Thursday, April 23, 2015

Guest Post: Why This MD Can No Longer Be Called Dr. Dum Dum

Many months ago, pediatrician Kevin Wineinger, reached out to me to let me know of a battle he'd be waging - the battle to change his office's practice of providing lollipops to children following their vaccinations. I asked him if he might take a moment to share his story with you. Reading it, keep in mind the fact that no single raindrop thinks it's responsible for the flood. Here's to one less raindrop.

As a primary care physician with a special interest in tackling obesity, I spend a large portion of my day pointing out the obstacles between my patients and a healthier lifestyle. In the United States, these stumbling blocks are everywhere and often cloaked in legitimacy by people or groups that hold sway over consumer confidence. Say for instance, the placement of a seal of approval by The Academy of Nutrition and Dietetics on a Kraft Singles package. I rant and rave to anyone within earshot when I see this happen in my town or on social media.

Until this fall, I was the pot calling the kettle black. I was a Dum-Dum dealer.

Dum-Dums are a 25-calorie lollipop with a waxy wrapper, paper stick and a host of delightful flavors. Last year, an assortment of Dum-Dums were available at our clinic’s checkout desk and were the reward for many a teary-eyed toddler following their immunization.

The irony of our post-vaccination lollipop dawned on me last summer. In one room, I was passing out tips on how to navigate our obesogenic environment with an adult patient who had diabetes and obesity. In the next room I would counsel a 4 year old’s parents on the importance of food choices at this age.

The growth charts are important and are a component of our discussion regarding food intake, but more importantly you and your family are establishing life-long behaviors pertaining to food.

  -Dr. Kevin Wineinger (that is me) mere seconds before I offered a lollipop if they were brave for their immunizations.

Duh. Wrong message, bad role-modeling. I was sending the signal that tears and sadness could be washed away by junk food.

I knew what I had to do. I was going after the lollipops.

I was ready to support my position of a lollipop-free clinic and prepared for fierce resistance from my colleagues on our Office Improvement Committee. When I had the floor during the meeting, I delivered my request to remove lollipops and replace them with stickers. I was met not by resistance or acceptance, more like ambivalence. Someone suggested we finish out the lollipops already purchased. I offered to buy them. They relented. Motion passed.

After a period of adjustment, our clinic is now lollipop-free and everyone seems happy with their Captain America and Elsa stickers. Our vaccination rates have not plummeted, nor have our patient satisfaction scores. In fact, some parents were happy with the change because the Dum-Dums often made a mess or caused fights between siblings.

Obesity is obviously multi-factorial and studies to identify the effects of small interventions such as lollipop removal will not likely produce significant results. Additionally, many would argue that a 25 calorie treat after a yearly vaccine is a drop in the calorie bucket and has no impact on their long term health. However, this type of reward runs contralateral to many of our recommendations regarding snacks and their usage in behavioral modification. Progress in our march toward a more reasonable food environment will be marked by numerous small victories that seem inconsequential to most people at the time.

Dr. Kevin Wineinger is a Family Medicine physician in Central Indiana, who has set his sights on the 500 calorie snacks and juice drinks passed out to his son’s Little League team after the game. Seriously!?!? You can find him on Twitter!