Jim Hill:

Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:

And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

Jim Hill:

Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:

Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

Jim Hill:

Ready for the “And” factor?

Holly Wyatt:

Let's dive in.

Jim Hill:

Here we go.

Holly Wyatt:

Hey, everybody. Today's episode, I think, is one that you're not going to want to miss because we're talking about something that's shaping the future of health in this country and something that you've asked specifically to talk about on this podcast. We're talking about pediatric obesity. So if you're a parent, a teacher, a health professional, or if you just care about the next generation, we crafted this episode just for you.

Jim Hill:

Holly, childhood obesity rates have skyrocketed in the past few decades. It wasn't that long ago that obesity in kids was actually pretty rare. Today, it's really a crisis. Why is this happening? And more importantly, what can we do about it? Are we failing our kids? And how do we turn things around?

Holly Wyatt:

And to help us answer some of these really big questions, we have an incredible guest with us today.

Jim Hill:

Yeah, Dr. Tom Robinson is a leading expert in pediatric obesity, and he's one of the most respected voices in the field. I've known Tom for decades, and he has been out in front in this area, so we are really, really happy to have him. He's a professor of pediatrics and medicine at Stanford University, where he directs the Center for Healthy Weight. His research has transformed how we understand and treat childhood obesity, from the role of screen time and media exposure to innovative real-world interventions that have changed thousands of lives. His work has shaped policies, programs, and treatments used across the country. Tom, we're so excited to have you on Weight Loss And. Welcome to the show.

Tom Robinson:

Thanks, Holly and Jim. It's great to be here.

Jim Hill:

So, Holly, this is our first podcast focused on pediatric obesity. Now, we know that in this country, gosh, almost 75%, two-thirds of adults are overweight or obese. But what about kids? Tom, what are the latest statistics on childhood and adolescent obesity?

Tom Robinson:

Well, the latest statistics come from measures taken from 2021 through 2023, and they indicate that currently about 21% of children between the ages of 2 and 19 meet the definition of obesity. That's one in five children in the U.S. That's increased more than four times since we first started following this epidemic, which was in the early 80s. And one of the most concerning parts about it is that the most rapidly increasing part of that statistic is children with severe obesity, children who are at least 20% higher than the definition of obesity, meet that definition. And that figure now sits at about 7%.

Jim Hill:

Wow.

Tom Robinson:

The numbers are a little less for younger children and higher for adolescents. So the rates are higher in the upper end of that age range. They're also higher in children from lower income groups and from some ethnic minority groups, racial and ethnic minority groups, particularly Black, Latino, and Indigenous children.

Jim Hill:

So it's a real problem.

Tom Robinson:

Yeah, definitely a real problem. And you can't think of many other health issues, public health issues that we deal with that involve one in five children.

Jim Hill:

Wow.

Holly Wyatt:

Yeah, that's true. And so it seems like it wasn't as big a problem in the past. I mean that it wasn't always this common. And then it seems like it's really increasing. So what's changed? Why are we seeing this kind of change?

Jim Hill:

Oh, here's the answer. Tom, I'm really anxious to hear this because I know it's not simple.

Tom Robinson:

No, not simple at all because everything's changed, right? Just like it has for adults. And I'm sure you talk about that a lot is that as all the changes that occur particularly in the environment. We've made highly tasty, cheap, high calorie, convenient food, ubiquitous, you know, everywhere in our environment. And then we spend billions to try and get kids to consume the least nutritious of those foods. And those foods are available everywhere in schools, in gas stations, you know, places that we never used to have food in the past access. At the same time, we've very systematically engineered physical activity out of our lives. We've made it very tough or much more difficult for children to just be out and play and get those activities, whether it's in school or after school or in the communities in which they live. With the combination of those things, we've really created an environment that has made this epidemic of obesity almost inevitable.

Jim Hill:

Wow.

Holly Wyatt:

Yeah.

Jim Hill:

So, Tom, do you see the causes of obesity in kids as very different from the causes of obesity in adults?

Tom Robinson:

I think the underlying causes are pretty much the same. Those changes in the environment that we just spoke about. But kids are, those changes are manifest differently in the lives of children than they are in adults. Also, we should be aware that kids are effective differently as they develop through childhood and adolescence. You know, we can't say all kids are the same. You know, you're talking to a pediatrician, so you're getting someone who thinks developmentally because infants are not just small, you know, Toddlers and toddlers aren't just small preschool children and preschool children aren't just small school-age children and on and on and on. Because childhood is a period of continuous change, continuous development. Actually, adulthood is too. For some reason, we seem to ignore that when we deal with adults. But in childhood, we all think very developmentally. And so as a result, you have to think of where kids are at different points in their childhood and adolescence. They often live in families. They depend upon their parents or caregivers, especially early on in life, to provide all the food and opportunities for play and activity.

Their parents or caregivers often control those environments much more than, say, adults can more control their own environments. They're also surrounded by other kids and are subject to the peer pressure and other influences of other kids. And they spend a lot of their time in school, you know, which is maybe the equivalent of the workplace for adults, but it's where they spend a lot of time in where these environments are able to have influence. They also are specifically, you know, they live in a very different technology and median environment, and kids are particularly targeted by marketing in those environments for particularly unhealthy foods and more and more ways to maintain their sedentary lifestyles. So while the energy balance issues are very much the same in adults and children, they really are applied in different ways.

Jim Hill:

Interesting.

Holly Wyatt:

It sounds like kids, we have the same kind of environmental pressures, but they're more at risk. They have kind of, you know, they may not understand the choices they're making. And you're right, parents and families are deciding some of those things for them. So while the food environment and activity environment may be similar, the changes we see for adults versus kids are similar. It kind of impacts and it may be even higher risk for them.

Tom Robinson:

Yeah, also, because it is a period of change and they're experimenting as well as they go through their childhood, you're seeing that opportunities for those things to influence them maybe a little more in some ways. They're not as set in their ways as adults might be. Maybe they don't have the same routines as adults might have.

Jim Hill:

Tom, let's focus for a minute about the consequences of obesity in kids. Start with the health consequences. What do we know about the health of kids and how obesity relates to that?

Tom Robinson:

Yeah, the health consequences are actually more prevalent than people are aware. More than two-thirds of children with obesity, and we don't have great recent data on some of this, but more than two-thirds, even looking historically, when kids weren't as heavy, More than two-thirds of kids with obesity have at least one risk factor for cardiovascular disease or cancer, stroke. So things like hypertension, hyperlipidemia, prediabetes, insulin resistance, those are the most common fatty liver or problems with their liver associated with having excess weight. And we see those very, very common in children with obesity if you just look for them. However, they're not really looked for in many places.

Jim Hill:

Now, you've been doing this for quite a while, maybe not as long as I have, but for a while. And my guess is when you first started out, you didn't see very much type 2 diabetes in kids. Has that changed?

Tom Robinson:

Well, it's still that we don't see a lot of type 2 diabetes in kids. So although it's increased you know many many fold it's still fairly rare but we are seeing it and we used to never see it, especially in general pediatrics. And so now it's definitely there. And pre-diabetes is everywhere. I mean, children with impaired glucose tolerance, you know, children who have high fasting glucose levels who are at risk for developing diabetes is very high. In some samples we've worked with, it's almost been close to half in some of our very high-risk samples of kids in which they have abnormal, they have prediabetes or evidence of prediabetes.

Jim Hill:

What's your prediction for those kids as they become adults?

Tom Robinson:

Yeah, well, I think you know it is that unfortunately, they have a very, very high likelihood of developing diabetes as young adults and as they go through adulthood.

Jim Hill:

What about the mental health consequences of pediatric obesity. Has that been studied very much?

Tom Robinson:

Yeah, it has. And I think in many ways, we see those as almost at least as devastating and maybe more troublesome than some of the physical ones because they affect kids in the here and now. It's not about developing chronic diseases that will manifest later in life. It's about things that are affecting their lives in the present. Children with obesity definitely have a higher risk of eating disorders, depression, anxiety, low self-esteem, loneliness, and basically almost any, you know, all mental health problems are just much more common in children with obesity. They also suffer terribly from, like adults, from discrimination and stigmatization. And because they're developing and developing their identities, it can be particularly harmful to them. I have a lot of very salient images in my head of children who've cried in front of me, talking about their weight or talk about not being able to find a school uniform that would fit. Or things that seem as routine as that can be very, very difficult for these kids because they feel so stigmatized. They're also treated very differently because of their weight and stereotyped as being undisciplined or lacking willpower, not having friends and not smelling well. You name it.

You can think of all the stereotypes that our society has about people with obesity. And it's particularly sad when they internalize those stereotypes themselves and they start to believe them themselves. Even if they don't believe them, the stereotypes have negative effects, and actually, that's one of the things if you don't mind, one of the most exciting new things that I've been working on lately is trying to address some of those stereotypes to make obesity treatment more effective, behavioral treatments more effective.

And so we're doing work now where we are using very brief, what are called wise, social psychological interventions. In particular, we're using growth mindset interventions and self-affirmation, value self-affirmations to try and help children going through a behavioral weight control program be more successful at it because allowing them to learn more from what we're teaching them. It turns out a lot of this work came from the education world and really, I think, is one of some of the most exciting psychology that there is out there. And that is that these brief interventions that last even just as 30 minutes at the beginning of middle school or a few hours can actually have dramatic effects on reducing the achievement gap between girls and boys in math and science and between minority and white students across the board with effects that last up to nine years in some clinical trials. As I started reading this stuff 15, 20 years ago around stereotypes threat and stuff, it struck me that this is really what you could substitute in children with obesity as well for many of these issues. And so working with some really super bright social psychologists who are pioneers in this area, and I'm really excited about the potential of these types of interventions that focus on changing a person's mindset, how they respond to the cues that they're getting from their environment and from other people, and how that may make them much more successful at adopting the behaviors we all know or we all want them to adopt.

Jim Hill:

Holly's laughing because this is what we talk about all the time. We have a new term, a sort of a new term that rather than mindset, we call it mind state because it's mindset and more. But what we believe is that the big three are what you eat, how you move, and how your mind functions. And the more we work on this, that third one, the power of the mind may be really the key to long-term success.

Holly Wyatt:

Yeah, I think it has to be there. And I think even in adult treatment, we have not done enough with that. We concentrate on the food. We concentrate on the activity. But we don't concentrate on what you're thinking and how you're feeling and the mind state, as Jim says, that you have. So the fact that you're intervening and children with the mind, love it. Like that can make a difference. And what you're saying is make a difference in obesity, but make a difference in their life, which makes it even bigger than just about their body state.

Jim Hill:

Well, we've learned that you cannot separate managing their weight from managing their life. Your weight is so tied up in every aspect of your life that you can't just go aside and manage your weight and then go back to the life you live. They're so intertwined.

Holly Wyatt:

The beliefs you have impact then all aspects of your life. And I think what you're saying is obesity is starting to impact what they believe, and you're going in there and doing an intervention to kind of change that, to make it different.

Jim Hill:

You can tell we're excited about this, Tom.

Tom Robinson:

No, that's good. Yeah, I am too, because I think if a child feels that they don't have the ability to change their way. It's often called a fixed mindset, that they're born that way, or everyone in their family is that way. It make s it very difficult for them to change their conclusion. If they fail is going to be, "Well, it was destined to be. I'm not good at this." Same way as they may say I'm no good at math instead if you fail on a math test. If someone has a growth mindset, if the child has a growth mindset, you can actually change those things. If child has a growth mindset, their response is to say, "Well, I didn't do as well, but I could have done better if I studied in a better way, if I studied harder." And same with the stereotypes. They just get in your head and take up space in your head and block you from being able to take advantage of all these resources in your environment, all that behavioral counseling, and all the behavioral methods are being taught. You can't do that.

Holly Wyatt:

Yeah. Limiting beliefs.

Tom Robinson:

Yeah.

Holly Wyatt:

Limiting beliefs. They limit you instead of allow you to change over time. So you're speaking our language. We love it. I have one question. You talked about development, and I think that's so important. That's one of the things that makes kids different than adults, although you brought up that adults are developing in a way, too. But one of the things I think a lot of parents wonder about, and even sometimes I've heard pediatricians say this. So let's say you have a child that's overweight at eight years old or 10 years old, what are the chances that they'll grow out of it? What are the chances that they're currently obese, but as they get taller or as they go through adolescence, they're going to grow out of this obesity?

Tom Robinson:

Yeah. Well, some kids do because kids have a great advantage over adults in that they're continuing to grow in height. And so if they slow their weight gain, they are effectively reducing their excess weight, their obesity. However, I wouldn't count on it too much because the vast majority of kids go. And the factors that affect that are, first of all, how heavy they are to start with. So how high their BMI is.

The higher your BMI, the less likely you are to grow out of it, to do that. The more likely you are to become an adolescent with obesity and an adult with obesity. And part of that is sort of obvious, is that if you just look at the growth chart pediatricians use in our offices for charting kids, you can see if kids gain no weight, if they stayed the same BMI or their BMI even decreased, it would take years to get back for many kids to being a normal weight. So it's something that's not going to happen quickly. It's something that happens over years, over long periods of time. The other factor is how old they are at the time you're looking at them, at the time they manifest their obesity. And so if they're prior to puberty and young childhood, they have a much better chance of growing out of it than after puberty. After puberty, the risks are very, very high that you're going to become an adult with obesity.

Probably 90% or more based on some of the historical cohorts where we follow people over time. It's probably worse than that now because kids with obesity are heavier now than they were, and kids with obesity were when those cohorts were started, when we started following those kids. But yes, once you've, you know, that's one of the reasons we do a lot of our interventions in childhood, and particularly in that 8 to 12-year-old age range, is because it's really focused on trying to interrupt that process so that kids don't take that excess weight and take it with them into adolescence through puberty.

Holly Wyatt:

I think the key there is you're intervening though. So I think a lot of parents are saying, do I need, let's say I have a kid that is obese at, you know, eight years of age. Do I do nothing? And if I do nothing and just let, let's see what happens. Or do you say, no, intervene. You don't need to cause weight loss necessarily, let him grow, but does there need to be an intervention there or can you just wait?

Tom Robinson:

Yeah. I mean, my belief is there should be, well, it depends on the level of obesity that they have. If they're hovering around being at risk of hitting that level of obesity, I'd say you definitely should intervene. And there are things you can do that aren't formal interventions, even though behaviors you can change within your family and the home. But definitely, I think you're not going to see it change in the vast majority of kids. You're not going to see it change on their own. They're not just going to grow out of it naturally.

Jim Hill:

That's really important that most of them are not going to naturally grow out of it. Tom, let's take a step back and tell maybe parents who may be listening who don't know this, how do you know if your child's overweight or obese?

Tom Robinson:

I actually think many of them are aware of it, even if they're not acknowledging it, especially if they come. But the way, the formal way is to ask your pediatrician or primary care provider to plot their weight and height and then calculate a BMI. And that gives you a pretty good idea of where they stand compared to what the public health community and the medical community believes is a healthy way. And that's based on historical norms. It comes from measures of kids in the United States that were done between the 60s, you know, in the 60s and 70s, before we started seeing a big rise in obesity in the 80s. And it gives you an idea of where they stand compared to what is considered standard. And while there's a lot of people who have issues with BMI these days, or there seems to be a lot of vocal opposition to BMI, including in the medical fields, it's still the best measure we have itself. And so, I don't know, you may get calls about that because there are people who have very strong feelings about BMI, but I don't know anything we measure as reliably as height and weight that you can measure and as easily. And it's highly correlated with all of those physical and psychological problems that we spoke about before. And so, we don't even have the same data for things like percent body fat in kids or for, you know, weight circumference doesn't seem to be a great measure in kids, although it's better in adults. It's also really hard to measure accurately.

Jim Hill:

I agree with you. I think BMI is a very, very useful measure. You know, Tom, a lot of times in the adult world, we say that maybe the primary care physicians aren't really, they're a little bit hesitant to maybe address weight because they don't know what to do about it. What's the sense among pediatricians? Are they on to this topic? Are they bringing this up? Are they paying attention to it in general?

Tom Robinson:

Yeah, I think many of them are. I mean, when I started doing this work, I felt like I was the only pediatrician who was interested in childhood obesity. And that was in the 90s. And so it seems like everybody is now. And there's a lot more interest in pediatrics and in primary care, you know, taking this seriously and as an issue. The AAP organized an expert panel and put together some guidelines for children with obesity that now are out there, came out a couple years ago. You know, it took a long time. There were always those things that came from other groups. I was involved with a sort of first recommendation guideline group that I think was probably in the nineties, maybe the early two thousands that came up then. Now, this is the first time that the AAP has really made a big statement about it. I mean, they've been interested, different groups, but this, you know, it got a lot of attention and it was really pushed out there. Oh, sorry, the AAP is the American Academy of Pediatrics. I should have mentioned that. And so I think if we're seeing it, it's more accepted. But you do see pediatricians are cautious by nature in some ways, because you're dealing with children and developing children. If you've taken care of kids with eating disorders, there's a lot of fear that in some people's minds that we're going to create eating disorders. But in fact, the evidence is the opposite, that structured, well-designed programs and focusing on healthy eating and healthy physical activity to control your weight in a healthy way actually prevents eating disorders. That's one of the things that we combat in terms of perceptions.

Holly Wyatt:

I'm so glad you said that because I think that that is a myth that's out there. I can't talk about food in any way or nutrition in any way because I'm putting my child at risk of an eating disorder. And so I think people need to hear that if it's done in the right way. The data doesn't support that. I think that's something people don't know. So I'm really glad you brought that up. And that kind of leads us to, I know a lot of our listeners are parents and they want to say, “Okay, what can I do as a parent?”

Jim Hill:

That's what I want to know. I want to get to the “what do we do about it” part. At some level in my mind, kids go to school, say kindergarten through 12th grade or something. And if we could create environments in schools that kept kids healthy throughout that period of time, what do we know about school-based interventions? What's the hope? What's the challenges? What have we learned?

Tom Robinson:

Yeah, I think the main thing we've learned is that, probably could have guessed that schools have a lot of potential to do this. And in fact, there are some interventions that have been done in schools that have been very, very successful. Because as you say, that's where the kids are. That's where they're spending a lot of their time. On the other hand, schools are asked to do everything these days. And so it makes it very, very difficult for them, especially because they're so underfunded. They have so few resources and they're supposed to deal with everything in a child's life, in addition to teaching them to read and do math, and think critically. And so over the years, we've moved more towards doing more after-school programs where there's a little more flexibility and a little more ability to do that. But I would say we definitely need to work in schools and change the schools and make sure that those environments where kids are getting lots of healthy nutrition and opportunities for physical activity. I mean, we saw how difficult it was, took decades to get the Healthy Hunger-Free Kids Act, which made pretty modest changes in school lunch during the Obama administration. That was extremely difficult to get that passed and get that implemented. And since its implementation, there's been many, many attacks on it, trying to take it away and trying to go back.

It almost didn't pass because a certain senator didn't want a restriction on the number of times per week you could eat french fries because they drunk potatoes in her state, you know? And so it's really tough to get schools to do this. Individual schools have a chance.

Jim Hill:

All right, I want to press you on this one because I agree. I think there's so much potential. So in today's climate, we're hearing about make America healthy again. And Robert F. Kennedy Jr., I'm sure he listens to our podcast routinely. So if resources weren't an option, it seems to me like schools could absolutely feed kids two healthy meals a day and give them an hour of physical activity. That does not seem to me to be a terrible, hard thing to do. And the outcomes would be incredible.

Tom Robinson:

Well, I think they would. I mean, it's all if there's a will, there's a way.

Jim Hill:

Yes.

Tom Robinson:

If it's a high enough priority, unfortunately, kids are not the priority in our country in doing things for them. I think we like to say so, but when you look at the budget and look at programs available, they're often at the end of the line. And so I would love it, you know, and I would not just say schools, I'd say, universal preschool and after school programs. And those same type of programs should be incorporated throughout the day for children and those types of resources.

But it does. It just requires resources. We don't even pay our teachers enough. How do we get them to also have the resources to do that? So I'm with you on that, and I will advocate for it until I'm out of breath.

Jim Hill:

But it seems silly. At some point, if you wanted to reduce obesity, you'd give up on adults and focus on your kids as the most likely way to say. And I'm not saying giving up on adults. But if we don't invest in our kids, we're continuing to create generation after generation of obesity. And Holly and I have to figure out how to weight reduce.

Holly Wyatt:

Oh, my gosh. All right. Jim got you off topic. So I'm going to pull. It's his fault. He does this all the time because he loves this topic. But I know our listeners have written and they want to know what can they do. I mean, it's great. The schools. I think we had a whole another episode, Jim. We could have a whole another episode.

Jim Hill:

I'd love to look at what we could do in schools.

Holly Wyatt:

Yeah.

Jim Hill:

But anyway, I'll let you get back on topic.

Tom Robinson:

Yeah. I think that what we've learned from a lot of the school studies we've done and after school studies, too, I think is very important as well in terms of the work we've done, it's not health education.

Jim Hill:

Right.

Tom Robinson:

People already know. It's really a lot of it is the stuff we've done with sports programs for kids and after-school dance programs, and we've even done stuff around climate change. And the whole idea is that we can make children's lives much more healthful, and children much healthier without even having to lecture to them about health.

Jim Hill:

Love it. Okay, Holly, getting back on track.

Holly Wyatt:

Okay, pie in the plate. Pie in the plate now for some of our listeners that say, "Okay, I have a child. What can I do before we change the school districts? Can I do something starting this week?" What are some practical things they could do?

Tom Robinson:

Right. Well, my first and probably most important piece of advice is behave the way you want your children to behave.

Jim Hill:

Ah.

Tom Robinson:

As a parent or caregiver, you are a child's most influential and important model. They will copy your attitudes and behaviors even if you don't think they're watching. Because they are. Kids are smart. They're observing everything. They know exactly what you're doing. You're not putting anything over them. So the first thing is that. Then I would say, it differs by age a little. So if your kids are younger, the parents and caretakers have the most control. They can create a home environment that we talked about a little before that's more healthful with lots of nutritious food and opportunities for activity that kids can have because parents have all the control in young kids. For example, one of the things that we very strongly endorse is don't bring sugary drinks, sweets, high-calorie foods into the home at all. It makes it easier for you not to eat them, and it makes it easier for them not to eat them. If they're not there, they won't eat it.

And at the same time, you can instead fill your home with plenty of his possible fresh fruits and vegetables that are attractive. Snacks can be vegetables that are that are attractively laid in the refrigerator. So they come home from school or they're there, that's the first thing they grab for because they're right there and they're easy. And related to sort of that behave the way you want your kids to behave is also you need to eat those same foods yourself and enjoy them and feel good about them, so snack upon those as well. The other thing is on the exercise or physical activity side of the equation is create lots of opportunities for kids to be active. And that may be signing them up for an after-school program. It could be a sport. It could be a team of some type for some kids, but it could also be going out and finding frogs in the backyard or whatever it is. It's making sure that they're outside. A child's normal state is a state of play. I mean, they're always curious. They're always learning. They're always looking for stuff. And so try and get them away from their screens and out there. And that's sort of the third big thing I would say is that have some family rules about screens. I've done a lot of work on screens and we can talk about that later if you want. But in general the two priorities I would say is no eating in front of screens. Also no screens in the bedroom particularly at night because I think those are the things that would have the greatest impact because we're losing the battle against screens at this point and we have been since the start of television.

I also, I think, important for parents and caregivers to set limits for kids. Sometimes parents think they need to be friendly, you know, friends of their child. It's important to have a good relationship with your child, of course. But a child's job is to learn how the world works, to learn what's good behavior, what's bad behavior, what's acceptable, what isn't. And so it's really parents make it easier for children if they set limits. If they set family rules and they follow through on them. They're consistent with their feedback on them.

Holly Wyatt:

Yeah. So the parents are doing that, too. I like that you just gave really two concrete things that people could do tomorrow. Don't eat in front of screens and then no screens in the bedroom. And I like that. And then the parents got to do that, too, though, right?

Tom Robinson:

Yeah, it's tough. But if you set a family rule, it makes it easier for you to do it as well. I mean, this technology is as addictive to adults as it is to kids. We tend to worry about kids more because we feel they don't have the agency that adults do. And we try and protect them. But in fact, billions and billions of dollars are being spent to attract you to these devices and keep you on there. That's their business model. And children are not just small adults, but adults are just big children, you know, in my mind. We function the same way.

Holly Wyatt:

Love that.

Jim Hill:

So, Tom, I've always thought that in many, many families, spending time with parents is a reward in itself. Kids love to do that. And so if parents are using that time for the healthier thing, they're both modeling and helping kids with behavior.

Tom Robinson:

Yeah, I'm glad you brought that up because that's key. Spending time with parents is probably more motivating than almost anything you can do. Certainly more motivating than giving kids gifts and rewards and more extrinsic rewards. There's nothing that is more valuable in a child's life than spending and getting the attention of their parents. Attention drives so much. Adults as well. I mean, the attention of your spouse, the attention of friends and colleagues but for kids it's parents and so, Jim, as I think you were suggesting, planning weekend activities afternoon activities together, go for family outings and bike rides and show kids that how much you like spending time with them and being active with them.

Jim Hill:

Good practical stuff. So I have to ask this one. What about the new weight loss medications in kids?

Jim Hill:

They're revolutionizing treatment in adults. Is there a place for medications with obese kids?

Tom Robinson:

Yeah, I think there definitely is. And I'm quite supportive of their use in kids with really severe obesity and those who are unlikely to benefit as much from other interventions and particularly those who have consequences of their obesity, already experiencing consequences in health or psychological. At the same time, because I think they're revolutionary. I mean, like they are in adults and kids, I think the outcomes of just been amazing so far. But at the same time, I'll say, especially as a pediatrician, that I'm cautious about it. I don't think they should be handed out willy-nilly. It should be a discussion with parents and caregivers and the kids themselves about the benefits and the potential risks. We really don't know the long-term effects of these drugs, even the short-term effects that much on a developing brain and a developing body. I mean, you're putting a person sort of into a semi-starvation state, and these drugs affect cells all over the body. I mean, we know that they affect the brain, you know, and central parts of the brain. We know they affect the GI tract and the liver and other places. And every day we seem to find some other part of the body they're affecting.

Well, kids' brains are still developing. Their bodies are still developing and growing, and we really don't know the impact of that. So I think it's very, very important that we study those, especially long-term studies, more than just a year and in more age groups as well. The other thing with them is as a public health-oriented person, I have concerns about these drugs' widening disparities is right now people with the most access to them, and it's going to continue. And this is a case with basically all new medical interventions.

But the people at highest risk in this case are low socioeconomic status and racial and ethnic minority groups who have the least access to these drugs. And so the populations who need them the most are going to have the least access to them. And so we're going to see widening of disparities in this case as opposed to narrowing of disparities, which we all want to see. The other thing is that I'm worried that all the hype around the drugs, which is in some ways earned because they are such a revolution in weight control, but the hype around them is drawing attention, I worry, away from the other things we've talked about, the environmental changes, the behavioral changes. And if we start to see less attention and less resources going into those other areas, we're going to be shot. Because as you know, not everybody wants these drugs. It's only a minority of people who are using them. And a lot of the people who use them don't continue them, which is another big problem. And that's happening in kids as well as, I mean, we know more about it in adults, but it's happening in kids as well as that they're coming off for a whole variety of reasons. And so we're always going to need behavioral interventions and making these environmental changes. And I really worry those things are underinvested in now already.

What's going to happen when everybody says, well, we have this way of treating things after the fact. And like you, I'm a total believer in prevention. I mean, that's what got me into this in the first place. I'd much rather prevent it and wait until kids develop obesity and have to treat it.

Jim Hill:

Well, we're totally with you on the meds. We think the meds are welcome new tools, but they're only tools and they're not the answer. And just using the meds without some other lifestyle changes isn't success in our minds.

Tom Robinson:

Yeah, I mean, you don't see patients automatically start to eat all the fruits and vegetables and become physically active. Those behaviors have benefits of their own beyond weight loss.

Holly Wyatt:

Independent.

Jim Hill:

Absolutely. Holly, we need to get to some listener questions.

Holly Wyatt:

Yeah, I have one that I promised I would ask. So I know we're getting a little late on time, so I want to make sure I get this one in, Jim, and then you can ask another one. This is from a listener that says, what is the best way to talk to my child about their weight without harming their self-esteem or doing damage. I think they want to bring up weight, but aren't sure how to do it and definitely don't want to cause any damage to the child's self-esteem or otherwise. What do you tell a parent about that?

Tom Robinson:

Yeah, that's one that a lot of parents are concerned about, especially parents who've had obesity themselves, you know, or who are with obesity themselves, because they knew what it was like to be a child with obesity, or many of them did if they were obese as children. Now, based on what you asked, I'm assuming this is for talking with the children who, a child who does have an issue with their weight, who is overweight. And so I would say the first thing and most important is to start the conversation at all. I think if you avoid it and you ignore it, you know, kids know themselves that they are heavy and they also know that you know. And so avoiding it makes them think that you're unhappy with them or that you're trying to avoid it because there's something bad about it. And so if you don't talk about it, it can make it worse because they think that you're that. The way I generally suggest that parents talk about it is start with a question like, do kids at school talk about weight, talk about other kids' weight? I mean, what's happening at school? Is this an issue at school? That sort of frees the kids up to go as far as they want and talk about their own experience or talk about other kids' experience, what the norms are. And then if they don't bring it in hopefully they will start to talk about their own experience. If they don't it's like, have you ever thought about your own weight and how kids look at you, around that type of stuff, but the goal is not to be judgmental and have the parents make them show any disappointment in the child at all but instead put the parent in the position. Put yourself, in this case, yourself the parent in the position of being there to be supportive in whatever the child needs and wanting to get them, hopefully, to see if they admit something is a problem with themselves or that they are being teased or something else happens, then it opens the door to being able to help them do something about it. A lot of the principles of all of our interventions is really, at least with kids about starting about age eight and above, is the focus has to be on the child wanting to make change and the child's motivation and the child's agency. And the parent is not there to police them. The parent there is to support the child in achieving their own goals.

Jim Hill:

All right. Let's do one more quick one, Tom. We get this one a lot. How do I get my child to eat healthy? They don't like healthy food. They just like the junk food. And when I give them healthy food, they don't eat it. What can I do?

Tom Robinson:

Yeah, well, I go back to that earlier advice that behave the way you want your child to behave. The first thing that has to happen is you need to be eating those foods and modeling that for them. If they suspect that there's a choice or that there's something that you don't really believe in it, then they're not going to want it good. The other thing is you have to let them learn to like them themselves. One is to continue serving them. And it depends on the age again, too. But in younger kids, where we often get this issue in pediatrics where kids don't like certain foods, you just got to keep making it available. And also, we suggest not creating whole separate meals for your kids. What the family eats is what the family eats. What the parents decide is a healthy, nutritious meal for the family is what's served. If the child doesn't want to eat it, that's okay. They don't eat it. You don't reward them for not wanting to eat it by giving them something else that's less healthy but theylike more because that's going back to children are that their job is to learn how the world works and one of the things I love about pediatrics is I've gotten to spend a lot of my life watching children manipulate their parents.

Because they are, as someone interested in behavior, children are the most incredible behavior analysts because they know exactly how to get what they want. Because they've been, since before birth, they've been practicing. It's all trial and error. They've been figuring out how to get their parents to meet their needs and how to get what they want. So, you know.

Jim Hill:

My kids are in their 30s and they're still good at that.

Tom Robinson:

Yeah. They're the best. They know exactly what buttons to push.

Jim Hill:

But a good answer. And you don't hear, Holly, of lots of reports of kids starving to death with healthy food on the table. So again, relax and follow Tom's advice. All right. You want to do a vulnerability question?

Holly Wyatt:

Sure, Jim. Why don't we go with yours? I think I like yours that we have written down here.

Jim Hill:

All right, Tom. One of my colleagues said that it's more likely we will all become obese than that we will reduce obesity rates to where they were between before 1980. What do you think?

Tom Robinson:

I think it's sort of a false comparison in some ways because I don't think those are the only two options. In fact I think neither of those options is likely. So, I know you said more likely but I don't know. I guess I sort of agree. I don't think we're going to get back to the rates we were below 1980. At the same time I also don't think the whole population is going to end up being obese as well. I don't think that's our biology even if we have a toxic environment. And so I would say that I think the high likelihood, and I will be positive here. I think the whole likelihood, the greatest likelihood is that we're going to end up lower than we are today, but not back to where we were when we started, I think. I believe we're going to flatten the curve. Right now we're continuing to go up in race slowly. And I think we're going to stop that and we're going to reverse it at some point. But I don't think it's going to go all the way back to where we were, I think. I'm not that optimistic.

Jim Hill:

Good. Well, good answer.

Holly Wyatt:

I like it. He's on record.

Jim Hill:

I was looking for some optimism here and he gave me a little bit. So this is good.

Holly Wyatt:

Yeah.

Jim Hill:

So, Tom, let's close with this. And again, I think we have hopefully parents listening and they're very concerned about their kids. What's one small step they could take right now to get started in helping their kids weight?

Tom Robinson:

Yeah, I think, not to add too many things, I'll go back to the sort of top three that I think I mentioned before. And one is, adopt the behaviors you want your child to adopt. That's the first thing. Be a model of health. Be the best example that you can. That's going to have the greatest payoff of anything you do. In terms of concrete, other sort of concrete things and specific behaviors, get junk food out of the house if you don't want kids to eat it if you want and then it shouldn't be there and no one ever had a deficit or malnutrition from not getting enough whatever your favorite junk food is, and the third being what we talked about and Holly, you reinforce, no eating with screens and try and keep screens out of bedroom. Those are my top three at this point.

Jim Hill:

Perfect. So despite what we tell our kids, they tend to do what we do.

Tom Robinson:

Exactly. And we shouldn't be surprised.

Jim Hill:

I love it. Tom, thank you. This was amazing. Holly, we had so many more questions, but I think we addressed what's a really, really important topic. If we're going to make America healthy again, we have to start with our kids. There's no way around it. So I hope we get serious about doing that. And to our listeners, this is such an important topic. We want to keep the conversation going. If you have questions, struggles, or success stories about your child or your own childhood history, we'd love to hear from you. Send us a message and we might cover your question in a future episode. Thanks everybody and see you next time on Weight Loss And.

Holly Wyatt:

Bye.

Jim Hill:

And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:

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Jim Hill:

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Holly Wyatt:

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