← The Pediatrician Next Door - Simple Advice on Parenting and Family Health
The Pediatrician Next Door - Simple Advice on Parenting and Family Health
Ep. 120: When to Worry About Your Child’s Weight
00:25:15
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- [00:00]
Dr. Wendy Hunter
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- [00:21]
Dr. Natalie Muth
The perfect denim does exist.
- [00:24]
Dr. Wendy Hunter
Shop Abercrombie Denim in the app online and in store. This episode is brought to you by State Farm. Checking off the boxes on your to do list is a great feeling. And when it comes to checking off coverage, a State Farm agent can help you choose an option that's right for you. Whether you prefer talking in person on the phone or using the award winning app, it's nice knowing you have help finding coverage that best fits your needs. Like a good neighbor, State Farm is there Today I tackle a question that's on a lot of parents minds, especially in this new era of weight loss medications, and the question is, when should you be concerned about your child's weight? Kids develop their height and their weight on a variety of trajectories. You know, some kids are a little chunky and then they suddenly get taller and they thin out. And then other kids are super skinny and they're like that their whole lives. And this can all be totally normal. But parents worry. I know you do. You worry about whether your child is a healthy size and you wonder if you're feeding them right. To help answer this question, I'm joined again by Dr. Natalie Muth. She's a pediatrician, a registered dietitian, and a national expert in childhood obesity and healthy lifestyle counseling. She's also the author of Family Fit Plan, a fantastic and very practical guide for parents who want to raise healthy, active kids without shame or stress. It's a great book. She and I talked about how pediatricians think about weight today and what's changed over the last decade. We talked about how parents can support their kids health in a way that builds confidence, not anxiety. I'm Dr. Wendy Hunter and I'm the pediatrician next door. I'm that doctor friend you call for practical advice about your kids health. I mix the science of medicine with the reality of parenting. As a pediatrician, one of the most common questions I get during, well, child checkups is how does the growth chart look? And the truth is there's not a one size fits all answer. You aren't looking for your child to be on the 50th percentile. I know that seems intuitive, but it's not true. There are a lot more factors to consider. Primarily we look at the trend, but we also look at the family and we take into account some other factors. What the chart tells us is complicated and it's also very helpful. How do we use it without letting it define a child's health or their self worth? Here is my conversation with Dr. Muth. We talked a bit about how we look beyond the number to understand a child's overall wellbeing. Has the way we think about childhood obesity changed in the past, I don't know, 5, 10, 20 years?
- [03:24]
Dr. Natalie Muth
Yeah. Our approach, especially from like the pediatrician side and the clinical side to childhood obesity is evolved a lot, really, Especially in the past couple of years. We used to have an approach of, you know, let's watch and wait and kind of see how things go. Let's take a staged approach to kind of thinking about increasing steps and being able to help families where the child has obesity or struggling with obesity. And we didn't really have any medication options or things other than saying like eat less, move more, which isn't really all that effective on its own. And we've learned a lot. There's a lot more studies, there's a lot more opportunities for different treatments and an understanding that this is not a willpower thing or anybody's fault or an individual responsibility thing. There are very many huge, complicated environmental factors, societal factors, and home and individual factors that go into this.
- [04:21]
Dr. Wendy Hunter
I know exactly what you mean because my training really just taught me that if a child's BMI was high on the scale, whatever, that all I needed to do was ask them about juice and then tell them not to drink any juice. But if the family didn't drink any juice, I had like literally nothing else to say. So now I guess we understand there are a lot more complicated factors. I'm getting better at it, but you're going to help me right now too. So let's go back just a step. As like I was saying, when I look at the BMI chart, we take it as an absolute. Like if a child's over the 95th percentile, then we're like, oh, okay, we need to do something. But I know there's a lot of nuance to that. And then sometimes I look at the chart and I'm like, okay, this kid's getting a little bit on the heavier side, but he clearly hasn't had his growth spurt yet. He's not tall. So when should a parent actually start to worry about their child's weight? When do you seek help and when can you just keep living your lifestyle?
- [05:15]
Dr. Natalie Muth
So there's a few things to consider. One is it's about health and overall kind of health and well being more so than a number on a scale or the BMI chart. And if we're looking at a child that has very healthy habits and the family has very healthy habits, they're eating family meals, they have regular meals, they have healthy options for fruits, vegetables, you know, they're active on a regular basis, sleeping well, all these things. If we have to look at labs and they all look fine, we're really can feel okay about where things are from a pediatrician side and something that I really encourage families to partner with a pediatrician is like, let's look at the growth chart and not just the height weight together, the bmi, but let's look at the trend of what's going on over time. Are there big changes that are happening? Maybe the child was tracking at a weight of the 85th percentile for the last five years and then now all of a sudden it's the 95th percentile. That's a change that's different than what we would expect. And so there might be something going on that's contributing to that. Let's explore that as a possibility. And if there is something that we can identify, then let's focus there. If it's that they haven't had their adolescent growth spurt yet and they gained a little bit of weight before they grew in height, the habits are the same. We don't identify that there's any big change. And let's check back in a few months and see how the trend is looking. But let's take a look at how things have been going over time and if there's big changes, we should take that seriously.
- [06:48]
Dr. Wendy Hunter
That makes a lot of sense. You also just mentioned labs, so getting lab results, what conditions would you look for that might indicate, okay, maybe the weight is a problem because we're seeing a problem in their blood.
- [07:01]
Dr. Natalie Muth
Yeah. So we generally for children or adolescents that are over 10 that have a BMI greater than the 95th percentile, which is really just a measure of height weight together, it's not perfect, but it works fairly well. So we check for if there might be weight related health concerns such as high cholesterol, which we see a lot, such as insulin resistance or pre diabetes. So starting to see abnormalities in glucose or such as a fatty liver disease, we could check a liver test and starting to see that there's some changes that can be Associated with that, Those are the labs and blood pressure. Of course we're monitoring that. That's kind of looking at the physical health side. But we also want to be thinking about the mental health side too. Are we seeing things like depression, anxiety going along with increased weight? Are we seeing disordered eating habits or risk of eating disorders? Are we seeing, is bullying happening or snoring? Is the child not sleeping well? All of these things can be associated with increased weight and with obesity. And to get to your earlier question about like, how have things changed over time? One of them is that we're looking in a much more factors and in a whole person approach to how weight can be impacting their physical and mental health.
- [08:20]
Dr. Wendy Hunter
So if self esteem is affected or there's bullying going on, even that is just enough to say like, wait, maybe we should do something to make the child feel better about their body image. I suppose it's not really necessarily about the weight. Absolutely. At that point.
- [08:37]
Dr. Natalie Muth
Right, right, exactly. And a lot of times it's not about the weight. Absolutely. Like we don't tell kids you need to lose weight. We don't ever want a child to go on a diet. We're really focusing on the health and their day to day habits. And so when there are things like bullying or low self esteem, we be thinking about what can help that child to be feeling better and stronger and more confident. And a lot of times different types of physical activity or sports or weightlifting, stuff like that. Especially if a child has obesity in many cases there's a lot of strength associated with that, like physical strength and getting involved in things that they enjoy doing that feel good to them and are fun also helps to increase self esteem and confidence and overall health and wellbeing, which ultimately I can't emphasize is enough, which ultimately is the most important thing when we're working with kids at all. And when we're working with kids who have obesity, it's not about the weight, it's about their health and well being.
- [09:38]
Dr. Wendy Hunter
Well, it's funny because I have a patient who is very low weight and she has a lot of depression and anxiety and as I talk with her through her lifestyle factors, she doesn't go outside at all. And so I realized, I mean she needs to go and play or do some kind of activity because it will increase her appetite because she truly doesn't, she doesn't feel like she's fat and she's not trying to be skinny on purpose, but her weight changed significantly on the growth curve. So I knew then to look into the other factors. But it's just interesting that it really could go either way. So maybe just like you said, pay attention to the trend.
- [10:15]
Dr. Natalie Muth
Yeah, I mean, these are not like totally unrelated things. When we see weight changes in either an up direction or a down direction, a lot of times there are some things that overlap a lot. And we want to be thinking about and kind of taking somewhat similar approach and especially thinking about overall health and well being both physically and mentally.
- [10:41]
Dr. Wendy Hunter
Yeah, it all goes hand in hand. So now that we have medications to control weight, it's just interesting because that means that there is some kind of metabolic thing going on that's sort of even separate from everything else. Because, I mean, you're talking about people like when they take the medications, they don't necessarily like purposefully change anything in their lifestyle, but all of a sudden they lose a lot of weight. So does that indicate to us that there's genetics or metabolism involved in how much you weigh?
- [11:08]
Dr. Natalie Muth
Yes, and it's really important. Like obesity is especially more severe. Obesity, we're not talking like necessarily, although it could be like BMI, you know, right at the 95th percentile. But when you're seeing adolescents or children that have very elevated BMI and BMI percentiles, it very often, almost always is related to genetics and physiology and biology and like brain chemistry. I mean, there's a lot of stuff going on that contributes to obesity that is way beyond this idea of not having enough willpower to eat in a proper way or to not being active. There's a lot of physiology to really think about and we know that more and more. And that's what's changed over time too. But also the way that people are responding to the medications, to the GLP1, you know, agonist medications especially that I'm sure everyone has kind of heard about, makes it even more clear that this is a physiological, biological, complex, chronic disease, not just a lifestyle problem.
- [12:23]
Dr. Wendy Hunter
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- [12:41]
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Dr. Wendy Hunter
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- [13:53]
Dr. Wendy Hunter
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- [15:01]
Dr. Natalie Muth
So with the gut microbiome, it's a very evolving area of research right now and seeming like there is probably a lot of contribution of the gut microbiome to risk for obesity. Interestingly, for example we know that children who have gotten multiple rounds of antibiotics when they're very young actually have increased risk for having obesity later, probably related in some way to disruption of the gut microbiome. And also physiologically, we often talk about using hunger to guide intake and satiety and feelings of fullness to stop eating. For many people with more severe obesity, especially those cues aren't working properly. There's been real studies to show the brain chemistry that some people don't get the cue to feel full when they've eaten enough. And so that is part of what can contribute to overeating.
- [15:55]
Dr. Wendy Hunter
I've heard there's something called culinary medicine and I think you kind of were alluding to that. What is that?
- [16:00]
Dr. Natalie Muth
Yeah, it's another fascinating area that's been emerging a lot over time. And culinary medicine, well, there's a. I mean there's lots of facets to it, but it's really understanding and using food and cooking and the experience of eating in a really positive way to positively impact health and well being. You can think of like antithesis to culinary medicine is like the typical American diet of ultra processed foods and eating out of a package and grabbing food on the run and pouches and snacking on stuff all the time. Whereas culinary medicine is this idea of helping people develop the skills and tools to be able to eat real foods, prepare real foods, enjoy them in an affordable way, in a way that is fun and enjoyable and also can be quick and fit into a busy life and fit into a limited budget. So it really takes us away from this diet mentality at all around health and well being and managing weight, to more of an enjoyment of real foods and incorporating different foods into one's eating plan that can really help promote health and well being. Again, physically and mentally.
- [17:15]
Dr. Wendy Hunter
Are there people who practice culinary medicine that you can specifically find or are they just like any dietitian?
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Dr. Natalie Muth
Yeah, well, so there's a lot of what are called teaching kitchens that are kind of popping up across the country where it's really different. Dietitians, physicians, there's culinary medicine physicians who do the medical side of food and like food is medicine and help families or help people who have chronic conditions to be able to eat in a way that helps to treat their disease. You can find them. There are more and more people that are doing this. Some are doing it as a, like, as a specialty, but others are doing it really kind of incorporating it into a clinical practice or having partnerships in the community. Whether our teaching kitchens to say, okay, you have obesity or you have high cholesterol, high blood pressure, Maybe medications are part of your treatment plan, but also nutrition and learning how to cook and prepare foods in a way, and eat in a way that's going to help treat your disease is a really important part of it, too.
- [18:17]
Dr. Wendy Hunter
What do you think are some of the pitfalls that parents fall into or misconceptions that they have when it comes to managing their children's weight? I mean, I think the first thing I think of is like, parents always blame screen time, which it probably is partly to blame. But what are some of the misconceptions you hear or pitfalls that you think parents do? Like restricting calories or. I don't know, what do you see parents doing to their kids?
- [18:42]
Dr. Natalie Muth
Yeah, well, to start, overall, I think parents come to addressing weight and weight concerns with a love of their child and wanting their child to be healthy and well and so commending that, of course, that love for the child. I think sometimes the approach that's taken can be really positive and great, and sometimes the approach that's taken can be detrimental or even counterproductive. In particular, when there's lots of weight talk at home, when there's lots of comments that may well intended, but that are made to a child or adolescent about weighing not enough, weighing too much, looking different because of weight in some way, putting them on diets, trying to restrict, especially if it's done like, you know, oftentimes one child may be at increased weight, another child may be at low weight and then treating them much differently. Well intended, but can actually be quite stigmatizing and traumatic for the child who has increased weight. So I really encourage parents and families to not talk about weight or emphasize weight or have it be about weight, and to never diet or put a child on a diet or talk about dieting or diet ourselves. Right. Like we are models for our kids, but rather taking an approach that's very positive and that's supportive for the whole family. For instance, having regular meal times is helpful for every child generally, whether you're concerned about their weight in up or down direction or not. Like trying to really have routines around breakfast, lunch, dinner, family dinners or family meals whenever they can happen as often as possible, totally recognizing that life is crazy. It's not always possible to do it all the time, but as often as it is possible to try to just eat together and eat the same thing and sit down without the screens and without our phones and everything else and enjoy that family meal together, talking, eating slowly, enjoying the food, not commenting on whether someone Ate something or not, or ate too much or not, which can be very hard. But those are all things that in the long run are supportive to the child and help them. Snacking is a huge challenge and I really encourage families to try to have a plan around snacking, limiting it to set times or not at all, depending on the situation, but trying not to have access to foods and snacks like all the time, all day long. Grazing, especially like right after school, eating is a challenge. And so families kind of working together, depending on the age of the child to address that. You know, we always see kids in clinic, right. They're like the littlest ones, like eating during, you know, while they're waiting and.
- [21:26]
Dr. Wendy Hunter
Eating all the time.
- [21:27]
Dr. Natalie Muth
All the time. Right. And it's like, oh, I just want to like.
- [21:30]
Dr. Wendy Hunter
Because you don't want them to be bored and you worry about them being hungry.
- [21:33]
Dr. Natalie Muth
Yes, yes. And so just try to really be thinking about how often is the kid eating throughout the day and try to have schedule and structure for meals and snacks. That's the number one thing we talk about from the very beginning with everyone because it helps everyone who can really adopt that. And then to your point about screens. Yeah. Try not to have screens while eating. We have screens while we eat. We're going to eat more. We're mindless about it. A lot of the time we're not paying attention and we may not realize it, but we're getting targeted constantly on our screens with food ads, food triggers, food this, food that, and our brain is like, oh. And then it makes us hungry and we go eat something that looks good. Uh huh. So you know, trying to just really like keep the screen separate from eating and try not to have the screen within like an hour of going to bed. So sleep can be better. We're learning more and more about how disrupted sleep contributes to obesity. You don't think about that, right? Like most time you're thinking, oh, physical activity, nutrition. But actually sleep matters as much as anything else most of the time, to be honest. Like if we were, if we were going to give a recommendation across the board and people were to follow it, which there's some caveats to all of that anyway. But my recommendation would be don't snack. Like eat breakfast, eat lunch, eat dinner, eat structured mealtime, sit at the table, eat together as often as you can, eat slowly, eat until you feel full and then be done. If that was practical and worked well for a lot of people, that would be very successful. People would eat pretty well, have good balanced meals. Much of the time and there'd be a lot less of these concerns. I've been asked before, like what if there was one thing that you would give advice to someone for around these things, what would it be? And it's family meal times, without a doubt. No question. Eat together. If you can do that, you're already 80% of the way there.
- [23:26]
Dr. Wendy Hunter
There you go, some concrete steps you can take that sets your kids and yourself up for a healthy relationship with food. So to get back to my original question, when should you worry about your child's weight? The answer is not a number. It's in the bigger picture of their habits, their health, and their relationship with food. One thing I've noticed in kids struggling with weight is how often food becomes a filler. It fills for boredom, stress, or just something to do. We live in a culture of constant snacking, especially compared to places like Europe where grazing all day just is not the norm. There, food is eaten at mealtimeswith intention and that makes a big difference. I love the philosophies of culinary medicine. It's cooking together, making meals colorful and fun, and shifting the focus to nourishment and connection. Thank you to Dr. Natalie Muth for her commitment to creating a healthy whole child. You can find her at drnataliemuth.com,/r N A T A L I E m u t h.com the link will be in the show Notes if you enjoyed this episode, please share it with a friend and rate and review the show. It really helps other parents to find the show. For more from the Pediatrician Next Door, find me on the web@ pediatriciannextdoorpodcast.com if you've got a question about the weird things kids do, send an email to helloediatriciannextdoorpodcast.com for a chance to hear your voice on the the show. I'm Dr. Wendy Hunter and I'm the Pediatrician next Door. This show is produced by Red Rock Music. Make sure to subscribe and leave a review wherever it is you're listening. I'll be back next time with more.