UCLA Health Interview: Dr. Ali Nsair

12/07/2020

We are excited to launch a new resource in this newsletter where we will interview various medical professionals at UCLA Health to provide detailed information about a number of important health topics. Our inaugural UCLA Health interview takes place with Dr. Ali Nsair, who is the Director of the Heart Transplantation and Mechanical Circulatory Support Program at UCLA.  He has a strong interest in sports medicine and extensive expertise in managing cardiovascular disease in patients of all athletic levels and directs the UCLA Sports Cardiology Program. Below, he shares his insights on how the pandemic has impacted our children’s physical activity and offers some solutions and guidance for those looking to help promote healthy cardiovascular habits with children.

Matt: What are the current concerns regarding obesity in children especially when it comes to this current pandemic and stay at home?

Dr. Nsair: Lack of exercise and childhood obesity are chronic problems in our community that have only been compounded and made worse with the current pandemic. Childhood weight gain occurs during time off from school in the summer and this weight gain accrues from summer to summer while much less weight gain occurs during school time. As well, childhood obesity correlates strongly with adult obesity and is linked to diabetes and heart disease.

 Multiple public health experts warn that the current pandemic will worsen the childhood obesity problem due to many factors: significantly reduced physical activity due to shelter in place orders and remote learning, increased screen time which is associated with increased snacking and less activity, and boredom and stress at home that are also associated with increased unhealthy snacking. While we are currently dealing with the acute events of the COVID-19 pandemic, the long-term effects of the pandemic, including increased risk of weight gain and obesity in children could potentially have serious health effects on an entire generation of kids.

Matt: What about diet and hydration with exercise in general and during the current circumstances for children playing sports?

Dr. Nsair: According to the American Heart Association, there are many causes of weight gain in children, such as larger food portions, poor nutrition by eating processed foods which are higher in calories and have processed sugars with high glycemic index, and less physical activity. All these factors have worsened during this pandemic due to staying at home and less participation in physical activities. As such, physical education teachers and parents need to incorporate recommendations for healthier diets, structured meals, and healthier snack ideas. They should also increase awareness of the risk of “grazing” all day and constant snacking rather than dedicated meals and snack times.

 With exercise, a typical 8 year old can expend ~ 150 calories during a soccer game; however, the average post-game snack bag can be anywhere from 300-500 calories. This can have detrimental effects on the kid’s health leading to weight gained. As such, it is incumbent on coaches, physical education teachers and parents to be educated on this calorie positive effect of high-calorie snacks both at home and during sports games. Pre and post exercise snacks are important for children participating in organized sports. However, parents and coaches need to be careful in the caloric quantity and quality of snacks. Those snacks and drinks such as juices and bars with processed sugars are high in calories and low in nutritional value causing weight gain. Many of these snacks also have a high glycemic index, which means they can induce an unnatural response in the body of exaggerated insulin production causing potential inflammation in the cardiovascular system which has poor long term health consequences. Naturally occurring complex sugars are lower glycemic index and lead to a slower release of insulin after eating which leads to less inflammation and weight gain.

 Hydration is another important aspect in the daily nutrition of children. High sugar drinks are the worst thing we can give due to poor nutritional value and high sugar content. Adult “sports drinks” are not designed for children playing sports due to many reasons such as the fact fluids and electrolytes lost during exercise vary between children and adults since children have a lower sweating rate than young adults even when corrected for weight. As well, when children are dehydrated this can lead to dysregulation of their ability to regulate their body temperatures.  Therefore it is important to select an appropriate fluid and electrolyte replacement strategy that addresses these children specific physiologic differences compared to adults.

Matt: What can we do as physical education teachers and healthcare providers to help with this unusual circumstances?

Dr. Nsair:  Parents are struggling at home with creative ways to keep their children physically active with remote learning and ongoing social distancing. As a Sports Cardiologist, my goal is to always encourage healthy eating habits and physical activity for adults to set a good example for children, as healthier parents will teach healthy habits to their children. Physical education for children is more crucial than ever and creative ways to incorporate physical activity into children’s daily remote education must be a priority to our educational system. The World Health Organization recommends for children aged 5 to 17 years old a minimum of 60 minutes daily of physical activity. The 60 minutes can be in multiple short bouts. Most of this activity should be aerobic activity like running or jumping for cardiovascular fitness and as well vigorous activity exercises such as climbing and push-ups need to be integrated to strengthen their muscles and bones. Physical activity not only will address heathier weight and cardiovascular health, it has been deemed to help children with anxiety, depression and overall wellness.  As such, we recommend developing an “Exercise Prescription” for school curricula. We encourage parents to have structured, planned and dedicated time during classes and during off days for physical activity. Educators and parents must try to make sure that the total daily activity reaches at least 60 minutes daily. A daily “Exercise Report Card” is valuable to write in these activities as it can be hard to keep track of daily activities. Some suggested activities that have been recommended are: 

• Planned 5-10 minute sessions between classes for children while on remote learning for physical activities (jumping jacks, running in place, dancing, etc.)
• Dedicated physical education sessions during remote learning by schools.
• Family Exercise: Parents to model good behavior and have dedicated daily time for family exercise (walking outside, biking as a family, backyard sports)
• Taking advantage of on-line exercise and exercise video games and challenges that can be enjoyable by children.
• Taking an exercise fitness class. On-line live and recorded classes are available and being offered by some school districts and local health fitness clubs for parents and children.

Matt: How will the current growth in the digital educational platforms be used in the future post pandemic?

Dr. Nsair: One of the few positives of this current pandemic is the large networks of digital communication between schools, teachers and parents and children that have been developed over the past few months. If physical activities that are structured and delivered online can be optimized, this will allow children the opportunity to effectively exercise remotely. These techniques and methodologies can be utilized in the future for increased access and allow lower income families and children that do not have the means and access to recreational facilities to have structured exercise and educational materials at home. We need to take advantage of the evolution of the digital platform to have more access for children beyond school time after the pandemic ends to continue encouraging the development of healthier habits.

Matt: What is the risk of current pandemic and patients and children seeing their Doctors?

Dr. Nsair: There has been a significant concern across the medical community of patients not seeking medical care due to fear of COVID-19. It is critical for patients and parents to ensure that they are maintaining follow-up with their physicians and seek urgent care if any concerning symptoms develop. We do not want an unintended consequence of this pandemic to be patients missing or avoiding their clinical care and suffering unnecessary illness due to preventable reasons that can be addressed with your doctor.