Delivery of Care

Heavy weather

The latest data suggests that Rhode Island is grappling with a large gap in access to food, food insecurity, and nutrition, reflecting the state’s racial, economic and ethnic disparities

Graphic by RI Kids Count, image is photo by Richard Asinof

The latest chart of children who are overweight and obese in Rhode Island in 2021.

By Richard Asinof
Posted 6/12/23
The efforts by Rhode Island Kids Count to document the health disparities around children ages 2-17 being overweight and obese reflect a renewed advocacy agenda under Paige Clausius-Parks, the organization’s executive director.
How can the latest study results by Joseph Braun and his colleagues be integrated into the data constructs around children who are obese and overweight in Rhode Island? Is there a way that Rhode Island pediatricians can replicate the innovative approach developed by Dr. Mona Hanna-Attisha of giving parents a prescription for healthy, nutritious foods from the local food coop? How can the findings around food deserts and food swamps in Rhode Island be integrated in the approaches to teaching nutrition to students and their parents?
The comments during the gathering on June 7 reminded ConvergenceRI of a cooking class he had developed in Orange, Mass., working with young parents, called “Starting from Scratch,” where cooking lessons were taught by local chefs from the community – and, most importantly, free day care was provided to the mothers who participated in the classes. Would Rhode Island Kids Count or one of the health equity zones consider undertaking such a pilot program, perhaps working in concert with The Genesis Center?

PROVIDENCE – There was a lot to digest at the community conversation hosted by Rhode Island Kids Count to talk about the “Root Causes of Overweight and Obesity” in Rhode Island, held on Wednesday morning, June 7, at Farm Fresh Rhode Island.

The data presented included the latest graphs charting the prevalence of overweight and obesity in Rhode Island children, ages 2 to 17, in 2021.

The numbers weighed in as follows:

• For the entire state of Rhode Island, a combined 39 percent of children ages 2 to 17 were obese [23 percent] and overweight [16 percent] in 2021.

• For the core cities of Central Falls, Pawtucket, Providence, and Woonsocket, a combined 49 percent of children ages 2 to 17 were obese [32 percent] and overweight [18 percent] in 2021.

• When it comes to race and ethnicity, in Rhode Island, Hispanic [50 percent] and Black children [46 percent] are more likely to be overweight and obese, compared to white children [33 percent] in 2021.

• And, not surprisingly, since the onset of the COVID-19 pandemic, the disparities for low-income families and families of color have widened around the measurements of obesity and overweight children in Rhode Island in 2021.

The data project, publication, and public conversation coordinated by Rhode Island Kids Count was supported by Blue Cross & Blue Shield of Rhode Island, with additional financial support provided by the Robert Wood Johnson Foundation.

The sources of data, which were analyzed by the School of Public Health at Brown University, came from the clinical and billing records from KIDSNET, CurrentCare, Blue Cross and Blue Shield of RI, UnitedHealthcare and Tufts Health Plan, collected by the R.I. Department of Health.

Health equity in action
What made this gathering different from most other gatherings was the emphasis on community-driven solutions to address the causes of why children were overweight and obese in Rhode Island, with the discussion led by community partners: Belinda Phillip, Central Providence Health Equity Zone/ONE Neighborhood Builders; Jesus Alaya Figueroa, South Providence Healthy Equity Zone/Family Service of Rhode Island, Liz Moreira, Central Falls Health Equity Zone/LISC, and Michelle Rivera, Progreso Latino.

Translated, it was the community talking with members from health equity zones up front and central to the conversation. Hopefully, the policy makers are listening. [Some of the policy makers attending the session had departed long before the conversation ended, when the discussion had heated up, ConvergenceRI observed.]

The messages, as articulated by a number of the panel members, were direct: “We have the stories that support the data,” and “The stories are the data before it is coded.”

Toward the end of the 90-minute session, one of the panel participants said plaintively: “You can teach the students about nutrition education, but they’re not the ones buying the food.”

A parent and teacher in the audience urged that the messaging to parents needed to be: “It’s not your fault!” And, that the mantra should be: “Meet people where they are at!”

An advocate for more, better recess for students who was attending the session was met with pushback by one of the panelists, who suggested that recess in many schools was a time when many students felt unsafe – and anxiously waited to be let back in their classroom, where they felt more secure.

Food for thought
Given all the attention by Gov. Dan McKee, promoting his new education initiative, “Learn365RI,” targeting out-of-school learning in order to boost attendance and test score performances, the lack of attention on food insecurity seemed like a big, big disconnect, in ConvergenceRI’s opinion.

At a gathering in April in Newport to promote Learn365RI, Gov. McKee said, as reported by RI Current: “This is not instant oatmeal [emphasis added]. It will take time, patience and a focused effort involving the entire community rallying behind our municipal leaders.”

Perhaps it should involve instant oatmeal, given the latest data presented by Rhode Island Kids Count.

Looking at the deep root causes
On the same morning that Rhode Island Kids Count held its community conversation at Farm Fresh Rhode Island, the skies over the Northeast were filled with toxic smoke from the forest fires burning in Canada, creating a tangible warning sign of the dangers of environmental pollution as a result of climate change.

That same morning, on June 7, Dr. Joseph Braun, Ph.D., Professor of Epidemiology at Brown University, and his co-authors released a study, “Associations of Gestational Perfluoroalkyl Substances Exposure with Early Childhood BMI z-Scores and Risk of Overweigh/Obesity: Results from the ECHO Cohorts,” published by Environmental Health Perspectives. The study found that “using data from 8 ECHO cohorts, Liu et al. found that prenatal exposure to higher levels of PFAS was associated with slightly higher BMI z-score and risk of overweight or obesity.

Translated, the environmental consequences of PFAS toxicity in food and water may lead to an increase in the incidence of children being overweight or obese. As reported by The Guardian, ‘Forever chemicals’ exposure can lead to low birth weight and obesity in later life: Children whose mothers are exposed to toxic PFAS can experience a phenomenon previously linked to fetal tobacco smoke exposure.”

In The Guardian story, Braun explained the phenomenon as well as what could be done to mitigate it. “PFAS seem to have a programming effect … that lasted for up to 12 years,” Braun said. Overall, the research found about a 12 percent increase in the likelihood of obesity among PFAS-exposed fetuses.

The Guardian story continued: Those who are exposed can mitigate the effects later in life through regular exercise, Braun said, but it is difficult for mothers to protect themselves and their fetuses because PFAS are so widely used. The US government estimates the chemicals are in 98 percent of Americans’ blood, and they often have long half-lives, so PFAS from an exposure years before a pregnancy could still harm a fetus.

There were steps that people could take to reduce PFAS exposure, Braun explained in The Guardian story: Broadly speaking, people can take some steps to reduce PFAS exposure, Braun said. That includes filtering water – the chemicals are thought to be contaminating drinking water for more than 200 million Americans. Indoor dust is another major exposure route, and using a vacuum cleaner that has a HEPA filter can remove contaminants from the indoor environment, Braun said.

ConvergenceRI shared the most recent data report from Rhode Island Kids Count with Braun, who responded: “I think that there is sufficient evidence to suggest that early life exposure to some environmental pollutants may increase the risk of later life obesity.”

Braun continued: “PFAS are a suspected chemical obesogen because they have a similar chemical structure to fatty acids in our body and have been associated with reduced fetal growth,” he said. “Diet can be a source of exposure to some of these obesogens, including PFAS, either because these chemicals bioaccumulate in the food chain or are used in food processing or food packaging materials.”

Translated, R.I. Attorney General Peter Neronha’s lawsuit against the manufacturers of PFAS takes on even more significance as a way to protect the future health of Rhode Islanders.

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