Engaging the Oral Health Community in Childhood Obesity Prevention

National Conference— Executive Summary

Supported by the Robert Wood Johnson Foundation

November 3–4, 2016Georgetown University, Washington, DC

Holt K, Tinanoff N, Garcia RI, Kleinman D, Battrell A, Casamassimo P, Grover J. 2017. Healthy Futures: Engaging the Oral Health Community in Childhood Obesity Prevention National Conference—Executive Summary. Washington, DC: National Maternal and Child Oral Health Resource Center.

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National Maternal and Child Oral Health Resource CenterGeorgetown University Box 571272Washington, DC 20057-1272(202) 784-9771E-mail: OHRCinfo@georgetown.eduWebsite: www.mchoralhealth.org

EXECUTIVE SUMMARY 3

Introduction

C hildhood obesity is a major public health

problem in the United States1,2 and glob-

ally.3 Obesity is associated with and represents

risk factors for a number of chronic diseases

across the life span. The causes of childhood

obesity are multifactorial and include genet-

ic, environmental, lifestyle, and nutritional

variables. Between the 1970s and 2012, the

prevalence of obesity rose from 5 percent to

8.4 percent in children ages 2 to 5 and from

6.5 percent to 17.7 percent in children ages 6

to 11 in the United States.4 Childhood obesity

has both immediate and long-term effects on

health and well-being. The increasing num-

ber of children who are obese has led fed-

eral policymakers to rank childhood obesity

as a critical health threat. Children who are

obese are likely to be obese as adults and

therefore, compared with children who are

not obese, are at higher risk for adult health

problems such as heart disease, type 2 dia-

betes, stroke, several types of cancer, and

osteoarthritis.5

An association between childhood obesity

and dental caries, the most prevalent disease

of childhood, has been suggested by sever-

al studies.6 Dental caries is also caused by a

combination of factors, including cariogenic

diet (especially sugar consumption), inade-

quate fluoride exposure, a susceptible host,

and the presence of caries-causing bacteria in

the oral cavity, which interact with a variety of

social, cultural, and behavioral factors.7 Twenty-

three percent of children ages 2 to 5 in the

United States have experienced dental caries.8

One explanation for the association between

childhood obesity and dental caries is based

on the rationale that frequent consumption of

sugar-sweetened beverages (SSBs) and foods

are common risk factors. Many foods and bev-

erages that children consume have substantial

amounts of sugar, and even a single serv-

ing can exceed the daily sugar consumption

recommendation for children.9 In light of this,

the association reported between body mass

index, a weight-to-height ratio, and dental car-

ies risk in children6 points to the value of using

interdisciplinary approaches in health promo-

tion and disease prevention to address the

common risk factors. Multiple approaches are

necessary to meet the challenge of childhood

obesity, and health professionals of all types

have roles to play.

4 HEALTHY FUTURES4 HEALTHY FUTURES

Robert Wood Johnson Foundation Efforts

For more than a decade, the Robert Wood

Johnson Foundation (RWJF) has worked to

advance public policy and industry practic-

es and improve community environments to

ensure that all children have healthy weights,

which contributes to a better quality of life. The

efforts of RWJF have resulted in several nota-

ble developments, including the replacement

of sugar-sweetened foods and beverages

with healthier options in school cafeterias and

vending machines. RWJF has also advocated

for requiring food and beverage companies to

clearly indicate the amount of added sugars on

the labels of packaged items.

Conference Overview

Another manifestation of RWJF’s efforts to

promote healthy weight in children was its

support of the Healthy Futures: Engaging the

Oral Health Community in Childhood Obesity

Prevention National Conference, held on No-

vember 3–4, 2016, at Georgetown University in

Washington, DC. The conference aligned with

two RWJF goals: (1) to eliminate young chil-

dren’s consumption of SSBs and (2) to ensure

that children enter kindergarten at a healthy

weight.

The 2-day conference was coordinated by

five national organizations: the National Ma-

ternal and Child Oral Health Resource Center,

the American Academy of Pediatric Dentistry

(AAPD), the American Dental Association,

the American Dental Hygienists’ Association

(ADHA), and the Santa Fe Group. In addition,

conference planning benefitted from valuable

assistance from the project’s multidisciplinary

advisory committee, which consisted of repre-

sentatives from 19 federal agencies and na-

tional organizations.

The aim of the conference was to increase

awareness of evidence-based recommen-

dations; identify strategies; and promote

EXECUTIVE SUMMARY 5

collaboration efforts that oral health profes-

sionals, oral-health-related organizations, and

others can employ to prevent obesity in chil-

dren under age 12. The conference addressed

the following goals:

• Increase understanding of the science

focusing on oral health and childhood

obesity.

• Increase understanding of strategies that

oral health professionals and organizations

can use to prevent childhood obesity.

• Increase understanding of how the oral

health community can work with other health

professionals and organizations to prevent

childhood obesity.

• Provide opportunities for networking and de-

veloping relationships to identify strategies

to prevent childhood obesity.

About 125 individuals attended the confer-

ence, which encompassed a broad spectrum

of health professionals (dentistry, medicine,

nursing, nutrition), representatives from

oral-health-related and other organizations,

and experts in childhood obesity and oral

conditions.

Before the conference, a series of background

papers was commissioned; these papers

included systematic or scoping reviews of the

scientific literature designed to examine (1) the

state of the science related to preventing

childhood obesity, (2) the state of the science

related to reducing children’s consumption

of SSBs or in some cases sugar-containing

beverages (SCBs), and (3) strategies that could

be employed by oral health professionals and

organizations and others to prevent childhood

obesity. In addition, national surveys were

conducted by AAPD and ADHA to obtain in-

formation about pediatric dentists’ and dental

hygienists’ knowledge, skills, and attitudes

related to childhood obesity. Additionally, the

surveys explored oral health professionals’

interest in and likelihood of adopting clinical

practices to identify children who are at risk

for obesity or who are obese, inform parents

about risk, and provide referrals for these chil-

dren to obtain additional care.

6 HEALTHY FUTURES

Conference Agenda and Key Findings

The conference began with a keynote presen-

tation by Margo G. Wootan, who spoke on the

topic of building bridges to create action to pro-

mote oral health and prevent childhood obesity.

Her presentation was followed by three panel

presentations, each with three to four speakers

and two reactors to provide responses.

The first panel included Donald Chi, Clemencia

Vargas, and Julie Frantsve-Hawley, who

focused on an overview of the science relat-

ed to dental caries in children and childhood

obesity. Jonathan Shenkin and Linda South-

ward were reactors.

The second panel included Barbara Green-

berg, Robin Wright, Ankit Sanghavi, and Kimon

Divaris, who focused on what can be done.

Patricia Braun and Jane Forrest were reactors.

And the third panel included Diane Dooley,

Lisa Mallonee, and Mary Foley, who focused

on supporting and promoting involvement in

efforts to prevent dental caries in children and

reduce childhood obesity. Burton Edelstein

and Claude Earl Fox were reactors.

Key findings from the scientific literature re-

views and national surveys of pediatric den-

tists and dental hygienists presented at the

conference, as well as proposed strategies,

are listed below.

Findings

• There is growing recognition among oral

health professionals of their dual role in pre-

venting childhood obesity and dental caries

by targeting SSB consumption.10

• Many elements of the food environment

(i.e., elements that influence individuals’

food choices and food availability), the

natural and built environment (i.e., commu-

nity design factors that may also contribute

to levels of physical activity and access to

food), and the social environment (i.e., ele-

ments associated with resources and limita-

tions related to a family’s or an individual’s

socioeconomic position) are associated with

weight in children under age 12.11

EXECUTIVE SUMMARY 7

• Results of a systematic review support a

positive association between consumption

of SCBs and total and central adiposity

among children under age 12. This associ-

ation is most consistent for total adiposity

among children under age 5.12

• Evidence of dental schools’ and dental hy-

giene programs’ efforts to address obesity

and SSB consumption in children in their

curricula is scant, and Commission on Dental

Accreditation standards make only sporadic

reference to diet and nutrition.13

• In a survey of pediatric dentists, more re-

spondents stated that they offer childhood

obesity interventions than in previous sur-

veys, but a small percentage suggested that

a child’s weight is seen as a medical rather

than an oral health issue.14

• Most pediatric dentists provide interventions

related to consumption of SSBs, perceiving

the issue as integral to their care of children.14

• Most dental hygienists provide parents with

advice on children’s consumption of SSBs;

however, few offer advice on preventing

childhood obesity.15

Proposed Strategies

Following each panel presentation were

structured breakout sessions for participants

to build upon the panel presentations

and contribute strategies to promote the

conference goal of engaging the oral health

community in childhood-obesity prevention.

Proposed strategies from the breakout ses-

sions follow.

8 HEALTHY FUTURES

health centers, federally qualified health

centers, and other integrated health-care-

delivery systems to engage in efforts to

prevent childhood obesity and dental caries.

• Evaluate oral-health-care-based childhood-

obesity-screening and referral programs

(e.g., private practices, public health clinics),

and identify characteristics, policies, and

practices that make them successful.

• Develop and test interventions to improve

understanding of the effects of SSB con-

sumption on dental caries and obesity in

children and to identify common risk factors.

• Develop tailored home-, community-, and

practice-based behavioral interventions

and behavior-modification tools to reduce

consumption of SSBs and promote positive

dietary habits to prevent dental caries and

obesity in children.

• Develop communication strategies and

patient referral systems between oral health

professionals and pediatric primary care

health professionals or dietitians/nutritionists.

• Assess parents’ attitudes toward childhood

obesity screening and referrals by oral health

professionals to pediatric primary care health

professionals or dietitians/nutritionists.

Dental Students’ Education and Training• Modify dental school and dental hygiene

program curricula to include risk factors

associated with dental caries and obesity in

children, as well as the role of oral health pro-

fessionals in preventing these diseases.

Research• Develop content and test ways to best in-

corporate childhood-obesity-screening and

prevention content into dental education,

dental hygiene education, continuing educa-

tion, and dental practices.

• Develop interdisciplinary models of care and

referral within academic settings, community

EXECUTIVE SUMMARY 9

• Develop guidelines and care pathways to

help oral health professionals screen for

childhood obesity, educate children and

their parents about obesity prevention, and

refer children who are at risk for obesity.

• Offer continuing education on communica-

tion techniques (e.g., active listening, motiva-

tional interviewing, teach back) and handling

potentially difficult conversations about

patients’ weights and eating behaviors.

Advocacy/Policy• Engage in making the food environments

healthier—for example, by taking part in soda-

tax legislative efforts, encouraging directing

of tax revenue toward health services, and

restricting children’s access to SSBs.

• Develop new standards or enhance Com-

mission on Dental Accreditation standards to

increase dental students’ and dental hygiene

students’ knowledge about childhood obesity

and skills in screening for and preventing it.

• Train dental students and dental hygiene

students on using effective communication

techniques (e.g., active listening, motivation-

al interviewing, teach back) and handling

potentially difficult conversations about

patients’ weights and eating behaviors.

Oral Health Professionals’ Continuing Education and Training• Conduct courses and campaigns to improve

oral health professionals’ knowledge about

childhood obesity, screening, communi-

cation techniques, and patient referrals to

pediatric primary care health professionals

or dietitians/nutritionists.

10 HEALTHY FUTURES

• Integrate or link electronic dental and med-

ical records and add information about the

child’s weight, height, and obesity risk to

patient history forms to track trends, and

provide referrals as appropriate.

• Engage dietitians/nutritionists to provide

obesity screening, education, and counsel-

ing in dental and medical practices.

Reimbursement• Work with third-party payers to establish pol-

icies to reimburse oral health professionals

for services to prevent childhood obesity.

• Design and test innovative payment models

that incentivize health professionals’ delivery

of childhood-obesity-prevention services.

• Encourage oral health organizations to de-

velop guidelines and policies on identifying

children at risk for obesity, education pro-

grams, and referrals.

• Encourage oral health professional organiza-

tions to have strong conflict-of-interest poli-

cies in place for presentations and published

articles and for sponsorship of professional

meetings and continuing education courses.

• Provide oral health professionals with train-

ing on how to effectively engage in advo-

cacy and policy activities to prevent dental

caries and childhood obesity.

Consumer-Based Education Interventions• Share simple messages that oral health pro-

fessionals can use with children and families

to help them reduce consumption of SSBs

and choose healthier beverages (e.g., fluori-

dated water, plain milk).

• Launch a national campaign to encourage

people to choose healthier beverages (e.g.,

fluoridated water, plain milk) instead of SSBs.

• Work with families to adapt values, attitudes,

and practices to reduce children’s risk for

dental caries and obesity.

Interprofessional Collaboration• Establish approaches to ensure interdisci-

plinary coordination and collaboration to

promote screening for and prevention of

dental caries and obesity and to facilitate

effective referrals.

EXECUTIVE SUMMARY 11

• Pursue opportunities with state and city

health departments, tribal organizations, and

national and community organizations to

prevent chronic diseases, such as diabetes,

dental caries, and obesity.

• Develop a new current dental terminology

(CDT) code that includes nutrition education

for the prevention of both dental caries and

obesity.

Conclusion

Thanks to the support of RWJF and the par-

ticipation of key leaders and organizations,

this national conference was an important first

step in engaging the oral health community

in contributing to the prevention of childhood

obesity. Much work remains; however, the

importance of interprofessional collaboration

was stressed repeatedly throughout the event.

Health professionals need to work together

and with families to prevent childhood obesity.

The ultimate goal is to help ensure that all chil-

dren in our country have healthy weights, good

oral health, and, in turn, the opportunity to lead

healthy, happy, and productive lives.

Acknowledgement

Support for this executive summary was pro-

vided by the Robert Wood Johnson Foun-

dation. The views expressed here do not

necessarily reflect the views of the foundation.

12 HEALTHY FUTURES

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