Be Well Kids Clinic

Podcast Transcript

Dr. Scott Steele: Butts and Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Dr. Scott Steele: Hi again, everyone, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And today, we're very pleased to have Dr. Jennifer Brubaker, who is a Certified Nurse Practitioner that specializes in childhood obesity and sleep medicine. She works closely with adolescent bariatric patients and is one of the lead providers of the Be Well Kids Clinic here at the Cleveland Clinic. Dr. Brubaker, welcome to Butts and Guts.

Jennifer Brubaker, PhD, CNP: Thank you, glad to be here.

Dr. Scott Steele: So, we always want to start out with each of our guests by telling us a little bit about yourself. So, where were you born? Where'd you train? How'd it come to the point that you're here at the Cleveland Clinic?

Jennifer Brubaker, PhD, CNP: So, I am born and raised in Cleveland, Ohio, and I've been an employee of the Cleveland Clinic since 1998. My bachelor's degree was from the University of Toledo Medical College of Ohio. I have a master's and a doctoral degree from Case Western Reserve University, also here in Cleveland. I've been working within the Be Well Clinic for probably around the last eight years.

Dr. Scott Steele: Well, we're glad you're here. And today we're going to talk a little bit about the Be Well Kids Clinic. So, to start, could you share an overview of this program with our listeners?

Jennifer Brubaker, PhD, CNP: Sure. So, the Be Well Kids Clinic is a multidisciplinary clinic, and I do think that that is probably the best thing about it. We have several medical providers that are coming in with a variety of different backgrounds. So, we have me as a nurse practitioner. I have experience in sleep medicine, which is where I'm currently working, as well as cardiology and general pediatrics. And then Dr. Shah is one of our sleep medicine physicians. And then we have Christina Fink, who is a pediatric cardiologist, and we are all under the supervision of Dr. Roy Kim, who is our pediatric endocrinologist. So, I think from a medical perspective, we have a great breadth of experience and expertise.

And then, to complement that, we have also several other providers within The Clinic. So, we have our amazing, registered dieticians, who see all of our patients and are skilled in determining their nutritional intake and giving nutrition recommendations. We have an amazing behavioral health team, which is comprised of psychologists, as well as counselors. And then we also have our physical therapy counterparts who do great physical assessments on our patients in assessing their functional capacity and things like that. So, a really broad team that has a great overview of all of our patients.

Dr. Scott Steele: So, let's delve into it a little bit more. What kids are eligible for this program? And you mentioned a little bit, but what are the treatment options that are available?

Jennifer Brubaker, PhD, CNP: So, we can see just about any pediatric patient. Typically, our patients are somewhere between the ages of two and 18 when they enter our program. We do keep patients beyond the age of 18 depending on their medical history and any other significant issues that are going on with them. We offer a large breadth of treatment options. I like to think of Be Well as a lifestyle clinic, where really our aim is to make our patients healthier, to make their families healthier, to really put health at the forefront of their minds. To complement that, if we are struggling, if those lifestyle recommendations are not successful, then we offer a variety of different treatment options, including medically managed diets, weight loss medications, and then bariatric surgery.

Dr. Scott Steele: So, Jennifer, I'm a parent and I'm lucky enough to get my child into the Be Well Clinic. So, what can I expect going through this process? I'm hitting the door, what's my day looking like?

Jennifer Brubaker, PhD, CNP: Okay, so I always like to preempt this with the first visit is a little long. We're working on ways to facilitate the process. But really, truly, in order to make a difference in our patients' lives and to really give appropriate lifestyle recommendations, it's very important that we have a good understanding of what is going on at home, what is going on at school. And so, it may be overwhelming for patients and families to be in a two-hour clinic visit, but that's about our average - it's two hours.

Now, during those two hours, you're going to see at least three or four healthcare providers. So, it is constantly moving and changing. So, I think that at least helps us to keep our patients' attention. But we start with a medical evaluation. So, my medical colleagues and I are looking for any medical issues that your child may be faced with, and that may be things that you come in knowing that they're an issue or that may be things you had no idea where an issue. And I think each of us brings our own perspective. So, we're really trying to get into the nitty-gritty and understand what's going on.

Then the next step would be a nutrition evaluation, and that's a 24-hour in-the-details assessment of what your child is eating, how they're eating, where they're eating, if there are any concerning eating behaviors going on, for example, like food sneaking or bored or emotional eating, if there's any concern about unhealthy eating habits, like vomiting or purging. And then we would spend a lot of time giving recommendations based on that assessment.

The next thing we would do is a physical assessment. And this is done by our physical therapy colleagues, and we are using a variety of different methods to assess your child's fitness status. For their functional abilities, we use something called "The Bot," which is an objective, standardized assessment of their functional strength. And then we also do something that's called a "Six-Minute Walk Test," where we're trying to get an idea of what their cardiovascular function looks like. These are abbreviated tests; it doesn't take a long time. So, each section of this visit is around a half hour.

And then we like to wrap up with our behavioral medicine colleagues. Their job is to assess any psychological concerns or issues that you may have or that your child may have. And then I also think probably one of the best and most important things that they focus on is goal setting. So, we try to have the behavioral medicine piece towards the end of the visit because they really do a nice job in helping families to prioritize the various recommendations that they've been given throughout this visit. And they also are really helpful for parents to help them figure out how to put the recommendations that they've been given into practice in their homes. So, I always say the things that we are talking about are not necessarily rocket science, sometimes the recommendation is very simple. But it's very easy for me as a healthcare provider to say, "Don't allow your child to eat junk food or fast food." But as a parent, that's not always the easiest thing to do in your everyday life. And so, I think our behavioral med colleagues do a really great job of helping parents troubleshoot. And some of that is preemptive, like what to expect. If you tell a parent something and they say, "Oh, my kid is never going to do that." Then we want to spend some time with them, giving them ideas of how to get around those potential roadblocks.

Dr. Scott Steele: That's fantastic. It also sounds like this same program could be used for adults, as well. So, truth or myth: teenagers with serious medical complications and a severely elevated body mass index may qualify for weight loss surgery?

Jennifer Brubaker, PhD, CNP: So that is 100 percent true. I think we want to make sure that we have attempted some of the other options, and we may not go immediately to bariatric surgery unless there's a medical reason to do so. But yes, many, many teenagers do qualify for bariatric surgery, and that is becoming, I think, more and more commonplace as we understand the data better. But yes, we do refer patients for bariatric surgery.

Dr. Scott Steele: So, you talked a little bit earlier about the role of the family. So, can you talk a little bit about how a parent can help their overweight child lose weight?

Jennifer Brubaker, PhD, CNP: Sure. So, I think prevention is my end goal at any point. I think if we can avoid excess weight gain, unhealthy habits, before they become a medical problem, we are really doing our children the best service as parents. If we have ended up here one way or the other, I think you want to be supportive without being judgmental. I think you want to be a good role model. So oftentimes, we'll hear or see where parents are saying to their kids, "Well, don't eat that," or "Don't drink that." And then maybe doing exactly that same thing in front of their child. And that gives a really mixed message to the kids, "Well, if my parents can do it, why can't I?" So, I think modeling healthy behaviors is really, really important.

And then I think being a resource where your child is comfortable coming to you with their particular concerns and just knowing that they have your support and that you're going to help them. And maybe that best help is to get them to a multidisciplinary clinic because, I always say, a parent and I may say the same thing, but it sounds different to the child coming out of my mouth because I am not in their house every day. And so, I think bringing them to a medical provider or behavioral health provider, nutritionist or physical therapist might be the best thing that you can do as a parent.

Dr. Scott Steele: You brought up a very good point earlier in saying that we want weight loss to be healthy and in healthy ways, and not just lose weight to lose weight. So, can you talk about the "why" behind weight loss?

Jennifer Brubaker, PhD, CNP: Sure. So, I think weight is a part of the equation, it's not the only factor that we look at in Be Well. We tend to use body mass index as our marker of health. But I always say, I'm less concerned about the number on the scale than I am about the healthy behaviors that are being done. So, I would rather have a patient carrying a little bit of excess weight but following through on the recommendations of getting 60 minutes of exercise every day, eating five servings of fruits and vegetables. So, I think we don't want to just focus on the number. If your child has medical problems related to carrying excess weight, then the data shows that reducing your weight can decrease your risk of cardiovascular disease or heart disease, stroke, diabetes, high cholesterol, things like that. And my goal is to get these patients to adulthood without having any of those problems. So, if a child comes to me and they have a high cholesterol level and they're eating a lot of fast food or unhealthy foods, then I think you're really doing them a service by educating them on what may happen in the future, and trying to get them to eat more healthy foods, more vegetables, drink more water, etc. so that they don't have to deal with that when they're an adult.

Dr. Scott Steele: So, are there any advancements on the horizon for the Be Well Kids Clinic or in general treating children with childhood obesity?

Jennifer Brubaker, PhD, CNP: So, I think in my career in Be Well, we have really recently seen a big increase in the use of medications. Pediatrics, we're always the last to the game with medications because we need to know that they're safe in adults first. But very recently, some of those weight loss medicines that have been used in adults for many years are starting to trickle down into pediatrics. So, I think that that's a great thing for our kids who are really struggling. Bariatric surgery has really exploded onto the scene as a safe way to reduce excess weight and to decrease medical illnesses for our older teenage population. So, I think both of those things have been really helpful for us. We are always looking at different diets and different ways to exercise and things like that, as far as lifestyle recommendations go. But definitely, we've seen an increase in medication use and surgery in pediatrics.

Dr. Scott Steele: Well, that's fantastic. And so now it's time for our quick hitters where we get to know you a little bit better. So first of all, what's your favorite food?

Jennifer Brubaker, PhD, CNP: My favorite food is probably pizza. Interestingly, my daughter says that it's salad. So, I feel like that made me feel good. She had to write that on something for school, and I laughed to myself. But I think I eat salad a lot because it's a healthy thing to do. But as far as enjoyment goes, I do enjoy a good piece of pizza.

Dr. Scott Steele: Fantastic. What is your favorite TV show?

Jennifer Brubaker, PhD, CNP: I am a nurse practitioner, my favorite TV show currently is Call the Midwife. I like the medical history in that.

Dr. Scott Steele: Have not yet seen that one. What's your favorite book of all time?

Jennifer Brubaker, PhD, CNP: There is a book called The Alchemist. That was one of my favorites. It's a short read.

Dr. Scott Steele: Yeah, absolutely. And so finally, what's a place on your bucket list in terms of travel?

Jennifer Brubaker, PhD, CNP: Oh, definitely New Zealand, 100 percent. I can't wait to go.

Dr. Scott Steele: Well, I hope you can make it there one day. So, what's a final take-home message for our listeners in regard to either childhood obesity or the Be Well Kids Clinic?

Jennifer Brubaker, PhD, CNP: I always tell my patients that the United States is not the healthiest place. We have all of the resources to be healthy, but it's very hard to be healthy in the United States. And so, I like to tell my patients, "We have to be on the defense." We've got to prepare our kids to say no to things that may be marketed to them or that they may see all of the time in their communities. And it's hard to do that on a day-to-day basis. So, I think you should reach out for support, be that any of the individual providers that are in the Be Well Clinic or to us as the Be Well Clinic as a whole, because it's hard, it's hard work, and it's difficult to navigate the medical system because it is so complex. Don't give up. I feel like there's this myth that you have to be perfect every day, you have to eat healthy, drink your eight glasses of water, exercise 60 minutes every day. And in reality, that doesn't happen. And when it doesn't happen, don't give up and just say, "Well, I can't do it." I think we can always be healthier every day in small ways. And so, if you're always on the lookout for healthy choices, then you're probably ahead of the game.

Dr. Scott Steele: Super. So, to learn more about the Be Well Kids Clinic, call Cleveland Clinic Children's at 216-444-5437. That's 216-444-5437. You can also visit our website at clevelandclinicchildren's.org/bewellclinic. That's clevelandclinicchildren's.org/bewellclinic. Dr. Brubaker, thanks so much for joining us on Butts and Guts.

Jennifer Brubaker, PhD, CNP: All right. Thank you for having me.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts and Guts.