Preventing heart disease in kids: how can we doctors do better?

Claire McCarthy, MD

A week or so ago, the American Academy of Pediatrics came out with a report entitled “Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents.” It’s a 44-page report full of evidence-based recommendations for preventing kids from getting heart disease when they grow up.

I wasn’t going to write about it. After all, it seems like everyone’s eyes glaze over when I talk to them about diet and exercise; why should I waste the time writing something people likely won’t read? And even if they read it, chances are they won’t follow the recommendations. I know I sound cynical, but that comes from years of talking to families about healthy habits with really minimal results.

But here’s the thing: cardiovascular disease is the leading cause of death in the United States. And the risk factors and risky behaviors that lead to cardiovascular disease can and usually do start in childhood. I can’t really call myself a good doctor if I don’t talk about this stuff. I just wish I was more effective.

Look, I get it. I’ve done my share of cajoling/begging/yelling to get my kids to eat vegetables, with variable results. I know what it’s like to try to get a kid who has absolutely no interest in exercising to exercise (especially when it involves me exercising too—just kicking them outside, like our parents did, doesn’t always work out). We are all short on time and would prefer to keep negative interactions with our family to a minimum. Especially when it’s all about something that won’t happen for years (if at all).

Also tough: keeping our kids healthy means taking a long hard look at our own health and habits—because whether it’s the food we serve or the example we set, we have an impact.  It means eating better, not smoking, exercising, going to the doctor regularly, watching our weight and our blood pressure…ah! The eyes are really glazing over now. I can see it. Denial is way more comfy.

It’s not like we never make our kids do things for their future good. We push them to do well in school, we help them make choices that might help them get into a good college, even if they don’t like doing homework or aren’t interested in sports and clubs. (Maybe this is easier because we don’t have to change our habits.) But they aren’t going to get much out of being a doctor or lawyer if they die at 45 of a heart attack.

Like I said, the recommendations go on for 44 pages.  But here are the bottom lines, so to speak:

  • Family history matters when it comes to heart disease. Know your own cholesterol values.  Find out what Uncle Jimmy died of so young. If there is a change in your health or the health of a close relative, let your child’s doctor know.
  • Don’t smoke, or let your kids be around people who do—and do everything you can to stop them from smoking as teens. If you smoke, talk to your doctor about smoking cessation program.
  • Baby fat and kid fat turn into adult fat. Know your child’s Body Mass Index (BMI).  If it’s over the 85th percentile, take action. Don’t ignore it.
  • Make sure your child’s blood pressure is taken at every checkup from age 3 on, and talk to your doctor about when to do a blood test to check for hyperlipidemia (all children should be checked at age 9-11 and 18-21, but some might need it earlier or more frequently).
  • Eat healthy. This means:
    • Breastfeed for at least the first 6 months, if possible
    • Keep portion sizes reasonable
    • Serve whole grains, lean meats, and lots of fruits and vegetables
    • No sugar-sweetened beverages—and preferably no juice.  Low-fat unsweetened milk and water should be all anybody drinks.
    • Try to keep fat and cholesterol to a minimum (including fast food)
  • Shut off the TV and get your kids (and everyone) moving for an hour a day.

I know, you’ve heard all of this before. We all have. But here’s why: because it’s important.  It could literally save your child’s life.

It makes me sad every day that I can’t seem to make significant changes with my patients when it comes to diet and exercise and weight and smoking and everything else. I try to work with families and understand their individual lives and needs, but it’s not enough. My friend and fellow doctor-blogger Wendy Sue Swanson is asking her readers for their perspectives and practical suggestions—maybe that’s what all of us doctors should be doing.

So if your eyes haven’t totally glazed over, chime in. Why aren’t we doctors more effective? What should we be doing differently? What makes it hard? What has worked, or might work, for you?

8 thoughts on “Preventing heart disease in kids: how can we doctors do better?

  1. Having worked at CHB in the past, being a Social Worker, and being somewhat familiar with the community health program in which you work, I assume that some of what you are struggling with is out of your control. I expect that many of the families you work with struggle financially. And sadly, healthy foods are expensive (I know you know this). I recently was behind a father in line at the grocery store who was paying with food stamps. He was clearly trying to balance health with feeding what was probably a large family. He had to compromise somewhere. He bought as many healthy things as he could, but also stocked up on “tummy fillers” that weren’t necessarily healthy. It made me really grateful that I don’t have to make those tough decisions. Our society needs to figure out a better solution to help these families…..

  2. As director of the Preventive Cardiology Program, I definitely understand the struggle providers face trying to help families make healthy choices, and as a mother of 3, I get this real time when I get home.  The Halloween candy our kids collected can be measured in pounds!  The idea that I would throw it away is just about as horrible as getting rid of the 100th stuffed tiger my kids are hoarding in the toy closet. 
    In the end, there is no easy answer and no quick fix, but I try to keep in mind that every time we make a good choice it makes a difference, and if we make a less healthy choice, there is always next time to do better. 

  3. Here’s the rub –

    Adding a healthy lifestyle is *hard*.  It requires multiple changes to be effective, from revamping diet, adding exercise, changing cooking and shopping habits, and changing a mindset.  It’s also often painful – kids don’t like healthier foods, and getting in shape requires physical pain often for out of shape people.  I honestly believe living a healthier lifestyle is harder than quitting smoking was.

    It’s also true that we need to make large-scale societal changes.  Healthy foods need to be *less* expensive than processed alternatives.  Access to local healthy foods needs to be improved.  Large agribusiness needs to stop being subsidized to force corn and corn syrup into everything we eat.

    It’s depressing, but until these societal issues are resolved, I really don’t think there is anything your average doctor can do that will reach many people.

  4. Sometimes its how the doctor comes across bringing the message. Just because my teen was over weight i kept getting the same speech about diet and excersies. But I tried to tell her for months something was going on and she wouldn’t listen. when i talked her eyes glazed over or they rolled. I felt all she was seeing was a parent making excuses for her fat teen. Finally we wrote a food  and excersise log and now we are seeing another doctor to see if there is something going on. I was on the verge of giving up, was so sick of feeling bad and seeing my daughter feel bad after leaving her office.

  5. With my two sons I have allowed them to eat what they like. But everything in moderation; not over eating; and limited the sweets. But most importantly kept them active. Going for walks, playing ball in the yard etc. They are both very healthy. As a suggestion to Doctors, don’t be so critical of what kinds of food the kids eat. Instead focus on the importance of being active; and it doesn’t have to be extreme exercise. In today’s age the issue is to the parents and allowing their kids to play video games for hours on end or worse using the T.V. to be the kids babysitter. As being former military and instructor the imbalance is discipline, lack of self esteem and self confidence.  Do not be so hard pressed on the food, encourage the parents to be parents and spend time with their kids on  “play dates”. Family walks, going to a park, playing catch etc. As far as smoking is concerned, people are going to make that choice on their own. In the case of smoking around the children in some cases that will happen anyway. You can not make people quit if they do not want to. As a rule of thumb; suggest to smoke outside or open a window in the house. Smoking has risks we all understand; but to the people who do smoke they do so because they want to; if they did not they would seek help to quit or go “cold turkey”. Instead of doctors being critical and caviling. Be objective and use suggestions, most importantly be tactful; people do not like being told what to do. Hint: if you make it seem like the patient thought of the idea, as a doctor you just may get the result you desire.

  6. As a parent of two I dont think the Doctors are doing anything wrong.  They are not effective because we as parents have chosen not to be effective.  We will have to change our own habits in order to really teach our children to change theirs.  We need to shut the TV off and get outside and move with them, not buy those chips ect…. The only way for parents to be effective is to be a good example.  This is the hard part as the economy continues to crumble and we have to work more and the “healthy” food is so much more expensive.  Thankyou for the reminder, Its always a good kick in the butt to hear it again 🙂

Comments are closed.