For Shari Barkin, MD, MSHS, improving public health isn’t just a profession. It’s a passion.

As director of the Division of General Pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Barkin has dedicated her practice to the prevention of childhood obesity – an epidemic plaguing 17 percent of American kids ages 2 to 19, according to the Centers for Disease Control and Prevention.

The Road to Research

A Maryland native, Barkin earned her undergraduate degree at Duke University, her medical degree at the University of Cincinnati, and completed her pediatric residency at Children’s Hospital of Los Angeles. She was selected as a UCLA Robert Wood Johnson Clinical Scholar and completed a fellowship in Health Services Research. 

“I started my research by looking at big public health issues and wondering what the role of the physician is in addressing these,” Barkin said.

While in Los Angeles, that meant working with teachers, parents and providers to identify ways to prevent violence. After accepting an academic position at Wake Forest University, however, Barkin witnessed another dangerous epidemic unfolding among pediatric patients: obesity.

“At a macro level, I saw children walking through who were much larger than they had been a few years earlier,” Barkin said. “It made me ask questions, like why weight was outpacing height. What was different? It wasn’t sudden slothfulness, gluttony or technology, but a combination of many things.”

Barkin began writing grant proposals to fund research to understand early growth trajectories in children and to learn why some stay healthy while others veer off toward obesity. Her focus became one of prevention rather than weight loss.

Taking it Outside

While Barkin attempted to answer some of her questions by studying children in medical practices, she found many under a physician’s care were already obese.

“Once I established that health happens in families and communities, I took my research out of doctors’ offices and developed a partnership between the university and the community, creating collaboratives to strengthen families and neighborhoods,” Barkin explained.

Among her accomplishments was development of a 90,000-square-foot learning center with teaching kitchens and space for health screenings and counseling. “It was a place for the community bring ideas to us and vice versa, where we could develop ideas and test them,” she said of the North Carolina facility. “When I was recruited to Nashville in 2006, my vision was to expand that and build a series of collaboratives across the country to develop ideas to prevent obesity and increase public health.”

The Nashville Collaborative

Once in Nashville, Barkin discovered a natural partner in Metro Parks and Recreation and former Mayor Bill Purcell.

“Mayor Purcell had doubled the number of community and recreation facilities, and wanted to focus on how they could be utilized to enhance wellness and health,” she explained.

In 2008, Barkin spearheaded a citywide effort to improve the health of families. Now in its eighth year, The Nashville Collaborative has received eight grants and been featured in 30-plus peer review publications.

Comprised of staff from Monroe Carell Jr. Children's Hospital at Vanderbilt and Metro Parks and Recreation, the group works together to improve the health of local children. All of the initiatives are community-centered, family-based, sustainable, and have measurable results.

The Nashville Collaborative has received multiple awards from the Tennessee Association of Pediatrics, and Barkin has been invited to present the community health model in Italy, New Zealand and France. In 2014, Barkin was elected to serve as vice president of the Society for Pediatric Research, with succession to the presidency in 2016.

Obesity Prevention in 2016

Barkin said there’s no golden ticket when it comes to obesity prevention. “We do ourselves a disservice if we look at only one factor at a time,” she said. “It’s most impactful when we consider the dynamic interaction between factors and understand that timing of these exposures matter, too.”

The problem is multi-faceted, from our western diets to the way we grow food and the size of our plates. And then there’s the simple lack of movement in both work and leisure environments, triggered by an abundance of technology … and oftentimes, a perception of danger when it comes to outdoor play.

Attitudes about how we interact with resources also are a contributing factor, Barkin said. Socioeconomic status and early stressors in life can change a child’s physiology and inflammatory pathways, which alters how fat is stored and partitioned. There is also the incredibly complex science behind microbiomes (think gut bacteria changes), genetics and the evolving nature of protein expression from exposure to environmental factors.

“Our bodies are in a dynamic interactive state, and addressing one factor doesn’t allow us to make strides in a large public health way,” Barkin said. “Often these types of health issues, like obesity prevention, are really a family-focused health endeavor. It’s not one child at a time; it’s one family at a time. We, as clinicians and pediatricians, have an opportunity to engage the whole family and develop family-based strategies for maximum health.”