[Re: https://www.hifa.org/dgroups-rss/who-issues-first-global-guidelines-chil... ]
Dear Neil, and colleagues,
Thank you for opening this up, and for steering it toward the HIFA questions of awareness and reach rather than the clinical detail. I would add a connection we see from an unusual vantage point, running dental and primary care under one roof: the sugar driving childhood obesity is the same sugar rotting children’s teeth. In our clinic the two arrive together, and the decay is usually the first of them to show — a visible early warning of a diet that is also raising a child’s risk of obesity and later NCDs. WHO’s own guidance on sugars treats both harms as one problem, which matches what we see in the chair.
On awareness, I can speak from thirty-five years in the Dominican countryside. Most health workers in Latin America know “boca de biberón” — the mouthful of decay in a small child sent to sleep with a sweet bottle — because sugary drinks are cheap, often cheaper than the healthier option, and they do what a weary parent needs: they quiet the child. Over those decades I have watched the introduction of not only sugary drinks but prepackaged, convenient sugary snacks into even the most remote communities. And there is something harder to fight than price: now that nearly everyone is connected to the outside world, consuming these products has taken on a kind of status — aspirational, however hollow. Against that advertising and cultural pull, information alone is a modest weapon.
What we do have, after three and a half decades rooted in one place, is a respected voice, and we use it patiently to educate. The school sits just across the dirt road from the clinic — we built it, and we keep it supplied. A hygienist, and sometimes visiting dental students, give periodic oral-hygiene sessions to the children, and we bring the students across to the clinic for check-ups and cleanings. It is simple, low-cost, and repeatable, and it carries the same single message — less sugar — that protects both a child’s teeth and their weight.
That, I think, is the practical heart of it. For a time- and money-poor clinic, obesity and oral health cannot be two separate programs with two separate messages. They are one shared sugar problem, and the efficiency — perhaps the only realistic path — is one simple message, repeated at every contact, dental or medical, by any member of the team. Childhood obesity, dental disease, and type 2 diabetes are more honestly understood, and far more cheaply prevented, together than apart.
With best wishes,
Frank Brightwell
Founder and Executive Director
Somos Amigos Medical Missions
El Naranjito, San José de las Matas, Dominican Republic
HIFA profile: Frank Brightwell is Executive Director at Somos Amigos Medical Missions, in the United States. Email: frank@somosamigos.org