: It's always a joy having you. I appreciate you stopping by.

Travis Gallagher also joins us today. Travis is a certified athletic trainer with Sports Medicine at Nationwide Children's Hospital and plays an important role in the physical activity component of our New U and Play Strong programs. So it's with a warm PediaCast welcome that we say hello to Travis. Welcome to the show.

Travis Gallagher: Hello. Thanks for having us.

Dr. Mike Patrick: Appreciate it.

0:06:19

And Dr. Amy Sternstein is a physician with the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital and an assistant professor of Pediatrics at the Ohio State University-College of Medicine. Her clinical interest include wellness and nutrition education, obesity prevention, school health and physical fitness. Dr. Sternstein serves as coordinator of our Ounce of Prevention Program, which we'll expound upon in a few minutes.

But first, let's welcome her to the PediaCast studio. Thanks for joining us Dr. Sternstein.

Dr. Amy Sternstein: Thank you. It's a pleasure to be here.

Dr. Mike Patrick: Really appreciate all three of you stopping by.

So we're making PediaCast history today. This is our first round table discussion with three guests in the studio. So we've got four open mikes. We are in an office — it looks like a studio, but at the end of the day, it's an office building — so we may pick up some ambient noise with all these mikes open, but folks will understand. Right?

0:07:13

Dr. Amy Sternstein: I hope so.

[Laughter]

Dr. Mike Patrick: Yeah, I think they will. They'll give us a little grace on that.

All three of our guests today are experts in preventing and treating childhood obesity at one way or another, whether it's more on the diet side, the nutrition side, or the physical activity side of it.

Dr. Fischer, let's start with you. When we talk about childhood obesity and maintaining weight, those really are the two main controllable component, right? I mean, it's really about calories in and calories out.

Dr. Stacy Fischer: Right. It's what we refer to as an energy balance in that sense. That to maintain a healthy weight, you want to have the same amount coming in as going out so that you don't tip the scale in one direction or another.

Dr. Mike Patrick: Now, sometimes, we see obesity problems kind of run in families. And so, some families may have this concern that, well, there's a hormone problem. Can you address that?

0:08:03

Dr. Stacy Fischer: Yes, I mean, indeed sometimes there are different genetic conditions that can lead to various disorders that can cause kids to put on more weight than their peers or than their family members. There are also just families who inherit similar body types from their parents and grandparents and thereon forward. So certainly though, I would advise rather than just say, "Oh, everybody on our family is big," it's good to get a physician's opinion and see how much is genetics and how much is modifiable.

Dr. Mike Patrick: And really, when you have a family, typically, in that family unit, people are eating the same kind of foods. They're getting the same sorts of physical activity. So even then, often — in fact most of the time, really — it's probably still about that energy balance and calories in and calories out.

Dr. Stacy Fischer: Absolutely, absolutely. I think that families however will oftentimes kind of fall back on "Well, I think it runs in our family." So that's a really great place to educate families and not just turn the child's weight around but perhaps everybody as well.

Dr. Mike Patrick: Yeah. I think, for all of us and I'm guilty of this to some degree as well, it's easier to say, "Oh, it runs in my family," than "I have to actually do something about this."

0:09:14

Dr. Stacy Fischer: Right. Right., Nobody wants to have to change what seems like all of their habits overnight. It could be intimidating.

Dr. Mike Patrick: Yeah, absolutely.

Now, along with that though, when we do change our habits particularly with regard to physical activity, the benefits that we get really extend beyond just weight management. What are some of the other benefits of increasing our physical activity?

Dr. Stacy Fischer: Well, especially in children, as they continue to grow, we're going to see physical activity actually change their bodies as they're growing. In fact, not just their bodies but also their brains. So, we're looking at kids to build muscle mass, to build bone mass, things that are going to last them the rest of their life. But we also find that their activity is going to change the make-up of their brain: how much is active, what centers that control. For example, their cognitive function develops as a result of that exercise.

0:10:08

We're also going to see exercise almost the great equalizer as far as helping to maintain sleep schedules, helping to maintain mood, helping to improve concentration. I think most families out there who have children will understand how a restless child is difficult to keep on task and difficult, sometimes, to control.

Dr. Mike Patrick: Absolutely.

Now, it sounds great. Like we want to encourage more physical activity in ourselves and in our kids. In particular, how do parents really encourage more physical activity in their children?

Dr. Stacy Fischer: I think there's a number of different ways that they can. One way is to try and make just basic activity part of your daily life, whether it's walking to school, or walking short errands or to friend's house, things like that. There is certainly a lot of organized activities that kids can be involved in, but outside of that, families might enjoy going on a bike ride together, or a hike together, camping, exploring, different ways of getting activity outside of the school day, and outside of organized activities.

0:11:15

Dr. Mike Patrick: When we also talk about limiting screen times, if you're going to increase physical activity, that means you have to decrease something else, because there's only so many hours in a day. And not that video games are evil in and out of themselves, although there are some that are, but if you limit the time spent and especially if you play it together. Like my 17-year-old and I, we play Mario Card and Legend of Zelda all the time, but we limit it no more than an hour a day or so.

Dr. Stacy Fischer: Sure, sure. I think everything in moderation. And that can be said for most apparent vices.

[Laughter]

Dr. Mike Patrick: Yes, absolutely. So that's where the calories-out part of weight management. The other thing we have to think about is calories in, right? So what are some nuggets of information on calories in that parents need to know about?

0:12:10

Dr. Stacy Fischer: I think a basic approach is to make sure that your children are fueled all day long. That's how we like to refer to it in sports medicine, is by energy or by fuel rather than calories perhaps. Make sure that your children are fueled all day long so that they don't hit those extreme areas of hunger. So all kids should be eating breakfast, all kids should be eating lunch, and dinner, and snacks, if able. Parents should look to their schools for help with that if they're not able to provide all of these meals for their kids.

We also look at the quantity as well as the quality of the foods that they're eating. So foods, we would like to have a high nutrition content, as well as being low in added sugars or fats or salts, something that is more of a natural food, if you will.

Dr. Mike Patrick: It's easy to talk about these things and to say we need less calories, more nutritious food. We need to be more physically active. But those are kind of broad categories, and I think this is where a lot of families really stumble because you really got to come up with a plan. You need to know how many calories your child needs, either to lose weight or maintain a healthy weight. You have to know how to do that in a nutritious way. You have to know what kind of physical activities are going to be fun and the most bang for the bucks, so to speak.

0:13:29

And I think that's really where this programs, and in particular, the first one we're going to talk about, New U, it's really a program to help families deal with both of these aspects of the energy balance. Dr. Sternstein, can you give us an overview of the New U program?

Dr. Amy Sternstein: Well, the Center for Healthy Weight here at Nationwide Children's offers multiple options for family that's really looking for better health promotion, and I want to say that's one of our key messages, is that we're really looking for viewing the patient as a whole and not just looking at a number on the scale. That certainly doesn't tell the whole story.

Dr. Mike Patrick: Yeah, absolutely.

0:14:07

Dr. Amy Sternstein: So families are either referred to our clinic by their private physician, their family physician or nurse practitioner, or they can actually come on their volition. And when they get to the center, we're really looking at overall health promotion.

So the programs that are offered are varied. We have typical clinic appointments within our center. We also have some evening programs that's age-dependent. I'll go into more detail in a moment. But in general, what we're providing is multidisciplinary approach, and it's absolutely a family-based approach. So oftentimes, it really is some education and some action steps that parents can take, as well as the patients that are coming to our clinic.

So we're calling our daytime clinic, essentially, kind of New U Flex Program. And when I say multidisciplinary, the patients and families will see our dietitians, our medical staff, our physical therapists or access into athletic trainers which Travis will go into in a moment, as well as psychology support.

0:15:14

So that's the daytime option. We also have two evening programs that are going on. One is called the New U, and the other is New U Junior. The difference between these programs — and these are group sessions — is the New U is typically children 18 years of age and up, as well as in the New U Junior, it's typically starting at age 5 and going to age 10.

Dr. Mike Patrick: Great. With regards to this program, how is it that families find out about it and get plugged in to a program like this?

Dr. Amy Sternstein: The initial appointment with our Center for Healthy Weight will then help determine whether it would be most appropriate for as to continue in the daytime setting, in a typical clinic setting, or whether they, the family, would be most interested in an evening program.

The evening program is perceived… I didn't say this earlier, but this is a weekly program, as often as twice a week. And so, it's much more of an intensive program, even though our habits hopefully will be transformed for life, it's a different perspective.

0:16:28

Dr. Mike Patrick: Now, the clinic part of it really then is about trying to figure out what the goals of… And I would imagine these are really individualized for a particular patient and family, but really trying to figure out what those goals are. And then are some group visits as well. Tell us a little bit about those.

Dr. Amy Sternstein: What we're doing essentially is part of our strategy is really initially to get to know the family — what are the family's need, what are potentially their obstacles or their barriers for change. And so, I think, even within the "group setting", we are still trying to individualized our care.

The only group activity that we're providing right now is the evening group activity, When the families do come in during the day, that is individualized care.

0:17:16

So, the fact that it's such an individualized program then, really speaks to the fact that there's so many outside factors in the kids' life, and really in a family's life, in terms of what's going on from a nutritional standpoint and what's going on from a physical activity standpoint. So you have to look at each family in order to figure out what the best strategy is or maintaining or reaching a healthy way, and then maintaining it.

Dr. Amy Sternstein: Right. Although I have to say, one of the benefits of the group session is that support. That support system really can't be underestimated. There are multiple families that had been through our programs and they'll say specifically was that social piece, that interactive piece, that peer support, that has been really the most effective part of our program,

Dr. Mike Patrick: Sure. And probably, not just from an encouragement point of view, but also one family may come up with a creative idea, "Hey, this has really worked for us," and another family, and even the clinicians, may have thought of that approach before. So it's really kind of sharing of ideas and what works and what doesn't work.

0:18:20

Dr. Amy Sternstein: Absolutely.

Dr. Mike Patrick: Now, in terms of team members in this multidisciplinary program, so from a physician's standpoint, what's the role of the medical doctor in this?

Dr. Amy Sternstein: In the group session, in the New U Junior, which is the program that is for the children ages five to ten, it's approximately ten weeks long, we start out with the essential medical evaluation by the physician. But then, the family will attend our evening sessions and that is taught by our physical therapists –we have physical therapists that do, not only just oftentimes rehabilitation from an injury, but they're health promoters; they know a lot about bones and muscles and physical activity — as well as the nutritionists.

0:19:09

So that family, that program will meet once a week, and that's the typical nutrition lesson and a lot of fun physical activity. So part of that is to have the kids play, enjoy activity, be with their peer group and really encourage them to continue doing so on their own.

The other program in the evening, the New U program for the older children utilizes not only the nutritionist, the dietitian, as well as that's actually the athletic trainer. Because that is a program where it's taking place within a facility like our Nationwide Children's Westerville Sports Medicine office, that has a full gym in the whole second floor of the building. So they're actually doing a little higher-end physical activities, interaction with Travis we'll tell you more about. We also include psychology in that program, and that's a twice a week commitment.

0:20:07

Dr. Mike Patrick: So we got physician, we've got the potential of interacting with a pediatric psychologists, dietitians, physical therapist, certified athletic trainers. Really, just all the resources that a child and family would need to do this are at their fingertips with this program.

Dr. Amy Sternstein: Yes.

Dr. Mike Patrick: Travis, tell us a little bit more about the physical therapy and the certified athletic trainers. What are their roles in terms of this program and getting kids active?

Travis Gallagher: Really, our approach with that is, obviously, when they're there, we want to work them out, and we wanted to sweat. But at the same time, we try to make it fun and have them smile. So if each class begins to sweat and smile, that's great. If we just kick their butt and that's all we did, they're not going to want to come back and they're definitely not going to continue those habits.

Dr. Mike Patrick: So this is not a The Biggest Loser kind of environment?

Travis Gallagher: No, no. We're much more like cheerleaders and general instructor.

[Laughter]

0:21:01

Dr. Mike Patrick: Good. Good. And what are some of the specific activities that you get the kids doing?

Travis Gallagher: With the New You — and later on we'll talk about Play Strong — one night a week, we have traditional exercise using traditional equipment, Bosus and stability balls, TRX, and what you would think of with that. But the second half of our class, or sometimes they're first, but the other half is play, and we play games. And for the kids, it's like "All right, exercise is over. Now, we get to play." From our benefit, there's working just as hard, they're sweating just as much, and in fact, in some cases, we're even working harder. It's great, because we're not necessarily tricking them into exercising, but they don't realize we're exercising as planned.

Dr. Mike Patrick: Yup.

And that's really, if you're going to make it a habit, you want kids to have fun and you don't want it to seem like a chore. You wanted it to be something that they want to do.

Travis Gallagher: Definitely. And then, like I said, we don't want it to end when the program ends. So the other night, we introduced them to a number of activities. We're bringing guest instructors and we'll teach them yoga one night, and kickboxing. We've had taekwondo coming in. We've had someone from the Columbus Crew teaching them soccer, and Otterbein Volleyball coming in, and really just showing them a bunch of different ways to be active. If they don't like the workouts, maybe they like being active in other ways. If we find an activity they'll enjoy, then they can continue with that.

0:22:25

Dr. Mike Patrick: That's fantastic because they may, through that program, then be exposed to something, an activity, that they wouldn't have otherwise been exposed to, and so they wouldn't know that they like doing that.

Travis Gallagher: Right. And then, down the line, if they get the opportunity to do it again, the hurdle to do it isn't as great because they've tried it before.

Dr. Mike Patrick: Yeah, because kickboxing for instance. If the kid just heard, "Hey, you want to go to a kickboxing class?" that just sounds so foreign and like, "I don't even know, it's out of my comfort zone." But if they've done kickboxing before through this, then it's something that they're more likely to be agreeable to doing again.

Travis Gallagher: Exactly.

Dr. Mike Patrick: That's fantastic.

0:23:00

Now, Dr. Fischer, why is it important to involve families? I know the New U Program really, that I think it's required that there be an adult participant from within the family. Why is that such an important thing?

Dr. Stacy Fischer: From the basic standpoint that these children aren't going to be able to make these types of permanent changes for themselves. They need guidance and they need support from someone who they're really close to, and for most kids, that's a family member. By having one parent involved and one child involved, oftentimes, you can get the whole family involved and make this an entire family-oriented initiative.

Dr. Mike Patrick: And that's just so important because if the child is really isolated as 'this kid has the problem', that may put so much more stress and anxiety on them. I was just thinking, it would be much of an easier experience knowing that the family is going through this together.

Dr. Stacy Fischer: Absolutely, it's a team initiative.

Travis Gallagher: It put some of the responsibility on the parent too, so it's not just "All right, those professionals are solving the problem. I can sit back and let them take care of it." They're hearing the message over and over again. They're involved actively, and we're doing it together as a team.

0:24:12

Dr. Mike Patrick: So you're really kind of turning the parent into a health coach, so that once the program is over, they can kind of take over and still be involved in this.

Dr. Amy Sternstein: Well, some parents don't realize how important they are as a role model. So this is across the board in all parenting aspects, but I think it really emphasizes the importance of this. Plus, when oftentimes, we talk about building a family-based program, and so we want the families to understand that there's somewhat of a division of responsibility. These are still minors typically and so, their parents are the ones that maybe providing some of the healthy, nutrition options within the home. But then, the child has to decide, "Well, OK, I hope to go for that healthier option."

Or it's same with physical activity, if the parents are encouraging they turn off the video games or they turn off the television set, "I'd really like you to go outside and play." Boy, if a parent goes outside and throws the football with their kids and plays hoops a little bit, that's wonderful and that really emphasizes that long-term, life-changing behavior.

0:25:18

Dr. Mike Patrick: Yeah, absolutely. I think as I'm hearing this, one thing that has really struck out at me is that one barrier to this must really be kind of pride on the part of the parent. Because up until this point, if we're saying that weight issues are energy balance and it's a matter of how much energy is going in and how much physical activity is going out, I would think as a parent, you feel a little responsible that the fact that you have an overweight child is your fault. Then, there becomes this pride, "I'm a parent, I know what I'm doing, my parents did it fine. I'm doing it fine."

I think we have to break that wall down and say it's OK that you haven't done it right up until now, or that you've done it the best that you could. But I think all of us have to just tear that pride down. It's for ourselves, it's for our family, and say, "Starting at this point, we're going to do things differently." So, I don't know, I think the biggest thing that I, as the host of this, can say to parents out there listening right now is don't feel bad about it, but do something about it.

0:26:24

Dr. Stacy Fischer: Right.

Dr. Amy Sternstein: At our center, we don't judge anyone, we don't make any comments based on exactly what you're considering with the past, but we have an opportunity to look forward and to make some of those changes.

Dr. Mike Patrick: Yeah. I think that important for us not to be judgmental about it, but to come alongside.

Dr. Amy Sternstein: There's too many external factors. Honestly, and I know that we talked about it but school doesn't have gym everyday like it used to. And that's not the parents fault. Or the marketing with a lot of food opportunities is not the parents' fault. So, it's not worth spending that much time looking at blame.

Dr. Mike Patrick: Absolutely.

Dr. Amy Sternstein: That's so unproductive. So we really just try to move forward.

Dr. Mike Patrick: Yeah, that's fantastic.

0:27:02

So where do these New U activities take place then? So for the listeners who are here in Central Ohio, where can they expect to go, if they were involved in this program?

Dr. Amy Sternstein: Well, we have two locations. First is the Westerville Nationwide Children's Hospital location, the Sports Medicine Building in specific. And that's taking place typically two nights a week. We also have the advantage of a partnership with the Franklin Conservatory on East Broad Street. And so, we have that location as well. We try to offer both classes at both locations.

Dr. Mike Patrick: Then for the clinic visits, are those here on campus?

Dr. Amy Sternstein: Yeah, thank you. The clinic visits, we are offering those clinic visits down at the main campus downtown and also at the Westerville Center.

Dr. Mike Patrick: Great. I had mentioned in the intro that insurance might cover this. Is that true?

Dr. Amy Sternstein: Yes, yeah. I forgot to mention, recently we started doing clinic visits at Dublin as well.

Dr. Mike Patrick: OK, sure.

0:28:03

Dr. Amy Sternstein: Yes, it is typically covered by insurance.

Dr. Mike Patrick: Do you find that true for both private insurance and also public insurance through Medicaid and the various companies that manage that?

Dr. Amy Sternstein: We definitely have very good coverage through the Medicaid programs typically. But we also do find that a lot of the private insurance payers are now understanding the importance and the significance of this. This really can be perceived as more of a chronic disease and particularly, if there's a medical condition associated with the obesity, then we will bill for that.

Dr. Mike Patrick: Really, when you look at long-term cost, by getting kids to change their habits and maintaining healthy weight, certainly, it's beneficial from a cost standpoint, too.

Dr. Amy Sternstein: Absolutely.

Dr. Mike Patrick: But that was a big battle, wasn't it? I mean I can think back to when I was training, there's no way that this sort of thing would have been covered in the past.

Dr. Amy Sternstein: Yes. The coverage is getting better and better. We still have long ways to go but I think just the awareness has significantly change the… Like you said, that's the long term benefits. And if you see an adult disease in a child, that's pretty much an incentive to start thinking, "OK, we got to change something here, so we don't have a huge medical bill."

0:29:17

Dr. Mike Patrick: Yeah, absolutely.

So how can listeners find out more and actually connect with the New U Program if they really wanted to take part in it?

Dr. Stacy Fischer: Well, the initial visit is required at the Center for Healthy Weight and Nutrition. The phone number directly is 614-722-4824. And once they get involved in our clinic setting, then we will offer that option for one of the New U programs.

Dr. Mike Patrick: Great.

Travis Gallagher: And you can read about it on the website. So if you just went to nationwidechildrens.org and search New U or search Healthy Weight and Nutrition, there's a number of pages.

Dr. Mike Patrick: Great. Also, in the Show Notes for this particular episode, if folks go to pediacast.org, and click on the Show Notes for Episode 297, they'll also find links to the New U program there. And then, also, we'll put a Welcome Center link, like we do with each of our shows, and basically, that's just a way to connect with the hospital. You give them contact information and someone will get back in touch with you. The New U Program is one of those things that you could say, "Hey, I'm interested in this," and the hospital get in touch and just help get plugged in to the right place to make it as easy as we can.

0:30:28

All right, so that's the New U Program. Now, we have another program called Play Strong. Travis, why don't you give us an overview of the Play Strong Program? What's that all about?

Travis Gallagher: Well, we in Sports Medicine, a number of years ago, at first — this was even before I got here — we had a parent contact us. Her child had finished treatment. She had cancer, finished treatment, and was looking for a way to get her back into playing sports. And that just kind of a little light bulb, "Hey, we can run with this." So, initially, that's how the program was developed, for cancer survivors who are post-treatment and they have the mindset to get back into playing sports but their bodies aren't quite ready for it.

0:31:09

And so, we can take our rehab skills that we do with athletes and slowly get them back into whatever their goals are. And we've had one girl. Her goal was simply to play tater ball at recess. And we had another one that wanted to get into college soccer, so we had the whole spectrum.

Dr. Mike Patrick: That's great. So you really individualize this program depending on what the goals of the individual are.

Travis Gallagher: Definitely. Even though we encourage them into the group program eventually, we have an hour-long evaluation that we just go over what their goals are, what their motivation is, what their current habits are. We don't dictate what they do homework-wise, although we do give them some exercise if that's what's needed. But whatever their activity interests are, that's what we encourage them to get into.

Dr. Mike Patrick: This is, again, where I had to be the bad guy in this interview. Sometimes, there's a barrier with the parents there too because your child has a chronic disease and you look at them as being fragile. And so, you may not be quite really in there and encouraging them to be physically active. But this is a program that a child with a chronic illness, you'd have some expertise in knowing what kind of activity would be safe for them.

0:32:24

Travis Gallagher: Exactly. We started this off as a cancer survivor's program but it really has expanded into a number of different disciplines that sent it to us, from cardiology to the bone clinic. And so, there are different instructions with each of them. So that's part of the referral, and we adjust it based on that. But one of our goals of the program is confidence, and not just of the kid, of the patient who had the confidence to get back into activity and do the things that they haven't done in a long time or had never tried, but also for the parent who just want to wrap them in bubble wrap and not let them get out and play. They see, oh, they can run around, and they can do this, and they can interact with others. And they may fall and get back up and keep playing. It's a way for them to kind of loosen the grip a little bit and let them get out and play.

0:33:13

Dr. Mike Patrick: Yeah. Kind of in a supervised environment where to the family may feel it's a little safer. But then, by the time they graduate from the program, then the family has an idea of what that child can and can't do.

Travis Gallagher: Right. it will be a big step for them to just go to a park and let their kids run from there, with no control. So here, everything we're doing is controlled and we're thinking Zero Hero safety first, and make sure that we can control as much as we can at the same time that we're playing games. And so, we're going to control as much as we can, but we want them to get out there and be a little uncontrolled.

[Laughter]

Dr. Mike Patrick: When we talk family participation with the New U Program, I get participants with the Play Strong are encouraged to bring a friend.

Travis Gallagher: Definitely, it's so much easier. You have these kids who haven't been active in so long for whatever the reason and you walk into this facility. It's a huge facility, and it's filled with all kinds of equipment. Some look fun, some look scary, and to be able to bring whether be it a sibling or a friend makes it so much easier. And they participate harder because they're relying on that person. They don't want to let them down. And so we get much better participation with them.

0:34:23

Dr. Mike Patrick: Then once they've sort of graduated from the program, then they do have that friend that they can continue to play with and be active and encourage one another.

Travis Gallagher: Yeah, when you look at anyone — adults, kids — when you want to get in better shape, if you have a buddy and someone to rely on, it's going to make it so much easier. And then, we don't charge for that friend coming, so that makes it easier, too.

Dr. Mike Patrick: Do these activities also take place at the same locations, where New You, in terms of like the evening program? The same?

Travis Gallagher: Not exactly the same. So we have two Sports Medicine buildings. One in Westerville and one in Dublin. So our primary location is Westerville, but if travel or location's an issue, we can also be seen in Dublin.

Dr. Mike Patrick: Great. And is this the kind of thing that also can be billable to insurance?

0:35:10

Travis Gallagher: Yup. We're having good success with that. We're billing and we do an insurance check beforehand, so that they're not also getting these big bills.

Dr. Mike Patrick: Yeah. I had a note to mention that. So the Finance Department here at Nationwide Children's really does a nice job of working with the families so the people know upfront what their insurance is going to cover, what it's not going to cover, so they're not going into this blind.

Travis Gallagher: Right.

Dr. Mike Patrick: Yeah, I think that's important.

Where can listeners find out more and connect with Play Strong?

Travis Gallagher: The same as I said with New You. I would go to Nationwide Children's.org, and just search Play Strong, and there's a couple of pages. Some are out there now, and some are being built to include our partners that are coming in for that second night, so that will be up soon. But just search Play Strong.

Dr. Mike Patrick: Do parents need a referral from the child's primary care doctor for Play Strong?

Travis Gallagher: That depends on their insurance. They need a referral into the program and whether that's coming from one of the specialist they're seeing, or their primary care physician, or from… It needs to be a referral from a physician, but who it comes from isn't as important as…

Dr. Mike Patrick: Where.

Travis Gallagher: Yeah.

0:36:21

Dr. Mike Patrick: So, I guess the point I'm getting at is this isn't just for patients who are absolutely are Nationwide Children's Hospital patient. So, if a person has a chronic disease and they have a family practice doctor, they're half-hour away, it's something that they could be referred into regardless of who their doctor is.

Travis Gallagher: Right. So whether they're coming from Cardiology, their bone clinic or Endocrine, we've also had just primary care physicians in the area, that it's simply a kid that needs to be in better shape, to have improved fitness, whether weight is an issue or not. We have some that are underweight also. But if they just need improved fitness, they come from primary care physicians also.

Dr. Mike Patrick: I'm thinking about a kid who has, like they're in remission from their cancer and they just moved to Central Ohio and maybe they do see the oncologist once of every couple of years or something, but their primary doctor thinks that they could benefit from this program. That's a kid that you would take in.

0:37:15

Dr. Stacy Fischer: Yeah, and I think, one of the advantages of having a referral for these children is if they do have any activity restriction, whether it's due to one of the treatments that they sustained in battling their illness or fragility of their skeleton or something like that, that is on the referral. And that gives our athletic trainers a clue as to how they're going to help design that program for them, because sometimes the parents aren't as knowledgeable about those types of limitations as the physicians who's writing the referral.

Dr. Mike Patrick: Yeah, absolutely. So, again, you can find more information if folks go to the Show Notes at pediacast.org for this episode, which is 297, we'll have a link to the Play Strong Program page. And again, you can also utilize the Welcome Center to help you get connected with that,

Excellent. All right, well, let's move on to Ounce of Prevention. Dr. Sternstein, what is that? What is the Ounce of Prevention Program?

0:38:07

Dr. Amy Sternstein: Well, the technical title is Ounce of Prevention is Worth a Pound. So the Ounce of Prevention Program was designed and established at about the same time that there was a publication in the Pediatric Literature really looking at the fact that we were seeing a higher incidents of childhood obesity. And the question was, where was the pediatrician's role into try to combat this and actually try to prevent it? They came up with very clear guidelines as to what kind of parameters the pediatrician should be looking for as the children are growing, and actually try to intervene early and prevent some of the obesity.

So that was sort of the background. And fortunately, we were very, very lucky to collaborate with Nationwide Children's Hospital, the Ohio Chapter of The American Academy of Pediatrics, the Ohio Department of Health, the Ohio Dietetic Association, and the American Dairy Council Mideast. So there was a really statewide interest in looking how to best provide tools for the pediatrician where they can really start giving nutrition and activity advice in their offices starting as early as birth.

0:39:25

Really, the particulars in terms of the information and then the age ranges, it's from birth, but really for every age range up until how old?

Dr. Amy Sternstein: Actually up into adult years. We started the program and focused specifically on the first five years of life, because typically most families will take their children to the doctor anywhere from 10 to 12 times during those five years just for well visits. And so, we really wanted to capitalize on that opportunity. But the feedback from the pediatricians who are doing the program were so enthusiastic that they said, 'can you please expand this up to age 18?" which is what we did.

Dr. Mike Patrick: So really these are educational materials on nutrition, diet, physical activity, just ways to maintain a healthy weight?

0:40:16

Dr. Amy Sternstein: Exactly, pediatricians are good at health promotion in general, but what we really wanted to build is not only physical health but mental health, self confidence. We wanted to have people believe in their own bodies, their own abilities. Sleep is critically important, and we really want all these dietary habits, physical activity habits. They all influence the overall health as well as weight.

Dr. Mike Patrick: Yeah.

Dr. Amy Sternstein: So we thought if we took more of a comprehensive approach, then we would be able to target our ultimate goal.

Dr. Mike Patrick: Yeah. And it's probably hard for parents to keep track of everything that's going on during that well checkup, so it is nice to have some information that you can take home and refer to as you're living life.

Dr. Amy Sternstein: We also looked at focusing at age specific changes, because your developmental milestones will then determine what kind of advice you should give. So there's a big transition from either breastfeeding solely, or formula-feeding than to start solid food. Or that is another transition from just starting baby foods, but then actually table foods.

0:41:22

So, we really wanted to get in there and take advantage of those age-specific developmental changes. So the family only had to worry about what should I do with my six-month-old. I don't need to read a book of 200 pages. What specifically is the best advice right now?

Dr. Mike Patrick: And these materials are really available for any provider, pediatricians, family practice doctors, nurse practitioners, anybody can access this material and download, print off copies to hand out.

Dr. Amy Sternstein: Right. Everything's available for free on the website here at Nationwide Children's. It's www.nationwidechildrens.org/healthyweight. And if you get on to the main Healthy Weight website, you'll see that there's some options on the right side of the screen, if you'll scroll down, you'll see Ounce of Prevention as one of your options.

0:42:15

Dr. Mike Patrick: Great. And we'll put a link to that in the Show Notes for this episode, 297, as well. And these materials are available in English and Spanish?

Dr. Amy Sternstein: That's correct. We were fortunate. Not only do we have a direct translation, but it was an acculturated and it was done by Hispanic dietitians. So we really try to make it culturally appropriate as well.

Dr. Mike Patrick: Yeah, that's fantastic. Because sometimes the translation, if it's just a translator doing it who doesn't have a medical background, then things may not be put exactly how we want it to be put, right?

Dr. Amy Sternstein: Yes.

Dr. Mike Patrick: And they're also available, I understand in full color and also black and white options, so individual providers out there who may have leanings to one or the other or you want to save your colored ink or something then you have the black and white versions available, too.

Dr. Amy Sternstein: Yeah, absolutely. The entire collection is available online, and we also try to do some specific handouts specifically like we got the Sports Med people here today. There's a big difference between a young child who's playing outside and is thirsty and wants to come in and hydrate with water, versus the football player who's a senior in high school, who's working on football practice in August with a lot of sweating, and that maybe an appropriate place for a fluid, a sports drink like Gatorade. But we were seeing a lot of… There were differences there.

0:43:36

So we also have some snacking information. We have dairy information about calcium needs. We have hydration information about the athlete versus just the young child who's playing outside. So there's also some specialty handouts in addition to those really age-specific handouts.

Dr. Mike Patrick: One of the links at that side, if you go there, is Managing Obesity. It's kind of geared toward providers, just some resources to put in the hands of physicians on managing obesity. And I think that's an important thing because maybe things have changed a little bit, but at least when I was training, there was not much education on healthy nutrition, physical activity, managing these kind of things. You learn how to manage disease, but we didn't really look at this as a disease, and so, I'm sure there's a lot of pediatricians and family practice doctors out there who feel a little bit like they don't have the tools that they need to manage this. And so, this has just put some tools in the hands of docs.

0:44:35

Dr. Amy Sternstein: Absolutely. because of the guidelines that came out, we're really trying to… Also, the Center for Healthy Weight is expanding into the community, and we've really tried to provide a lot of educational materials, and get not only just specialized pediatricians but the schools, and YMCA Programs. We'd like to help Head Start, a preschool program. Really trying to get all of them, the ones that see the children on a regular basis involved in this class, to make sure that we are really building the fundamentals so we don't have to treat the obesity. We can prevent it.

Dr. Mike Patrick: So parents out there, next time you go in for a well check up or a sick office visit or an ADHD recheck, let your doctor know that these materials are available and just send them to pediacast.org Show Notes, Episode 297. There'll be links to all these things that we're talking about.

0:45:29

Parents can access on their own right from our site. You don't have to get them from your doctor. Correct?

Dr. Amy Sternstein: Yeah, absolutely.

Dr. Mike Patrick: I have to warn everybody, I did not tell you that I was going to do this and I apologize, but this is easy. Can you just tell us a little bit about the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital? Just tell us a little bit about the program in general, or the Center, I should say.

Dr. Amy Sternstein: Well, the Center was really designed initially because the hospital was wonderful in recognizing that we were really struggling with some of health of some of these wonderful young attractive, intelligent young children that we're ending up having, as I said earlier, maybe high blood pressure problems as a teenager or developing diabetes very early. And the truth be told, it typically was related to the weight gain.

0:46:22

So the hospital made a team, brought together a team and that's what I have mentioned. It was the physicians and dietitians, the physical experts and physical activity, as well as psychology and really decided it would be important to focus.

The Center has several components. I mentioned the New U Program, which is on our medical component. I did briefly mentioned our community aspect, because we're really trying to expand our services, not only within the hospital and to the Nationwide patients specifically, but to look at the schools, the YMCA who are our partners in the community that can be promoting health.

0:47:02

And then, we do have a Bariatric Program – that's surgical weight loss – in our center and we have a very similar comprehensive approach, multidisciplinary approach in that avenue. Because there are really are some families that really need a little bit more intervention. We do require that they have medical weight management as a prerequisite prior to surgery but we've had same very successful surgeries. And we do have information sessions for families, that there's no commitment required but they can come in and go to the information session and learn more about what it means to have bariatric surgery. That information is also available online.

Dr. Mike Patrick: And we did a PediaCast — it's been a couple years now, I think — but we had the surgical team in and we did a whole show on bariatric surgery. So folks can look that up. I'll put a link to that in Show Notes as well, where you can… I don't remember what episode number, it was off the top of my head, but if you Google PediaCast and bariatric surgery, it's going to come right up. But I will put a link to that in the Show Notes as well.

0:48:09

All right. And then, let's put a plug in for Sports Medicine at Nationwide Children's Hospital. Dr. Fischer, just tell us a little bit about the Sports Medicine Program here.

Dr. Stacy Fischer: So Sports Medicine Program started about twelve years ago here under the direction of Dr. Tom Pommering and really to fulfill a need in the community, to provide care for young people. I don't even want to necessarily athletes. We take care of most musculoskeletal injuries. We have concussion clinics. We provide care to female athletes. We have excellent athletic trainers and physical therapists to help us rehab the children back to or even greater than they were before, and it's a hit.

Dr. Mike Patrick: We're going to make a stronger you, right?

Dr. Stacy Fischer: That's right. Better matter, faster, stronger.

[Laughter]

Dr. Mike Patrick: Yeah, exactly.

0:48:57

Travis and I were talking before the program and I do some shifts in our Urgent Cares. For the first time this year, I'm kind of embarrassed to say it's the first time I've even taught of it, I've been seeing a lot of kids with marching band injuries, and I've started sending them to Sports Medicine.

[Laughter]

Dr. Stacy Fischer: Oh, yes. Oh, yes. And it's really fun, because then we had to ask them what instrument they play, because that will actually affect their return to sport, if it's a piccolo versus a sousaphone. It's interesting.

Dr. Mike Patrick: You know, when I referred my first one, I thought I wonder if I'm going to get an email or a phone call. Is it going to be like, "What are you doing?" And then, I mentioned it to one of the other doctors I was working with in Urgent Care, and he's like, "Oh yeah, I send marching band people there all the time." So I've done several now.

Dr. Stacy Fischer: Thank you. It's fun. It's fun to have the non-traditional athlete.

Dr. Mike Patrick: Yeah, but it is a workout.

Dr. Stacy Fischer: It is, and they're prone to various different… I mean, we'll see the acute injuries which may be musical instrument injuries, but we'll also see a lot of 'overuse' injuries. They march a lot. So their hips and their knees…

Dr. Mike Patrick: And a lot of those kids were maybe not so active during the summer. So, for folks who are having problems in marching band, next spring would be a good time to start a conditioning program.

[Laughter]

0:50:10

Dr. Stacy Fischer: Absolutely.

[Laughter]

Dr. Stacy Fischer: Some of the bands here in Columbus are very competitive.

Dr. Mike Patrick: Absolutely.

Travis Gallagher: What's nice, we can debate what an athlete is. But now, in Sports Medicine, we can see the traditional athletes. We can see those non-traditional athletes who are active. And now at Play Strong, we can get those who are not active, too. So we're kind of hitting everyone.

Dr. Mike Patrick: Yup. And it's really great having certified athletic trainers and we've had several of them. Travis, and we've had others as well on the program. I think it's a fantastic resource, for the Sports Medicine Program, to have you guys available.

So in addition to the Play Strong Program, the New U Program, what are some other functions of athletic trainers within Sports Medicine here?

Travis Gallagher: Well, you have what you normally think of, if you're watching a sporting event and someone goes down, the person that runs out to see what's wrong with him, that's an athlete trainer. So you most likely have one at your school. Or hopefully, you will, eventually if you don't. And that's at college, professional, high school, all that. We also do it in functional rehab so the kids who are trying to get back into playing sports, and that's where the New U and Play Strong programs are based. And then, just working within the clinic, rooming the patients. So if you go see Dr. Fischer, it's going to be an athlete trainer who's rooming you to get the medical history and relay the information on to her.

0:51:29

Dr. Mike Patrick: Great. So it's just a fantastic resource, really.

Dr. Stacy Fischer: It's amazing. There's really nobody who's better trained in all aspects of sports medicine than the certified athletic trainer and their training includes working with athletes, and they start before even we sport meds doc do. They're taking care of these athletes through high school and into college, so their experience is immeasurable.

Dr. Mike Patrick: And we even have some who worked with the US Olympic athletes.

Dr. Stacy Fischer: Oh yes. Mm-hmm.

Dr. Mike Patrick: To their training center in Colorado, I think. All right.

Dr. Amy Sternstein: And one aspect I want to say about that Sport, which I'm so thrilled out is that they do look at every individual as far as what they're interested and willing to do. So, it's not exclusively athletes.

Dr. Mike Patrick: Yeah.

0:52:18

Dr. Amy Sternstein: And that's really critical, because I think the most typical consumer in the family out there just assumes at sport medicine, you have to be an athlete, to be eligible in that program. But that's not the case, that they want all kids moving, all kids healthy. And like Travis mentioned, part of our program was just to have fun, and realize that physical activity can be fun and it doesn't have to be regimented and sports-oriented.

Dr. Mike Patrick: Yeah. And that's what the individual goals just comes. Some people think, "Oh, I don't want to see an athletic trainer. I'm embarrassed to see one because I'm never be going to be able to compete at…" whatever level you have in your mind. But really, it's just a matter of pushing ourselves and want to be active and healthy.

Dr. Stacy Fischer: Absolutely.

Dr. Mike Patrick: All right, let's go around the table here. What is, for each of you, kind of a take-home nugget? Because we have a lot of people who listen to this program who aren't even in Ohio. But the things that we've been talking about, how can parents put them into practice to make for a better, healthier home?

0:53:21

Dr. Stacy Fischer: I would advice all families to, again, make play and make daily activity part of their daily routines. So, if you're used to driving your kids to school, walk your kids to school. After school, go ahead to playground and let them run around. Go on picnics, take things with you. It doesn't need to be organized, it doesn't need to be formal. It doesn't need to be high level. Get out of your house, and go and play.

Dr. Mike Patrick: That's great. Great advice.

Dr. Amy Sternstein: I guess, one piece of advice for sure is that the parent has a very vital role as a role model and they still are in charge in the parenting pieces, very important not to underestimate. Because it isn't just about physical health. It's about mental health. It's about self-confidence, self-esteem. I mean, we've seen lower levels of anxiety and depression, better engagement at school, less behavior problems. These things have all been evidence based on research.

0:54:22

So I want the parents not to think that it's a chore. This is not a chore. This is the best gift you can give to your children.

Dr. Mike Patrick: Absolutely. And Travis?

Travis Gallagher: I'm going to steal a little bit from both of them. So whether you're dealing with the kid who is overweight, who doesn't like being active or the kid who wasn't allowed to be active because whatever disease he had, or simply a kid who's pretty active but he's not in shape or he or she is not in shape, find ways to make it fun. I don't want it to be a chore. Like go to your homework, take out the garbage, go be exercised.

Dr. Amy Sternstein: Go be exercised.

Dr. Mike Patrick: Yeah.

[Laughter]

Dr. Amy Sternstein: I'll prescribe that.

Travis Gallagher: And teach proper English while you tell him that.

But just make it fun. Find out what their habits are, what they want to do, and then do that. They don't necessarily want to do Richard Simmons sweating always. They may not really run around the block the block with you, but they may just want to throw a ball around and go to playground. So make it fun, don't make it a chore.

0:55:16

Dr. Mike Patrick: Absolutely. And my son, I will say, if he could play video games for eight hours a day, he would do it. And so, to find something that he would actually say, "I want to go do that," and for us it indeed up being racquet ball. At Ohio State, being a faculty member there, we have access to great facility, and they have racquet ball. There is almost always a court available. And so, my son who normally would be just play video games is like, "When are we going to go play racquet ball again?"

And then, I think the part about it just working up a sweat and having a fun, you put me in a racquet ball court with someone who really knows how to play racquet ball, I'm going to get hurt.

[Laughter]

Dr. Mike Patrick: There's no question. But we play at our own speed and we're working up a sweat and we had fun doing it.

0:56:05

Dr. Stacy Fischer: Yeah, there's so many opportunities out there. It's easy in your community to see those that are obvious, the kids playing soccer or the organized sports, but if you dig a little, you're going to find amazing opportunities. For example, here in Columbus, there's now a mountain biking clinic for our children at one of the elementary schools, where one of the PE teachers literally dug out a mountain bike trail behind his school.

Dr. Mike Patrick: Wow.

Dr. Stacy Fischer: And kids are coming in and they're doing it along recess, they're doing it afterwards. There's rock climbing. There's so many different types of opportunities that surely you would hope that if you expose your child to enough opportunities, one of them just has to appeal to them.

Dr. Mike Patrick: Yeah.

Travis Gallagher: Just having a conversation asking them what do you like to do or what did you like to do in the past, or what have you like to do you've never tried. What would you want to try and just listening to him and kind of be open, and not just "This is what I think you should do," or "This is what I like to do." Just listen to him and try it.

Dr. Mike Patrick: Absolutely.

0:57:05

Let me toss one more nugget out there. So we really concentrated on the physical activity part of it. From the nutrition standpoint, and our last show that we did was one of our News Parents Can Use shows. And for those of you out there who may have not listened to that one, I want to say this again because I think it's so important. There's a lot of controversy out there right now with the school lunch program. Because there's new guidelines and it's a lot less calories than it used to be, and so there are kids who are complaining that they're still hungry. They have to have so many food on their plate, and so there's been some controversy about kids wasting food because it's not food that they're going to eat.

And so, there's been kind of a push, I think over the last year or two for more kids to pack their lunches because they can take whatever they want to school because there's no bag checker on what's on the bag. And so, there was a study out that showed that the meals the kids are packing and taking to school are really nutritious than the old guideline used to be. And so, if you really want to make a difference in your kids' health, I think really as a parent, if you're packing their lunch, is to do some research, do some investigating and you got to get that sweet spot of it being nutritious but something also that your kid's going to accept and eat. So, that's why I think that the federal government really, I think the guidelines are great. But I think there may be some unintended consequences with packed lunches.

0:58:32

Dr. Stacy Fischer: Right, and I think there's also a lot of concern along those lines with the food insecure kids. So the kids who don't know when or where their next meal is coming from, and there are a lot children I'm afraid who were depending on that high calorie punch at lunch to perhaps get them through the day.

Dr. Mike Patrick: To fuel.

Dr. Stacy Fischer: Exactly, because those kids who didn't get breakfast who might not get a dinner until their caloric intake was very distressing for a number of patients, or students, I guess I should say. Fortunately, there are a lot of other programs and they are up and coming, so certainly, look for them in your neighborhood but a lot of schools are doing breakfast now. A lot of schools are helping to provide some of those nutrition guidelines so that families can plan around that and have the right resources available for each student.

0:59:22

Dr. Mike Patrick: When you talk about kids who may not have access to good nutrition, summertime programs become really important for them. And I think, next summer, that's one of the topics probably early on and well, maybe early spring, we'll have some folks on and talk about that because some communities really have some great programs.

Dr. Stacy Fischer: They do. They're popping up all over the place. What's really interesting about that to me is a lot of these programs are popping up in communities that you wouldn't think needed them. And that just underscores how important and how broad-based nutrition is. I mean, relatively affluent communities need lunch in the summer for their residents.

Dr. Mike Patrick: Yeah. absolutely. So a lot of think about. We can go on talking for another hour.

Dr. Stacy Fischer: Forever.

[Laughter]

Dr. Mike Patrick: But unfortunately, we don't have time.

All right, I want to thank all three of you really for stopping by. Links in the Show Notes, we're going to have links to the New U Program, the Play Strong Program, the Ounce of Prevention materials, Managing Obesity. We'll also have links to the Center for Healthy Weight and Nutrition, and a link to Sports Medicine at Nationwide Children's. So lots of great resources at your fingertips.

And then, we also, as we usually do in the Show Notes have a link that says Connect Now With A Pediatric Specialist from Nationwide Children's. That will take you to our Welcome Center. You basically put your name, what you're looking for, what you're after what program you want to be connected with, what you think your child needs and then contact information and then our hospital will reach out to you and just help you get plugged in. And even if it's something that needs a physician referral, then we'll get in touch with your physician. We just try to make it as easy as possible. So it's one link that basically gets you plugged right into everything at Nationwide Children's.

1:01:08

So I want to thank you for coming by. Really appreciate it.

Dr. Fischer: My pleasure.

Dr. Amy Sternstein: Thank you.

Dr. Mike Patrick: All right, we are going to take one more break, and I'll be back to wrap up the show right after this.

[Music]

Dr. Mike Patrick: All right, I am well over my one-hour time limit that the hospital puts on me.

I want to thank all of you for taking part and making PediaCast a part of your day and your week. I also want to thank Dr. Stacy Fischer with Sports Medicine, Dr. Amy Sternstein with the Center for Healthy Weight and Nutrition and Travis Gallagher, one of our certified athletic trainers here, all of them from Nationwide Children's Hospital.

That does wrap up our time together. PediaCast is a production of Nationwide Children's Hospital. Don't forget, PediaCast and our single-topic short format program, PediaBytes, are both available on iHeartRadio Talk which you'll find on the Web at iHeart.com, and the iHeartRadio app for mobile devices.

1:02:29

Our show archive, which includes nearly 300 programs, as well as our Show Notes, transcripts, terms of use and our contact page are all available at the landing site, which is pediacast.org.

We're also on iTunes, under the Kids and Family section of their podcast directory, and of course, reviews in iTunes are always helpful. You'll also find PediaCast on Stitcher, TuneIn, Downcast, iCatcher, Pod Bay and most other podcasting apps for iPhone and Android.

We're also on Facebook, Twitter, Google+, and Pinterest. Of course, we really appreciate you connecting with us there, and sharing, retweeting, re-pinning all of our posts so you can tell your own online audience about our show.

1:03:04

We also appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids, or anyone who takes care of children. And as always, be sure to tell your child's doctor about the program when you go in for your next, again, well-child checkup, sick office visit, ADHD recheck. Whatever it is, just let them know about the program and we do have posters available under the Resources tab at pediacast.org.

Until next time, this is Dr. Mike, saying stay safe, stay healthy and stay involved with your kids. So long, everybody.

[Music]

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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