Dr. Marquita Lyons-Smith has spent over two decades in pediatric healthcare, starting on daycare floors and in neonatal intensive care units before settling into primary care. There, she found herself asking a question that would shape the rest of her career. Why were so many children in underserved communities struggling with obesity, and what was nobody doing about it?
A pediatric nurse practitioner, nurse educator, and academic leader at North Carolina Central University, she now leads the Health Administration Program at NCCU while running a reverse mentoring program that is rewriting how students and faculty connect.
What inspired you to focus on childhood obesity prevention and management in your work?
I’ve always loved working with kids, starting with working in daycare, and then starting as a nurse in a NICU. When I started in primary care, I was serving mostly the underserved, a lot of Hispanic patients, a lot of Black patients. I noticed an increased number of patients with high BMIs. I wanted to figure out, was there a gap in our education, the way we’re talking to patients? What can we do to help the underserved and somehow reduce the trend.
What are some of the biggest risk factors for childhood obesity that you see in your practice?
Some of the risk factors are social determinants of health, where they live, some of the decisions that their parents make, some of the decisions that are made when they’re younger, access to fresh fruits and vegetables, whether or not they’re living in food deserts, whether or not they have the education and the information about long-term problems, whether it’s financial, emotional, or physical, that can happen because of eating habits.
Even though we know it’s not all just about choices, we do know that those are some of the things that we can work on, along with some of the other issues that are not in our control.
From a clinician’s standpoint, why is prevention important when it comes to childhood obesity?
Prevention is important because there’s so much information out there about things that happen when we’re young that can affect us long-term. Some of the microorganisms that are in our intestines are so vulnerable when we’re young to hold on to calories because of the imbalance of those microorganisms. We have to control what those organisms do by learning how to diversify our microorganisms that will metabolize our food better, and not hold on to those calories by making sure that we eat in a way that will cause this to happen.
In infancy, we do want to encourage breastfeeding. We also want to make sure they don’t introduce sugary foods too early, because all of these things can set up our children for having difficulties later on in life. Prevention is also important because the habits that we establish when we are young are oftentimes the ones that we hold onto as we get older. And it also gets more and more expensive over time, because these are habits that are very difficult to break.
How do you partner with families to create sustainable health behavior changes?
Part of my DNP project was to intentionally implement motivational interviewing when discussing childhood obesity in the primary care setting, partnering with some of my colleagues to make sure that when we go into the room and we’re talking to the patients, that this is a collaborative effort.
This isn’t unidirectional, where I come in and say, “this is what I feel like you should do, and when you come back for your next appointment, give me proof that you’ve done it.” That’s not very effective. What we’ve done intentionally is say, “hey, what’s a small win for you?” “What do you see as a concern here?” “If I have a list of things that can help you, what do you feel like is something that you can definitely accomplish?”
We try to offer open-ended questions to get a buy-in of the parents as well as the children. I have found a lot of success with that, because the kids are excited to come back and say, “I did what I said I was going to do.”
As a nurse educator, how are you preparing future healthcare professionals to address childhood obesity with compassion and empathy?
The same thing that I practice, I make sure to discuss with students at our precept meeting. I have nurse practitioner students that come to my site. We’ll have UNC, Chapel Hill, and Duke University nurse practitioner students come in with me when I do my visits with kids that are living with obesity. I make sure that they understand motivational interviewing, I make sure they understand checking their biases at the door, I make sure they understand that obesity is a social, environmental, genetic type of issue. It’s not something that is necessarily just a choice.
You have a reverse mentoring program. Can you tell us what it is?
There’s untapped knowledge that we have from our students. There are so many things that students have to offer, and we don’t necessarily tap into it, because as educators, we’re so focused on what we can give them. There’s also a widening gap between what we’re teaching and how students want to learn. Reverse mentoring empowers the student to inform and instruct the professor.
We have mentors and mentees that are placed together, matched together, and over a course of 8 weeks, we have intentional meetings where the student comes in empowered as the teacher and says, “hey, I’m going to teach you about social media today.” “I’m going to teach you about some technological skills that I feel like would work well in the classroom if you implemented them.”
In exchange, the professor can offer leadership skills, professionalism, things that the student wants to learn from the professor. This improves engagement between the different generations and helps the professor to understand the student better. We expect this is going to drop failure rates and improve morale, because that’s where we kind of began, seeing that there was a decrease in morale, especially after COVID and with the increase in the use of AI tools.
What is one message you want parents or healthcare providers to hear about childhood obesity prevention?
I want parents to know that this is something that starts early. How you feed your infant is going to affect them long-term. The choices that you make in that moment after birth matter. If you know there are some changes you want to make with your child, don’t wait for the provider to bring it up. This is something that should be mentioned at every single well child visit, but you don’t have to wait on the provider to do so.
If the provider is giving you information and it is not palatable the way they’re presenting it to you, sometimes you have to fire the provider, because you should not feel shamed, and your child should not feel ashamed in talking about something that is multi-layered.
As far as the providers, I want clinicians to check their biases at the door, and to remember all of the different dynamics that go into the problem of obesity, and being careful with the language that we use. It’s the child living with obesity, or a child who has obesity, not obese child.
Clinicians also need to make sure they’re intentional about this with every single visit, treating it as prevention, and when we get to a management piece, that part has to be managed with care. The American Academy of Pediatrics reminds us that we need to take a multidisciplinary approach, so that we can prevent worsening risk factors and a worsening future for our patients because of clinician neglect.
To connect with Dr. Lyons-Smith or learn more about her work in pediatric health, education, and community wellness, reach her by email at [email protected].