Scholar Story: Jennifer Woo Baidal, MD, MPH

I want to live in a world where, if you’re on one side of the city, country, or globe, you don’t see these stark health differences for children.

As a second-generation American living in Los Angeles, Jennifer Woo Baidal witnessed childhood health disparities firsthand.

“I grew up on the side of the city where kids were getting ketchup as their vegetable at school,” Jennifer says. “When I went to UCLA on the other side of town, I realized I didn’t have the same options as kids in wealthier communities. I saw that these kids have access to healthier nutrition options, which was a stark contrast to my upbringing—not because people didn’t care, but because those were the only options available.”

Jennifer’s paternal grandparents immigrated from China, first to Mexico and then the U.S., and her mother’s parents came to the U.S. from Mexico. Living in an underserved, minority neighborhood in Los Angeles, her grandparents had a child die because they could not afford to seek health care.

“That knowledge instituted in me a drive to promote health equity and ask how do we achieve health equity? How do we provide an equitable start for children?” Jennifer says. “I want to live in a world where, if you’re on one side of the city, country, or globe, you don’t see these stark health differences for children. Is that realistic? I don’t know, but every day when I wake up I think: How can I help make child health better?”

After completing her undergraduate education at UCLA, Jennifer became interested in child health and nutrition, particularly in underserved areas where disparities in obesity rates are apparent. From 2011-2014, 14 percent of white children age 2-19 developed obesity, compared to 19.5 percent of Black children and 21.9 percent of Hispanic children. While participating in research training with the National Institutes of Health (NIH) in Washington D.C., she began volunteering as an EMT. Jennifer realized that she loved the combination of research and on-the-ground patient interactions, which inspired her to enroll in medical school at Harvard. While completing her pediatric residency, Jennifer became involved with the non-profit Proyecto Pastoral in Boyle Heights, East Los Angeles, which serves low-income Mexican and Central American families. Jennifer developed interventions at their early childhood education center to promote child nutrition and healthy activity. Realizing that she wanted to evaluate the efficacy of these programs as well, Jennifer decided to get her MPH.

With her interdisciplinary background in clinical work and public health research, Jennifer’s work at Columbia University focuses on preventing childhood obesity and its health complications, particularly in disproportionately burdened populations, such as racial-ethnic minority and low-income neighborhoods.

“A high proportion of children have obesity,” Jennifer says. “Each year that passes, I feel we have the opportunity to shift the needle by making the healthier choice easier for people.”

Partnering with the Massachusetts Department of Public Health, MassGeneral for Children, and Harvard School of Public Health during her fellowship, Jennifer implemented and evaluated a multilevel, multi-sector approach to reduce childhood obesity in 2 to 12-year olds. The team introduced five evidence-informed interventions in primary care, WIC (Special Supplemental Nutrition Program for Women, Infants and Children), school and afterschool settings, and community sectors. Using these existing platforms, Jennifer found they were able to improve body mass index (BMI) outcomes and reduce their obesity risk factors as well as racial-ethnic disparities in childhood obesity among children in WIC.

“That’s where I’m hoping to leave a lasting impact—in developing and fortifying where prevention is most promising and to work in early life to improve child health for all children,” Jennifer says.

Currently, Jennifer works with WIC in New York to observe risk factors for obesity in the first 1,000 days of a child’s life to identify population-level interventions that could help to reduce the risk factors, such as excess gestational weight gain and rapid infant weight gain.

The guidance clinicians have for obesity from the U.S. Preventative Services Task Force recommends evidence-based services to primary care physicians. Their guidelines suggest screening children ages 6 to 12 for obesity and, if the children are at risk, delivering intensive  behavioral interventions to reduce their BMI scores. In terms of evidence, there is little evidence  for effective ways to prevent and treat obesity in younger children, Jennifer notes.

In a study she conducted in Washington Heights, a neighborhood in Manhattan, Jennifer found that many parents of infants were confused by the lack of health recommendations from clinicians. Out of 280 families with infants, 66 percent of infants were drinking sugar sweetened beverages. While the American Heart Association recommends no sugars before the age of two, marketing in many low-income areas can mislead parents. With few dietary guidelines, Jennifer says it is difficult for families to see through the smoke of what’s healthy or unhealthy.

Another barrier to reducing obesity risk in the population with which Jennifer works is getting families the support they need. While Jennifer often provides referrals to SNAP or WIC, families must navigate the system alone. On top of that, it’s difficult for many families to come to regular appointments at Jennifer’s clinic, as this often requires taking time off work, traveling via car or public transit, paying for parking, and long waits—all of which may not be feasible for low-income parents.

“That’s a missed opportunity to link families with existing programs that might be helpful to them,” Jennifer says. “Moving forward, I want to focus on how we can integrate existing systems and evidence into day-to-day practice. If clinics and WIC, for example, are on the same page, we have a lot of potential opportunities to intervene not just for the babies, but for the parents.”

Receiving the New Connections grant soon after finishing her MPH was crucial in helping to sharpen her research, Jennifer says. With the grant and its focus on mixed methods research, Jennifer was able to bridge the gap between clinical work and public health and policy research.

“Meeting other New Connections grantees has helped me to develop collaborations,” Jennifer says. “I have upcoming publications that have come from those relationships. Since receiving the grant, I have come into my own and moved my stream of research forward.”