In today’s modern world, our role as healthcare providers must evolve—returning to the original intention of medicine: caring for the whole person. This means going beyond diagnosing disease to also address the physical, mental, emotional, social, and environmental factors that influence health, especially in chronic conditions like obesity. At this point in history, it’s imperative that we reclaim this holistic approach. Yet, our current healthcare system has created time constraints and inadequate reimbursement structures that often prevent us from delivering the kind of comprehensive care our patients truly need. Perhaps it’s time we rethink how we approach obesity in a non-stigmatizing, culturally sensitive way—focusing on overall health, not just weight.

Leo’s story is a poignant example. I first met Leo at age 3 when he was struggling with poorly controlled asthma. After several emergency room visits, we finally managed to get his asthma under control. As Leo got older, his BMI skyrocketed into the severely obese category, and I noticed a dark rash on his neck—an early sign of insulin resistance and potential diabetes. When I shared these concerns with his mother, she was deeply worried. Leo’s family has a history of obesity and Type II diabetes – his sister, at 16, lives with severe obesity and uses Wegovy for weight management, while his 6-year-old brother has already been diagnosed with Type II diabetes.

Leo’s mother is desperate to prevent him from following the same path, but she faces systemic challenges: food insecurity, limited access to culturally relevant health resources, and a lack of safe spaces for physical activity. While I am fortunate that my clinic has a social worker and community health worker to assist families like Leo’s, the reality is that most providers often lack the time, resources and structural support needed to effectively address these issues – despite their critical role in addressing obesity and chronic diseases. This is where we must rethink our approach and provide holistic, community-based care that extends beyond the clinical visit.

One potential solution is group visits. In a group medical visit, children with a common medical condition or similar concerns—such as obesity or asthma—are able to meet together with their family and other families in a supportive, structured setting to receive medical care, health education, and peer support, all while being guided by a multidisciplinary healthcare team. These visits can integrate health education, cooking classes, structured physical activity programs, and other activities, giving families practical tools they can easily incorporate into their lives. Additionally, involving social workers and community health workers fluent in patients' native languages can bridge the gap between clinical recommendations and the real-world barriers families face. However, implementing group visits comes with several barriers, including time constraints for planning and facilitation, limited staff capacity, and the need to develop or adapt resources tailored to the group’s needs. Practices may also face logistical challenges, such as scheduling, space limitations, and obtaining reimbursement. To overcome these hurdles, some clinics have found success by starting small, leveraging existing educational materials, and collaborating with community partners or trainees to support facilitation. Billing under shared medical appointments or wellness education codes, when appropriate, can also help offset costs and sustain the model over time.

To sustain these approaches there must be changes to the reimbursement structure. We need to advocate for policies such as mandated screening for social drivers of health that allow us to spend time addressing the root causes of obesity—nutrition, exercise, sleep, mental health, and community resources—just as we do for asthma or diabetes care. While AB 2250, a bill mandating the screening for social determinants of health, was introduced in California, it was previously overturned. AB 2250 would have made screenings for social determinants of health a covered benefit for Medi-Cal beneficiaries and required the State Department of Health Care Services or a Medi-Cal managed care plan to reimburse for these screenings.

Obesity prevention is not just about individual willpower; it’s about access to education, resources, and support. For example, research has shown that people living in food deserts are more likely to suffer from obesity because of the limited availability of healthy food options1. Additionally, it’s been found that children residing in neighborhoods with more parks and recreational areas are more likely to engage in physical activity, which in turn contributes to lower obesity rates2. And moreover, research shows that children from lower socioeconomic backgrounds are more likely to experience obesity—not due to a lack of willpower, but because of economic barriers that limit access to healthy food, safe recreational spaces, and other essential resources3.

Leo, like all kids, deserves to enjoy his childhood without the burden of chronic illness. There is a pressing need for integrated culturally responsive solutions that will empower families, like Leo’s, to make long-term healthy lifestyle changes. As a pediatrician, I see the potential for change when given the right tools and environments. By adopting integrated, culturally sensitive approaches to obesity prevention, we can help children and their families lead healthier lives and reduce long-term healthcare costs. This is about more than weight management; it’s working together to give families the resources they need to create a healthier future. With integrated approaches, everyone benefits.

I urge my physician colleagues to consider adopting innovative solutions like group visits, community health workers, and interdisciplinary care teams, as well as to become involved in advocacy towards solutions and systemic approaches to this complex public health issue. Together, we can create a healthcare environment where patients are supported, empowered, and equipped to lead healthy lives—at any size.

References:

1. Walker, R. E., Keane, C. R., & Burke, J. G., 2010. Disparities and access to healthy food in the United States: A review of food deserts literature. Health & Place 16(5), 876-884.
2. Wolch J, Jerrett M, Reynolds K, McConnell R, Chang R, Dahmann N, Brady K, Gilliland F, Su JG, Berhane K. Childhood obesity and proximity to urban parks and recreational resources: a longitudinal cohort study. Health Place. 2011 Jan;17(1):207-14. 
3. Liang R, Goto R, Okubo Y, Rehkopf DH, Inoue K. Poverty and Childhood Obesity: Current Evidence and Methodologies for Future Research. Curr Obes Rep. 2025 Apr 11;14(1):33.

Clarisse Casilang, M.D., is the community pediatrics lead physician and medical director of Wellness on Wheels at Children’s Hospital of Orange County (CHOC), now part of Rady Children’s Health.