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“There was a guy standing at the end of my hospital bed that I didn’t know,” recalled Brandon Younce. “I’ll never forget this. He had a shirt on that said ‘Got Narcan.’ He introduced himself as Aaron from Voices of Hope. He said he was a peer recovery specialist, and he asked me, ‘Hey, man, are you ready to go to treatment?’” This encounter took place before the peer recovery specialist program at Voices of Hope formally partnered with ChristianaCare’s Union Hospital and the Cecil County Health Department in 2023 to grow the program into the robust offering it is today. For Younce, the program has meant not only a path to reaching and maintaining his own sobriety: It has also allowed him to become a specialist himself. And for the over 600 patients assisted through the program in fiscal year 2024, 440 of whom were connected to long-term recovery treatments, the program has meant receiving a chance at healing under the stewardship of peers who have themselves experienced addiction and recovery. Emily Granitto, M.D., of Emergency Medicine at Union Hospital, said that the process “works really seamlessly: We have a discussion with a patient and say ‘hey, we have someone available. Would you like to talk to peer recovery and see what we can do to help?’ Then a specialist comes, and they talk through the resources and options.” By having the specialist located in-hospital and ready with resources at the patient’s bedside, said Granitto, the chances for a patient’s successful transfer to long-term treatment are much higher than if the patient is expected to fend for themselves upon discharge. “We’re able to address their substance abuse concerns and tie it all into their visit here in the Emergency Department. That opportunity may not necessarily arise otherwise in the community — so offering it here and providing that olive branch can be a good bridge to the next step,” she said. The need for programs like these has never been more urgent. According to a 2022 Community Health Needs Assessment report from ChristianaCare and the Cecil County Health Department, Cecil County’s “drug poisoning death rate” is nearly double the statewide rate and triple the national average. Services like the peer recovery specialists at Union Hospital are a critical lifeline for many. Harnessing the Power of Lived Experience The peer recovery specialist program currently places 10 trained peer specialists at Union Hospital to provide supportive coverage for patients admitted to the emergency room in active withdrawal or with a history of addiction. “The peer program at Union Hospital is the perfect example of what is possible when you harness the power of lived experience and strong community partnerships,” said Health Officer Lauren Levy, JD, MPH, of the Cecil County Health Department. “The collaboration between caregivers and the peer workforce has been integral to strengthening linkages to care and improving health outcomes for people with substance use disorder.” In collaboration with caregivers — including doctors, nurses and social workers — these specialists help to support patients and to connect them with longer-term treatment and rehabilitation options within and outside of ChristianaCare. They’re present and available at the hospital from 8:30 a.m. to 1 a.m., seven days a week. Doctors and nurses who work alongside peer recovery specialists can pair patients with specialists based on patients’ needs; some patients are admitted in active withdrawal, whereas for others, a need for treatment comes up as part of their intake. “What the peers do is really very magical because they can connect to the patient,” said Lisa Fields, manager for community engagement on ChristianaCare’s Cecil County campus, “They can tell their story to the patient and say, ‘This is where I have been. I do understand.’” Partnerships Support People in Need Voices of Hope, with a primary mission of supporting addiction recovery for Maryland residents and their families, trains peer specialists alongside the Cecil County Health Department, another vital partner in the peer recovery specialist program. Training requires 500 hours in the role and 25 hours of supervision from a registered peer supervisor. Peer recovery specialists provide a form of connection that is unique and impactful for someone struggling with substance use disorder: empathy informed by personal experience. For Erin Wright, Voices of Hope’s chief operations officer, this partnership has enabled all the involved providers to build a unique, vital community to support people in need of help. “The opposite of addiction is connection,” she said. “I’ve had doctors come to my peers, and say, ‘How did you just do that?’ A peer can walk in the room and, in 20 minutes, walk out and say, ‘Listen, here’s the plan.” Back in 2019, Younce’s emergency-room encounter with Aaron led to a treatment plan that included rehab, which led to his graduation from treatment and ongoing sobriety, which then led to his decision to become a peer recovery specialist himself and eventually, he hopes, a social worker. “It’s very surreal,” he said, “working at Union Hospital and actually telling patients, like, ‘I know how you feel. I’ve been in this position.’” Recovery Support Through Project Engage in Delaware ChristianaCare’s commitment to supporting patients with substance use disorders is systemwide. Project Engage, a vital initiative serving ChristianaCare’s Newark, Wilmington and Middletown campuses, aids patients struggling with alcohol or drug use by providing early intervention and referrals to substance use disorder treatment. Peer recovery specialists engage with patients in the emergency department and at the bedside, helping them understand their substance use and offering treatment options. Since 2012, Project Engage has served more than 13,000 patients and conducted over 27,000 patient engagements, with more than 60% of these engagements resulting in referrals to community treatment at discharge.
GRANDSPLAINING...It's as Bad as it Sounds!
Summary: "Grandsplaining" is a playful term that captures the all-too-familiar situation where younger generations offer unsolicited advice to older family members, often in a manner that is as condescending as it is unhelpful. This behaviour can be perceived as disrespectful and potentially creates awkward communication barriers, emotional strain, and family tension. Rooted in ageist stereotypes, it can even undermine elders' self-esteem. Here, we explore alternatives to grandsplaining, including the radical concepts of genuinely listening, asking open-ended questions, demonstrating empathy, and avoiding assumptions. These suggestions aim to help adult children support their older family members—not merely swoop in with a "fix-it" attitude. The Disrespectful Impact of Condescending Advice on Seniors When I helped older Canadians navigate financing their retirements, I often witnessed what can only be described as "grandsplaining in the wild." Conversations between adult children and their elders usually felt less like dialogues and more like lectures—one-sided advice sessions that left everyone gritting their teeth. The younger relative, likely well-meaning, would offer suggestions like, “You should downsize and buy a condo,” “Sell and rent,” or, the pièce de resistance, “Move in with family!” Judging by the withering looks from their elders, it was clear this approach wasn’t winning any "Favorite Child" awards. The older family members often felt patronized, as though their decades of life experience had been conveniently forgotten. The advice was condescending, painfully obvious, and usually impractical or unwanted. The dynamic reminded me of the cringeworthy experience of being "mansplained." And that’s when it hit me: this is “grandsplaining.” Unfortunately, grandsplaining can turn retirement planning conversations into a crash course on how not to communicate! Fortunately, with a little effort (and much less lecturing), families can turn this ship around and build stronger, more respectful relationships. What is "Grandsplaining"? In an age where communication flows freely across digital platforms, I define "grandsplaining" as a colloquial expression to describe a situation where younger generations offer unsolicited advice to older individuals, often patronizing or condescendingly. Grandsplaining typically involves a younger person explaining something to an older individual in a way that belittles their experience or intelligence. The term combines "grand" (suggesting age or status) and "splaining" (a slang term for condescendingly explaining something). While the intention behind such advice may often be well-meaning, the delivery can be patronizing, reinforcing stereotypes about aging and competence. This behaviour can significantly undermine the dignity and autonomy of seniors, leading to feelings of frustration, resentment, and a sense of being marginalized. Understanding the nuances of grandsplaining sheds light on intergenerational dynamics in these conversations. We must find a better, more respectful, and effective way to communicate with our elders considering retiring. The phenomenon of grandsplaining can manifest in various contexts, not just financing retirement—whether it’s discussing technology, lifestyle choices, healthcare options, or even social norms. For instance, a grandchild might explain how to use a smartphone app to a grandparent, assuming that the older generation cannot understand it despite their own lifelong experience with technology in different forms. Communication Breakdown In an era where financial literacy and retirement planning are more crucial than ever, "grandsplaining" has become a significant barrier to effective communication between generations. Retirees often feel overwhelmed or dismissed when their relatives provide unsolicited advice, especially if it contradicts their wants or financial strategies. This can lead to a reluctance to engage in discussions about finances, creating a rift that undermines the potential for collaborative planning. When adult children dominate conversations with preconceived notions of financial management, it stifles the opportunity for seniors to express their feelings, share their knowledge, and collaborate on effective retirement strategies. The Generation Gap in Financial Understanding Adult children may rely on outdated financial paradigms that no longer apply to their elders' realities. The economic landscape has changed dramatically over the past few decades, with shifts in real estate markets, a lack of formal retirement plans, and longer life expectancies. This generational gap can lead to misguided advice that does not consider modern challenges such as retiring with debt, little or no pension income, or rising living costs. Emotional Strain and Family Tension When relatives impose their views, it can evoke frustration, resentment, or inadequacy in their elders. This dynamic can shift the conversation from one focused on financial empowerment to one steeped in emotional conflict and shame. Instead of fostering a supportive environment for discussing retirement goals, grandsplaining can create adversarial relationships where seniors feel belittled or pressured, further complicating an already sensitive topic. Erosion of Autonomy When relatives try to impose their methods or strategies, it can undermine the seniors’ independence, making them feel a lack of control over their finances. Financial decisions are deeply personal and often intertwined with individual circumstances, goals, and values. This loss of agency not only affects financial outcomes but can also impact the mental well-being of older adults, leading to feelings of incompetence or anxiety about their financial futures. The Context of Ageism The implications of ageism are particularly concerning in a rapidly changing world characterized by technological advancements and unprecedented changes in social norms. While younger generations may genuinely wish to assist their elders in navigating these changes, their actions can reinforce negative stereotypes rather than empower seniors. Grandsplaining highlights the generational divide, creating an "us versus them" mentality that hinders collaboration and mutual understanding. Grandsplaining is deeply intertwined with ageism, a pervasive societal attitude that discriminates against individuals based on their age. Ageism manifests in various forms, including stereotypes that depict older adults as technologically inept, resistant to change, or incapable of learning. These stereotypes can lead to the marginalization of seniors within families and communities. Not cool! When younger generations adopt a condescending tone, they inadvertently reinforce ageist stereotypes that portray older adults as out of touch or incapable. This affects individual relationships and perpetuates societal narratives devaluing older individuals' contributions and wisdom. The Impact on Relationships Grandsplaining can strain relationships between generations, fostering resentment and conflict. For many seniors, unsolicited advice can infringe on their autonomy, making them feel infantilized or disrespected. I've seen firsthand how parents can react defensively to younger family members and sometimes withdraw altogether from conversations. When assistance is delivered condescendingly, it can backfire. The resulting tension may prevent meaningful conversations about important topics, such as healthcare decisions or lifestyle changes, which are crucial for seniors' well-being. The Psychological Impact on Seniors Being on the receiving end of condescending advice can also lead to diminished self-esteem and increased feelings of inadequacy. Seniors may begin to internalize the belief that they are not capable of making sound decisions or understanding new concepts, which can further exacerbate issues related to aging, such as cognitive decline and depression. Encouraging Respectful Communication with Seniors Addressing the issue of grandsplaining requires a concerted effort from both younger and older generations to cultivate respectful communication. Here are several strategies to foster more positive intergenerational interactions: 1. Actively Listen: Younger people should prioritize active listening when engaging with seniors. This involves hearing what the older person says and validating their experiences and perspectives. Younger people can create a more respectful dialogue by acknowledging their knowledge and expertise. 2. Seek to Understand: Younger generations must approach conversations with empathy. To quote Stephen Covey's wise words, "Seek first to understand, then to be understood." Recognizing seniors' challenges, such as health issues or technological gaps, can foster a sense of compassion. This approach can help bridge the generational divide and promote more constructive conversations. 3. Avoid Assumptions: The tendency to assume that older adults are out of touch or incapable can lead to grandsplaining. Instead, younger individuals should avoid making assumptions about seniors’ knowledge or abilities. Asking questions like “What do you think about this?” or “How do you feel about that?” can empower seniors to share their insights and experiences. 4. Offer Support, Not Solutions: Ask questions like, “What does a successful retirement look like to you? How do you plan to finance your retirement? Do you want to stay in this home? Are you open to moving? If so, where? Do you have enough in savings? How can I support you in having an independent and dignified retirement”? 5. Understand the Bigger Picture: Don’t assume that the traditional strategies of downsizing, selling, renting, or moving in with family are reasonable solutions for your elder in today’s economic environment. These retirement strategies are problematic for today’s seniors. In most cases, downsizing only works financially if the retiree is willing to move to a smaller, more affordable community. Most seniors want to stay in their communities and not move away from family, friends, churches, or familiar shops and services. Selling, renting, or moving in with family requires the sale of their significant appreciating asset. Given today's longer life expectancies, it's not always a wise choice. 6. Humour: By skillfully using humour, you can turn potentially patronizing situations into moments of connection and shared joy, ensuring that conversations with elders remain meaningful, respectful and memorable. For example, you could start the conversation this way; "The last thing I want to do is give you advice. That would be ridiculous. You’re the wise sensei here—I’m just the clueless apprentice trying to save enough downpayment to buy a shoebox of a house." This approach humorously flips the script, poking fun at the presumptuousness of unsolicited advice while emphasizing the elder's experience and wisdom. People often feel judged or vulnerable when discussing finances or significant life changes. Humour shifts the dynamic, showing that you approach the conversation as an ally, not an adversary. For example: "Talking about budgets isn’t fun for anyone—I mean, who loves math? But it’s worth it if we can figure out how to turn this retirement conversation into the fourth of July rather than Labour Day!" This playful approach lowers barriers, making the discussion feel collaborative rather than critical. Laughter fosters connection. Sharing a laugh creates a sense of camaraderie, making it easier for people to open up about sensitive topics. When elders feel that you’re not judging them but partnering with them—and can make them smile—they’re far more likely to trust your intentions and take your advice seriously. Humour invites the other person to join the conversation, breaking the ice and encouraging them to share their thoughts. It sets a tone that the conversation is a dialogue, not a lecture. Example: "You’ve been making great financial decisions for decades. I’m here to ensure we don’t accidentally end up with a basement full of K-tel Veg-O-Matics… unless that’s the plan?" This allows them to laugh, respond, and engage while respecting their autonomy. A word of caution. Humour is only effective when paired with genuine respect and sensitivity. Pay attention to your elder's reactions and adapt if they seem uncomfortable or unamused. The goal is to build rapport, not to win laughs at their expense. Using humour skillfully, you can turn potentially patronizing situations into moments of connection and shared joy, ensuring that conversations with elders are respectful and memorable. Before You Go Before You Go Grandsplaining: the art of lovingly over-explaining to elders as though they’ve been napping since the Great Depression. While it often comes from a place of care, the unintended consequences can include derailed retirement conversations, strained family dinners, and a spike in eye-rolling from grandparents everywhere. Good financial planning thrives on clear communication, but grandsplaining tends to turn productive discussions into monologues that undermine elder autonomy and trigger emotional static. To create a more harmonious environment, families should swap their megaphones for listening ears and embrace a collaborative approach that respects seniors' wisdom and frames younger relatives’ financial theories as conversation starters, not TED Talks. After all, when it comes to navigating retirement planning, a little less "know-it-all" and a bit more "let’s figure it out together" can go a long way. Think of it as building a bridge, not a lecture podium—because nothing says "family unity" like tackling compound interest together! Don't Retire---Re-Wire! Sue
Welcome to Retire with Equity: Where a New Retirement Journey Begins
Summary: A recent study reveals that 40% of Canadians over 50 feel financially unprepared for retirement. Retire with Equity aims to address this issue by educating retirees on the importance of leveraging home equity. The initiative emphasizes transparency, financial literacy, and personalized guidance to help seniors make informed decisions and achieve financial security in retirement. According to a recent National Institute of Aging study, almost 40% of Canadians over 50 feel they are not financially prepared for retirement. As a seasoned citizen myself, I know we can do better. That's why we've created Retire with Equity. It's time to help Canadians get the knowledge they need to make more informed financial decisions. My observations from my time in the industry, enriched by the research I've done over the past few years, clearly reveal a growing retirement crisis in Canada. I've worked in the banking and mortgage industry for over 25 years, specializing in equity lending, and spent the last 6 years as an executive at Canada’s largest Reverse Mortgage bank. Many people are struggling with mounting debt and no company pension. And they are living longer. Additionally, the long-term care situation in Canada has many seniors looking to age in place in their homes. Strategies like downsizing and moving in with family are often too simplistic and have little appeal to today's seniors. Some eventually, often begrudgingly, turn to home equity options such as reverse mortgages as a solution. However, Canadians are conservative by nature, and many think it is taboo to touch their equity (nest egg). Consequently, a reverse mortgage is a last resort. 76% of people over 65 are homeowners, many of which have built up a substantial amount of equity yet cannot afford to retire. (Source: Statistics Canada) Income is the only way to solve the retirement crisis. Many are choosing to work longer to delay spending savings. Some need to pay off debt to eliminate payments that will free up cash flow. Others do not have enough savings to retire. I saw the stress this caused watching my Mother “do without” in her retirement. With the benefit of experience, I now know there was a better way for her to finance her golden years. The Retirement Problem in Canada is Dire Many 55+ Seniors Don’t Have the Funds They Need: Many need an adequate budget and financial plan. And many don’t fully realize that employer and government pensions will fall short of their cashflow needs. Home Equity Unlocks Opportunities, But It's Misunderstood: Many retirees don’t fully understand the short—and long-term impacts of their home equity financing decisions. They rely on biased, incomplete, anecdotal information from friends and family. Seniors Need to Be Cautious: Homeowners are especially vulnerable targets for misinformation and fraud. However, this demographic does not have time to recover from a financial mistake. Making the wrong choices that affect how they finance retirement and protect themselves could leave seniors without enough money later when they need cash for costly expenses like health care. The Financial Industry Needs to Do More: There is a need for unbiased, transparent, and trusted sources of information on home equity options that are aligned with consumer interests. Gone are the days of cookie-cutter retirement plans and guaranteed pensions. Every Canadian needs to proactively craft their unique vision and path for retirement. Banking on My Experience The Retire With Equity mission is dedicated to helping retirees find the right combination of financial strategies to achieve their goals. The Equity Advantage One of the standout features of Retire with Equity's approach is our focus on home equity as a key component of retirement planning. For many Canadians, their home is their most significant asset, and unlocking its potential can be a game-changer. Whether through downsizing, refinancing, or reverse mortgages, Retire with Equity will offer guidance on integrating this valuable resource into a retirement strategy. The Human Touch At Retire with Equity, we promise to offer straightforward advice with a personal touch. It's not just about the numbers – it’s also about the dreams you have for retirement. We will bring patience, empathy, and respect to every conversation. And we won't forget our sense of humour, as retirement is supposed to be fun. We're committed to making things easy to access and understand, no matter where you are in life. Education is Everything Two of our core values are empowering education and epic transparency. Our online resources, webinars, and workshops will be tailored to demystify the world of finance for retirees and soon-to-be retirees, increasing their financial literacy. We will bring transparency to the vital information reserved for the small print, answering the questions retirees don't even know to ask. Whether you're a financial guru or just starting to think about your nest egg, we'll have something for you. A Senior-Friendly Approach Our approach will integrate technology with a user-friendly interface so that retirees can access their services without hassle. Gone are the worries of getting stuck in the weeds of complex interfaces or endless financial jargon. We bring "kitchen table" logic when explaining all financial details, no matter how complex the concept is. Stories that Inspire From coast to coast, Retire with Equity will share personal stories that help educate and motivate Canadians. We want to show you visible proof that it's always possible to rethink and revitalize retirement plans. Hearing from fellow Canadians who have successfully navigated the retirement waters offers hope for those still planning their way. Feelings of guilt and shame are common among retirees searching for retirement options. Learning about countless other retirees in similar situations often alleviates this guilt and shame. Join the Revolution Retire with Equity is more than just a company—it’s a movement. Canadians across the country will join in and transform their retirement years into the best chapter of their lives. Empowered by new tools and expertise at their fingertips, they will not just survive but truly thrive in retirement. As an "Equity Advocate," I pledge to help Canadians navigate the complexities of retirement in ways that educate, inspire, and entertain. I look forward to the conversation. Please subscribe to our regular updates and follow us on social media. Here's to the best years ahead! Don't Retire---Re-Wire! Sue
An innovative Baylor University study has shed light on the often-overlooked experiences of women doing “daughtering” in families, particularly during the COVID-19 pandemic, which created immense challenges in their relationships with parents and other family members. “Daughtering” refers to the ways adult daughters contribute to flourishing family relationships, according to Allison M. Alford, Ph.D., clinical associate professor in the Department of Information Systems and Business Analytics in Baylor’s Hankamer School of Business. Alford’s latest research, Daughterwork in Times of Social Upheaval, published in Qualitative Research Reports in Communication, explores how societal changes caused by the pandemic required women to reconfigure their relationships with their parents and emphasizes the critical role adult daughters play in maintaining family connections, particularly in times of crisis. "This study highlights how social upheavals like the COVID-19 pandemic can both challenge and reinforce the essential work that daughters do in their families," Alford said. “Past research has shown that women often bear the brunt of responsibility when crises occur at home, work or in the extended family. Particularly for professional women – those who are balancing changing workplace demands alongside immediate and extended family concerns as well as societal shifts – increased care needs or the perception of such for parents can increase stress and negatively impact well-being, yet women still persist in providing upstream support for a variety of reasons.” Using in-depth, semi-structured interviews of women who identified change to their daughtering, professional and family lives, Alford discovered four themes about how a crisis can provide opportunities for flexible daughtering, meaningful connection and reflection on one’s most important relationships. Daughtering is adaptive action The pandemic forced many daughters to rapidly adjust their caregiving practices with their parents. When normal forms of communication were not an option, many daughters turned to technology to bridge the gap. This included increased use of video calls, social media, and other digital communication tools to maintain contact and promote family connection. Alford’s research found that daughters also took on new, often physically demanding tasks to ensure their parents’ well-being – delivering groceries, managing household repairs and organizing virtual family gatherings. “These actions were not only about adapting to the context of social upheaval but also about intensifying their caring efforts to meet the evolving needs of their parents,” Alford said. Daughtering is adaptive timing The study revealed that daughters had to maintain a heightened state of vigilance, constantly prepared to address unexpected crises, Alford said. Unlike the more predictable daughtering routines of the past, the pandemic introduced a level of uncertainty that required daughters to be in a near-constant state of readiness. One study participant described her experience as being in "constant problem-solving mode," which added significant stress to her daily life. “This ‘adaptive timing’ meant that daughters often found themselves juggling sudden care demands with their own professional and personal obligations,” Alford said. “This theme underscores the mental and emotional toll on daughters who had to manage the unpredictable nature of daughtering during the pandemic.” Daughtering is a priority Despite the challenges, Alford said, many daughters reported that they continued to prioritize their daughtering responsibilities, driven by a deep sense of familial duty and personal values. “For these women, daughtering was not just another task but a core part of their identity, often taking precedence over their professional responsibilities,” Alford said. “This commitment was evident in the time and resources they dedicated to maintaining their relationships with their parents, even when it meant sacrificing their own well-being or career advancement.” One participant noted, “I value family, so I still made it a priority,” reflecting a sentiment shared by many women in the study. This theme, Alford noted, highlights the internal conflict that many daughters faced, balancing their dedication to family with the competing demands of their own lives. Daughtering involves reflecting Challenges prompt many daughters to reflect deeply on their roles and relationships, and the COVID-19 pandemic was no different, Alford said. “This period of social upheaval generated a moment of introspection, leading daughters to reassess their priorities, boundaries and the nature of their relationships with their parents,” she said. “For some, this reflection led to a greater appreciation for the importance of family, while for others, it was a time to set new boundaries and redefine their roles within the family structure.” One participant observed, “COVID was a catalyst for emotional support,” while another reflected on the need to “carve out time mentally” to fulfill her roles as both a daughter and a professional. This theme illustrates how the pandemic not only challenged daughters but also provided an opportunity for personal growth and redefinition of their familial roles, Alford said. Key strategies to recognizing daughters’ “invisible” labor The research underscores the critical need for greater recognition and support for the invisible labor performed by adult daughters, suggesting that both families and society at large have a role to play in alleviating the burden on these women. “It’s crucial that we not only acknowledge the burden placed on these women, “Alford said, “but also seek ways to support them, whether through family empathy, shared responsibilities or societal recognition.” Alford emphasizes the importance of three key strategies: Awareness and acknowledgment Families should recognize the labor involved in daughtering and ensure it is acknowledged and appreciated. This can help prevent the exploitation of this labor and ensure that daughters feel valued for their contributions. Outsourcing and support Where possible, families should consider outsourcing some care tasks or providing additional support to relieve the burden on daughters. This might include hiring help for household chores or seeking external emotional support through counseling. Expressing gratitude Expressing gratitude and acknowledging the efforts of daughters can significantly enhance their sense of well-being and fulfillment. This recognition is vital in helping them feel that their contributions are meaningful and valued. National Daughter’s Day National Daughter’s Day is Sept. 25, and while this holiday has been around since 1932 to honor the daughters in our lives, it can often quietly pass us by. Alford recommends parents using this day to officially acknowledge all the ways in which daughters support their families.
National Teacher's Day is tomorrow! Covering? let us help!
Celebrating National Teacher's Day is not just about recognizing the individuals who dedicate their lives to education; it's a moment to reflect on the pivotal role teachers play in shaping society's future. From instilling knowledge and critical thinking skills to fostering creativity and empathy, educators mold the next generation. The significance of this day extends beyond the classroom, touching upon broader themes that resonate with the public: The evolving landscape of education in a digital age Challenges and innovations in teaching methods and curricula The impact of teachers on students' mental health and well-being Addressing inequalities in access to quality education The role of teachers in promoting diversity, equity, and inclusion Supporting and empowering educators amidst changing societal needs As we commemorate National Teacher's Day, it's an opportune moment to delve into these critical issues and highlight the invaluable contributions of teachers in shaping a brighter future for all. Connect with an Expert about Education and Teaching in America: Kitty Kelly Epstein, Ph.D. Faculty Trustee + Doctoral Faculty - School of Leadership Studies · Fielding Graduate University Brendan Cantwell Associate Professor · Michigan State University Kristina R. Llewellyn Associate Professor, Department of Social Development Studies · Renison University College, University of Waterloo Amanda L. (Glaze) Townley Associate Professor · Georgia Southern University Marta Baltodano Professor Emeritus · Loyola Marymount University To search our full list of experts visit www.expertfile.com Photo Credit: Kenny Eliason
Amid "Likes" and "Shares," Facebook Jeopardizes Children's Health and Safety
On February 4, 2004, a 19-year-old Mark Zuckerberg launched “TheFacebook.” Developed in his Harvard University residence hall, it began as a networking service for his roughly 7,000 classmates. Today, it is the most popular social media platform in existence, boasting over three billion monthly active users worldwide. Through two decades of “likes” and “shares,” Facebook has transformed how people connect, interact and think. Driving everything from dinner parties and concert outings to political campaigns and protest movements, it has frequently been celebrated for its ability to convey information, mobilize groups and galvanize change. However, it has also been criticized for its questionable content management choices, its suspect data collection practices and, perhaps most notably, its role in feeding an ever-growing mental health crisis among children and adolescents—a charge Zuckerberg refutes. Elizabeth Burgess Dowdell, PhD, RN, FAAN, is a professor in Villanova University’s M. Louise Fitzpatrick College of Nursing and an expert on the health and safety risks posed by social media. From her perspective, Facebook and platforms like it have undoubtedly played a part in heightening levels of emotional distress and physical harm among youths. “Statistically, it’s well-established in the literature that mental health issues and concerning behaviors among children have escalated tremendously,” said Dr. Dowdell. “They’re becoming sadder, more depressed and lonelier, even though they’re very connected.” To Dr. Dowdell’s point, mental health disorders began rising precipitously among young people in the years following Facebook’s launch. Per the Centers for Disease Control and Prevention (CDC), the percentage of children aged 6 to 17 years “ever having been diagnosed with either anxiety or depression” increased from 5.4% in 2003 to 8% in 2007 and 8.4% in 2011-2012. And just last year, in the era of Instagram and TikTok, Mental Health America found that 11.5% of children in the United States were struggling with severe depression, with 16% of youths aged 12 to 17 years having experienced a major depressive episode in the past 12 months. A contributing factor, according to Dr. Dowdell, is the way social media construes reality. Flooded with images, posts and videos that show hyper-idealized, rose-colored representations of life, impressionable young users can be made to feel isolated, inept or dissatisfied with their appearance. “I think adults understand that a ‘perfect’ picture is often preceded by a dozen other photos,” she said. “Kids don’t always see it like that. They focus on what makes them happy and what makes them sad—and what makes them feel sad about themselves.” Tragically, throughout the social media age, this sadness has been tied to increasing rates of suicide, self-harm and risky behavior among youths. A 2023 CDC study found that the suicide rate for children aged 10 to 14 years tripled from 2007 to 2018 (from 0.9 deaths per 100,000 to 2.9), and in 2021-2022, the National Center for Missing and Exploited Children noted a 35% year-over-year increase in reports of suspected child sexual exploitation. Amid these frightening statistics, Dr. Dowdell emphasizes the importance of caring, compassionate adults’ involvement in young people’s lives. She notes these individuals’ presence can not only shield youths from potentially hazardous situations but give them the tools to cope with traumatic episodes and feelings of despair. “The critical factor that helps children become resilient is having a support system—having family members, parents or trusted adults with whom they can talk,” Dr. Dowdell shared. “They might go down the rabbit hole, but they have someone to pull them out, someone to help them.” For adults concerned about their loved ones’ social media use, Dr. Dowdell stresses that empathy and understanding are key. In turn, she advocates for an approach that reflects the supposed purpose of Facebook and platforms like it: active conversation. “It all comes back to communication,” she said. “Parents and guardians need to role-model responsible behaviors. They need to talk about these things: ‘What did you look at today?’ ‘What was good?’ ‘What was bad?’ ‘What did you think?’ ‘How did you feel about that?’ “It’s much like, when children are little, reading them books. When we read to children, we engage them… Why not read the social media feeds, look at the Facebook posts or go through Instagram? These forms of engagement, the conversations we have, let them know they can come and talk.”
Baylor Expert: Don't Lose Focus on Spiritual and Mental Well-being
Baylor Social Work professor shares tips and resources during stressful half-way mark of semester Holly Oxhandler, Ph.D., LMSW., associate dean for research and faculty development and associate professor in the Diana R. Garland School of Social Work. October marks the halfway point to the fall semester and can carry all the excitement, stress and anxiety of another academic term winding to a close. The month also typically marks one of the busiest times of the year for university counseling centers across the nation. With unique challenges in 2020 related to COVID-19, the University has acknowledged those hardships for all in the Baylor Family by taking the initiative to focus on mental health throughout October. Baylor University’s Holly Oxhandler, Ph.D., LMSW, associate dean for research and faculty development and associate professor in the Diana R. Garland School of Social Work, is an expert on mental health, primarily anxiety and depression, as well as religion and spirituality in clinical practice. In this Q&A, she shares tips and resources to students, faculty and staff who are facing all of the typical challenges of another mid-term while also navigating a global health crisis. Q: The 2020 fall semester provided challenges and obstacles never seen before in higher education. Why has COVID-19 been a uniquely stressful influence on the mental and spiritual well-being of students, faculty and staff? There are a number of reasons COVID-19 has been a uniquely stressful influence on the mental and spiritual well-being of those in higher education. First, there are the unanticipated layers and learning curves of new considerations and adjustments to course delivery, safety protocols, dining, campus activities and communication, to name a few, on top of the typical adjustments and emotions we all navigate at the beginning of each fall semester. Second, those in higher education entered fall 2020 without the “typical” summer that’s needed to reset, make adjustments and plan for the upcoming year’s activities. For example, many administrators, faculty and staff spent the summer not only planning for the usual upcoming academic year but also reconfiguring classes to be hybrid or online or simultaneously include both in-person and online students, in addition to modifying student activities and faculty research project timelines and plans. For degree programs that include internships, like social work, there have also been additional layers of consideration in order to comply with our professional accreditation standards. Third, we recognize that many students, their family members, as well as Baylor faculty and staff members’ loved ones, have been affected by the economic impact of COVID-19, adding a layer of financial stress. Fourth, many within the Baylor community – staff, faculty and students – have needed to juggle childcare and homeschooling their children as they continue to engage in their own work and/or educational expectations. Finally, the fear of contracting COVID-19, especially among the most vulnerable and high-risk populations, has been constantly present. Not only are we adjusting to this academic year with new ways of being and new protocols that keep us and one another safe, we’re also facing unexpected waves of fear and layers of grief for the missed events, opportunities and connections we had hoped to experience. As resilient as our community is, I think it’s important to remember we cannot “operate as usual” because things aren’t usual. Instead, we must allow ourselves and one another the time, margin, flexibility and grace needed to sit with and move through the rising emotions, grief, stress, loneliness, fear and uncertainty as they come. We cannot skip or bypass these emotions, but instead, must move through them, often with the support of loved ones and/or a trained mental health care provider. Q: Mental and spiritual health are challenging during even a typical semester experience. What are some of the effects and reactions you’ve witnessed to these circumstances among students, faculty and staff compared to a non-COVID-19 semester? As human beings navigating a global pandemic to the best of our ability, our mental and spiritual health have all been impacted to some degree this semester as we have individually and collectively faced a number of unexpected difficulties. I have also seen a beautiful response to the reality of this collective struggle in my interactions with Baylor faculty, staff and students that includes deep empathy for one another and an increase in valuing authenticity as we engage in the high-quality, meaningful work we each do. It has been a gift to witness Baylor community members holding space for colleagues’ and students’ vulnerability as we admit this is hard for various reasons and recognize that we cannot just push our way through this season. When we admit this isn’t easy and that we are all juggling so much to the best of our ability through thick layers of uncertainty, it gives those around us permission to admit their experiences, too. In fact, I think when we create space for that shared vulnerability and empathy in our interactions with others, we can better assess the current situation, remain present to one another and discern what steps are needed to move forward together, particularly because we’re not carrying an additional layer of effort pretending that everything is fine. That said, the Garland School of Social Work conducted a couple of well-being surveys since this summer to internally check in on how our faculty and staff are coping with this season and identify the biggest stressors they’re facing and sources of support. Our faculty and staff have also been continually checking in on our students through this season. Not only do we see many noting the same stressors that we’re all facing these days, normalizing how difficult this is for each of us, but the act of nonjudgmentally holding that space for ourselves and one another has been a tangible step of offering the care we know is uniquely woven into the Baylor experience. Q: How can individuals within the campus community tend to their spiritual health to close out the semester? I would invite readers to take a moment to pause and identify a few spiritual practices that uniquely support them well, even if that means thinking back to less stressful seasons. The key to note here is that these are practices which require regular engagement, similar to if we were to practice a new instrument or sport. Spiritual practices can vary based on our faith tradition and may include praying; meditating; centering prayer; reading our religious text; walking a labyrinth; journaling; practicing gratitude; listening to a sermon or faith-based podcast; praying over and contemplating scripture; engaging in creativity; practicing daily examen; or listening to spiritual music. Some practices may involve other individuals that can be done safely, including seeking spiritual direction, participating in a Bible or faith-based book study with others or engaging in worship (even virtually!). These practices can offer a sense of groundedness and a reminder that God is with us, including through this season. As we continue to navigate this season of uncertainty, it is critical that we intentionally weave in spiritual practices that offer rhythms, routines and a grounded faith that can support us well through the waves of difficulty. Especially on campus, I would encourage Baylor community members to follow along with Spiritual Life’s resources and events, or check out Better Together BU, a partnership supported by both Spiritual Life and Multicultural Affairs. Q: How can individuals within the campus community tend to their mental health to close out the semester? Tending to our mental health in this last stretch of the semester will be so important as we move into the stress of finals, the complex emotions tied to the holidays, grief with upcoming celebrations looking different this year (including how we celebrate holidays, who we celebrate with and the reality of many having lost loved ones to COVID-19) and the reality of seasonal affective disorder on the horizon. In fact, in a typical year, about 5% of U.S. adults have seasonal affective disorder (SAD), with another 10-20% having mild forms of it. In light of all of the added transition, uncertainty, complexity of caregiving and homeschooling while working/studying at home, layers of loneliness and grief, I do hope our Baylor students, staff and faculty will actively prioritize taking good care of their mental health and supporting others’ mental health care, too. One way I highlight this with my social work students is by recommending creating a self-care plan that pays attention to our physical health, mental health, social support and spiritual health. If we can identify some strategies to holistically care for ourselves well and be mindful of potential barriers to navigate, we may have more resilience and practices to draw from to cope with challenges and stressors that arise. Finally, although NAMI highlights that 1 in 5 of us are currently facing a mental health struggle, some studies have shown that over 80% of us will meet criteria for a mental illness by young adulthood or middle-age. Therefore, I highly recommend that anyone who is noticing any changes in their mood, diet, sleep habits, behaviors or overall well-being immediately reach out for help. Students are encouraged to reach out to Baylor’s Counseling Center, CARE team or the BARC. Faculty and staff also have resources available through Baylor’s employee assistance program. Other resources for finding a mental health provider include HelpPRO, Psychology Today, Low Cost Help or these additional resources. For those who are deeply struggling, please reach out to the Suicide Prevention Lifeline at 1-800-273-8255 or text ‘HOME’ to 741-741 for the Crisis Text Line. As part of my faith and my social work values, I believe that each of us are worth caring for ourselves, including caring for our mental health alongside our spiritual and physical health. Q: What successes or bright spots have you seen within your campus experience that offer encouragement to how the Baylor Family has handled the crisis throughout the semester? I am regularly amazed by the Baylor students, faculty and staff, the ways we have navigated the crisis together this semester, and I am especially grateful for President Livingstone’s and Provost Brickhouse’s leadership since March. This semester, some bright spots have included Dr. Deborah Birx’s reflections on Baylor’s efforts to keep everyone safe from COVID-19, the Fall Faculty meeting and Dr. Peter Hotez’s appreciation of how Baylor leaders have kept the Baylor and Waco community safe and following along when Baylor students take over Baylor’s Instagram account (like Brandon Nottingham’s takeover on World Mental Health Day!). As the Garland School of Social Work’s associate dean for research and faculty development, I have also loved learning about the ways so many Baylor faculty are offering their unique research expertise and wisdom to serve others through this difficult time, such as Dr. Emily Smith’s “Friendly Neighbor Epidemiologist” Facebook page to explain COVID-19 information. I’ve also been reminded of what a gift it is to be a part of the Garland School of Social Work (GSSW) and this community of faculty, staff and students. The resilience, creativity, love for serving others, dedication to the social work profession and care for our students is so apparent within the GSSW. I have especially seen how my faculty and staff colleagues have adapted courses and assignments, creatively considered students’ needs and juggled their research responsibilities while extending grace to themselves and one another as we navigate this season together as a school to the best of our ability. Similarly, seeing our students’ resilience, flexibility, support of one another, commitment to the profession and heart for the clients and communities they serve is truly inspiring. Finally, Dean Jon Singletary’s servant-leader heart for the GSSW and the ways he has supported our school through so much transition over the last five years has been a gift. One example of this includes the two hours of weekly well-being time he extends for all GSSW staff and faculty to use in support of our spiritual and mental health care. Q: What gives you hope for the spring semester and beyond as students continue through their academic endeavors? Truthfully, our students’ presence and their enthusiasm over the fields of study they are dedicating their lives to gives me hope. As a professor, there is nothing like watching a student become fully alive in the work they are passionate about and feel as though they were made to do. Our students’ willingness to fully participate in the transformational education that Baylor offers, especially in this difficult season of COVID-19, is an honor to witness as a professor and certainly gives me hope. Further, seeing the ways our students are empathically caring for their neighbor by following Baylor’s safety guidelines, growing in their faith, checking in on one another, understanding faculty and staff are doing their very best and continuing to demonstrate their determination to learn and grow is an inspiration. My hope and prayer for our students as well as our staff and faculty colleagues as we move through the remainder of the fall semester and into the spring is that they rest as they need to and prioritize taking good care of their mental and spiritual health. I also pray that we recognize as a community that by caring for our spiritual and mental health, by taking this season one day at a time, by trusting we are doing our best and by reaching out for help when needed, we give others permission to do the same.
Reflection, Recognition and Expression: The Science of Cultivating Gratitude
Baylor positive psychology researchers offer three ways to increase gratitude and empathy Credit: Marina Demidiuk / iStock / Getty Images Plus Gratitude research delves into the science surrounding human emotions and the physical, mental and spiritual benefits of actively expressing gratefulness. Leading Baylor University positive psychology researchers Sarah Schnitker, Ph.D., and Jo-Ann Tsang, Ph.D., who specialize in the study of gratitude, have identified three science-based mechanisms that can cultivate gratitude and improve empathy. This work is especially timely during the Thanksgiving and Christmas seasons. Through the examination of previous studies and the broader literature on the process and benefits of gratitude, the associate professors of psychology and neuroscience have discovered that some previous understandings of gratitude may not tell the whole story. By engaging gratitude in a way that benefits the whole community, the researchers identified ways to engage in gratitude that move the emotions of gratitude beyond a fleeting feeling and become virtuous through helping others. “Gratitude does seem to increase well-being, but not all the time,” Schnitker said. “It sometimes decreases depression and anxiety symptoms, but not always. It makes you more generous, more kind, more caring, but again, not always,” Schnitker said. “[That’s why] we’ve been looking at how to cultivate gratitude in such a way as to really impact flourishing. Not just individual well-being, but also the well-being of other people around them.” Deep reflection Through intentional deep reflection of what we are grateful for, we can move past the cycle of “hedonic adaption” – a theory that proposes people will quickly return to a baseline level of happiness, despite the effects of major positive or negative life events – and into a positive emotional state of gratitude. “You have to pay attention and be intentional about reflecting,” Schnitker said. “Part of the reason is that, like a hedonic treadmill, we get used to our current state; it becomes part of the background, and it no longer benefits our well-being.” Schnitker describes intentionally recognizing who and what you are grateful for as a tool that leads to feelings of greater happiness and connection. “What we find is that by incorporating practices that engage deep reflection – that are structured and effortful – it will lead to higher levels of life satisfaction and gratitude,” she said. Recognizing a giver When you recognize the person for whom you are grateful, you begin to move from feeling thankful for that person to feeling thankful to that person. Schnitker suggests writing gratitude letters to acknowledge those for whom we feel grateful. “Go beyond being thankful and think about the giver; whether that is God or someone else in your life, take the time to deeply consider them,” Schnitker said. “The suggestion of writing a letter over a list is effective in that you are addressing it to someone outside of yourself, and it can build deeper connections.” Jenae Nelson, Ph.D., a postdoctoral research associate in Schnitker’s Science of Virtues Lab at Baylor, has found that expressions of gratitude through letter writing towards an entity increased empathy and transcendent indebtedness in participants significantly more than writing a gratitude list. Participants who felt transcendent indebtedness, or a desire to pay it forward, were much more generous in charitable donations than those who just felt gratitude during the experiment. “This is compelling evidence that gratitude has to work in harmony with other prosocial emotions such as indebtedness and empathy to promote generosity, which are only activated when someone thinks about a person to whom they are grateful,” said Nelson. Outward expression The act of outwardly expressing thankfulness to the giver, whether that is a human, nature or God, can transform it from a temporary feeling into virtuous gratitude. It is the intentional effort of action that contributes to the flourishing of other people. “So many of the studies will have people just write a letter and not necessarily send it,” Schnitker said. “Writing the thank-you note and sending it – either electronically or in the mail – may enhance the impact of the gratitude practice. Expressing gratitude is a natural response and can compound its benefits because both the recipient and giver of thanks can experience an increase in positive emotions.” Essentially, you might not be able to thank the person directly, but expressing your gratitude outwardly could lead to expansive generosity. Research suggests that people treasure feeling thanked. It boosts their own well-being, especially in Western societies and the cultural context of the United States. "So have the courage to reach out and thank them," Schnitker said. Gratitude expressed with these components and mechanisms promotes well-being for both self and those around you. “We find that when people feel that genuine gratitude, not only do they want to pay it back, but they also want to pay it forward,” Schnitker said.
Peer Support Program Helps Patients With Substance Use Disorders
Recognizing that stigma may keep people from accessing treatment and recovery resources, ChristianaCare Union Hospital is partnering with the Cecil County Health Department and Voices of Hope to make peer recovery specialists available at the bedside for patients who have experienced a drug overdose or live with substance use disorder. Ten peer recovery specialists are available at Union Hospital seven days a week from 8:30 a.m. to 1 a.m. to talk with patients about behavioral health care navigation, access to treatment and referrals to harm-reduction and recovery-support resources. Patients can be connected with a certified peer recovery specialist if they are brought to the Emergency Department because of a drug overdose, or if they screen positive for substance use while they are a patient in the hospital. ChristianaCare Union Hospital is partnering with the Cecil County Health Department and the Maryland nonprofit Voices of Hope to make peer recovery specialists, pictured in blue t-shirts, available at the bedside for patients who have experienced a drug overdose or live with substance use disorder. Patients are not required to speak with a peer recovery specialist, but the specialists’ unique combination of lived experience and training to help people experiencing behavioral health issues offers an opportunity for people with substance use disorder to get help without fear of judgment or stigma. “Substance use disorder continues to be a serious health problem that affects people of all ages and walks of life,” said Lanre Akinkunmi, M.D., interim chief medical officer and medical director for population health at ChristianaCare Cecil County Campus. “The good news is that it is treatable, and when people are in the hospital or the emergency department, they are often most receptive to discussions about treatment. Through this expanded use of peer recovery specialists at Union Hospital, we are making a positive impact on the health of our patients and our community.” A voice of experience Peer recovery specialists who work on the weekdays are employed by the Cecil County Health Department, supported by a grant from the National Association of County and City Health Officials. Voices of Hope, a nonprofit focused on recovery support for people in Harford and Cecil counties in Maryland, employs the peer specialists working evenings and weekends. “This program is a great example of using resources wisely and effectively. We already know the tremendous work being done by Voices of Hope and Cecil County Health Department to help our neighbors who have been impacted by substance use disorder,” said Lisa Fields, manager of Community Engagement at the Cecil County Campus. “By partnering on this important program, we are building trust with our patients and helping them to get on the road to recovery.” Since the expanded program launched in September, there have been about 40 referrals for patients to speak with peer support specialists, and more than half of them have agreed to some kind of treatment, Fields said. Unique connection “Helping people get through what I went through really warms my heart,” said Hannah Dean, a peer recovery specialist with the Cecil County Health Department who works at Union Hospital. “I love what I do.” Cecil County’s death rate from drug overdoses is nearly twice as high as the rest of Maryland and more than three times the U.S. rate. The drug overdose death rate in Cecil County more than doubled between 2016 and 2020, according to the 2022 Cecil County Community Health Needs Assessment. Because peer support specialists have lived experience with substance use disorder and recovery, along with specialized training to support people struggling with mental health or substance use issues, they can connect with patients on a personal level and offer empathetic guidance, said Lauren Levy, health officer for the Cecil County Health Department. “Allowing peer recovery specialists to engage bedside with patients who may be struggling with substance use disorders will not only enhance access to behavioral health treatment but will also help reduce stigma surrounding substance use disorders and foster a more compassionate and supportive community,” Levy said. “We are honored to be a part of this innovative private-public collaboration and to work alongside ChristianaCare Union Hospital and Voices of Hope, Inc. This project helps to break down barriers to treatment and provide immediate support to those in need.” A history of support ChristianaCare has long been a pioneer in the use of peer recovery specialists, going back to the launch of Project Engage at ChristianaCare’s Wilmington Hospital in 2008. Union Hospital first partnered with the Cecil County Health Department 10 years ago to provide a peer recovery specialist in the Emergency Department. That program, the first of its kind in Maryland, was recognized with a best practice award from the Maryland Association of Counties in 2014. However, it operated only on weekdays during daytime business hours, and its ability to connect with hospital patients slowed during the COVID-19 pandemic. This reinvigorated peer recovery program is strengthened by the high level of collaboration among these Cecil County organizations, said Erin Wright, chief operations officer for Voices of Hope. “As community-based organizations, we are in a position to make a difference, and our perspective in the care for people with substance use disorder is really valuable,” said Wright, who has been in recovery for eight years. “As someone who has been through it, we are able to have that empathy. Even if the person does not want to go to treatment, you sit with them and maybe plant a seed.” Catharine Murray hopes her role as a certified peer recovery specialist can help someone struggling with addiction see recovery as a viable option for themselves. “This wasn’t available to me when I was trying to get better. I want to make it more accessible to others,” she said.
New Policy on BMI Use Will Change How Physicians Approach Diagnoses and Care
The Body Mass Index – or BMI – table was created in the mid-1800s, and for the last several decades has been viewed as the choice tool to diagnose obesity. However, the American Medical Association (AMA) recently issued a policy clarifying the role of BMI after taking a comprehensive look at both its benefits and limitations as a diagnostic tool. In short, the new policy urges physicians to use BMI only in conjunction with other measures of risk and recognizes the historical shortcomings of the oft-used formula. Lisa Diewald, MS, RDN, LDN, is the program manager of the MacDonald Center for Nutrition Education and Research with Villanova’s M. Louise Fitzpatrick College of Nursing. She applauds the AMA for embracing a more holistic approach to weight and health in individuals. “This is a huge step forward and I think it will ultimately lead to better health care and an improved practitioner-patient relationship,” Diewald said. To understand why, one must first understand the history of BMI’s use. The formula that spits out the number we have all come to understand as our BMI considers a person’s height and weight. It was developed in the mid-19th century by a Belgian sociologist to measure the socially ideal person. The modern term and application came about in the 1972 and has been a routine measurement ever since because it is easy, fast, costs nothing and in some cases, said Diewald, does correlate with body fat. But in recent years, large scale studies have exposed some of the limitations of the measure, building to the point where they needed to be weighed against the overt benefits. For starters, BMI does not measure body fat – or adiposity – directly. Adiposity, per Diewald, is more closely associated with health risk than BMI. “For this reason, health risk for some individuals with normal BMI but high body fat has been underestimated, and some with high BMI but normal body fat levels have been overestimated,” she said. Nor does it “differentiate between muscle, bone and body fat, or distribution of fat on the body,” Diewald said. “We know that all these factors can influence health and chronic disease risk.” Other comorbidities or chronic conditions that wouldn’t show up on a BMI chart alongside a number in the “normal” range can also impact health. Conversely, there are health conditions that might be incorrectly assumed just because a BMI is high. “Not every person with a high BMI experiences these chronic conditions, so developing a more holistic approach can lead to better assessment, treatment and outcomes,” Diewald said. Another shortfall she pointed out was its failure to factor in gender, race, body composition, ethnicity or physical activity level. Think back to the origins of the chart, intended to be a social standard created in Europe nearly two hundred years ago. “BMI tables were originally designed in the 1800’s using a population of white men,” Diewald said. “Understandably, at one point in time it was all we had to evaluate weight status, but it may not be accurate to use this standard alone with all groups of people.” These societal, gender and racial/ethnic factors led the AMA to explicitly cite “historical harm, use for racist exclusion and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations” in the new policy on its clinical use. Additionally, the policy addressed the differences in body composition across genders, races and ages that were not being considered. There is also an ignored mental component in its use to diagnose obesity, which can lead to avoidance of doctor visits and, in turn, further physical issues. “Obesity is a multifactorial, complex condition and addressing it with individuals needs to be done with empathy and sensitivity, beginning with how it is measured,” Diewald said. “There are numerous factors influencing weight well beyond simply food intake, physical activity level and BMI, so it is important for practitioners to recognize that and communicate this to patients. “It is extremely difficult for people with higher weight to be told that they have a high BMI and simply need to eat less and move more. When BMI is used as the sole indicator of weight status, this can be psychologically damaging. We know that many who have been told to lose weight simply based on a high BMI may avoid going to the doctors for routine medical visits and skip necessary preventive care.” It will not be easy, she said, to move away from a method used for so long that has been ingrained as a part of a routine medical visit, but Diewald thinks utilization of the tool in conjunction with other assessments is the best way put this new policy to practice. She advocates for measures such as “Using BMI as only one of several indicators of chronic disease risk, asking permission to discuss weight and health risk, [and] using shared decision-making between practitioners and patient to determine course of treatment.” Education is also paramount to proper assessment of weight-related health risks. “Education cannot stop with physicians, however,” she said. “I think this provides an excellent launching pad for enhanced collaboration among health professionals such as dietitians, nurses, nurse practitioners, physician’s assistants and others involved in providing care, nutrition counseling and lifestyle modification support to patients… Doing this can better fine tune recommendations for treatment, leading to improved outcomes.”
