WHEN GREAT MINDS COL­LAB­O­RATE THE BIG QUES­TIONS ARE AN­SWERED

Dr. Grace O’Mal­ley, StAR Re­search Lec­turer at the Di­vi­sion of Population Health Sciences at RCSI (Royal Col­lege of Sur­geons in Ire­land) and prac­tic­ing Char­tered Phys­io­ther­a­pist dis­cusses CHILD­HOOD OBE­SITY, and the ben­e­fits of col­lab­o­rat­ing na­tion­ally and

THE (Times Higher Education) - - NEWS -

Child­hood obe­sity is recog­nised as a pub­lic health epi­demic with more than 380 mil­lion chil­dren clas­si­fied as over­weight or obese glob­ally. There are 41 mil­lion chil­dren world­wide with clin­i­cal obe­sity and an es­ti­mated 70,000 chil­dren and ado­les­cents with this con­di­tion in Ire­land. The hu­man body’s in­cred­i­ble abil­ity to store fat in each and ev­ery tis­sue has fa­cil­i­tated our sur­vival, how­ever that same abil­ity has led to an in­crease in obe­sity-re­lated health prob­lems. When fat cells ac­cu­mu­late in the body’s tis­sues and or­gans they interfere with how those or­gans func­tion and can lead to early heart dis­ease, mus­cu­loskele­tal prob­lems, res­pi­ra­tory dif­fi­cul­ties, high blood pres­sure and a myr­iad other co-mor­bidi­ties in child­hood. In turn, the child is at in­creased risk of de­vel­op­ing adult chronic dis­eases like type 2 di­a­betes, heart dis­ease and many can­cers. The fo­cus of my re­search to date is on those chil­dren with clin­i­cal obe­sity. I have at­tempted to gain an un­der­stand­ing of the eti­ol­ogy of child­hood obe­sity and as­so­ci­ated co-mor­bidi­ties in ad­di­tion to the de­vel­op­ment and eval­u­a­tion of in­ter­ven­tions to treat the con­di­tion in chil­dren and ado­les­cents. The over­ar­ch­ing aim is to im­prove the health of the child while pos­si­bly in­flu­enc­ing the early de­vel­op­ment of adult dis­ease. The fac­tors lead­ing to child­hood obe­sity are mul­ti­fac­to­rial in ori­gin and en­com­pass: bi­ol­ogy, phys­i­ol­ogy and be­havioural psy­chol­ogy at an in­di­vid­ual level; fam­ily and neigh­bour­hood func­tion­ing at a com­mu­nity level; and epi­ge­net­ics, so­cial psy­chol­ogy and eco­nom­ics at a so­ci­etal level. As a prac­tic­ing phys­io­ther­a­pist I am greatly in­ter­ested in the World Health Or­gan­i­sa­tions International Clas­si­fi­ca­tion of Func­tion­ing, Dis­abil­ity and Health (WHO ICF). Ap­proach­ing re­search with this model in mind en­sures that the work is al­ways child-cen­tred and has helped me to fo­cus my in­ter­ests on how the body’s struc­tures and func­tions (e.g. tis­sues and phys­i­o­log­i­cal func­tion­ing) af­fect ac­tiv­ity (e.g. walk­ing, jump­ing, run­ning) and par­tic­i­pa­tion (e.g. go­ing to school, play­ing). In my ini­tial work as a re­search clin­i­cian, I in­ves­ti­gated the pres­ence and pre­sen­ta­tion of musu­closkele­tal and car­diores­pi­ra­tory co-mor­bidi­ties in chil­dren at­tend­ing clin­i­cal obe­sity ser­vices in Ire­land. This work built on ev­i­dence de­scrib­ing the dele­te­ri­ous ef­fect of ac­cu­mu­lated fat tis­sue on de­vel­op­ing bone and mus­cle in ad­di­tion to the im­pact on the func­tional health of the child (im­paired mo­tor skill, mus­cle strength and ex­er­cise ca­pac­ity). There­after a Ful­bright award al­lowed me to travel to the USA to ex­plore the car­diometabolic prob­lems that can de­velop when a child is clin­i­cally obese and in par­tic­u­lar the patho­phys­i­ol­ogy of in­sulin re­sis­tance and type-2 di­a­betes in ado­les­cent obe­sity. Dur­ing my time in the US I de­vel­oped a greater in­ter­est in the need to ad­dress obe­sity at a population level and in par­tic­u­lar how en­vi­ron­men­tal in­flu­ences can af­fect nu­tri­tion and weight. I was lucky to ex­pe­ri­ence first hand the im­pact of food avail­abil­ity on food choice. I had to travel over 4 miles (1.6 km) in or­der to ac­cess fresh veg­eta­bles whereas I had ac­cess to over 10 fast food out­lets and cor­ner stores stock­ing en­ergy-dense foods within 0.2 miles (350 me­tres) of my apart­ment. I also nur­tured a grow­ing in­ter­est in be­havioural eco­nom­ics and how both in­cen­tives (e.g. be­ing able to par­tic­i­pate in fun play or ac­tiv­ity at work) and dis-in­cen­tives (e.g. a tax on sugar-sweet­ened drinks) can af­fect hu­man be­hav­iour and po­ten­tially influence health out­comes. I no­ticed how smart­phones had in­creased in pop­u­lar­ity and the fields of con­nected health and mo­bile health were be­com­ing more re­al­is­tic as modes of de­liv­ery for per­son­alised health in­ter­ven­tions. I re­turned to Ire­land with the aim of merg­ing my grow­ing un­der­stand­ing of the ef­fects of obe­sity on the in­di­vid­ual with a ba­sic in­ter­est in en­vi­ron­men­tal de­ter­mi­nants of obe­sity, con­nected health, nudge the­ory and how in­cen­tives and dis­in­cen­tives might af­fect be­hav­iour change and influence health out­comes. This re­search has led to an in­crease in pub­lic dis­cus­sion around the im­por­tance of ad­dress­ing child­hood obe­sity and the re­spon­si­bil­ity of so­ci­ety to safe­guard the health of chil­dren. Sim­i­larly, I have lever­aged ad­di­tional fund­ing which led to the es­tab­lish­ment of a mul­ti­dis­ci­plinary clin­i­cal ser­vice for child and ado­les­cent obe­sity at Tem­ple Street Chil­dren’s Univer­sity Hos­pi­tal, an RCSI teach­ing hos­pi­tal. This ser­vice has fa­cil­i­tated im­prove­ments in the qual­ity and re­spon­sive­ness of the pae­di­atric health­care sys­tem to the chal­lenge of clin­i­cal obe­sity in child­hood. In turn, this has im­proved ac­cess for chil­dren to ev­i­dence-based care and has a pos­i­tive im­pact on the health and well­be­ing of users of the clin­i­cal ser­vice. I have been lucky to col­lab­o­rate and learn from many skilled and pas­sion­ate sci­en­tists, clin­i­cians, ed­u­ca­tors, par­ents, pa­tients, tech­nol­o­gists, economists, non­govern­men­tal or­gan­i­sa­tion, pol­icy mak­ers and politi­cians. Us­ing the WHO ICF model as a lens through which to de­velop and carry out my re­search, I have con­nected and worked di­rectly with mul­ti­ple individuals and or­gan­i­sa­tions na­tion­ally and in­ter­na­tion­ally. Each col­lab­o­ra­tor has brought dis­tinct skills and strengths. Such di­ver­sity of back­ground in­evitably brings chal­lenges around com­mu­ni­ca­tion, agenda and method of work­ing how­ever, by fo­cus­ing con­stantly on the needs and rights of chil­dren I have found that chal­lenges can be over­come or re-con­tex­tu­alised! I re­ally do believe in the idea that if you want to go fast, go alone but if you want to go far, go to­gether. For me, this phrase en­cap­su­lates the im­por­tance of col­lab­o­ra­tive re­search in or­der to af­fect sus­tain­able im­prove­ment to child health. In turn, col­lab­o­rat­ing with those who are dif­fer­ent to me, with vary­ing ex­pe­ri­ence and cultural back­ground en­riched me not only as a re­searcher but as a hu­man. Grow­ing re­la­tion­ships with international col­leagues has led to in­creased un­der­stand­ing of how so­cial sys­tems and cultural norms can af­fect health, how vary­ing health­care sys­tems re­spond and how gov­ern­men­tal pol­icy, ac­tion or in­deed in­ac­tion can safe­guard or threaten the health of cit­i­zens. These pro­fes­sional and per­sonal re­la­tion­ships have led to in­vig­o­rat­ing con­ver­sa­tions and a number of joint fund­ing ap­pli­ca­tions. Re­cently my col­lab­o­ra­tors and I have de­vel­oped a pack­age of re­search to ad­dress the use of big data in mon­i­tor­ing the en­vi­ron­men­tal driv­ers of child­hood obe­sity. In ad­di­tion, we are de­vel­op­ing a se­ries of projects to eval­u­ate how sugar-sweet­ened drinks taxes influence the con­sump­tion of sug­ar­sweet­ened drinks and what meth­ods can be used to eval­u­ate the ef­fect of such dis­in­cen­tives. Dr. Grace O’Mal­ley was ap­pointed as StAR Re­search Lec­turer (ORCID 0000-0002-2421-3866) at RCSI in 2017. RCSI’s Strate­gic Aca­demic Re­cruit­ment (StAR) Pro­gramme is an am­bi­tious ini­tia­tive to ac­cel­er­ate the de­liv­ery of in­no­va­tive, im­pact­ful re­search in the health sciences across a range of ground­break­ing work in­clud­ing the cre­ation of novel med­i­cal de­vices and the de­vel­op­ment of new ther­a­peu­tics and new di­ag­nos­tic tests. Backed by sig­nif­i­cant in­vest­ment, the ul­ti­mate ob­jec­tive of StAR is to trans­fer im­pact­ful re­search dis­cov­er­ies more quickly to clin­i­cal prac­tice for the ben­e­fit of pa­tients. RCSI is an international not-for-profit Univer­sity of Medicine & Health Sciences, with its head­quar­ters in Dublin, fo­cused on ed­u­ca­tion and re­search to drive im­prove­ments in hu­man health world­wide.

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