Practice Spotlight: Judy Hochstadt, MD

Childhood obesity: a growing epidemic
 
When Dr. Judy Hochstadt began to practice medicine in 1982, juvenile diabetes, or type 1, was all she encountered.

"And Grandpa had sugar diabetes," she said, referring to a then-popular term for type 2.

But by the 1990s, grandpa's disease began to show up in the grandkids, and has grown exponentially ever since, Hochstadt said.

"When I started watching my own 8-year-old gain extra weight, that got me completely out of my chair," said Hochstadt, an ACLM member. "I told my partners, 'We don't know how to feed a kid, and my job is going to learn how to feed a kid."

A practicing pediatrician and endocrinologist from Trumbull, Conn., Hochstadt made it her personal quest to find an answer to the problem, beginning with teaching her young patients how to eat right and exercise.

In 2004, Hochstadt, better known in her field as Dr. Judy, founded Healthy Eating Lifestyle Program (HELP) to bring healthy eating habits to the tables of America's youth and their families.

"How to eat healthy should be grass roots, Hochstadt said. "One of my inner city patients took a veggie platter and low-fat dip to a party. He was shocked that the kids ate it. It was his 'eureka' moment.
 
"Families, communities and physicians need to partner together to fix this problem," she added. "What's the expression? It takes a village."

Hochstadt's journey into to pediatric endocrinology began with her internship, residency and fellowship at Yale New Haven Medical Center. Her research at Yale involved working with children and adolescents on the prototype insulin pump.

For 18 years, she ran a Yale satellite diabetes and endocrinology clinic at Bridgeport Hospital, where she witnessed firsthand the emergence of obesity and the type 2 diabetes mellitus epidemic. "Obesity and its related diseases, including type 2 diabetes and cardiovascular disease, is the number one health problem facing our country," said Hochstadt, now a senior attending physician at Bridgeport Hospital, Yale New Haven Health Clinic. "One out of every four children under the age of 17 is overweight or obese. One out of three Caucasian children born today will get diabetes in their lifetime, and worse still, one out of two children of color will face this dreaded diagnosis."



To address the growing need to reverse unhealthy eating and exercise habits in children, Hochstadt began taking HELP outside of her suburban practice to schools, hospitals, rehabilitation centers, even local YMCAs. 

"We teach parents there are many ways to reward a child," she said.

"It doesn't have to be with an Oreo. Try some book time, physical time with an adult, just a simple hug ... reward doesn't have to translate to food."



Hochstadt practices what she preaches at her practice, a mixture of general pediatric health issues and pediatric endocrine problems, including short stature, thyroid and calcium issues, precocious puberty or pubertal delays as well as diabetes. She works with 22 physicians and three nurse practitioners at her office, which serves about 55,000 children a year.
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I love working in the trenches with these kids, and feel an obligation to do the right thing with more than one patient at a time," she said, "advocating for change in the local political arena."

The only childhood endocrinologist in her area, Hochstadt loves to see when her young patients "get it."

"When the tumblers fall into place, it just starts happening," she said. "They start seeing all their health risks reverse. It's a beautiful thing!"

Hochstadt's dream is to be "put out of work," she said.

"No more type 2 diabetes epidemic in our children," she added. "I never want to have another kid have a heart attack at 17."

That patient, she said, died of heart failure.

The upside of her job she said is that, unlike some physicians, she is always paid for her work, and people refer patients to her all the time. Unfortunately, the workshops typically are not covered by insurers, she added.

Various grants and, in part, insurance, cover a portion of the family-based workshops and program outreach. Hochstadt refuses to take a salary, for her workshops and advocacy work, calling her contribution a "give-back" to the community.
Her investment pays off when her young patients turn their lives around.

"Patients all tend to do well while attending a workshop," she said. "Without the team behind them - physicians, nurses, dieticians and nurse practitioners - they tend to lapse a bit. But the relearning rate is a lot faster after attending HELP, as they know what they need to do. It's the practical, life in our obesigenic environment that stumps them."

Hochstadt monitors her patients' risks and ongoing progress by measuring more than just the typical A1C hemoglobin levels.

"Usually we run  comprehensive blood screenng," she said,  looking  at blood chemistries, liver function tests, adrenal and thyroid levels, inflammatory markers, lipid panels ... maybe even a full GTT, with corresponding sugar and insulin levels, to identify where they might be in the prediabetes/diabetes spectrum."

Hochstadt also measures vital signs, neck and waist girths as measures of cardiometabolic risk.

"Many of these patients with a mere 5 to 10 percent weight loss change their metabolic profiles dramatically," she said. "That's an enormous benefit that goes way beyond their health now - it's a giant step in their long-term health."

Just teaching little things helps her patients understand how important and significant their choices are. For example, she teaches teens that the calories in one 20-ounce sugary drink per day over one year can equate to a 25-pound weight gain that year.

"Or not, if they remove that from their diet," she explains. "And that it takes 17 miles of walking/running to lose one measly pound."

People in medicine are trained to fix things quickly, Hochstadt said.

"They don't think of obesity as a chronic relapsing disorder," she said. "There is no quick fix here. The key is not to be judgmental, but to be universally supportive, available and understanding."

But staying the course is not always easy, she added.

"One of the hardest jobs we face going forward is providing healthier lunches at our schools and talking schools out of offering big cookies with 60 grams of fat, soft drinks and other unhealthy snacks," she said.

"Getting the message to the people in control is tough," she added. "But we can't give up."

For her HELP graduates, Hochstadt has successfully altered the kind of school lunches parents send, snacks they buy, even activities they do. She's helped them strategize how to tackle holidays and vacations and how to eat out successfully.

"I'm one of the first waves in the fight on childhood obesity, and I hope to leave a big ripple," she said.

Her "expert" status among her peers she accepts modestly, using it only to reach out to others who want to help stop the rising trend.

Her advice to those considering a career in lifestyle medicine?

"Don't give up or get disheartened," Hochstadt said. "Prevention is the key. I may be a bit of the Marines, because I'm one of the first ones on the beach, but I need the infantry - the Army - behind me."

Hochstadt's second wave is eHELP, an online version of her program now underdevelopment. When completed, eHELP will be accessible to parents and children outside of Southwestern Connecticut.

Hochstadt is a fellow of the American Academy of Pediatrics and holds memberships in the American Association of Clinical Endocrinologists, the Endocrine Society, the American Diabetes Association, and the North American Association for the Study of Obesity. She is also the past president of the Fairfield County, Conn., chapter of the American Diabetes Association.
 
ACLM Disclaimer: Our Practice Spotlights are intended to provide examples of Lifestyle Medicine in practice. We recognize that Lifestyle Medicine practices vary widely, and inclusion in Practice Spotlight is not intended to imply official endorsement of individuals or practices.