April 10, 2017

Interview with Dr. Kofi Essel, M.D., FAAP: General Academic Pediatrics Fellow at Children’s National Health System

Healthy Homes, Healthy Futures is an obesity-centered home visitation curriculum for pediatric residents at Children’s National Health System. Co-collaborators of the Healthy Homes, Healthy Futures program include: Dr. Kofi Essel, M.D., FAAP, Children’s National Health System; Sirisha Yalamanchi, M.D., Children’s National Health System; and Erin Hysom, R.D.N., M.P.H., Maryland State Department of Education; Cara Lichtenstein, M.D., M.P.H Children’s National Health System.

We chatted with Dr. Essel about the importance of focusing on prevention, the significance of immersion, and how better training for health care providers leads to better care for families.

Q: Why did you choose to focus on obesity prevention? Why is this so important?

A: If we can influence providers — their outlook, their language and confidence, their empathy for and understanding of their patients’ environment and the social-cultural context of obesity — we can become a very important piece of the narrative to prevent and better manage obesity from the clinical setting.

The persistence of obesity stigma in medicine is a huge issue. Through my training, I began to notice, anecdotally, a lack of understanding around nutrition, physical activity and overall frustration in the management of obesity among my peers. This frustration is reinforced by the fact that there’s no quick fix for obesity, and office visits focused on obesity often have very high attrition rates. These concerns are why we created the program and why we focused on obesity and physical activity. Instead of us waiting for our families to come to us, we decided to get out of our comfort zones and go to their home base.

Q: What are the major innovations of your program?

A: When I think about the major takeaways, I think about three key areas. The first, is that formalized medical training has done a poor job equipping the next generation of providers to manage/prevent obesity. We have to do better. This program equips providers to feel more confident and develop realistic strategies to manage obesity. The second is understanding of social-cultural context in managing obesity. Without this context, the work becomes futile. The third is that immersion builds empathy, cultural awareness and awareness of biases. This program takes skills learned in didactic moments and allows for real-world experiences while providing instant feedback from families, colleagues and senior medical providers.

Q: What’s one surprising lesson you’ve learned from this program?

A: One of the most interesting things I learned through our focus groups and discussions is how easily preconceived ideas can shape residents’ outlooks on obesity management. When residents counseled their patients, they often envisioned an ideal home setting — large green spaces in the front and back yards, large tables in the house where families would sit and enjoy meals together, etc. Home visits shattered their preconceived notions and helped them develop more effective strategies for the families they are working with. Instead of saying “this is how you need to do things,” they learned to ask more intentional questions and work alongside their families to empower them to make internal long-term changes.

Q: What’s one piece of advice for other health care provider training and education programs thinking about doing something similar?

A: I would share the words straight from the mouths of our residents: some of them felt very knowledgeable about obesity from their past experiences but didn’t feel confident managing it in a clinical setting. Immersion became the key that enhanced their learning and made it tangible and realistic. My advice is to focus on immersion, which takes learning one step deeper for trainees. Using immersion, we can really influence how the next generation of providers can understand, manage and communicate about the complex disease of obesity from day one.

Q: What’s your hope for the legacy of the program?

A: Locally, I would love for us to get funding and tap in to grant support so we can help families even more. We’ve done this with a lot of support from our residency program but no external, formal funding stream. We would love to have more tools to help families. This curriculum has been published through a peer-reviewed open access publication source known as the MedEd PORTAL, but it’s important for the work to continue to be disseminated more widely. Home visitation programs have been done with other diseases in residency programs all over the country, but the obesity paradigm offers many unchartered opportunities using a chronic disease model. Ultimately, my hope is that the program can influence the national narrative around obesity, build empathy for families, reduce/bring awareness to our own stigma and help providers gain confidence in communicating about and managing obesity through the family context.

Healthy Homes, Healthy Futures is a winner of the 2017 Innovation Award for Health Care Provider Training and Education. To learn more, visit innovatinghealthcare.org