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Agents of Change

Meet an Agent of Change – Dr. Patricia Riba Leading the charge in Orange County against childhood obesity and diabetes.

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To most new parents, a roly-poly toddler with "those cheeks" that beg to be pinched is something to smile about.  Babies are supposed to gain weight.  Chubby legs and baby fat are good things, right?  Usually.  But to internationally-known pediatrician and leading authority on childhood nutrition Patricia A. Ronald Riba, M.D., a young child's weight is more than just a measurement of cuteness.    To Dr. Riba, what the youngest in our society eat and how much they weigh are serious medical issues.  In fact, she is devoting her career to the prevention and treatment of overweight and diabetes in children 0-5 years old. "When I first started to practice medicine I would see obese children come into the (Huntington Beach Community) clinic every day.  It was shocking and it was scary.  These children and their families needed help and most did not even realize it.  There was no standardized treatment plans for them, but I knew if we did not get them on a healthy path right away, they were headed for serious trouble down the road.  I had to do something," she explains.     So she founded Orange County's Children's Wellness Program and set out to find funding to reach out to children in trouble and their families so they could be educated about proper nutrition and weight management, and get individualized plans tailored to each child's needs so  things could be turned around.  Proposition 10 funds from the Children & Families Commission of Orange County (CFCOC) was exactly what Dr. Riba needed.  It enabled her to bring her idea to reality, and is keeping Dr. Riba, now the Program's Medical Director, and her amazing multi-disciplinary team of experts working in the community, where they are having an enormous impact.   She calls Prop 10 funding "the wind beneath my wings."   And it's a strong wind. Children and families receiving treatment through the Children's Wellness Program reduce their weight and Body Mass Index (BMI) scores significantly.    63 percent of children who participated in the program from July 2008 to July 2009 showed a statistically significant decrease in BMI.  And almost 3 percent of the children in the overweight and obese category at their initial clinical visit reduced their weight by 10 percent or more.       Impressive as those numbers are, Dr. Riba points out that the Children's Wellness Program "isn't just about weight.  We address barriers to a healthy lifestyle, medical and oral health, physical activity, underlying socioeconomic factors, psychological issues affecting families,developmental factors, and access to medical care." Dr. Riba and her team realized early on that when it comes to healthy nutrition and weight management issues, there is no such thing as a "one size fits all" solution.  They found many families did not even know they had a problem.  Once they did, solutions ranged from encouraging families to eat together, helping with menu planning, to providing refrigeration for fresh foods, to identifying places where food could be cooked if it was impossible to do so at home. "It's amazing," Dr. Riba laments, "The obstacles  that many of my poorest families face in trying to be healthy: not having a refrigerator, access to a kitchen, or pots or pans, coupled with a poor understanding of nutrition and its implications to health." That's what makes her so passionate – some might call her relentless – about her mission, and motivates her to make speeches, write, give interviews, and visit with health care providers, community members and school officials at a pace that is one step short of frantic.    "We have to be out in the community every day, working with children, families, schools and everyone else who has a role.  And sometimes it's an uphill battle.  For example, we get families on the right track at home, and then the kids get chocolate milk at school!  This is an epidemic and it can't just be one doctor with a rallying cry.  We need partners at all levels," Dr. Riba exhorts.      When it comes to enlisting partners, it might be surprising some people to learn that Dr. Riba finds obese parents sometimes make the best partners of all in the battle against childhood overweight and diabetes. Far from resenting a doctor raising issues of healthy weight, BMI, childhood diabetes and proper nutrition, many overweight parents welcome the intervention.  "They tell us they don't want their children to end up like they are, but they don't know what to do to help them." The first thing Dr. Riba tells parents is to take cues from their children.  "When a child is done eating, that means they're full and we should never force or pressure them to eat more.  The child can and should be allowed to decide how much to eat."  She notes that the feeding relationship between parent and child—beginning with breastfeeding – is a key component in healthy nutrition.  Parents are encouraged to shower their children with love at the table and leave the decision of how much to eat up to the child. . She recommends that families "eat and drink like a caveman:" avoid sugary drinks, processed grains, artificial foods, and fruit juice. Offer children a variety of whole grains, fruits, vegetables, proteins, and calcium-rich food, and let them decide if they're going to eat and how much. She cites studies showing that children who skip breakfast are more likely to end up obese than children who eat a good breakfast, and she urges parents not to allow kids to have televisions in their bedrooms. "Some of it may seem like common sense, but we're constantly surprised by how many well-meaning parents do things they genuinely do not realize can harm their children," Dr. Riba says.  "It's all about education. For example, many parents are shocked to find that chocolate milk, sports drinks, 100% juice, and even flavored yogurt are unhealthy options. To educate more families, Dr. Riba believes it is essential for the County's Children's Wellness Program to grow and expand throughout the Orange County community.  Originally a one-family-at-a-time grassroots program with limited reach, thanks to funding from Prop 10, there are now plans for a Children's Wellness Program hub at the new YMCA Aquatics and Wellness Center in Santa Ana, and for the creation of satellite clinics throughout the county.   "A key component in the success of our program is being easily accessible to families.  We've found that we're not as successful in changing family lifestyles if they have to commute to receive services," Dr. Riba notes. Having a positive impact on family lifestyles is what Dr. Riba is all about.  It has been her dream as far back as she can remember.  Originally, though, it was animal families she wanted to help.  At age five she found an injured bird in her back yard and nursed it back to health.  From then on, she was hooked on the idea of helping sick animals and for the next 16 years or so, she planned to become a veterinarian.   But while studying biology and sociology at the University of Southern California, she witnessed a shooting and administered emergency first-aid to the victim, helping to save his life.  That experience changed her forever.  A few days later she told her parents that as much as she loved animals, she felt her true calling was to help people – in particular those she called "underdogs" – those whose socioeconomic circumstances might not offer them access to the care they needed.    After graduation from the University of Southern California, Patricia Riba's journey took her to Boston University School of Medicine, where she earned dual degrees as a Master of Medical Science for the Department of Anatomy and Neurobiology and a Doctor of Medicine.  Then it was back to southern California, where she completed a residency in general pediatrics at Children's Hospital of Orange County.   Before founding the Children's Wellness Program, Dr. Riba served as a Pediatrician for Orangewood / Juvenal Hall, Doctors of Children in Irvine,  Huntington Beach Community Clinic / Alta Med, as well as a consultant in obesity for the Latino Health Access Obesity Program.  Recognized as one of the country's leading experts, she has written and lectured extensively on the subject of childhood obesity and nutrition, and has received numerous awards for her work, including being chosen for the "Healthy Smiles: Hero of Oral Health Award," and now as an "Agent of Change" by the CFCOC.    Accolades and awards don't seem to matter very much to Dr. Riba, nor does she consider herself a hero.  She is laser-focused on her mission.  "This is where I need to be," she says.  "I'm just a pediatrician who saw a need and am doing what I can to help.  Without Prop 10, none of this would have been possible.  We're making children healthier, but we have a lot more to do.  What I ultimately hope to do is make Orange County not just ‘the happiest place on Earth,' but the healthiest place on Earth for children to grow up in.  We're working to create a model here that can be utilized throughout the nation in preventing childhood obesity." To Patricia Riba, doing that is nothing short of essential.  To those who know her, there is no doubt she'll succeed.   So if you're ever in Orange County and notice that a lot of the toddlers there don't have chubby legs, double chins or "must squeeze" cheeks, don't worry.    It's a good thing, and it's all due to a little girl who once nursed an injured bird back to health, and now, as one of the country's most respected pediatricians, works tirelessly every day make sure the youngest in our society start off healthy so one day they can soar, too.

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