Inspired by big questions and convinced they had even bigger answers, Eliana Perrin took the advice of a professor and began conducting research on one of the most pressing issues facing the nation. Her findings and dedication to her work, her patients, and her trainees, earned Perrin a Phillip and Ruth Hettleman Prize for Artistic and Scholarly Achievement.
We asked Dr. Perrin five questions about how she became a researcher, her most recent findings, and how parents and doctors can work together on the issue of childhood obesity.
Well, when I was a pediatrics resident at Stanford, one of my preceptors said, “You ask too many broad questions; you should probably do a research fellowship.” That was true. I was always really honored to do clinical work, but I also had a lot of questions that were broader. So I applied for and was accepted into the Robert Wood Johnson Clinical Scholars program at Carolina. It was a fantastic program, and I learned research methods and public health. As part of the fellowship, I got my MPH at the School of Public Health here at UNC.
At that point in my career, I was really interested in restrictive eating disorders, but this was before Dr. [Cynthia] Bulik’s arrival and the beginning of our UNC Center of Excellence for Eating Disorders. People reminded me that the far greater public health problem was obesity. Since I was interested in biospychosocial issues in general, it was not hard to start research in childhood obesity. Now, I realize how related obesity and restrictive eating disorders are to each other and the role that stigmatization plays in perpetuating each of them.
In 2012, you and colleagues reported that most parents with overweight children said that their doctors don’t talk about weight with them. How did you go about figuring that out and what were some reasons why doctors didn’t talk about weight with parents?
Well, what we found was that from 1999-2008, 78 percent of parents of overweight children reported never having been told by a health care provider that their child was overweight. This is from a national data set (NHANES), but it echoes some of the conversations we’ve had with parents in our interview work. Though our cross-sectional data can’t explain what’s going on, we think there are some main possibilities. The first possibility is that we physicians are not screening appropriately. The second possibility is that we’re screening but we’re not able to effectively communicate screening results to families. Third, maybe families have been unwilling or unable to hear or remember such information. In short, we’re not doing it, we’re not communicating it, or they’re not hearing it.
Obesity remains a stigmatizing condition, and while most doctors think that screening makes a difference, many pediatricians don’t think parents want to know or at least find the conversation difficult. Yet we know from other research that many parents do want to know their child’s weight status and want any possible health relationship drawn into the conversation.
We need to remember our role as health care providers throughout many transitions for children and their parents. First, we can promote healthy habits from the beginning of life. We can help parents by teaching them how to learn from their infants when they are hungry and full. This is a life skill that we can empower parents to learn. So many very young infants are put in front of the television, strapped away from play space, encouraged to eat unhealthy foods like french-fries, and given juice and soda early in life.
When toddlers become preschoolers, their body mass index physiologically drops. Many parents think their 3-8 year old children are too thin. We need to help them know that children are supposed to look skinny at this time of life. Then, we can help later as well as children go to school and later as adolescents, they’ll be bombarded with images that encourage stigma about weight at the same time as they’re bombarded with advertisements for calorie-dense and nutrient-poor foods. We can help children learn media literacy so they meet these messages with skepticism and empowerment to have a healthy body image.
Finally, as a provider in a safety net clinic, I know that many families face incredible challenges of poverty and food insecurity. We need to always make sure our counseling is sensitive to econonomics and cultural.
Right, so we’re learning that there are likely genetic determinants of obesity, but the rates of rise of this condition over the last 30 years are such that genetics is not the whole explanation. How we eat and whether and how we exercise are determined largely by culture – what are the social norms of the family, of the peer group, of the area where people live? Do the parents smoke? How much healthy food can the family afford? What are the messages about eating and activity that children are exposed to?
In a great new project we’re starting, we’ll be looking at children’s movies to determine what messages children take form them -- messages about eating, activity, stigma, and obesity. We hypothesize that these messages are part of the social determinants of obesity.
I like thinking about the big picture. I have always had the “research bug” – that drive to try to know more than we can ever know. I like thinking about big problems and trying to figure out the skills and education various people bring to the table to try to get to the bottom of big issues. Collaboration is very important to me – particularly in studying a problem as interdisciplinary as obesity. When a student or someone I’m mentoring comes to me excited about their work or approach to a problem and I know I’ve helped them develop the research bug and hopefully some skills to use in research, that’s the most rewarding of all.
Eliana Perrin, MD, MPH, is an associate professor of pediatrics in the UNC School of Medicine.
Media Contact: Mark Derewicz, 919-923-0959, firstname.lastname@example.org