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Dentists in unique position when dealing with childhood obesity

November 07, 2016

By Jennifer Garvin


Knowledge: Barbara Greenberg, Ph.D., of New York Medical College, shares the results of a scoping review of the existing literature on oral health professionals' past efforts to address systemic health issues.
Washington — When it comes to tackling the growing epidemic of childhood obesity, dentists are in a unique position to start a conversation with parents.

They already talk about the dangers of sugar-sweetened beverages, the importance of not letting babies go to bed with bottles— so why not take it a step further and talk about obesity?

This was just one of the solutions proposed at Healthy Futures: Engaging the Oral Health Community in Childhood Obesity Prevention. The Nov. 3-4 conference brought together 125 dentists, hygienists, physicians, nurses, educators, researchers and dietitians to discuss ways the professions can work collaboratively on prevention.

"Dentists have a remarkable opportunity to bring the topic of sugar consumption into a team based conversation of disease prevention and overall health," said Dr. Jane Grover, director, ADA Council on Advocacy for Access and Prevention. "This meeting brought together a diversity of health-related professionals who are all looking to the ADA for interprofessional leadership in this area."

According to the Centers for Disease Control and Prevention, childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. And because obese youth are more likely to be obese as adults, this can put them on a path to heart disease, type 2 diabetes and many other serious medical conditions as adults.

It's a problem no one profession can solve singlehandedly, which is why words like interprofessional and collaboration were stressed repeatedly during the two-day event.

"The big take home message for me was that diet is a common risk factor for many diseases — caries, obesity and diabetes — and a coalition is needed to tackle this," said Julie Frantsve-Hawley, Ph.D., R.D.H., executive director, American Association of Public Health Dentistry.

During the conference, presenters shared studies, evidence-based recommendations and advocacy efforts already in motion. They also discussed new ways to engage parents, educators, communities and insurers on the importance of the issue.

This need for health professionals to work together was timely: On Nov. 1, the U.S. Preventive Services Task Force issued draft guidance recommending clinicians screen for obesity in children and adolescents age 6 years and older.

Barbara Greenberg, Ph.D., of New York Medical College, talked about how chairside screenings have been shown to be an effective tool for dentists to identify patients at increased risk yet unaware of their risk.

"Not diagnosing disease," she stressed, "but identifying those at an increased risk."  

Dr. Greenberg, along with Dr. Michael Glick, editor, Journal of the American Dental Association, and Dr. Mary Tavares of the Forsyth Institute and Harvard School of Dental Medicine, reviewed the existing literature on oral health professionals' past efforts to address systemic health issues such as blood pressure management, diabetes management and obesity in order to develop strategies for preventing childhood obesity.

In one of their attitudes' surveys, they found that 76 percent of patients were willing to have their height and weight documented by their dentist, but only 57 percent of providers reported interest in providing the screenings.

"Patients are ready for this," Dr. Greenberg said.

Robin Wright, Ph.D., assistant director, Pediatric Oral Health Research and Policy Center, American Academy of Pediatric Dentistry, shared the results of her organization's surveys conducted with Nationwide Children's Hospital earlier this year.

The surveys, which were coauthored by Dr. Paul Casamassimo of Nationwide and a professor at the Ohio State University College of Dentistry, asked both pediatric dentists and pediatric dental residents about their efforts to address childhood obesity. They found that of 5,400 pediatric dentists and 1,000 pediatric dental residents, only 17 percent currently offered childhood obesity interventions, but 94 percent provided information and other services on the consumption of sugar-sweetened beverages.

One reason, Dr. Wright noted, is that there's a big difference between talking to parents about the dangers of sugar-sweetened beverages and discussing their child's weight and obesity. Pediatric dentists were more likely to talk about healthy weight management if they considered it a part of their role as oral health professionals and if parents asked about the topic. According to Wright, "The biggest barriers to addressing childhood obesity were concerns of appearing judgmental or offending parents, as well as simply not knowing how to start the conversation."

In his presentation, Dr. Ankit Sanghavi, director, community and oral health research, policy and advocacy, Texas Health Institute shared the results of a peer-reviewed literature study he performed with Nadia J. Siddiqui, a senior policy analyst at THI, on the oral health profession's advocacy efforts. They concluded that while there is a growing recognition for the oral health community to get involved, the question still remains on whether or not it will be effective.


Breakout session: Dr. Kimon Divaris, right, of the University of North Carolina School of Dentistry, brainstorms on ways health professions can work together to combat childhood obesity. At left is Dr. Jane Gillette.
Dr. Kimon Divaris, research director, pediatric dentistry, University of North Carolina School of Dentistry, presented on the systematic review he conducted with Dr. Vaishnavi Bhaskar and Kathleen McGraw. The researchers looked at what dental schools and dental hygiene schools are doing to educate students on childhood obesity. They reviewed three studies, including a 2009 survey where 50 percent of the pediatric dental residents survey reported receiving formal curriculum on managing obese pediatric patients. They also cited the oral health rotation currently in use at New York University College of Dentistry's pediatric dentistry clinic.

While proposed solutions such as oral health curriculum in schools, increased chair-side screenings and dentists providing nutrition guidance were favorable received, so were the existing barriers. For every potential game-changer exists the sobering reality that everyone—be it a solo practice, dental school or hospital — needs more time, money and training. The issues of reimbursement — would insurance cover this? — and mostly incompatible relationship between medical and dental electronic health records were also discussed.

In addition to talking solutions, presenters and participants alike talked evidence, and the need for more of it.

"We need to encourage the National Institutes of Health to fund more robust studies on this topic," said Dr. Frantsve-Hawley, who said she was surprised at the science around her presentation topic: the association between sugar containing beverages and weight gain in children under 5. "But taking all the information presented in the conference, there is sufficient knowledge that we should consider taking some action now."

Healthy Futures was organized by the ADA, National Maternal and Child Oral Health Resource Center, American Academy of Pediatric Dentistry, American Dental Hygienists' Association and Santa Fe Group. It was supported by the Robert Wood Johnson Foundation and its commitment to eliminating young children's consumption of sugar-sweetened beverages and ensuring children enter kindergarten at a healthy weight. A reception was provided by the DentalQuest Foundation.

For a complete list of conference presentations and resources, visit www.oralhealth4healthyfutures.org.

For more information on the ADA's advocacy efforts on nutrition, visit ADA.org/nutrition.