Perspectives: Before you came to Einstein Physicians Pennypack, you worked as a pediatric nurse practitioner at a practice in Upper Bucks County. You have a special interest in childhood obesity. Do you see any differences between obesity among chldren in Upper Bucks County and children in Philadelphia's Northeast?
Katelyn Schafer: Obesity is truly an epidemic and it does not discriminate. We see childhood obesity in all ages, ethnic groups, and children with different socioeconomic status. Having said that, I do feel there are subtle differences in each community. One community may have more play- and exercise-related programs after school, while another community’s school districts may really focus on the school lunches and what’s offered in the school vending machines. In addition, coming from the Bucks-Mont area to here, I see differences in the way obesity is viewed by parents and by the children.
Perspectives: How do you account for childhood obesity in the area served by Pennypack?
Katelyn Schafer: Often, parents have a hard time even recognizing that their child might be overweight or obese. While we look at the elevated growth curve and BMI (body mass index, a ratio of height to weight) together, I often hear comments such as: “But they look normal,” or even “I actually think she’s skinny!” It is clear that they are in the overweight or obese range, but they just aren’t seeing it. These cases are the hardest and pretty common. We are in a society where much of the population is overweight and obese, and unfortunately, to society, this is becoming “the norm.”
Perspectives: So how do you get the point across in a way that is considerate of parents’ and children’s feelings, but still gets the point across? Do you use words like “obese?”
Katelyn Schafer: How often do we hear, “it’s not what you say, but how you say it?” This is exactly the approach I take when discussing the concern of abnormal weight gain with parents and children. Using words such as “elevated BMI” rather than “obese,” and increasing “activity” rather than “exercise” are important. Other key words and phrases might include “making healthy food choices” rather than “diet.”
Starting off on the right foot is very important with any weight management program. The program is about making a positive start and feeling good about your body and the healthy changes you make. I do not draw any attention to body image, as this is a major issue, particularly for teens these days.
It’s important as the provider to remind the patient that they are here to help make changes that affect the “inside of their body.” We talk a lot about “keeping their heart healthy” and making changes that will allow them to play and stay active for their whole lives.
Perspectives: If parents and children are receptive to the message, how do you approach the problem of getting children down to a healthy weight? What’s your model?
Katelyn Schafer: Reeducating is the name of the game. There are eight modules the program is based on: portion size, empty calories, fluid intake, screen time, activity, sleep, fruits and vegetables, and routines. The first step is attaining a thorough history from each child and parent. Based on that history at each visit, we focus in on a couple of modules and the teaching begins. At the end of the appointment, we create three customized, small goals together. These goals are created with the child, with the expectation that they can be achieved at the end of each month.
For example, today I had an 8-year-old child in for her initial consult. Two modules we focused on were screen time and empty calories. She played a lot of PlayStation and also had a TV in her bedroom. I let her pick the change she wanted to make. She could choose to remove the TV from the bedroom or limit the PlayStation. The decision was hers to make, so she feels in control of the change and the goal set for her next appointment. Another goal for her was in regards to her snacks. She was eating two unhealthy snacks a day—things like cookies and cakes. We agreed she could continue to have two snacks a day, but she agreed to swap one of the unhealthy snacks for fruit.
Weight management programs are tough. It’s hard to set these kinds of goals and achieve them. However, I do see children stick to all of the goals—or sometimes only one or two. We do see weight loss and we do see maintenance. The child’s lab work is a great tool to help see change as well. It’s a concrete repercussion of an elevated BMI, or, for example, if the cholesterol is elevated. Equally, patients and parents take pride in lowering cholesterol when they succeed in the program.
Perspectives: Why did you come to Einstein?
Katelyn Schafer: Einstein is a healthcare network where you can get all of your care under one umbrella. It’s a large network with an enormous amount of primary, specialty care, and providers. However, with each practice, you get the compassion, and the small practice “feel,” that is so important as a patient.
Perspectives: You started as a pediatric nurse assistant, and worked in pediatrics units in a medical center before working as a nurse practitioner in a pediatrics practice. Why pediatrics?
Katelyn Schafer: I always knew I wanted to work with children in some capacity since I was a kid myself! In high school, I experienced what healthcare was all about first hand, and I knew then that I wanted to be a nurse practitioner. After graduating from University of Delaware, I went right into pediatric nursing. I worked in the hospital and shortly after graduated from Rutgers with a master’s degree in advanced practice nursing.
Perspectives: What’s your favorite book?
Katelyn Schafer: “To Kill a Mockingbird.” The story is timeless and the characters are one of a kind! Its relevance, unfortunately, is still prevalent today. Therefore, there is still a lot to be learned from its pages.
Perspectives: Favorite movie?
Katelyn Schafer: I loved all of the Harry Potter movies, as well as the books. I’m definitely a big Harry Potter fan. I can’t wait to reread the series and watch the movies with my own children someday!
Perspectives: What is the one thing people might not know about you?
Katelyn Schafer: I enjoy yoga and travel. My husband and I just honeymooned in Thailand, and we can’t wait to continue to travel the world!