Pediatrician Engages Communities to Make a Lasting Impact on Child Health

Elsie Taveras, MD, MPH

Ofer and Shelly Nemirovsky MGH Research Scholar

Chief of General Pediatrics at MassGeneral Hospital for Children

Executive Director of the Kraft Center for Community Health

Imagine you are a pediatric clinician in an urban community health center. You notice that the majority of your patients have the same triad of conditions – obesity, asthma and behavioral health problems.

You can encourage your patients to lose weight, prescribe asthma medication or connect them with psychiatric services, all of which may help the symptoms, but not the root cause. What can you do in the short time you have with each patient to address the determinants of these conditions?

This is the question Elsie Taveras, MD, MPH, Ofer and Shelly Nemirovsky MGH Research Scholar, chief of General Pediatrics at MassGeneral Hospital for Children, and Executive Director of the Kraft Center for Community Health, confronted while completing her pediatric residency in a Boston clinic serving inner-city youth.

“I started realizing that, although much of my work was providing one-on-one patient care for these conditions, so many of the determinants of the health and well-being of the children I cared for had more to do with their social and environmental conditions and not their clinical care,” says Taveras.

These experiences guided her decision to focus on a combination of clinical and community-based research approaches to address the causes of childhood health problems and reduce health disparities. While working in community settings presents a unique set of challenges, Taveras says the relationships that she has built and the potential to have a long-term impact make the work incredibly rewarding.

Engaging Diverse Stakeholders

Taveras has found that conducting research within a community requires an understanding of context and who the stakeholders are, what matters most to them, and the best ways to engage them in the research process.

“In the same way that we wouldn’t build a home without a blueprint from an architect, you can’t design an intervention for families without families’ voices to inform the work,” says Taveras.

Other stakeholders can range from youth-based organizations and public health practitioners to school administrators and representatives from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). These stakeholders are an integral part of their communities and understand the barriers to proper health and health care.

Mass General’s Focus on Community Research

At a local level, Taveras is encouraged to see how the hospital has elevated community health as a key component of its mission under the leadership of President Peter L. Slavin, MD. Mass General is one of the few academic medical centers in the country to incorporate a commitment to the community in its mission statement.

“I’m thrilled by Mass General’s national leadership in community health and the opportunity to serve disadvantaged populations through the Kraft Center,” says Taveras. “I’m optimistic about the changes that I’ve seen and how that reflects our institutional support for community health.”

Between Taveras’ individual efforts and those of Mass General and the Kraft Center, they may be able to address the root causes of health issues in the urban communities in Massachusetts—and extrapolate those results to other communities nationally.

“Tremendous inequities in health exist, largely attributable to poor access to high quality care as well as social and economic factors that are distributed unevenly based on income, race and ethnicity,” says Taveras. “We can transform the health of children and their families by increasing access to care, investing in bold new solutions that improve social and environmental conditions, and supporting the training of clinicians and researchers who want to improve outcomes for medically underserved communities.”

New Research Uncovers Gender Differences for Risk of Developing Heart Disease

Mass General Research Institute goes red for heart month

Did you know that heart disease is the leading cause of death for both men and women in the United States? American Heart Month, celebrated in February, is an opportunity to raise awareness about heart disease and how people can prevent it.

Researchers and clinicians at Massachusetts General Hospital are working to improve treatment and care for patients with this disease. Over the next few weeks we’ll be featuring some of their research – stay tuned for more!

We can all agree that carrying a lot of fat on our bodies isn’t healthy. But when it comes to heart health, where the fat is located and the type of fat can make a big difference—especially for women.

New research from Massachusetts General Hospital finds that having a certain type of body fat known as ectopic fat in the midsection may put women at a greater risk for developing heart disease and other cardiovascular health issues in comparison to men.

Before we jump into the research, let’s define a few terms:

  • Coronary artery disease (CAD): the most common type of heart disease and the leading cause of death in the United States in both men and women. CAD develops when plaque builds up in the arteries that supply blood to the heart.
  • Cardiometabolic risk: your risk of developing conditions including diabetes, heart disease or stroke
  • Ectopic fat: a dangerous type of fat that accumulates around vital organs such as the liver and abdomen

Previous studies have shown that the way fat is distributed in the body may be a health threat. For example, people with fat accumulation in and around their abdomen (often referred to as apple-shaped bodies) have a higher risk for coronary artery disease compared to individuals who store fat in their hips and thighs (commonly known as pear-shaped bodies).

Now new research presented at the Radiological Society of North America (RSNA) 2017 Annual Meeting, led by Miriam A. Bredella, MD, radiologist at Mass General, finds that gender also plays a key role.

Exploring differences between men and women

Bredella and her research team examined 200 overweight and obese but otherwise healthy adults. 91 of the participants were male, and all participants had a similar body mass index (BMI) and age.

The researchers found that female participants had more total body fat and more superficial “pinchable” fat in their thighs, but had a lower lean body mass (the amount of weight you carry on your body that isn’t fat). Male participants had more ectopic fat in the abdomen (commonly referred to as a “beer belly”) and in their liver and muscle cells.

What’s more, the study found that the risks of carrying ectopic fat at the abdomen differed for men and women. Ectopic fat did not increase men’s risk of cardiometabolic disease but it significantly increased cardiometabolic risk in women with the same BMI.

“The detrimental fat depots deep in the belly, muscles, and liver are more damaging for cardiometabolic health in women compared to men,” said Bredella in an interview with Medical News Today.

This discrepancy could be due to the fact that men typically have higher muscle and lean mass, which are protective for cardiometabolic health.

More research is needed to better understand this discrepancy between men and women. More insights into the connections between body shape, gender and risk of CAD or other cardiometabolic disorders could also help to guide new treatment strategies for overweight patients.

However, there are actions that all individuals can take to reduce their cardiometabolic risk. Maintaining a healthy lifestyle with a balanced diet and exercise can help to increase muscle tissue and promote weight loss, both of which are beneficial to heart health.

This article was adapted from a post on Massachusetts General Hospital’s Advances in Motion. Read the original post here.


Research Your Resolution: Maintain an Exercise Routine for Health Benefits Beyond Weight Loss


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Fatima Cody Stanford, MD, MPH, MPA, FAAP, FACP, FTOS

Fatima Cody Stanford, MD, MPH, MPA, FAAP, FACP, FTOS, is an Obesity Medicine Physician at the Massachusetts General Hospital Weight Center, an Associate at the Mass General Disparities Solution Center, and Associated Faculty at the Mass General Mongan Institute for Health Policy. Her research and clinical practice take a holistic approach to both treat and advocate for patients who have obesity. Read more about her research.

Many people believe that exercise will lead to significant weight loss. However, studies have shown that exercise is a great way to help maintain your current weight.

When patients, especially those who struggle with overweight or obesity, do not experience weight loss after embarking on exercise program, they tend to get discouraged and revert back to inactivity.

It is important to keep up the activity because of the numerous health benefits for not only maintaining one’s weight, but also for heart health, improved mood, and longevity.

Research Your Resolution

Do you have goals for improving your health in the New Year? This month, investigators from the Mass General Research Institute are discussing the science behind some common New Year’s resolutions, and offering tips and advice based on their research into exercise, diet, healthy aging, heart health, and much more.

Massachusetts General Hospital is home to the largest hospital-based research program in the United States, a community of more than 10,000 people working across 30 departments, centers and institutes. The Mass General Research Institute works to support, guide and promote these research initiatives.

Research Your Resolution: Take a Slow and Steady Approach to Losing Weight


Emily Feig, PhD

Emily Feig, PhD, is a clinical research fellow in the Department of Psychiatry at Massachusetts General Hospital.

Dr. Feig recently published the results of a study she conducted as a doctoral student at Drexel University showing that individuals who maintained a steady rate of losing weight during the first few months of a behavioral weight loss program had better long term results than individuals who fluctuated in the amount they lost from week to week. Read more about her research study here.

If your goal for the New Year is losing weight, I recommend finding eating and exercise behaviors that lead to a steady weight loss week to week, even if the pace at which you are losing weight is slow.

For example, you might commit to bringing a healthy afternoon snack to work to replace stopping at the vending machine, setting a “kitchen closed” time when evening snacking will end, adding a vegetable to dinner five nights a week, or setting aside an hour each weekend to plan ahead for meals the next week.

By keeping track of how different behaviors affect your weight, you can adjust to find what leads to a slow and steady weight loss pace for you.

This is because we found that, in a sample of 183 participants in a behavioral weight loss program, better long-term weight loss at one and two years was achieved by those who lost weight at a consistent pace during the first few months of the program, compared to those whose weights varied more week to week.

So finding healthy behaviors that lead to a slow and steady rate of weight loss is likely a key factor in keeping the weight off long-term.

Research Your Resolution

Do you have goals for improving your health in the New Year? This month, investigators from the Mass General Research Institute are discussing the science behind some common New Year’s resolutions, and offering tips and advice based on their research into exercise, diet, healthy aging, heart health, and much more.

Massachusetts General Hospital is home to the largest hospital-based research program in the United States, a community of more than 10,000 people working across 30 departments, centers and institutes. The Mass General Research Institute works to support, guide and promote these research initiatives.

Research Your Resolution: Use Food Placement to Set Yourself Up for Weight Loss Success


Do you have goals for improving your health in the New Year? This month, investigators from the Mass General Research Institute are discussing the science behind some common New Year’s resolutions, and offering tips and advice based on their research into exercise, diet, healthy aging, heart health, and much more.

Anne Thorndike, MD
Anne Thorndike, MD, MPH

Anne Thorndike, MD, MPH, is an investigator in the Department of Medicine at Massachusetts General Hospital. Her research uses the principles of behavioral economics to develop strategies to encourage healthy food choices at home, in the workplace and in community settings. To learn more about her work, please visit her physician profile page.

Sticking to a healthy diet is difficult when you are exposed to unhealthy food choices on every street corner, restaurant, shelf and snack drawer.

It is even more difficult to make healthy food choices when you are busy, hungry, stressed or tired.

Using “point-of-purchase” nutrition information, such as menu calorie labels, and restructuring your home food environment are two strategies that can help you achieve your New Year’s goals.

For example, if that burrito you are thinking about for lunch has 1,000 calories, maybe it isn’t the best choice—it will give you approximately half a day’s worth of calories if you are a man, and more than half if you are a woman.

At home, you can engineer your kitchen to make healthy foods more convenient—and unhealthy foods harder to reach.

Put healthy snacks at eye level on the shelf, and hide the cookies on the top shelf.  Better yet, don’t even bring the cookies into the house!

Our research in the cafeterias at Mass General showed that labeling foods with simple traffic-light labels (red=unhealthy; green=healthy), and placing healthy foods in highly visible and convenient locations prompted cafeteria customers to make more healthy food choices (e.g. bottled water, salads) and fewer unhealthy items (e.g. soda, pizza).

In other research, we showed that placing fresh fruits and vegetables near the front of small urban food stores increased produce purchases by low-income families.

Weekend Links


We’ve hand-picked a mix of Massachusetts General Hospital and other research-related news and stories for your weekend reading enjoyment:

Creative Minds: A New Way to Look at Cancer

Better Patient-Provider Communication Needed for Obesity Care

Eugenics 2.0: We’re at the Dawn of Choosing Embryos by Health, Height, and More

6 Speaking Tips for Scientists and Engineers (editor’s note: Melissa Marshall, featured in this article, recently spoke to Mass General clinicians about how to effectively present scientific work. We were so impressed by her talk that we wanted to introduce her to our readers) 

Looking for a great book for the young scientist in your life? The long list of 2018 AAAS/Subaru SB&F (Science Books and Films) Prize winners for Excellence in Science Books has been released. Prizes are awarded each year in the following categories:

  • Children’s Science Picture Books
  • Middle Grade Science Books
  • Young Adult Science Books
  • Hands on Science Books

See the full list here


Top photo: courtesy of Tim Lahan, MIT Technology Review

Research Awards and Honors: September 2017

Massachusetts General Hospital’s talented and dedicated researchers are working to push the boundaries of science and medicine every day. In this series we highlight a few individuals who have recently received awards or honors for their achievements:


Aaron Aguirre, MD, PhD, of the Cardiology Division and the Center for Systems Biology, has received a 2017 Physician/Scientist Development Award for “Morphology and Dynamic Functions of Pericytes in the Heart.” Aguirre’s project will use state-of-the-art microscopy techniques to better understand the role of pericytes—unique cells that line the outer walls of the smallest blood vessels in the heart. Funding for the Physician/Scientist Development Awards is provided by the Executive Committee on Research along with the Center for Diversity and Inclusion.

“I am grateful for the research support provided by the MGH Physician Scientist Development Award. It will allow me to expand my current research into a new direction and to generate critical preliminary data necessary for future grant applications.”



David Chung, MD, PhD, attending neurointensivist in the Neurology Department, has been awarded the Timothy P. Susco Chair of Research and the Andrew David Heitman Foundation Chair of Research from The Brain Aneurysm Foundation for his work, “Impact of Spreading Depolarizations and Subarachnoid Hemorrhage on Brain Connectivity.” He is one of 14 awardees, given to those whose work is impacting a disease that affects one in 50 people in the United States, often leading to death or lifelong disability.

My immediate reaction to receiving this award was gratitude towards my mentors in the Department of Neurology at MGH: Cenk Ayata, Jonathan Rosand, Guy Rordorf, and Leigh Hochberg. Without their support, this work would not be possible. A major question in Neurocritical Care is how to prevent poor outcome after a ruptured brain aneurysm. Even when we successfully repair the aneurysm, many patients will develop a syndrome of progressive brain damage for unknown reasons. This award will enable us to examine unexplored causes of brain damage and poor outcome with the goal of improving quality of life in survivors of the disease.”



Julie Levison, MD, MPhil, MPH, of the Division of General Internal Medicine, has received a CFAR ADELANTE Award from the National Institutes of Health, the Office of AIDS Research and the NIH-funded Centers for AIDS Research to support new  investigators working on HIV research in Latinos. Hispanic/Latino populations in the U.S. currently bear a disproportionate burden of the HIV/AIDS epidemic. The ADELANTE team is composed of Dr. Levison (principle investigator), Dr. Margarita Alegría, chief MGH Disparities Research Unit, and Carmen Rios, Respite Case Manager at the Barbara McGinnis House.

“The ADELANTE award is a special type of research award because it recognizes the value of community-academic collaborations in overcoming disparities in HIV outcomes in Latino populations. In this study, we will use qualitative research to solicit the needs and priorities of HIV-infected Latino migrants with substance use disorders or who report male-to-male sex and we will use that feedback to tailor and evaluate a community-based intervention we have developed for HIV-infected Latinos with inconsistent HIV primary care attendance.”



Fatima Cody Stanford, MD, MPH, MPA, adult and pediatric obesity medicine physician of the MGH Weight Center, Department of Medicine-Gastroenterology and Department of Pediatrics-Endocrinology, has received a 2017 Physician-Scientist Development Award from the MGH Center for Diversity and Inclusion for “Exploring Referral Patterns and Shared Decision Making Regarding Weight Loss Surgery in Adolescents and Young Adults with Moderate to Severe Obesity.” Funding for the Physician/Scientist Development Awards is provided by the Executive Committee on Research in conjunction with the Center for Diversity and Inclusion. Stanford also has been selected to the inaugural class of Emory University Alumni Association’s “40 Under Forty,” a selected group of outstanding young alumni with impressive track records who are “go-to” leaders.

“I am delighted to be the recipient of the MGH Physician Scientist Development award in partnership with the MGH Center for Diversity and Inclusion and ECOR. I believe that we are just at the beginning of discerning issues associated with addressing obesity in the pediatric and adult populations. This award allows me to ascertain information about shared decision making in adolescents and young adults with moderate to severe obesity in which weight loss surgery might be utilized to help them achieve a healthy weight. To our knowledge, no one has investigated the use of shared decision making regarding weight loss surgery in young people. This awards allows us to do just that.”


Temel GreerJennifer Temel, MD, director of the Cancer Outcomes Research Program and Hostetter MGH Research Scholar, along with Joseph Greer, PhD, program director of the Center for Psychiatric Oncology & Behavioral Sciences, have received a research funding award from the Patient-Centered Outcomes Research Institute (PCORI) for their research “Comparative Effectiveness of Early Integrated Telehealth Versus In-Person Palliative Care for Patients with Advanced Lung Cancer.” The new awards were given to those whose work specifically focuses on community-based palliative care delivery. The goal of this project is to determine if telehealth is an effective, patient-centered, and accessible delivery modality for early palliative care.

“We are overjoyed to receive this research award from PCORI. By testing novel models of care using telemedicine, we hope to demonstrate that greater numbers of patients with advanced cancer and their families can access and benefit from essential palliative care services closer to the time of diagnosis.”


Whetstine.jpgJohnathan Whetstine, PhD, of the MGH Cancer Center and Tepper Family MGH Research Scholar, has received a Lung Cancer Discovery Award from the American Lung Association. This award supports investigators at any level of research experience focusing on novel treatments or a cure for lung cancer. His goal is to use studies about histone modifiers to provide insights into tumor heterogeneity and emerging drug resistance so that better molecular diagnostics, epigenetic therapeutic molecules, or use of novel therapeutic combinations can be achieved in cancer treatment.

“We are very excited to receive this award from the ALA.  This support allows my group to continue to expand our lung cancer research program in the area of tumor heterogeneity and drug resistance. Most importantly, these resources allow us the opportunity to explore novel regulatory pathways driving heterogeneity and copy gains of regions affiliated with resistant lung cancer, which provides insights into novel diagnostics and therapeutic opportunities in this hard-to-treat cancer.”



Alik Widge, MD, PhD, director of the Translational NeuroEngineering Laboratory, Division of Neurotherapeutics, has received the 2017 One Mind/Janssen Rising Star Translational Research Award from the One Mind Institute and Janssen Research & Development, LLC. This award identifies and funds pivotal, innovative research on the causes of and cures for brain disorders. Toward boosting the recovery of patients with illnesses such as schizophrenia, major depression or obsessive-compulsive disorder, Widge proposes to identify precisely the brain circuits that govern the inflexibility of thinking common among patients with such illnesses, and to test whether neurostimulation of these circuits could improve mental flexibility.

“I was very excited about the Rising Star award, for two reasons. First, it brings much-needed seed funding to our lab for an unconventional but possibly high-yield project. We have found that electrical brain stimulation in humans can improve mental flexibility — the ability to “take the road less traveled by” and explore new behavior strategies. That ability is impaired in many mental illnesses. Our problem is that we don’t yet know how the electrical stimulation improves flexibility. The Rising Star award will let us set up animal experiments to identify the circuit basis of the effect, findings we could then translate back into humans. 

Second, this is a really important award in psychiatric research. It’s brought our lab’s other work into the spotlight, which will help those projects progress. I’m grateful both to the OneMind Institute for the award and to the MGH team that helped me get the preliminary data that made it possible.”

Obesity Prevention Researchers Make Strides with First 1,000 Days Program

How early should we start taking steps to prevent childhood obesity? It could be before the baby is even born.

That’s the thinking of the research team behind the First 1,000 Days Program, an initiative launched by Massachusetts General Hospital for Children that provides assistance to women during the timeframe believed to be most critical to their child’s health – pregnancy and the first two years after birth.

The program is led by Elsie Taveras, MD, MPH, chief of General Pediatrics at MGHfC, and Derri Shtasel, MD, MPH, executive director of The Kraft Center for Community Health at Partners HealthCare.

Here are some quick facts about the growing childhood obesity problem in the United States:

  • One in 10 infants are considered overweight
  • By kindergarten, an estimated 1 in 5 children are overweight or obese
  • Being overweight or obese increases the risk of developing diabetes, high blood pressure and early heart disease
  • Overweight or obese children are also at an increased risk of being bullied, which can cause additional psychological problems

The 1,000 Days Program is based at the MGH Health Centers in Chelsea and Revere, and is designed to provide expectant mothers with the tools and resources needed to get their children off to a healthy start in life.

The research team is working to address childhood obesity by:

  • Encouraging pregnant women to maintain a healthy weight throughout pregnancy
  • Working with parents to help them distinguish between different cries from their children, so they don’t mistakenly feed a sleepy child
  • Advocating the complete elimination of juice and sugary drinks, which contribute to weight gain and cavities
  • Encouraging breastfeeding if possible, and if bottle feeding, for parents to watch for cues that the baby is full in order to prevent overfeeding
  • Holding off on introducing solid foods until at least four months, six months if possible
  • Revising expectations so toddlers are not required to clear their plate at every meal

The team also encourages parents to set a good example for their children by eating healthy as well.

The goal of the program is to reach 1,000 women during 2017. As of April the team had already met with over 600 women.

A portion of the study is supported by Dr. Taveras’ MGH Research Scholar award. These philanthropy funded awards provide investigators at Mass General with unrestricted funds that they can use to pursue promising new avenues of research. Taveras is an Ofer and Shelly Nemirovsky MGH Research Scholar.

Read more about the 1,000 Days Program here.

Raising Awareness of Belly Fat and Its Impact on Men’s Health

Body-Type-BannerDid you know that in addition to June being Men’s Health Month in the United States, this week (June 12th-18th) is Men’s Health Week in the UK? The focus this year is on belly fat which tends to be more prevalent in men than women.

Regardless of a person’s overall weight, belly fat—also called abdominal adiposity— can increase the risk for developing a number of health issues including colorectal cancer, stroke and sleep apnea.

A recent study by researchers at Massachusetts General Hospital also found that individuals who have a genetic disposition for belly fat were at a higher risk of developing both diabetes and heart disease when compared to individuals who store fat primarily in their hips and thighs.

While genetics are a big factor in where fat gets stored, proper diet and exercise can help lessen the risk.


Stay tuned for more posts about men’s health all this week leading up to Father’s Day.

Dr. Stanford Addresses Barriers and Disparities in Obesity Treatment

April is National Minority Health Month—a time to raise awareness on issues impacting health disparities and health equity in America. Learn how Mass General’s Dr. Fatima Cody Stanford is addressing barriers and disparities by taking a holistic approach to both treat and advocate for patients who have obesity.

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Dr. Fatima Cody Stanford, MD, MPH, MPA

Continue reading “Dr. Stanford Addresses Barriers and Disparities in Obesity Treatment”