When Dr. Robert Zarr wanted a young patient to get more exercise, he gave her an unusual prescription: Get off the bus to school earlier.
"She has to take a bus to the train, then a train to another bus, then that bus to her school," says Zarr, a pediatrician at Unity Health Care, a clinic that serves low-income and uninsured families in Washington, D.C. So the prescription read: "Walk the remaining four blocks on the second bus on your route to school from home, every day."
Kelssi Aguilar, his 13-year-old patient, wasn't exactly excited about the change at first. "He told me about the four blocks and I told him it was a 40-minute walk and I was too lazy," she said. "I was thinking, am I really doing this? I'm going to be late for school."
Kelssi was actually 10 minutes early the first day she tried the modified route. Kelssi has kept up the walking. And Zarr says she's moved from obese to just overweight — which is very good.
About 40 percent of Zarr's young patients are overweight or obese, which has led the doctor to come up with ways to give them very specific recommendations for physical activity. And that has meant mapping out all of the parks in the District of Columbia — 380 parks so far.
The parks, mapped and rated based on facilities and in a searchable database by zip code, can be linked to patients' electronic medical records. Zarr did it with help from the National Park Service and volunteers from George Washington University's School of Public Health, park rangers and other doctors. Zarr also received some funding for the project from the National Recreation and Park Association, the National Environmental Education Foundation, and the American Academy of Pediatrics.
Zarr writes park prescriptions on a special prescription pad, in English and Spanish, with the words "Rx for Outdoor Activity" on top, and a schedule slot that asks, "When and where will you play outside this week?"
But it's not just about the parks. It's about what the patients want, too.
"I like to listen and find out what it is my patients like to do," Zarr says, "and then gauge the parks based on their interests, based on their schedules, based on the things they're willing to do."
There are other park prescriptions projects getting started across the country, but none have matched the level of detail in Zarr's parks database.
Many children aren't used to going to parks, notes Dr. Steven Pont, medical director for the Texas Center for the Prevention and Treatment of Childhood Obesity in Austin.
"If you didn't grow up in a family that went camping or experienced outdoors and if you're more from an urban environment, then going out to a park and experiencing nature might seem a little daunting," Pont says.
A program like Zarr's can help reduce that discomfort, Pont says. "The park prescriptions really help kids and families engage and get to those parks and say, 'Hey, I belong here too.' "
Of course, not every park is safe, especially in the District. The neighborhood next to one of the parks Zarr discussed with Kelssi, Kingman Island, had 30 incidents of violent crime over the past year.
"The more parks are used, the more people are there, the safer and the better they are," Zarr says. "We want people first and foremost to be safe, and be active and be part of the solution to fixing parks that aren't quite what they should be."
Ultimately, Zarr says, he wants his parks database to exist in an app, on your smartphone, where doctors and patients alike can use it. And, one day he'd like to be able to track his patients' activity in parks, to find out exactly how much good a little green space can do.
RENEE MONTAGNE, HOST:
Pediatricians are on the front lines in the battle against childhood obesity. It's a challenge for them to get kids to eat healthy foods or spend more time outside playing. But NPR's Sam Sanders found one doctor in Washington, D.C. who has taken to prescribing the great outdoors.
SAM SANDERS, BYLINE: Pediatrician Robert Zarr says about 40 percent of his young patients are overweight or obese. One day last year, Zarr wanted to find a way to get one of his young patients outside more to help with her weight.
ROBERT ZARR: She has to take a bus to the train, then a train to another bus and then that bus to her school.
SANDERS: Dr. Zarr wrote her a prescription for a modified bus route to school.
ZARR: That one read, walk the remaining four blocks on the second bus on your route to school from home every day.
KELSEY AGUILAR: He told me about the four blocks and I told him it was a 40 minute walk and I was too lazy.
SANDERS: That's 13-year-old Kelsey Aguilar. She says at the first, she wasn't feeling the route change.
AGUILAR: I was thinking, am I really doing this? I'm going to be late for school.
SANDERS: Were you late for school?
AGUILAR: No, I was 10 minutes early.
SANDERS: Kelsey's kept up the walking. And Dr. Zarr said she's moved from obese to just overweight, which is very good. This micro-targeting of physical activity - tweaking Kelsey's specific school route - is something Zarr does a lot for his patients. And now Zarr says he might prescribe even more outdoor activity for Kelsey through a prescription for a park.
ZARR: For the last three years, I've been working on developing a way in which I and my colleagues can easily prescribe parks.
SANDERS: Lots of parks all over the District of Columbia.
ZARR: So what I have done is gone about mapping out all of the parks in D.C.
SANDERS: How many is that?
ZARR: So far now we have 380 parks.
SANDERS: All of them mapped and rated. Zarr did it with help - Public health students at George Washington University, Park Rangers, other doctors.
ZARR: And this is cool. I just love seeing people doing things in parks.
SANDERS: Yeah. Yeah.
ZARR: I mean, here she is jump roping - this lady next to me.
SANDERS: Zarr, standing in one of the parks in that data base - Meridian Hill park - talked about the rating system, which takes a lot into account.
ZARR: How to get there - parking - is parking available if someone's going to drive - bike racks - there's a section on pets - park safety. So we ask about lighting.
SANDERS: Zarr writes his park prescriptions on a special prescription pad in English and Spanish with the words RX for outdoor activity on top and a schedule slot that asks - when and where will you play outside this week? He says the program is not just about the parks. It's about what the patients want too.
ZARR: I like to listen and find out what it is my patients like to do and then gauge the parks I prescribe based on their interests, based on their schedule, based on the things they're willing to do.
SANDERS: There are other park prescription projects getting started across the country, in New Mexico, California, Oregon. Author Richard Louv wrote a book called "Last Child In The Woods." It actually inspired Dr. Zarr to start his park prescription project. Louv says programs like Zarr's carry a lot of weight because when doctors talk, parents listen.
RICHARD LOUV: Pediatricians can play a huge role and that's why doctors are - among others - is so important because they are so trusted by parents.
SANDERS: So doctors prescribing parks - good idea all around, right? But not every park is safe, especially in the district. The neighborhood next to one of the parks Dr. Zarr has spoken with Kelsey about, Kingman Island, had 30 incidences of violent crime over the last year. But Zarr says parks will only get safer with use.
ZARR: The more parks are used, the more people are there, the safer and the better they are. So we want people first and foremost to be safe, to be active and to be part of the solution to fixing parks that aren't quite what they should be.
SANDERS: Ultimately, Zarr says he wants his parks database to exist in an app on your smartphone. And one day he'd like to be out to track his patient's activity in parks, to find out exactly how much good a little green space can do. Sam Sanders, NPR News. Transcript provided by NPR, Copyright NPR.