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Bringing mental health care into the pediatrician's office

 April 10, 2024 at 1:58 PM PDT

S1: Welcome in San Diego. It's Jade Hindman on today's show , providing mental health care , and the pediatrician's office is showing promise for kids who need it. Plus , a new study finds fasting could be bad for your heart. We'll talk about that and much more. This is Midday Edition , connecting our communities through conversation. Welcome in San Diego , it's Jade Hindman. On today's show , integrating mental health care in the pediatrician's office is showing promise for kids who need it. Plus , a new study finds fasting could be bad for your heart. And the wave FC kicks off their season. This is Midday Edition , connecting our communities through conversation. As the rate of young people experiencing mental health challenges continues to grow. Pediatricians and therapists are looking for better ways to improve the well-being of children. Now , a program from Rady Children's Hospital is showing potential in doing just that. Doctor Anne Bird is leading the effort as the medical program director of behavioral health integration at Rady Children's Hospital San Diego. Doctor bird , welcome to midday edition.

S2: Thank you. Thank you for having me here.

S1: So glad to have you here. So this program is about integrating mental health care into a primary care setting.

S2: So what we're doing at Reading Children's is we are transforming this and we're providing a different model of delivering health care , and we're integrating physical and mental health together. As you mentioned , our nation is really struggling with a youth mental health crisis. The statistics that I'm sure your listeners have heard is really substantial and and concerning. The American Academy of Pediatrics declared this actually a national emergency. And suicide remains the second leading cause of death among teenagers nationwide. So now is such an imperative , important time to not only provide the access to our kids , but to provide that in a timely , convenient manner. A lot of kids who struggle with mental health issues can get better with treatment , and they can recover , and they can improve and they can heal. But so many don't receive the care that they need when they need it. And so what we're trying to do is to remove that barrier. And to be able to provide access alongside the pediatrician.

S1: Tell me about , you know , the benefit of addressing those mental health care issues early on.

S2: Yeah , no. The earlier you can catch kids who have , um , brewing mental health issues , depression or anxiety , the easier it is to get in , intervene quickly , and provide the treatment and the resources needed for them to improve and allow them to recover and heal quicker. So this program is really all about early identification , early intervention , which leads to early recovery. A lot of kids that I see in the emergency room these days , and our emergency room visits have rocketed over the last ten years or so for behavioral health concerns. A lot of those older kids say that they've been struggling with mental health issues from a much younger age , but they just weren't able to access care. So what our program is trying to do , and what I think it's doing successfully , is to catch them early to provide those resources , resources quickly to them so they can kind of get better.

S1: Our schools at all helping in this effort.

S2: Schools always help and schools are such an important place for kids. Kids spend so much of their time at schools. I'd say the places that you're going to really catch kids in terms of providing treatment to them would be at the pediatrician's office and at schools. And so we , in the bigger Transforming Mental Health initiative at Really Children's , are helping work and collaborate with local schools to provide education to the counselors , to the teachers , to the therapists there to help the kids who struggle and get identified at school.

S1: We hear so much about what's behind this rise in mental health issues among children. A lot's happened since 2020.

S2: Um , I think the answer is there isn't one culprit. Uh , there's a lot of culprits. Um , I think a lot of people sometimes think that it's just kids and teens perhaps being moody. The fact is that kids and teens are a lot more consistently willing to talk about their mental health these days , and it wasn't the pandemic that caused this. Our society was , you know , really in crisis before Covid hit. But of course , the pandemic , um , didn't help and absolutely exacerbated that. There's a ton of theories out there. Um , social media is a big one. Um , that comes up a lot. It's clearly impacting things. Um , there have been studies that have disputed that as well. And , um , although social media can lead to depression , especially in a sensitive age group of girls between 11 and 13 , it can also globally enhance social connection and positive engagements. Um , to me , it's really what social media replaces , which is sleep time , outside physical activity , connections one on one with people. And I think that is also , you know , what's causing some of these mental health struggles. There's a myriad of other kind of theories. Um.

S1: You know what I mean ? But do you think in any way that social media has helped provide youth with the vocabulary to articulate what it is that they're experiencing , leading to maybe getting the care that they need ? Yeah.

S2: I mean , I think there's a oh , gosh , there's so much out there , right. And I think what it really just comes down to , um , is , um , the right balance , moderation and monitoring. So making sure that if kids are on social media that they're at an appropriate age to do that and that they are , um , accessing websites and apps that are appropriate to help them in the way that you described.

S1: And , well , back to the program. It began in 2020. So how has it been working for patients so far ? Yeah.

S2: Um , I think it's been super successful. Um , I'm very proud of it. I'm honored to be part of it. Um , I think what it's really doing is providing same day access for kids and families , and I think kids and families have really appreciated that. The alternative often is that the pediatrician would provide potential resources to a family , and it would be then perhaps on them to go and try and make that appointment. And that's often a wait time of four , six , sometimes even nine months. So the fact that families can see some on that same day , it provides a lot of relief. And it's in a trusted environment. It's with their pediatrician who they've known oftentimes for a long time. And so the the feedback we're getting from families and kids is that they they love the access and they love the collaboration between the child psychiatrist , between the therapist , between the pediatrician and themselves , and that we're all working together to take care of not just the medical , but also the mental health concerns of their kids.

S1: So you're finding a lot of success ? Yes. Excellent. I want to bring in Nicole Kircher. Um , her son Lucas , is six years old , and they're part of this program with Rady Children's. Um , Nicole , can you tell us a little bit about your son Lucas and what led your family to become a part of this program ? Yeah.

S3: So my son , he was , um , diagnosed with severe ADHD , uh , when he was four , and we were dealing with a provider that it just didn't give us as much help as we needed. And then some other things came about , and and we ended up transferring and getting referred by our insurance company over to Brady's Children's Hospital. And , um , we have only been there since January. And the amount of change in Lucas is phenomenal in getting linked up with , uh , Doctor Rosenfield and Doctor Bird. They were able to get him on the correct dosages and medications to help him to succeed in school. And and now he's seen a behavioral health therapist as well , that's helping him to do coping skills and learn how to work with his peers. And they've been mentioning in school about how well that they can see the difference in the growth in him , where he used to be a lot more violent in school and now is able to , um , walk away from situations or be able to talk them out instead of the more , um , aggressive behaviors that he was handling , um , situations with. So it's just it's been such a great help and the tools that they were able to provide by the , the parent groups and giving resources on how to better parent Lucas and his needs. So not only are they working with Lucas and what Lucas needs , but providing resources and help for us to be able to take care of it on the home front as well as in school for him. So this program has really turned our our entire house around , um , in just a short time.

S1: That's excellent. I'm so happy to hear that Lucas is getting the care that he needs.

S3: The office and all of the staff are so easy to speak to , and , and , and the resources are provided that you don't have to you don't have to try and find it on yourself. You know , if they're offering a program , they're handing you the information or getting you scheduled to know exactly how to get into that program and what you're going to need. Um , where before it was kind of like a well , here's a website and , you know , good luck , you know ? So , um , it's just been such a hands on experience , um , with ratings in this program that if there's a tool that they know that you can use , they've basically put it in your hand. And that just makes it so much easier.


S2: And that's really the crux of our program. It's , um , having someone there to provide that quick and easy same day access for our families. So , you know , where is a family going to take their child if they have concerns or questions , they're going to go and see their pediatrician. It's a place , like I mentioned where they're , you know , they feel trust that there's trust there. They feel safe in that environment. And let's not forget that a lot of kids with mental health issues , it starts off with a medical concern , perhaps a headache or a stomach ache or or they're not sleeping too well. And , um , what's great then , is that our pediatricians , who we work to support and educate and train , are now really keyed in to identifying kids through screenings as well , who might be beginning to struggle with mental health concerns , ADHD , depression , anxiety. And instead of then the family leaving the clinic and getting kind of lost to follow up , they're able to walk that child in that family down the hall , and our expert mental health provider therapist is there and available in that moment to do what we call a warm handoff , um , with the family and the pediatrician with a pediatrician will talk the therapist with the family about some of the concerns , and they'll get introduced. And it's kind of a transfer of trust between the pediatrician and now the therapist. And it destigmatizing things. It helps families feel comfortable and encouraged by their pediatrician to follow up , and then our expert can have them come back in to do a evaluation and assessment and ascertain what aspects of our program can step in to help provide the treatment and resources that are needed. So it's really comes down to , if you think about it. When the child is in the pediatric office , you're catching them before they leave. So there's going to be a 100% engagement , a sort of 0% no show that you're going to be providing that information , even if it's just psychoeducation to the family , even if they decide they don't want to pursue and follow up on treatment. It's just making sure that we are there to identify and provide resources as quickly as possible. And that's really what gets you on the road to recovery. Wow.

S1: And that eliminates some of the frustration that you felt , Nicole , of not finding the right medical care you needed. And it's something a lot of families go through. It can really be difficult to navigate health care systems and know where to find the right care.

S4: Right ? Yes.

S3: Or who's accepting ? I mean , in the beginning , I can't tell you how many lists and handfuls of providers that I contacted to get , you know , the specific ADHD help. And I was left with a shut door of either we don't treat ADHD or we don't treat pediatrics , or. So just while you were left with all of these pieces of paper , they were all closed doors. So to be able to be plugged right into the provider without having to , you know , hope and pray that they are accepting , you just know that it's done. And that was such a blessing to know that it wasn't like , oh , great , I have a name , but I haven't. I've basically not gotten any more than I had before I walked through the door. So that was a big thing for us. Yeah.

S2: Yeah. I'm so glad that it worked out for you. Um , Nicole. And , um , that the model that we've got in place , um , is working. I think the other great thing is that it's not just that you're going to go and see , like a therapist or a child psychiatrist. You're going to go and see someone who's on the same team as the pediatrician. So the pediatrician , you know , we all know each other , so we all can kind of vouch for each other. It makes the families feel a lot more comfortable. We collaborate a lot about the treatment we meet every week to talk about our patients and to make sure that we've got everything in place that we need to have in place. And I think that's what really helps families feel comfortable , and it really helps with our outcomes , and it helps with our engagement. So people keep coming back , bring their kids back. Um , just to kind of mention in terms of , um , a lot of families just in kind of standard of kind of traditional care outside of our integrated care program. They do get oftentimes given a lot of resources , a lot of papers. And not only will they oftentimes find closed doors when they make that phone call , we've noticed that a lot of families and caregivers and parents are very anxious and nervous to to even pick up the phone and make that initial phone call. Um , they , they , they feel like it's a system that they're intimidated by and that the concern that they're not going to get anywhere. And so it kind of falls by the wayside. Not not for their fault. Um , just that it's not set up to be helpful and convenient for them. Right.

S1: Right. And I want to talk to you a bit more because you mentioned stigma earlier. How much does that play in here ? Um , often there are a lot of parents who don't want the stigma of a diagnosis , um , on their child and maybe delay care. Um , but this , this makes it so accessible. And , um , and you go through the process of educating parents before they even leave the office. Um , talk a bit about that. Sure.

S2: Sure. Yeah. Um , and that's all , you know , stigma is very , um , individualized. Um , and that's another great thing about the fact that oftentimes the pediatricians know the families and really know how to kind of pitch and , and sell the resources and treatments that they know probably are going to help. Um , we talk a lot with the pediatricians about how to present our program to families , um , using words like sad and stressed rather than depressed and anxious. Um , and , um , you know , using words like counselors as opposed to perhaps therapists when they talk about psychiatrists really kind of like , um , making a point to , um , explain what that means and what that's going to look like and that we know each other. So those are all ways that , um , I think the stigma , which is very rampant , very kind of understandable out there around mental health and that I hope over time will , you know , dissipate. Um , our program kind of helps to kind of focus in on. Yeah.

S1: Yeah. Well , given the positive results you found with this approach that you all are doing what's needed to expand the program to treat more kids like this.

S2: I think , um , I would love to see this become the standard of care for , well , the nation. But let's start with San Diego and Riverside. We have currently , um , we have , um , 11 primary care sites. We have four regional support hubs in San Diego and Riverside regions. And , um , I want to see that grow and scale. And , um , what comes with that is , um , needing to be aware of the fiscal , the fiscal issues that come with scaling these kinds of programs. Integrated care is somewhat new concept. There are other children's hospitals and definitely kind of adult programs that are doing integrated care , but I think the reimbursement infrastructure needs to catch up with the , um , the success and outcomes that we're seeing in order to appropriately reimburse us so we can scale and grow and make this become the standard of care.

S1: Well , now that that you've got this program going , do you have any advice for parents on how to make sure that their kids stay in good mental health ? Um hum , um hum.

S2: That's a great question. So important what every parent and caregiver wants to know , right. And I think it just comes down to connecting with your child , right ? Recognizing , asking , listening. Um , mental health issues can manifest in so many ways. You guys know your kids and know your children. If you notice a change in their behavior , perhaps they're sleeping differently or they're more isolated or irritable , tearful , not enjoying life. Those are things to pay attention to and to really kind of like give them time and listen in a non , non kind of judgmental way to find out more. I think trying to make home a healing place , you know , model wellness for your kids. Hard to do sometimes but important to prioritize uh as well as prioritizing. I kind of mentioned it before , but physical activity , there's been a lot of studies recently to show that , you know , physical activity really helps boost our mental health. So really prioritizing that , prioritizing social activities , uh , prioritizing interests. They have obviously sleep and and eating well and talking with them in a , in a healthy way , helping them reframe experiences , those um , to be more , more positive and , and to sort of normalize perhaps some of the issues that they're going through talking to school , making sure school is a supportive environment for them as well , and then just knowing when it's time to get more support and to reach out to an expert. And I would say that's when you know , you're you're worried or and if your child comes asking for help , that would be a time to reach out. Start with your pediatrician. Um , obviously , if there's any concerns about safety or an emergent concern to utilize emergency resources , and I can provide some of them kind of perhaps online later , but I think really just kind of having the concept of a kind of a wellness healing household.

S1: All right. And we'll have some of those emergency resources posted on our web page at Kpbs. Org. Nicole , what about you ? What advice do you have for parents.

S3: To be your kids advocate ? If it doesn't feel right , if you don't feel that you're you're getting the care that you feel your child should be needing to go out there and find something else. Because there there is , there is something better. Um , you know , I , I thought in what we were doing originally for two years was that was basically the options. And I stayed and then , you know , in research and , and discovery found this program. So if you don't feel that you're getting the resources that your child needs to be that your child's advocate and and find it , contact your insurance , contact , you know , contact people that can help you to find the resources that you need to make sure that your child's getting the care that they need because it it makes such a difference.

S1: All right. I've been speaking with Nicole Kircher , a parent whose child is being cared for at Rady Children's Hospital. Nicole , thank you for sharing your experience with us.

S4: Thank you for having me.

S1: Also , Doctor Anne Byrd is the medical program director of behavioral health integration at Rady Children's Hospital. Uh , Doctor Bird , thank you so much.

S2: Thank you. It's been fantastic being here.

S1: Up next , new research suggests intermittent fasting could be bad for your health.

S5: It did catch us by surprise because it's a diet that we highly recommend.

S1: You're listening to Kpbs Midday Edition. You're listening to Kpbs Midday Edition. I'm Jade Hindman with promises of weight loss , blood sugar control , and longevity , among many other things. The practice of intermittent fasting is popular , but research from the American Heart Association shows the practice may be damaging to the heart , finding that only eating during an eight hour window while fasting the other 16 hours raise the risk of heart attack deaths by 91%. And that raises a lot of questions. Pedro Cornelio is a nurse practitioner who specializes in cardiac care. He's also a professor at the University of San Diego. Pedro , welcome.

S5: I thank you for having me.

S1: So glad to have you here. Um , I'm sure hearing that the intermittent fasting could raise the risk of death from heart attack by 91%. Was that alarming to you ? Yes.

S5: It's definitely a bold statement by the American Heart Association. It did catch us by surprise because that's a diet that we highly recommend. Of course , with precautions we can , you know , determine that everybody should be doing intermittent fasting. But for the American Heart Association to come out and say that the intermittent fasting is bad for you and us recommending it. So it puts a dent in our practice here at the cardiac center. Mhm.

S1: Mhm. And you know that this is it's not a complete research study at this point. What questions remain for you at this point. Correct.

S5: Correct. So when that came out , I looked for the American Heart Association article , but I found out that it wasn't an article that it's peer reviewed. It's only a poster as of now. So it's a poster that came out supposedly the study. It's a longitudinal study. It is not a double blinded clinical trial that's randomized. It is a longitudinal study that's out in 2003. So it raised more questions than answers for me and for my colleagues. So I don't know whether , you know , we should take this poster and take it into practice as of now , or just wait for the publication to actually come out and see what they actually did.

S1: And so you say it's a poster.

S5: It hasn't gone through peer review where colleagues in cardiology look at this and it actually gets published in a journal. So right now it's a if you do a research study , you usually want to present your findings at a convention. And then you do a poster and you show your result. But when when it's it's just a poster. Sometimes it's not published just yet. So I was surprised that the American Heart Association put their stamp on this poster , being that it's not published yet. You know , maybe they do have really , you know , sound evidence that intermittent fasting is bad for you. But in where how what type of diet where they having where the people doing intermittent fasting and then eating nothing but potato chips and beef and pork ? Or was it people doing intermittent fasting for 30 days without eating ? Was it intermittent fasting , eating healthy foods ? So all those questions weren't unanswered with this poster. Yeah.

S1: Yeah.

S5: And then you have an eight hour window to eat. So patients can do any way they want it. So if they want to eat , um , their , their meal , their first meal at 12 p.m. and their last meal before 8 p.m. , and then they don't need anything between 8 p.m. and 12 p.m. the next day. But you can do intermittent fasting at any hours. Typically , we advise people to do intermittent fasting with a 12 hour window in the beginning , because it's very difficult not to eat for 16 hours. If you're used to the standard of eating three meals a day. Typically with this intermittent fasting , you're skipping one meal. Uh , so typically we have you start at 12 hours , don't eat any time between 8 p.m. and eight in the morning. And then we have you progress in a period of 2 to 3 weeks to maybe 14 hours , then 16 hours and as tolerated. But we never advise to do intermittent fasting for a lifetime. We have you do intermittent fasting , maybe five days a week and then , you know , take a break on the weekends so that it doesn't become very difficult and unsustainable for patients. Yeah.

S1: Yeah. And so you this is something that you recommend a lot of patients practice. So tell me more about the benefits of intermittent fasting.

S5: Because what it does , you're abstaining yourself from eating calories. Specifically , you don't want to be eating carbs so that you don't have these blood sugar spikes. So with this , it helps you burn the fat that you already have , burn the triglycerides that you already have , and turn them into energy. Ultimately , losing fat with these 16 hours of not eating , your metabolic rate actually improves , decreasing your risk of diabetes and metabolic syndrome. So technically , it's a very easy diet to follow. Of course , there are some limitations. You don't want to have patients with advanced diabetes with insulin or medications that drop your blood sugar. Do an intermittent fasting. It's not for everybody. And we understand that. Um , but it's a it's a great diet and it's worked perfectly in the last few years. Um , you know , it became popular probably 2018 , 2017. Um , but the study started back in 2003 , and it wasn't even that popular back then.

S1: Yeah , yeah.

S5: And I see their data because. I still , I'm a strong believer of this because I've treated patients with heart disease , with diabetes , and I put them in intermittent fasting and they've lost weight. Some of them lost 30 , £40 in one year. And I've seen improvement in prediabetes where they're no longer have to take their medications. And I've seen a spike. And this is just my personal experience , what I've seen with it. But I've seen patients , HDL , the good cholesterol spike up and the LDL drop down. Um , and I haven't experienced anybody having heart attacks as a result from intermittent fasting. So as of now , I'm still , you know , encouraging patients to do intermittent fasting , but I teach them how to properly do it because I understand that if they do intermittent fasting and those eight hours , they're eating nothing by processed foods beef , pork , um , and fatty foods , then of course , it's not. You may lose weight , but it's going to affect your your heart because you're not eating a balanced diet with fruits and vegetables. Yeah.

S1: Yeah. Given that that's the case , then why do you think this , uh , latest research , um , reflects a an elevated risk in heart attack , death from intermittent fasting.

S5: So I'm speculating and I'm making the assumption here that what they found was that patients that were starving themselves , it probably trigger a metabolic response to retain all the fat that you're eating , uh , to retain , um , products in your body that cause oxidation in your coronary arteries and , uh , it causing this what we call the cytokine response. So it causes inflammation and build up a plaque in your arteries , however even that. So I need to know which patients got that. Was it the ones that did intermittent fasting for you know , they didn't need anything for 14 days ? Or was it the ones that were doing intermittent fasting for 16 and eight hours ? And I need to know the variables that they looked at. I need to know if they took note of all the food the patients were eating , because that that is , those are good variables to look at so that we don't just say blanket statement and say intermittent fasting is bad for you. Maybe we should say intermittent fasting is bad for you. If you don't eat for 14 days and you eat these kinds of foods. But if you do intermittent fasting Monday through Friday with a balanced diet and you take breaks in between , then it's healthy. And we showed that nobody had a heart attack from that. But we don't know because it's not published yet. And we need to look at all the variables that they looked at and their full findings and the methods of how they did the research. Yeah.

S4: Yeah.

S1: Well , you know , there's a lot of interest in wellness and a lot of popular shows and influencers. Um , really talking about new fads and approaches.

S5: Should I stop ? I read this post or this , you know , publication that came out from the American Heart Association. So it may affect me because now I'm going to have to justify why they should continue. And there's maybe another five minutes at the at the with the patient explaining what the the results are. But so far nobody has come up at the clinic and say like , oh , I heard that intermittent fasting is bad for you. You know , I don't know. I'm not sure if , uh , if it's if this been published on TikTok and , and Facebook and all the sources where people are actually looking at this. Uh , but obviously , if you're in health care , you follow the American Heart Association and you're going to know about this.

S1: Um , you make the point that really , it's not a one size fits all , at least not intermittent fasting.

S5: Of course , there's other ways to lose weight. There's other ways to stay healthy. Most of the time when you hear intermittent fasting , you're not thinking of heart. You know , improving your heart health. You're thinking of losing weight. So most patients are going to. Intermittent fasting is because they want to build muscle and lose fat. But in order to be healthy , you just need to keep a balanced diet and limit beef and pork. So typically , I advise patients to not eat beef more than twice a week so that they don't build up LDL and build up plaque. I also advise patients to workout and specifically do cardio 20 to 30 minutes a day , for a total of 150 minutes of cardio a week in order to have good health. I also advise patients not to do a lot of strengthening exercises like bodybuilding , because bodybuilding technically is bad for you. Your heart is a muscle , and if you're bodybuilding , you're putting a lot of strain in your heart and you cause hypertrophy to your heart so you can end up with heart failure. Heart failure , uh , other things that I advise patients to is , um , live a stress free life , if you can. I know it's very difficult in the United States because it's all about work and , you know , getting that promotion. But we need to get eight hours of sleep every night. We need to get that cardio going , balanced diet and set time aside for your family and then , uh , reduce your stress. Also , one thing that nobody takes a consideration , consideration with heart health is staying away from your phone. Limit screen time. When we're spending time on our phones and we use our phone to go to bed and where that screen time , we're limiting our our ability to have a good night's sleep. And it eventually affects us , probably with some degrees of sleep apnea , of course. Um , you know , being on your phone doesn't cause sleep apnea , but you need to get a good night's sleep. Um , reduce your risk for obesity by not going to fast food restaurants and trying to cook meals at home. And one thing that we all need to do as Americans is sit down at dinner time with our families , with TV off , so we can have conversations with our partners , with their wives or their husbands and our children and have conversations. All these things eventually lead to bad habits. If we don't follow them and eventually leads to heart disease. Something as simple as just sitting down to eating dinner with your family. Wow.

S4: Wow.

S1: So lifestyle changes and paying attention to the evolving science behind heart health is is key here. Pedro Coleus is a nurse practitioner specializing in cardiac care and a professor at the University of San Diego. A professor Coelho , thank you so much for joining us. Great advice.

S5: You're most welcome. Thank you for inviting me.

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Rady Children's Hospital is seen on Oct. 31, 2023. San Diego, Calif.
Carlos Castillo
Rady Children's Hospital is seen on Oct. 31, 2023. San Diego, Calif.

A program at Rady Children’s Hospital-San Diego is tackling the youth mental health crisis by integrating mental health care services into physical care settings.

As the mental health of young people continues to be a major concern for caregivers, the program is showing success by including therapists and counselors into pediatricians' offices.

The idea is to treat children's mental health as early as possible and before they are in crisis.

"In the U.S., historically, mental health care and physical health care has been separated and divided and this sort of siloed approach fails to address the needs of the whole child," said Dr. Anne Bird, medical program director of Behavioral Health Integration at Rady Children's Hospital-San Diego.

Plus, new research is raising questions about intermittent fasting and heart health.


Dr. Anne Bird, medical program director of Behavioral Health Integration, Rady Children's Hospital-San Diego

Nicole Kueker, parent

Pedro Colio, associate professor, University of San Diego, nurse practitioner, Imperial Cardiac Center

Additional mental health resources:

California Youth Crisis Line:
Call/text: (800) 843-5200

Crisis Text Line:
Text HOME to 741741

LGBT National Youth Talkline:
(800) 246-7743

Suicide and Crisis Lifeline:
Call 988