Fernando Mendoza, MD, MPH Professor of Pediatrics Stanford University

1. Training the Future Generation of Minority Scholars in Childhood Obesity: The RAPID model Fernando Mendoza, MD, MPH Professor of Pediatrics Stanford University Fernando Botero

2. Overview • No conflicts of interest in presentation • Training the Next Generation of Childhood Obesity Scholars • Status of obesity in the Americas • Mechanisms of obesity • Obesity research and the challenge to academics • The changing face of obesity research • The challenge of obesity in U.S. minority children • The development of young scholar leaders to meet the challenge.

3. The Epidemic of Childhood Obesity in US

5. Global ObesityHarvard School of Public Health

7. Changing Profile of Malnutrition

8. Physical activity R. Martorell 2003, Emory University The emergence of obesity in developing countries: possible causes Food security & diversity Inexpensive vegetable oils Dietary changes and energy intakes Incomes Exposure to media Eating away from home Economic Development OBESITY Physically demanding jobs Motorization Sedentary recreation Urbanization Opportunities for physical activity

9. Source: http://www.bis.gov.uk/assets/foresight/docs/obesity/17.pdf

10. Source: http://www.bis.gov.uk/assets/foresight/docs/obesity/17.pdf

11. Academic Centers Efforts to Address Complexity of Childhood Obesity • Robinson and Kemby, International Journal of Obesity, 2013 • Biological – Genetic • Physiological • Behavioral • Cultural • Political • Economic • Environmental

12. Robinson & Kemby 2012

13. Changing Face of Research • Multidisciplinary Research • Researchers from a variety of disciplines work together, but have separate questions • Interdisciplinary Research • Researchers interact with the goal of transferring knowledge from one discipline to another. Allows researchers to inform each other’s work and compare individual findings. • Transdisciplinary Research • Collaboration in which exchanging information, altering discipline-specific approaches, sharing resources and integrating disciplines achieves a common scientific goal (Rosenberg 1992)

14. Changing Face of Research • Media • Internet allows for global research • Social media gives access to subjects, research community, and policy makers (e.g. monitoring infectious diseases by CDC, exploring management of chronic diseases in children, and informing policy makers about what matters to their community). • Community access channel networks; allowing for broader community information distribution

15. Changing Face of Research • Advancing Technology • Electronic Medical Records • Every patient can become an opportunity to learn. • Regional and national data will be more accessible for research and policy. • Evidence-based care and standardized patient education can become universal but still adaptive for region. • Web and cellular based • Chronic disease management and behavior modification

16. Changing Face of Technology • “BIG” Data • Logarithmic expansion of data • Combining data sets (genetics, clinical, economic, social determinants, environmental exposures, spending characteristics of populations) • Exploration for new hypotheses leading to new understanding of disease process (e.g.Kodama .. Atul Butte – ethnic pathways to type 2 DM- Diabetes Care June 2013: differences in insulin production and resistance: Africans higher insulin resistance but more production and East Asian the opposite )

17. United States Demographic Change and Childhood Obesity

18. 2009 US Census Projections to 2050 Percent of US Population

20. PERCENTAGE OF CHILDREN AGES 0–17 IN THE UNITED STATES BY RACE AND HISPANIC ORIGIN, 1980–2011 AND PROJECTED 2012–2050 NOTE: The acronym NH refers to non-Hispanic origin. The acronym NHPI refers to the Native Hawaiian and Other Pacific Islander population. Each group represents the non-Hispanic population, with the exception of the Hispanic category itself. Race data from 2000 onward are not directly comparable with data from earlier years. Data on race and Hispanic origin are collected separately. Persons of Hispanic origin may be of any race. Population projections are based on Census 2000 and may not be consistent with the 2010 Census results. SOURCE: U.S. Census Bureau, Decennial Censuses and Population Estimates and Projections.

21. Race: Pediatricians White Asian/Pacific Black/ Hispanic/ Other Islander African Latino Male Female Source: American Academy of Pediatrics, Division of Health Policy Research, Periodic Survey of Fellows #43, 2000

24. Obesity in Mexican-American vs. Mexican Children: 1999-2000(Ogden et al., 2002; Rivera Dommarco et. all, 2002, del Rio-Navarro et. al. 2004) Percent

25. Obesity by generation and ethnic group

26. Social Determinants of CIF CDC Model of Health Social Determinants Poverty Low education levels Race and ethnicity Culture differences Language and Literacy Societal “ISMs” Disenfranchisement from social institutions

27. Challenge for Minority Obesity In US • Minority populations, particularly Latinos, have less access to care and is usually not culturally or linguistically appropriate. • Social determiants are prominent among minorities • Although Affordable Care Act will increase care to minorities, US currently spends 18% of GNP, therefore necessitates efficient care. • Obesity is a chronic disease of genetics, physiology, behavior, environment, and policy; these maybe different for each minority group.

28. How do we train scholars in childhood obesity • Learn best practices in research, clinical care, policy, and advocacy. • Teach flexibility and transdisciplinary thinking • Provide access to mentorship that is expansive; multiple mentors from multiple disciplines and networks • Provide access to a peer network- colleagues • Link with academic leadership and develop young scholar’s leadership abilities

29. Examples of Young Scholars Programs • Robert Wood Johnson Clinical Scholars Program • Multiple national sites with specific research focus • Sites with long track record of research excellence • Strong linkages with academic mentor/ leaders • Extensive peer/alumni network • RWJ Harold Amos Medical Faculty Development Program • Targets URM, Academic network, Peer network

30. Research in Academic Pediatrics Initiative on Diversity (RAPID) • RAPID is a partnership with Academic Pediatric Association and NIDDK • Target young minority investigators • Targets childhood obesity and sickle cell disease • National Advisory Committee of senior scholars • G. Flores (P.I.), F. Mendoza (Co-P.I.), • E. Taveras, R. Perez-Escamilla, B. Caballero, M. Debaum, E. Fuentes-Afflick, J. Wang.

31. Conceptual Framework for RAPIDG. Flores, MD (P.I.) & F. Mendoza, MD, MPH, (Co-P.I.) G. Flores, MD (P.I.) & F. Mendoza, MD, MPH, (Co-P.I.)

32. Next Steps • PAHEF Young Scholars Program • Develop the next generation of scholars to address the epidemic of childhood obesity in the Americas. • Enhance cross border collaboration in addressing child and adult obesity • Facilitate the application of new technology and methodology to address childhood obesity

33. Next Steps • PAHEF Young Scholars • Identify Centers of Excellence • Identify senior mentors and academic networks • Funding of pilot program • Identify targeted activity to address in childhood obesity • Application of technology to treatment • “Big Data” of the Americans to innovate in childhood obesity .