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
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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