By: Loren Kalm for Heart1
Dr. Washington is a pediatric cardiologist who has practiced in the Denver area for more than 25 years, recently becoming the first Chief Medical Officer for the Rocky Mountain Hospital for Children. He is a former two term member of the national board of the American Heart Association and received the AHA’s physician of the year award. Dr. Washington serves on numerous national committees including the American Medical Association and the American Academy of Pediatrics among many others. He has been a long time advocate of pediatric obesity prevention and as such, has served as co-chair of American Academy of Pediatrics Task force on Obesity including a position as chair of the AAP Committee on Sports Medicine and Fitness. In 2007, Dr. Washington received the committee’s Thomas E. Shaffer Award, for his lifelong contributions in the field of sports medicine. Dr. Washington is also dedicated to furthering medicine through research and has published more than 60 articles in peer-reviewed journals on pediatric cardiology.
Heart1: One of your biggest focuses has been combating the childhood obesity epidemic. What are some of the biggest health problems that childhood obesity causes later in life?
Dr. Washington: First of all, as the obesity epidemic has really increased over the last 10-15 years, we’re seeing a marked increase in a variety of health problems even in children as young as 5-10 years old. Many people don’t think these problems occur until the children get older, but we’re seeing all of them. The most alarming problem that we’re seeing in children nowadays is type 2 diabetes, which is usually a result of obesity and lifestyle factors and can be just as serious as type 1. There has been probably a 10-fold increase in type 2 diabetes among children, with the vast majority of cases being in children that are overweight. We’re also seeing kids with high blood pressure (hypertension) and high cholesterol, both of which are related to their weight. Other complications which are less common, but equally serious include accumulation of fat in the liver and joint problems of the hip and knee from carrying excess weight. We’re also seeing problems such as depression in kids who are markedly obese, which can interfere with their school function and other activities. All of these are occurring at unprecedented levels in children.
Heart1: Children are often a difficult target audience when it comes to public health reforms. What approaches have you taken to spread the message of the importance of nutrition and exercise to children in particular?
Dr. Washington: There have been a lot of efforts to control childhood obesity, but none of them have been very successful. One example is with schools that have taken soft drinks out of vending machines. A year later they determined that this effort had no effect on children being overweight. What we’re finding is that since obesity is caused by so many different things, we need to treat all of them with the same vigor. While we’re taking soda out of the vending machines, we also need to be increasing physical activity by bringing physical education back into the school. We need to give children less homework at night so they can go out and play instead of going home and doing four or five hours worth of homework. We need to control the size of portions that kids get when they go to fast food restaurants. We need to control the advertising they’re bombarded with when they watch TV. We need to limit their computer time. What I’m getting at is that you have to look at all of these factors when you treat an obese child.
When we see that obese child in a clinical setting, we obviously need to change the family behavior. We can’t tell that family that “we want your child to eat a lot of vegetables and fruit but you can keep eating potato chips and candy and just make the child change.” It has to be a whole family adventure and not just an individual issue and approaching this problem as such is what makes this process work the best. I would submit, however, that we need to approach this as a societal issue as well. We can’t just pick on a family and expect them to solve this problem in a vacuum. It’s very difficult to get an individual child to change their behavior unless you get everyone who surrounds that child to change their behavior. That’s why it has been so difficult to see any headway with the problem
Heart1: One of your big passions is sports. Can you talk about how sports have shaped the definition of exercise in children?
Dr. Washington: More than not in this country, we’re talking about the lack of sports. Twenty or 30 years ago, it was not uncommon for almost every child to go home from school and do something outside whether it was basketball, baseball, or jumping rope.
Nowadays, what has happened as a result of the way we have organized sports is that kids go into organized teams and when they’re young everybody plays. What you find, though is when they get to be 9 or 10 years of age is that they are no longer encouraged to do so unless they’re winners. In soccer, for example, you might have kids divided up into two different leagues. On one hand, you have a competitive team which gets nice bags and they get to travel to play other competitive teams. The kids who don’t make the tryouts for the competitive team get put on a recreational team. The kids think this means that they’re losers and they generally don’t keep up with it very long. Whereas the competitive athlete will continue to play throughout junior high school and high school, the non-competitive athlete will drop out and not do any sports ever again. The society we are growing up in channels activities accordingly.
The only way an obese child in this country will play sports is if he’s an offensive or defensive lineman in football and if you look at those linemen as they grow older, they have all the health problems of an obese person. These are professional athletes who are very unhealthy. The way we have organized sports in this country is that we’re weeding out anybody who is not talented. In Europe, on the other hand, this doesn’t happen as much. Everybody participates in sports and they do so throughout high school.
Heart1: Last year you were appointed as the first Chief Medical Officer of Rocky Mountain Hospital for Children in Denver. How have specialized children’s hospitals of this caliber benefited the community as a whole?
Dr. Washington: Kids are not just small adults. They have different health issues, so the people who care for them need to recognize that. In the Rocky Mountain Hospital for Children, we have specialized nurses who have been trained specifically to deal with sick children and their families. In addition to the nurses, this includes everyone who works at the hospital, from the x-ray technicians to the people who work in the emergency rooms and even the people who empty the trash. This extends to the nutrition choices in our cafeteria and food services. Everything is geared to that sick child and their family. If you go to a non-children’s hospital, you can’t experience that. In addition, all of the x-ray equipment and other devices have to be specifically tailored for kids. Those are some of the advantages of a children’s hospital over a community hospital that does some work with kids.
One of the things we’re doing in Denver, is a bit unique. All of the hospitals affiliated with the Health One hospital system here have been customized so that all the pediatric wards, emergency rooms, and operating rooms are fit to the standards of our children’s hospital. We are actually carving those units out so that they resemble a hospital within a hospital. This means that the nurses and everything else I just mentioned is going to be tailored to that sick child and his or her family.
Heart1: What challenges do pediatric cardiologists in particular face in diagnosis and treatment of a disorder that physicians treating adults don’t have to think about?
Dr. Washington: By the time you get to be an adult, if you have heart disease, it is an acquired disease. In other words, your heart is fundamentally all right for a long period and then it develops an infection or atherosclerosis (hardening of arteries, which can cause a heart attack). In congenital work, meaning you are born with abnormalities, we see children whose heart valves have never formed or one of the chambers of the heart has not developed. Their hearts are defective from birth, which is a completely different set of medical issues in terms of surgical challenges and diagnostic problems, so there is really not much in common between adult cardiology and pediatric cardiology. We wouldn’t be very good at treating someone with a heart attack as an adult cardiologist is not good at diagnosing and treating a child with a defective heart from birth. Nowadays, as pediatric cardiologists we do a much better job than 20 or 30 years ago because of better technology, surgical techniques, and medications. However, we still do have a long ways to go and there are a lot of defects we really don’t do a very good job taking care of.
Heart1: Because pediatric cardiology is a relatively small market, has it ever been a challenge to get medical device manufacturers to respond to the hospital’s needs for child-specific products?
Dr. Washington: Absolutely. Medical device and pharmaceutical companies know that they’re only going to sell a limited number of their products in comparison to the adult world and it becomes a constant challenge to get new technology. This can even include testing equipment such as ultrasound machines, x-ray machines, or CT scans. There are a variety of challenges that small children present and a lot of companies will not endeavor into making those products because they can’t make their money back.
Heart1: If there were one message you could leave readers and patients with today, what would it be?
Dr. Washington: One of the things that this country is still very naïve about is the cost of healthcare. We hear all the time that in this country we spend a lot more money than other countries on healthcare. All you have to do is visit one of those other countries and find out the major differences in what you are receiving in terms of quality of care. If you have a hernia, for example, and the physicians suggest that you get it repaired, you may wait 6 to 9 months in some of these other countries just to get it fixed. If you go to somebody in the United States and you tell them that they need an operation, that person is going to demand it tomorrow rather than waiting 6 months. That’s just an example of the American attitude that we want everything now and we want it paid for. If you go to the emergency room because you have a headache or you passed out, you might demand a CT scan because you want to know every thing there is to possibly know. In other countries they will say that you don’t need a CT scan for this diagnosis and they won’t do it. We’re going to either have to spend a lot more money or change the healthcare that we demand, because there is no way we can do both. That’s a message that we as a country are going to have to painfully come to grips with.