Feature Story

From as early as he can remember, Jim Blackburn was the big kid.  Growing up in the South, Jim ate every meal with mounds of butter, lard, and fat.

“I was wired at a young age to eat a lot and eat bad,” Blackburn said.  “My mother’s cooking was not healthy, but it tasted good to me.”

After 47 years of warm biscuits and thick gravy, Blackburn weighed 420 pounds.

“I started to see my comorbidities increase,” Blackburn said.  “I had high blood pressure, chronic sleep apnea, and beginning stages of diabetes.  I basically couldn’t get up the stairs without being winded or having my knees or ankles hurt.”

Today, more than one-third of American adults and about 17 percent of children and adolescents are obese.

According to the Centers for Disease Control and Prevention (CDC), obesity-related conditions, such as heart disease, diabetes, and certain types of cancer, are some of the leading causes of preventable death.

Obese patients paying more

Obesity is an expensive problem too: According to researchers, chronic illnesses such as diabetes and heart disease account for some $100 to $150 billion in health-care spending in the United States each year.

Obesity rates in Georgia are particularly concerning – CDC research shows that by 2030, Georgia will have an obesity rate of 53.6 percent.

The healthcare costs linked to obesity in Georgia’s adults are currently estimated at $2.5 billion per year, according to a 2009 report from United Health Foundation, the American Public Health Association and the Partnership for Prevention.

If trends continue, the report projects that these costs could reach $10.8 billion by 2018, when as many as 41 percent of Georgians could be obese.

Why such high rates in Georgia?

Georgians rank among the lowest in the country in healthy lifestyles, contributing to their high obesity rates.

Only 17 percent of Georgia’s children and adolescents consume the recommended five servings of fruits and vegetables per day, according to the CDC.  Fewer than half of Georgia adults and only one in four children in 2009 performed the recommended amount of physical activity, which is two and a half hours of moderate activity per week.

But behavior is also related to people’s surroundings and the environment in which they live.

Unhealthy foods, such as fast food, are often cheaper than nutritious meals, and often more accessible.

The Georgia map is marked with several USDA-designated “food deserts,” where healthy foods, like fresh produce, are difficult to purchase.  These pockets of poor nutrition are mostly in high-poverty areas with high rates of obesity.

A push for earlier prevention

Medical professionals and researchers have agreed that addressing obesity before it happens is the best approach to improve health and decrease healthcare costs.

“Prevention is key,” said Dr. Stephanie Walsh, Medical Director of Child Wellness at Children’s Healthcare of Atlanta.  “You can’t ignore the kids who have issues, you have to treat.”

Diseases such as diabetes, joint problems and heart disease are now showing up in obese children, not just adults.  According to the CDC, children with extra weight are 80 percent more likely than other children to become overweight adults.

Annual health costs for an obese child being treated for obesity are estimated at $2,500 to $4,200 more than for a normal-weight child, according to the Robert Wood Johnson Foundation.

However, Georgia has made significant efforts to promote nutrition and encourage exercise.

With programs, such as the Georgia Student Health and Physical Education Act (Georgia SHAPE), and Children’s Healthcare of Atlanta, Strong4Life, Georgia is on the cutting edge of early preventive action.

Once known as the state with the second most obese children in the nation, Georgia now ranks 17th nationally, according to a new report by the Data Resource Center for Child and Adolescent Health.

“Georgia has made great strides, and these numbers are encouraging,” said Emily Anne Vall, Obesity Project Manager at Georgia Department of Public Health, who helps manage Gov. Nathan Deal’s anti-childhood obesity campaign, Georgia SHAPE.  “We must continue to motivate our kids and make our program fun and exciting.”

Georgia SHAPE

Georgia SHAPE, passed during the 2009 Georgia legislative session, began with a requirement that each local school district conducts an annual fitness assessment, FitnessGram, for all students in grades one through 12 enrolled in Georgia public school physical education classes.

According to Vall, SHAPE has tested over 1 million students in Georgia and found that 41 percent of all students in Georgia are outside the healthy guidelines for weight.

“We have mapped out our program based on the goals that come out of fitness gram,” Vall said.  “We have outlined that we want to help Georgia’s youth decrease body mass by one percent each year for the next ten years.”

Georgia SHAPE’s newest initiative is Power Up For 30, a statewide voluntary program that supports implementation of 30 minutes of additional daily physical activity in elementary schools.

“Incorporating just 30 minutes of physical activity into the daily school routine can enhance learning,” Vall said.  “If it’s fun they want to do it – they want to move, they want to wiggle.  We are hopeful that we will increase the health of our children.”

Children’s Healthcare of Atlanta, Strong4Life

In an effort to provide additional outlets for children and their families to fight obesity, Georgia SHAPE partners with Children’s Healthcare of Atlanta and their Strong4Life program.  Strong4Life is a wellness movement designed to ignite social change in Georgia and reverse the epidemic of childhood obesity and its associated diseases.

Strong4Life reaches families through the largest public awareness campaign on childhood obesity and wellness to ever hit Georgia.

“Despite the fact that we were number two for childhood obesity, nobody thought that childhood obesity was a problem,” said Dr. Stephanie Walsh, Medical Director of Child Wellness at Children’s Healthcare of Atlanta.  “If you don’t know there is a problem, then you can’t move forward.”

According to Dr. Walsh, 75 percent of parents who have children that are overweight or obese don’t know that their children are overweight or obese.

When Strong4Life was created in 2010, Dr. Walsh and her colleagues decided to focus their initial efforts on awareness and education.

“Our distinguishing factor is our media and our website,” Dr. Walsh said.  “We’ve done a lot of work to help families by looking at groups of people and learning what motivates them to change.”

Strong4Life encourages and promotes four healthy habits – limit screen time to one hour, make half your plate veggies and fruits, be active for 60 minutes, and drink more water and limit sugary drinks.

“We try to saturate the market with the same messages,” Dr. Walsh said.  “We are really focused on behaviors and not weight.  That is a key point.”

Parents taking responsibility

Although the Strong4Life programs aim to teach children to make healthy choices on their own, the Strong4Life staff realizes that the parents have a great amount of responsibility.

“We know that the kids aren’t grocery shopping and making the meals,” said Lauren Lorenzo, who leads Camp Strong4Life, which gives kids struggling with obesity the support they need to become healthier.  “We are very aware that the parents have to be on board and have to be role models or their child will not change.”

But not every child is fortunate enough to grow up with guidance from healthy role model parent figures.

Jim Blackburn, who weighed 420 pounds at age 47, was taught at a young age to never leave food on his plate.

“My parents told me not to waste food because there are starving kids out there,” Blackburn said.  “So I always cleaned my plate and often ate seconds.”

Dr. Walsh, a pediatrician and mother, said that without parental or family support, it is very difficult for the child to make drastic health improvements.

Bariatric surgery

If children don’t focus on their health and weight from an early age, they may become candidates for bariatric (weight loss) surgery, an invasive measure to treat obesity.

This was the case for Blackburn, who at age 48 underwent gastric bypass surgery.

“I think I added up 24 different diets that I had been on,” Blackburn said.  “I was on a lot of medications.  I had no other options.”

Blackburn lost 180 pounds during the first year after his surgery, and he has not gained any weight back.

“It took a lot out of me mentally and physically,” Blackburn said.  “It’s not an easy road.  It’s taken a while for things to adjust.”

Despite his daily challenges, Blackburn has become quite a success story.

Meagan Moyer, Clinical Dietitian at Emory Bariatric Center, who guided Blackburn through his surgical process, said that he is an inspiration.

“He has done absolutely fantastic,” Moyer said.  “He is now much more physically active and healthy.  His story is incredible.”

Since his surgery, Blackburn exercises almost every day and maintains a healthy diet.  He recently completed his first half marathon and plans to run his first marathon in February 2014.

“The surgery to me was just giving me a tool, and I have to be able to use that tool skillfully,” Blackburn said.  “It’s a very serious decision and very serious commitment, but it changed my life.”

Screen Shot 2013-12-13 at 10.26.46 PM

Transformation of Jim Blackburn

Although Blackburn had gastric bypass surgery as an adult, bariatric surgery has become a treatment option for children.

In 2004, Dr. Mark Wulkan, the Surgeon in Chief at Children’s Healthcare of Atlanta, performed the first adolescent bariatric surgery at Children’s and one of the first ever performed at a children’s hospital.

“I had a child come to my office who was 16 years old and weighed over 400 pounds,” Dr. Wulkan said.  “He had a tracheotomy because his sleep apnea was so bad, and he said to me ‘I just want to be able to swim’ – it hit me that I had to do something, so I helped start a surgical program.”

According to Dr. Wulkan, a child is eligible for surgery with a BMI over 35 with a serious comorbidity, or a BMI over 40 with a minor comorbidity.  The child has to have gone through the Strong4Life program for six months before being evaluated for surgery.

“The expectation with the surgery is that the child will lose half of the extra weight,” Dr. Wulkan said.  “But we really look at the comorbidities.  It’s really about health and not weight – it’s about controlling the diabetes, high blood pressure, and the other things they have.”

Although bariatric surgery is an effective and successful obesity treatment, Dr. Wulkan emphasizes the importance of preventing the need for surgery.

“What it comes down to is calories in and calories out,” Dr. Wulkan said.  “We need to get our kids up and moving.”

As the nation’s obesity rates increase and healthcare costs rise, so do Georgia’s efforts to combat obesity from a young age.

“We’ve done a good job, but I think we need to keep doing more,” Wulkan said.  “Now that people realize it’s a problem, we have to take that awareness and covert it into preventing obesity.”

SOURCES:

  • Jim Blackburn – Patient who had gastric bypass surgery
  • Emily Anne Vall – Obesity Project Manager at Georgia Department of Public Health
  • Dr. Stephanie Walsh – Medical Director of Child Wellness at Children’s Healthcare of Atlanta and pediatrician
  • Lauren Lorenzo – Director of Camp Strong4Life and registered dietitian
  • Meagan Moyer – Clinical Dietitian at Emory Bariatric Center
  • Dr. Mark Wulkan – Surgeon in Chief at Children’s Healthcare of Atlanta

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