Caren Vance, MD, FAAP & Miriam Rhew, MD, MPH, FAAP


As pediatricians for 20 years in our respective community based private pediatric practices with populations that are primarily publicly insured, we see patients every day like Sara who come in with an elevated body mass index (BMI) that has continued to increase over time (particularly during the pandemic) whose single mother is working so while there are foods from the food bank at home, she chooses to have a bag of Cheetos, a ham sandwich, and chocolate milk for dinner.  We see patients like Jamal who is afraid to leave the house because his brother was shot in the driveway last year and spends most of his time looking at screens to distract him when he is feeling anxious while both his parents are working.  We see patients like Kamila who is a refugee from Afghanistan and now lives in a neighborhood where it is much easier to grab a fast food meal with a soda rather than fresh produce.    We are tasked in 30 minutes, to try to educate and motivate patients to “eat more fruits and vegetables and eat less sugar” or “exercise daily and go outside” or “be more mindful”.  However, without providing our patients and their families with executable skills and practical knowledge, and without changing their mindset to feel empowered to change, we find ourselves repeating these recommendations at every visit without effect.  Inevitably, there is a progressive decline in their health as they move through adolescence.  To address the epidemic of unhealthy lifestyle often presenting as obesity, we hope to develop an online group health visit for primary care pediatric offices. We will teach young adolescents struggling with obesity skills to create inexpensive plant-forward meals, to incorporate joyful movement into daily life, to practice mindfulness and stress reduction techniques.  The treatment model is based on coaching, connection, motivation and accountability.  The goal is to make these foundational health behaviors habits for their lifetime.    We plan to do this in partnership with Open Source Wellness (OSW) in Alameda County. Open Source Wellness is a “Community and Behavioral Pharmacy dedicated to experientially facilitating and making enjoyable and sustainable the practices (behaviors) underlying well being” in the areas of nutrition, exercise, mindfulness, and connection.  They are currently working  with several federally qualified health centers (FQHCs) and have demonstrated improvement in mental health, blood pressure, increased minutes of exercise, and intake of fruits/vegetables for adult populations they serve. Their community partners include the Hayward Police Department and Dig Deep Farms, a regenerative urban farm that provides the bulk of the produce for each FQHC’s Food Farmacy.  We are in discussion with their founder,  Elizabeth Markle, to co-create a pediatric version for private offices such as ours, as well as expand their ability to share the pediatric model with FQHCs in a way that is sustainable, thereby reaching even more of the vulnerable families in our community.


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