Since 2003, the Weight Assessment for Teen and Child Health (WATCH) Clinic at UCSF Benioff Children’s Hospital has been helping children overcome obesity. The clinic brings together doctors, nutritionists, exercise physiologists and psychologists to evaluate the biochemistry and behavior of patients and their families to better understand the issues related to their balance between calories consumed and calories burned.
In 2009, I started working with pediatric patients and I couldn’t believe how many children and teens were already fighting obesity—and all that comes with it, physically and emotionally. Obesity is measured by Body Mass Index (BMI). According to the Centers for Disease Control and Prevention, BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters. For children and teens, BMI is age- and sex-specific. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex.
Obesity has many causes. At its most basic level, it is caused by more energy going in than is being utilized by the body. But the true causes of obesity are often rooted in physical, emotional, and cultural issues that are intertwined and must be addressed together.
Physical causes can include hypothyroidism (which slows the metabolism), familial causes (such as a mother having gestational diabetes while the child was in utero), and very occasionally, by our genes. Emotional causes can include a child using food for comfort or choosing to gain weight to appear less physically attractive as a defense mechanism. Cultural issues around food are often related to the social norms, that often include having food and drink as part of any social gathering.
As a nurse practitioner caring for children, I began to understand all the connections my patients and their families had to food. I referred morbidly obese patients (those with a BMI of 35 or higher) to the WATCH Clinic, but the waiting list was three to five months long and these families needed help right away. Even for those patients who were able to get in to the WATCH Clinic, they had to go to San Francisco for regular check-ups, which wasn’t very convenient. On a day without traffic, it takes a couple hours to get to UCSF and a couple hours to get home—and let’s face it, there’s always traffic.
Through my relationship with the WATCH Clinic, I met Dr. Patrika Tsai, a pediatric specialist in gastroenterology, nutrition and obesity. In 2015, after working with her for a while, I asked her if she would be willing to help me start a satellite WATCH clinic in Ukiah, and she enthusiastically agreed.
We set up secure communication channels so patient data would remain confidential, and I went down to UCSF for additional training. We set up a protocol by which I provide patient data and she directs care. Together, we help patients manage their weight through nutrition education and behavior modification; and when appropriate, through drug and surgical therapy.
Working at MCHC Health Centers allows me to work with medical colleagues as well as behavioral health colleagues. Because so many obese patients have social and emotional issues tied to food, the behavioral health support is incredibly important. We work together with the patient and family to create a healthier dynamic. We remind our patients that it didn’t take one day to gain the weight, so it won’t take one day to lose it, but it is absolutely within their power to reach and maintain a healthy weight.
Children who are overweight or obese have often dealt with ridicule from classmates or even family members. In our obesity clinic, patients know they will not be judged. We help patients regain self-confidence and self-love, and seeing them achieve their goals is one of the best parts of my job.
Cindi Mockel is a Family Nurse Practitioner in the Pediatrics Department at MCHC Health Centers, a local, non-profit, federally qualified health center offering medical, dental and behavioral health care to people in Lake and Mendocino Counties.