Stories: Voices from the frontline
Uma Pisharody, M.D
In less than four decades, the childhood obesity rate has more than tripled in the United States. Throughout that time doctors have told kids to eat healthy and be more active, but if simply saying that worked, millions of children today wouldn’t be on a path to living with nonalcoholic fatty liver disease, type II diabetes and a host of other preventable chronic health conditions.
Uma Pisharody, M.D., understands why those talking points never worked. Ever since recognizing the link between childhood obesity and a condition called metabolic syndrome, the pediatric gastroenterologist has chipped away at the problem, one child at a time. Now, with the knowledge that she and her team have gained over the last five years, she’s ready to step up the fight. “The Bishop Desmond Tutu said, ‘There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they're falling in,’” Dr. Pisharody says.
Later this year, she’ll launch the Resilience program, aimed at helping pediatricians identify the problem earlier and teaching parents how to prevent it altogether. We asked her how we got here and where we can go next.
What is metabolic syndrome?
It’s a cluster of four conditions; having any one of them—or a combination of them—would classify you as having metabolic syndrome. The first is weight gain, specifically around the belly. When that happens you’re storing fat cells in organs like your liver, which leads to nonalcoholic fatty liver disease, which leads to insulin resistance and diabetes. What’s challenging about it, though, is that you begin storing fat in your liver before there are any visible signs.
The second condition is high blood pressure. The third is an abnormal blood lipid profile, and the fourth is abnormal blood glucose levels.
None of those seems particularly easy to find unless you go looking for them—especially if there aren’t any early visual signs of nonalcoholic fatty liver disease.
That’s the problem with metabolic syndrome, and it’s why it’s so underdiagnosed. We now think that one in three people in the United States has it. And the vast majority are walking around with no clue. The best sign is diet.
How did this get to be such a problem among children?
The food industry. The food industry now puts sugar in 75% of packaged foods. Bread, hummus, dill pickles—there’s sugar in everything. People aren’t necessarily eating too many sweets. They’re accidentally getting sugar because it was put in foods where they wouldn’t expect to find it.
So could this all be solved just by cutting out sugar?
No. Sugar can be a dangerous toxin to the liver, and it’s what causes nonalcoholic fatty liver disease when consumed in excess. But metabolic syndrome is a little more nuanced and complex than that. Ultra-processed foods, which typically lack fiber, and lifestyle contribute as well.
What is the Resilience program, and how will it help?
The program will not only help families recognize the signs of metabolic syndrome by educating them, but it will also help them prevent it by teaching them how to cook nutritious meals. We’ll actually have classes on the weekends, where my nurses and I will help parents learn how to cook. We’d love to have families join us in person, but we’ll livestream it on Facebook as well. We want to show that it’s not as hard or as expensive as you might think. We’re also working on recipe cards that show how you can make these meals for $5 or less.
How do you hope to address this at the primary care level?
We’ll start with an annual continuing medical education event. We had one in 2017 and in 2018, and they were some of the most successful conferences Swedish ever held. There's a big need for that. There’s still nothing about this in text books. I mentor students who have no clue, so there’s an informational void. And do you know who’s filling that void? The food industry and social media influencers.
What are some of the things that you hope to share with pediatricians?
We want to demonstrate the importance of taking more time to look at what exactly their patients are eating. We want to give them a good definition of “healthy eating.” Do they understand the biochemistry of how fructose is metabolized in the liver? Do they know what causes nonalcoholic fatty liver disease? Do they understand the biochemistry of insulin resistance? They need to know all this.
You also plan to add a pediatric psychologist to the program. Why?
For starters, these sugary, ultra-processed foods are addictive. When your insulin levels go through the roof, that can affect the biochemistry in your brain and lead to addiction. So we need to approach treating metabolic syndrome with that in mind.
But you also have to walk a very fine line. Food and emotion are tied together, so we want to be very mindful of that and how much we can push them. I’ve had a few kids where we tell them to focus on eating healthy, and they don’t understand that fully, so they take it to an extreme. We want to motivate them without shaming them.
What would you say to all of the parents who are just now learning about metabolic syndrome and freaking out a little that their child may have it without even knowing it?
I’d say it’s preventable and treatable in childhood. Studies have shown that you can improve your liver numbers in just nine days by making the right changes. Talk to your pediatrician about what it means to eat real food. What's the difference between ultra-processed food and real food? That is the best conversation starter.
For more information about how you can help children build a foundation for healthy living by supporting the Resilience program, please contact Duncan Robinson at 206-386-3527 or [email protected].