Pediatric Obesity: Weight Bias and Stigma – PediaCast 562

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  • Drs Matthew Paponetti and Eileen Chaves visit the studio as we consider the bias and stigma associated with pediatric obesity. We explore strategies for overcoming these problems so kids can get the help they need to live healthy lives. We hope you can join us!

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  • Pediatric Obesity
  • Weight Bias and Stigma

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Dr Mike Patrick: This episode of PediaCast is brought to you by the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital. Hello everybody and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 562. We're calling this one Pediatric Obesity, Weight Bias and Stigma. I want to welcome all of you to the program.

So, childhood and teenage obesity is extremely common in the United States, and actually adult obesity is as well. But when we're talking about kids and teens, over 14 million of them meet the criteria for pediatric obesity. Making this one of the most common chronic conditions facing American youth and families.

Now the problem is that obesity is also often accompanied by stigma and bias, which can delay the diagnosis, interfere with management strategies, contribute to mental health issues like anxiety and depression, and result in additional medical problems. If the obesity is not addressed, such as high blood pressure, heart disease, and type two diabetes.

So, it's important that we eliminate the bias and stigma associated with pediatric obesity and tackle the problem head on so that kids and teens can get the help they need and live their healthiest lives. Of course, a group effort is required to make this happen with parents, doctors, teachers, and community members, all playing important roles.

So today we're going to deep dive into pediatric obesity with a particular focus on raising awareness. of the bias and stigma often associated with this condition and then giving you some ideas on how we can overcome the bias and the stigma and really get kids active and eating well and doing all the things that are helpful.

Because it really, and we'll discover this as we go on through the podcast, it's not just a matter of kids making healthier choices to eat and exercising more. And that is because there are so many other factors at play like parents doing the grocery shopping and advertisements on TV for food that's not necessarily healthy but looks fun and colorful and is certainly tasty.

And kids see those commercials on ads online as well. And when you go to the grocery store, you know, you, they are excited to try it. And as a parent, you're excited to make your kid happy. And so really, there's just so many factors involved. And we're going to open up. All of that and talk about all of those different issues in our usual PDA cast fashion.

We have a couple of excellent guests joining us this week with some pretty unique perspectives. Uh, Dr. Matthew Paponetti is a sports and orthopedic physical therapist at Nationwide Children's and Dr. Eileen Chavez. is a pediatric psychologist at Nationwide Children's. Both of them are also with the Center for Healthy Weight and Nutrition here at our hospital.

I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you are concerned about your child's health, be sure to call Your health care provider.

Also, your use of this audio program is subject to the PDA cast terms of use agreement, which you can find at PediaCast. org. So let's take a quick break. We'll get our expert guests settled into the studio, and then we will be back to talk about bias and stigma associated with pediatric obesity. It's coming up right after this.

Dr. Matthew Paponetti is a physical therapist with the sports and orthopedic physical therapy program at Nationwide Children's Hospital. Dr. Eileen Chavez is a pediatric psychologist at Nationwide Children's and an assistant professor of pediatrics at the Ohio State University College of Medicine. Both work with our Center for Healthy Weight and Nutrition, and have a passion for supporting children, teenagers, and families impacted by pediatric obesity, along with educating and empowering kids, families, and communities on obesity awareness and prevention, including the bias and stigma that often accompany this common condition.

Before we dig into our topic, let's offer a warm PediaCast welcome to our guests. Dr. Matthew Paponetti and Dr. Eileen Chavez. Thank you both so much for visiting with us today.

Dr Matthew Paponetti: Yeah, thanks for having us, Dr. Mike. I think we're both really excited to talk today.

Dr Eileen Chaves: Thank you, Dr. Mike. I really appreciate that you invited us to be here.

Dr Mike Patrick: Yes, absolutely. So, let's start with you, Matt. Just in general, can you define what we mean by pediatric obesity and how that's measured?

Dr Matthew Paponetti: Yeah, absolutely. So, obesity is measured using a BMI, which is a measure of height and weight. Okay. And pediatric obesity is defined as having a BMI greater than the 95th percentile, which is matched by age and sex.

And really what obesity, especially pediatric obesity, is, A common complex chronic medical condition that has serious physical and health and social consequences as well.

Dr Mike Patrick: Yeah, and it seems we hear a lot in the news and through research and through our own clinical experiences that obesity is on the rise in the United States.

So, there's more, a higher percentage of kids with official diagnosed obesity compared to 20, 30 years ago. You know, what are some of the causes, do you think, Matt, of this increase?

Dr Matthew Paponetti: Yeah, definitely. Well, we certainly have seen an increase. I think I just, I was looking at stats this morning and in the 60s, it was like 5%.

Of kids had obesity and some of the data in 2017 18 showed that it was up to 19%. And I think that COVID, you know, the numbers coming out after COVID are showing that that has continued to rise as well. And like I said, it's a really complex, multi-faceted disease. Really, you know, with causes ranging from the policy and kind of some systems level effects.

To the community, to the neighborhood, the schools, the family environment, the biology and genetics of the individual. You know, there's so many different things that can go into it. And I think it's helpful just to look at like, you know, our food environment, for example, you know, there's a lot of neighborhoods, even in, you know, right here in Columbus where the access to nutritious food is limited and what is prevalent is fast food and lots of ultra processed food.

So that's what's available. That's what's affordable. Makes sense. That's what. People are going to buy and eat and, you know, sorry to tangent and ramble on this a little bit, but the media too, you know, these, these companies use really specific marketing strategies to blast the ultra-processed food to kids and to teenagers.

And it just makes it really, really challenging. For families to choose and to find the healthy, nutritious foods. Yeah.

Dr Mike Patrick: Yeah. One of the things just to kind of demystify the whole why processed food is worse for you than whole foods. One is that they are really calorie dense, correct?

Dr Matthew Paponetti: Yes. Yeah, that's right.

So, we use that term ultra processed food, which, which usually just equates to, yeah, the really calorie dense foods that often don't offer a lot of Nutrition that like fruits and vegetables might offer.

Dr Mike Patrick: Yeah. And at the end of the day, really our way is a function of three things. The, our calories in the energy out that we use.

And then there's this black box of our metabolism, which is definitely, that's where you said genetics plays a role here because sort of how we process food and, and actually obesity results when we process food really efficiently. So, our, our bodies use. The calories that we're getting in a more efficient manner.

And so, then it stores the rest as fat for, you know, because from an evolutionary standpoint, you don't always know when your next meal is going to come. And so, if you store some of those calories, which can be really helpful when, again, you aren't necessarily getting a great meal every day. But then if you add in these calorie dense, super processed foods, it's just so much energy that you don't need all that.

And then it gets more, is that a good basic explanation of this?

Dr Matthew Paponetti: Yes. Yeah. Dr. Mike, I think that that's exactly right. We, you know, when we boil right down to it, that's that idea of energy in energy out. But I think what we try to really focus on our center is all the different pieces that play into that energy and energy out.

I think for a long time with that. In out approach, it just came down to the individual and it's just, oh, well, you just have to change what you're doing, but we know that there's so many really complex layers that, you know, contribute to that energy and energy out. So, we talk food, obviously that energy in, but the energy out to our physical activity environment is so different than it was, you know, the prevalence of screens and technology, you know, we have Advanced physical activity out of our world, you know, with these advancements, there's no more active transportation.

There's less outdoor play. So, no doubt that the physical activity piece is harder for Children as well.

Dr Mike Patrick: Yeah. And Eileen, I'm sure that you see this, these factors really at play as you talk to families, because as you say, it's, it's not really always the kid’s fault. And I say fault with quotations. Because, you know, the parents are buying the groceries and the ads on TV get kids really excited.

And then when you take your kids to the grocery store, they see what's on the shelf. And of course, you want to make your kids happy. And so, you think, well, you know, you've been good, so you can pick something. And it's, you know, one of the things that they've seen on TV. So, there's really so many layers, as Matt was saying.

And Eileen, I'm sure you see that in your practice too.

Dr Eileen Chaves: Yeah, I see that all the time, Dr. Mike. I, I like to think about the idea of like, modifiable factors and what we can actually control versus the things that we cannot control. And to be quite honest, there's a lot of things related to obesity that we just don't have any control over, right?

I think that idea of energy in, energy out, for a long time, just kind of like Matt was saying, put a lot of the emphasis on making changes on the individual, which then contributed to this idea of weight bias and stigma. And people thinking like, oh, well, if you want to change your body size, you just need to make different choices.

You need to move more. You need to eat differently. Right? But again, there's just so much that we can't control. There's genetics, obviously, kind of like we've talked about. There's the food environment. There are finances. There's time poverty. Just a lot of our families don't have time to cook foods that are whole foods and make nutritious meals.

There's knowledge related to like, we don't know how to cook. There are just all of these different things. The neighborhoods we live in that don't offer safe spaces to be active. our sort of emotional way that we, that we cope with food sometimes, which lots of us do. We have a hard day. We eat something that is going to be more sort of nutrient dense.

Like for me, its milkshakes, right? And that in the moment makes us feel better. But if we're doing that all of the time, because we have a very stressful life or we have trauma or anything else, we're in these situations where we're being teased or bullied about our weight or our size, then we can start to store those calories because we're using the food to cope.

And so, I do think it's helpful to think about modifiable factors to really, truly be honest when we think about it and think about what can we actually control.

Dr Mike Patrick: So, it really is a community issue, not just an individual or a family issue, but there's just so many factors that go into this that we sort of have to come together as communities to find solutions.

Matt, you know, the reason that this is even important to begin with is because obesity impacts our health, both our mental health, our physical health, what are some short term and long-term health impacts of pediatric obesity?

Dr Matthew Paponetti: Yeah, you know, I see. Really a lot of different consequences, both in the short term and long term.

I mean, I think short term we're seeing kids having high blood pressure, type two diabetes, problems with sleep, sleep apnea. And I think too, it's fair to acknowledge that these different comorbidities are associated with obesity in all kinds of different ways. You know, they contribute, but then are also contributed by obesity as well.

We know that different mental health concerns are associated with obesity and how we handle stress, anxiety, depression. From a physical therapy standpoint, there's musculoskeletal implications in terms of more force going through your joints, so that can contribute to aches and pains, balance and coordination, endurance deficiencies as well, and that's going to make it a little harder to play and be active, so really a lot of short term things that can affect a kid's health, but then we also know too that obesity and BMI trends into adulthood.

So, all of those same kinds of concerns really travel into adulthood as well, and that's where we see higher risk of pre serious cardiovascular disease, again, high blood pressure, high cholesterol, type 2 diabetes, as well as a risk for other kinds of diseases as well.

Dr Mike Patrick: Yeah, because those factors that led to obesity in the first place, all the things that we've talked about, really do follow you into adulthood, and so if we can make healthy changes as kids are growing up, Then those healthy habits are going to follow them into adulthood and not just habits, because again, that makes it sound like it's just the individual is the only thing at play here, but really trying to change, you know, society in terms of what foods are offered, what foods are available, making sure that people, regardless of their station in life, have access to healthy whole foods and opportunities to exercise and all of those things.

Eileen, I want to shift our focus a little bit to bias and stigma. Can you explain what, what do we mean by that in terms of weight bias and stigma in the context of pediatric obesity?

Dr Eileen Chaves: Sure. Thank you for the question. So, all of us have biases, right? We all have biases about lots of different things. But when we think about weight bias.

We're really thinking about two different types of biases. So, there's implicit bias and there's explicit bias. Implicit weight bias is something that's automatic. It's unconscious. It's ideas about people in larger bodies that just sort of pop into our head. We may not even realize that those ideas are there because they're unconscious, but they can shift and change our choices and behavior, right?

And so, like I said, we have biases about lots of different things. They come from the environment that we live in, the media we watch, ideas about weight and body size that maybe we've learned from childhood, from our families, from other peers. Explicit bias is where we start to recognize those unconscious thoughts and make them conscious, right?

So, it's where you sort of recognize that that thought is there, like, oh, okay, wait a minute, I had that thought, it was about this person in a larger body, it was maybe a negative thought or an unkind thought or just something that like popped into my head without me meaning for it to be there. Explicit bias means that we're aware of it and we can do something with that thought instead of acting on it.

Wait, stigma is where our biases become action, right? So, any of those either implicit or explicit biases, those thoughts that pop into our head. change our behavior. So, if we're thinking about like kids, for example, like if we were at a school, my kids at my kids’ school, there's like an extras table or a share table, right?

So, if a child didn't want part of their meal that they purchased, like a chocolate milk or a string cheese or something like that, right? They can put it on this extras table or the share table. And then any other kids can go over to that table and grab from the table, right? So, if I have weight stigma, if I see a kiddo in a larger body heading toward that extras table, I might say to them, you're not allowed to get an extra, right?

You're not allowed to pick up that chocolate milk, but just because they're in a larger body. Whereas if another child went over to that table and maybe that child was in a more average sized body, I might allow them to pick up something from that table. Even if the child in the larger body was saying, I'm still hungry, right?

So that's kind of an example of weight stigma.

Dr Mike Patrick: And how, how common is this? Like how, what is the scope of this problem as we think about bias and stigma related to obesity?

Dr Eileen Chaves: It is unfortunately very common. Research has shown that in kids and adolescents who are seeking weight treatment, treatment for their obesity, about 70 percent of them report having experienced weight bias and stigma.

And on top of that, about 30 percent of them talk about that stigma persisting for anywhere from one to five years. So, it unfortunately is very pervasive. It colors the way that kids think about themselves, their bodies, the interactions they have with others. Um, one of the things I would also like to maybe just define is internalized weight bias, which is where someone in a larger body has had the experience of weight bias and stigma in their life and they start to apply that weight bias and stigma to themselves.

One of the saddest things I think I'd ever heard was I was working in clinic one day and I had a teen girl, she was about 15 or 16, she was in a larger body, and she told me I'm a fat girl and fat girls don't deserve anything good. I know it broke my heart and that is just an example of internalized weight bias.

That can just be devastating, right, because that then changes your whole idea about yourself and your self-worth and the relationships you have and what you deserve in life.

Dr Mike Patrick: Yeah, and I suspect that that really then does impact that child or that teenager's mental and emotional health to the point where then they have secondary diagnoses based on that, such as anxiety and depression.

Do you see that in your practice? Yes.

Dr Eileen Chaves: Oh, my goodness, most certainly. I always like to point out that in general, depression and anxiety are not necessarily comorbidities of obesity. Instead, they're really comorbidities of living in a larger body in our society. Because of the weight bias and stigma most people experience, right?

So, we know that for people in larger bodies, there is a higher prevalence of depression, anxiety. There, there's a higher prevalence, especially in people with large, with higher BMIs. of eating disorders as well, especially binge eating disorder, but not just binge eating disorder. Like we also find that people have atypical anorexia nervosa or they have this kind of combination of disordered eating where they may swing towards restricting at one point in time and then binge eating in another point in time or even sometimes purging because they, they don't necessarily know and they're trying the best they can to sort of cope with Living in a larger body and having an experience where they have such negative experiences often

Dr Mike Patrick: and you know One of the other factors that we haven't mentioned is media and how what body size is considered?

attractive or normal and so when you just see folks who live in thinner bodies in magazines and on television and shows on the movie screen, then that really becomes what society thinks of as quote normal when really living in a larger body is actually the experience of more people than living in a thinner body at this point.

Dr Matthew Paponetti: Well, I was just going to say to, you know, like we're talking about the sources of stigma media. Is so prevalent and it's blasted at us all the time and I think that affects, you know, all different people in different ways and you know, we'll hear from our kids, and I know there's literature showing it to that.

This source of stigma comes from peers, which makes sense. You know, kids growing up and bullying and teasing, but then it also comes from teachers. Teachers treating kids differently because of the size of their body comes from coaches comes from parents Not of course meaning to but it can come from them and then I think the one that gets me most is it comes from our us from health care providers and this is documented across disciplines and You know, that's just an area where, you know, uh, you hope that kids can, can trust and feel like they're going to be treated really well by people under our roof, by people in health care, and that we're seeing is not, not always the case, at least across broadly the field of, of health care, and is just an area that I think we have So much opportunity for growth so that we can become that really good safe space for every kid for all kids Yeah

Dr Eileen Chaves: I think that is so important to talk about Matt and I just wanted to add to that just really quickly like We meet so many kids and families who have had such negative experiences in health care They, like, families will tell us, you know, I took my child to the doctor for an ear infection, but because my child is in a larger body, somehow we ended up talking about his weight as well.

Or I took my child to the doctor because they had a knee ache, and all of a sudden, it just became because of his weight, right? And there was nothing else kind of done to think about were there other causes of the knee ache. It was all boiled down to this single factor, his weight. And I just feel for families, because it has been so difficult for so many of them.

And what often happens is they end up dropping out of healthcare. And so, when they do come back to healthcare, their medical issues are significantly worse. Now we have to talk about more significant treatment. We can't talk about prevention because they've just not come for so long Because they know that the experiences are going to be so difficult

Dr Matthew Paponetti: and we're just left rebuilding trust

Dr Eileen Chaves: Exactly.

I

Dr Matthew Paponetti: mean I think that's what we do a lot of times our visits just like Can I get you to trust us as a, as a healthcare system again, because that's the, that's the foundation for any kind of positive behavior, you know, health behavior changes as well.

Dr Mike Patrick: Yeah, from the, from the provider's point of view, you know, they're trying to help the teenager, the parents, the family.

And in trying to help, though, they often then can impact a child's motivation and ability to engage in healthy behaviors because they're hearing it all the time, start to think less of themselves, kind of, you know, maybe they have tried to lose weight and the things that they have tried have not really helped.

And so, then they give up. And as you said, kind of fall out of the out of the medical system. And so, as providers in our attempt to improve a child's life, we actually make things worse. So, what can we do, Eileen, then as, as providers to give the right advice because the knee pain might be from their weight at the end of the day.

So, like, how do we do that in a way that, I don't, that it still empowers the kid and makes the kid feel special and worthwhile and that, you know, really gets the point across that we're trying to help, but without judging?

Dr Eileen Chaves: Sure. I think that's a great question. I think the number one thing providers can do is ask permission of the patient and the family before talking about weight, before bringing up the growth curve, before talking about food or eating.

And, and it sounds just like this, like, would it be okay if we talked a little bit about your eating today? Would it be okay if I showed you the growth curve? And then, if a patient or a family says, no, I don't want to look at that or I don't want to talk about that, give them the autonomy to say no. I usually follow that up with, would it be okay if I asked permission to talk about it the next time we see each other?

99. 999 percent of the time people say sure. Usually, they say sure the first time I ask, right? But I think just kind of putting that ball in their court, like asking permission. goes so far because then it lets them know that you are not just going to kind of bring something up without them wanting you to bring it up, right?

And I agree. Sometimes the knee pain really truly is because of their weight, but I think we can talk about lots of different ways to kind of think about like, like how body might be impacting that pain without just kiddos, hopefully getting the message that, okay, what I really need to do is lose weight.

And I've tried that and it's ridiculous. And now it's hopeless because my knees always going to hurt, right?

Dr Mike Patrick: Yeah. Matt, you were like jumping out of your skin to say something there.

Dr Matthew Paponetti: Yes. Well, anytime I, you know, we talk about musculoskeletal pain, all my physical therapy, Spidey senses go off. But, you know, so yes, of course, like what kind we had said at the beginning.

Okay. Weight can contribute to joint aches and pains just by nature of the forces that are going through that joint but what is there to counter forces is our muscle and our strength and how much more empowering for a kid to say You know, let's work on your strength. That's what's gonna take care of your knee pain versus let's have you lose weight I mean, that's like that's we see it all the time.

That is really monumentally hard because of the complexity of What goes into our weight, but if I can say, I'm gonna help you be stronger and that's what's gonna take away your knee pain, that's way more encouraging, way more motivating, and now, we've got a stronger kid that can run and jump and play sports without these aches and pains.

Regardless of if our weight has changed or not. Yeah.

Dr Mike Patrick: And it likely will change at least a little bit if you're encouraging more exercise and strength training. And so, I love that. So, you're getting the result that you want from a medical standpoint but presenting it and doing it in a way that sort of honors the kid.

And I would imagine too, that just normalizing these conversations, like maybe adding, hey, this is a conversation I have with all kids. Just about healthy eating and food choices. And, you know, this is something that's really important to me in my practice. And so, you know, may I please talk to you about it?

Like I talked to my other patients about it.

Dr Eileen Chaves: And I think on top of that, totally. And make sure we do it with kids in all, in all body sizes for real, right? Like. It's like, it's important to talk about eating a variety of nutritious foods with people in all sizes, right? It's important to talk about being active or mental health.

Things that we can do for coping for people in all body sizes, right? And so, then it just becomes part of what we're talking about at each of our visits. And we really, truly are talking about it with everybody, not just kind of reserving things for the kids in the larger bodies or for parents that are in larger bodies.

Dr Mike Patrick: Yeah. And if you do that with every kid, I think you're more likely to develop an approach that really does normalize it. Like, so it doesn't feel awkward and maybe that family knows you're going to talk about food every time I come in. And, you know, if they talk with other friends and, you know, who also say, Oh, yeah, whenever I talk to him, he talks to me about that too, because it's something that's, that's important in terms of, of, uh, bias and stigma, those are formed somewhere in, in our past, both as, you know, providers, as parents, as society in general, what, what are some common misconceptions, Eileen about children with obesity that maybe reinforces that bias in the stigma?

Sure.

Dr Eileen Chaves: Sure. I think one of the things that is a common misperception is that kids in larger bodies are lazy. That's something that we hear kids say, they've been told a lot. And sometimes they've been told that by friends or teachers, but also by family members. I think another common misperception is that kids in larger bodies aren't as intelligent.

And there have been some studies with school providers where they kind of ask teachers to sort of think about kids in larger bodies. And that's one of the things that school staff will often attribute to kids in larger bodies. They're just less intelligent. Another thing that often comes up is messy or smelly.

Another thing that often comes up is just not active or that kids in larger bodies can't be athletes. And all of those things we know just are totally not true. Even just thinking about, like, athletes and kids being active, Matt can talk about this too. We have so many kids that come to see us in the Center for Healthy Weight and Nutrition who are definitely athletes.

They are active all of the time, and they've been an athlete since they were very young, and being told that they are either not as capable as other kids on their sports team, or that they're or that they're going to like slow their team down, or they're not going to be picked next year. All of those things are really devastating for kids because they know that they're athletes and they know what their bodies can do.

Dr Mike Patrick: Yeah, yeah, absolutely. Matt, what, what can parents do to prevent and address weight bias and stigma at home?

Dr Matthew Paponetti: Yeah, yeah, that's a great question. I want to hear what, what Eileen says on this too, but I think the very first thing starts with, You're, you know, just self-reflection and awareness of, of what are your thoughts regarding weight or, or weight and how it relates to, to yourself and your own body, that's a good step one.

And then maybe start to listen in and really be mindful of what kind of things your kids are, are saying to you about how they value or, and they see their bodies and their weight. Be on the lookout for signs of that stigma or that bias that might be occurring outside of the home environment and then work with that that kid to work through those situations or, you know, try to be an advocate, which I think is so hard being an advocate for your kid in the school setting or on the sports team or whatever that You know, you want your kid to be treated, you know, as fairly as, as everyone else too.

Dr Mike Patrick: Yeah. Yeah, absolutely. But you know, a lot of times, the factors, the complex factors that then are built into obesity, often those factors are the same for parents and kids. So, they're eating a lot of the same foods, they're seeing the same commercials, they have the same genetics. And so often parents also may be struggling with obesity along with their kids at the same time.

And I think if parents make it like this is going to be a family plan, you know, we're going to get healthier. And so, motivate by example can also be helpful. Do you incorporate that into your, into your advice?

Dr Matthew Paponetti: Yeah, absolutely. I think a lot of our interventions, things that we talk about, it's, it's gotta be the whole family.

Yeah. Absolutely. Are we trying to have that be, we don't want it to be, you know, one kid singled out, especially if there's other siblings involved. But I think you bring up a good point, Dr. Mike, too, of just, you know, how challenging it is that parents might have had years and years of, of just kind of tough experiences or feeling that stigma and they're alive.

So, then they come into these visits kind of, you know, edgy with that mistrust as well. And so that's what we're building trust, not just with the kid, but with the whole family. I think when we do that, we see some. Some really cool, amazing things happen.

Dr Mike Patrick: So, we've talked about parents and providers, but what about schools and just communities in general?

What role do they play in reducing weight stigma?

Dr Matthew Paponetti: Yeah, I think it's a really, really big role. Like I said earlier, I think the, the healthcare setting just by nature of where we are is a really great place to start, you know, education to. To providers about weight bias. And I think that starts with, you know, education and again, awareness of your own biases.

I think it's, it's Harvard's project implicit is a really good resource that, that community members, anyone can use to start to be aware of what their own biases might be. And then having like, just like we're doing today, having the conversation about it. So, bringing the listeners, this is step one in, in working through, through biases as well.

And I think this kind of level of, of training can be expanded to, to coaches, to faculty and in schools, opening up to community members. I think the more we can kind of have conversations about it, that's where we're going to start to see some, some broader change. Eileen?

Dr Eileen Chaves: Yeah, I think on a systems level, Dr.

Mike, even doing things like making sure the built environment is built for every person of every body size is really helpful, right? So, when we think about this in the health care system, we're thinking about making sure that we have chairs in our exam rooms and our waiting rooms for people of all different body sizes and body types, making sure that we have blood pressure cuffs that fit different sized arms.

Making sure that all of our beds hold people of different body sizes securely and safely. The built environment is very important, but also, we think about things like, you know, any sort of media. So, I'm thinking about like, any websites that we might have any sort of print media that we might have, making sure that we're inclusive with the pictures of people that we put into those things, so that we don't just talk about being inclusive.

We include pictures of people in different body sizes, people of different skin colors, people of different cultures. Sort of, if we If we zoom up one level above that, I think about like different even policy changes that other communities can make, or cities or states can make. And some states and some communities do have different policies in place related to not discriminating against people based on their body size or weight.

Or height, but not all of them do, right? So even advocating for your community to have that kind of a law in place, really helpful. I think also too, sort of making sure that there are safe places for people to be able to run and play and move, right? That's really important because we know certain communities don't have those same safe spaces.

So, when we talk to families about, you know, is it possible for you to be more physically active? For some families, the answer is no, just because there's not a safe space in their neighborhood or around their home. So having a built environment that really truly provides opportunities for everyone to.

Be safe, be active, have an inclusive space is really helpful.

Dr Mike Patrick: Yeah, and in communities that doesn't necessarily happen without advocates to go out and make it happen. And so even if obesity is not directly impacting you or your kids, it is impacting your community. And we all, all of us need to be a voice for change that's going to help kids live healthier lives for sure.

Yeah. In terms of resources for parents to support their kids in maintaining a healthy weight, Matt, are there particular places, I would imagine the Center for Healthy Weight and Nutrition at Nationwide Children's probably has a lot of educational materials on their website, but are there other places folks can go for info?

Dr Matthew Paponetti: Yeah, definitely. Well, I always encourage, you know, families in our, in our center, but then outside too. You know, talk with your, your primary care doctor and, and that, let that be a really good source of resource and connection. We're lucky in Columbus. There are a lot of resources, you know, our Columbus parks and recreation system is wonderful.

I mean, if you Google the map of our community centers, there's like 20 of them scattered all around in different neighborhoods. And they offer, they're offering a lot of like summer camps right now. They do. A variety of sport programs, but then also like art and theater and dance and kind of this whole spectrum of really affordable physical activity too.

We have YMCAs in Columbus. That can be a great source for physical activity. Let's see, we've got, I know like healthychildren. org, that's the American Academy of Pediatrics. They've got a lot of different resources on their site, myplate. gov. That's a really good source for nutrition information. So, there's, you know, there are things out there.

I think it's just a matter of, of, of keying into them, searching for them. And then again, if us as healthcare providers can be that link for families, cause a lot of people just. Don't know what's available what's around. So, if we can be that hub for an individual family, I think that's where we can make a really huge impact

Dr Mike Patrick: and we're gonna put a lot of links in the show notes for this Episode over at PediaCast org.

It's episode 562 and we'll put links to all the things that you have already talked about Also, there's a great article in Pediatrics Nationwide, which is a journal that comes out of Nationwide Children's On pediatric obesity and how to treat it safely and effectively. There's an article from the NIH on weight stigma and bias, a guide for pediatric clinicians.

So even though this is our parent podcast, we do have a lot of pediatric providers who, who listen in the journal. Pediatrics had an article stigma experienced by children and adolescents with obesity. And the journal of pediatrics has one called addressing weight stigma and weight-based discrimination in children, preparing pediatricians to meet the challenge.

so much. So, these are just awesome resources, not only for families, but also for pediatric providers and, you know, for parents who may be a little bit more science minded and interested in diving a little bit deeper into this, I think that they would find those links interesting as well. So, all of that will be over in the show notes for this episode over at PediaCast. org. Matt, we have mentioned the Center for Healthy Weight and Nutrition at Nationwide Children's several times. What exactly is that? Matt.

Dr Matthew Paponetti: Yeah, sure. So, we are a multidisciplinary center. So, we've got medical doctors, nurse practitioners. We've got our wonderful team psychologists, physical therapy, our new registered dietitians, social work.

We just have a whole team of healthcare providers ready to provide That family-based lifestyle behavior interventions to families and we see kids with obesity. So again, BMI above the 95th percentile. Also to is kind of a more recent topic. You know, there is pharmacotherapy and bariatric surgery as additional options for obesity as well.

So, we kind of have a range of treatment options available to help kids help families be the healthiest version of themselves that they can be.

Dr Mike Patrick: Yeah. I know you guys are, are representing physical therapy and psychology. There is, as you know, a lot of buzz out there with these new weight losing drugs.

Um, you know what I'm talking about? They're very expensive. I think they're probably only approved for use in like age 12 and older. Is that, has, has your experience been that that's becoming more used or is this definitely not a first line kind of thing, Eileen?

Dr Eileen Chaves: So, we have a lot of families who come to us, and they have been trying for years to make the sort of lifestyle changes that we have talked about in terms of, you know, changing nutrition, changing the consistency that you eat, being more active, right?

And they need additional help. So, I would not say by any stretch of the imagination that the pharmacotherapy is sort of an adjunctive thing or something that you need to, you need to fail lifestyle treatment in order to have that. Not at all. Right. We have a lot of really skilled medical providers who offer that as a treatment.

I will say. The medication works best if there's also the ability to kind of make some of these lifestyle changes. And that really truly is just because we're trying to help people be, like Matt said, the healthiest versions of themselves. And so that means we want to make sure that people are able to get all of the nutrients and minerals our body needs by eating a variety of foods consistently throughout the day, right?

Being active in order to maintain their muscle, muscle mass, things like that, right? So, the two can definitely go together, but we see lots of families and lots of kids who are helped by those medication

Dr Mike Patrick: and as with any medication, there's going to be benefits and there's going to be risks and having a physician to kind of walk you through the risks versus the benefits because not addressing the obesity also has risks.

which may be greater than the risks of medication. But again, that's a discussion for families and providers to have together. And the right answer for one family may be very different for another family, depending on circumstances and risk tolerance and all sorts of other things. So, I think having open dialogue between families and providers can really go a long way to helping the individual family and kind of where they are.

For more information, visit www. FEMA. gov In, in all of this, um, speaking of that, um, Eileen, can you share a success story or two or examples of interventions that really have are working to reduce, especially weight bias and stigma?

Dr Eileen Chaves: Sure. So, I'm thinking mostly about like. The environment, right? So the environment of like the medical environment or the exam room, even if we're going to go a little bit smaller or the home, some of the things I think we've already really talked about, like making sure that you have pictures of all different people in all different body sizes around your space, wherever that is, the medical room, your website, your literature, whatever, right?

Again, making sure that you have furniture for all people of all different body sizes, that's really helpful. If you're at home, I think it's really helpful to think about the media that you watch. So, this would mean like, like if you watch TV shows, make sure you're watching TV shows with your kids where people are in all different body sizes and the kids in the media or in the movies, you're watching aren't just like the butt of jokes because of their body size, right?

Like you want to make sure that you are watching media where even kids in larger bodies are the protagonist and they are just one of the cast of that. thing, right? So, one of the things that I think is really sort of emblematic of that is the show Caillou, where they have one of Caillou's little friends, and I apologize, I don't remember his name.

He's a person in a larger body, like a kiddo in a larger body. Obviously, they're cartoons, you know, like he's just one of the kids. And I think having that experience where kids are seeing people of all different body sizes just normalizes that people come in all different shapes and sizes and that's fantastic, right?

The other thing that I think is really helpful is reading books where bodies of all different types and sizes are normalized. Like, I usually talk with families about several different books where you can see people in all different body sizes. And if you start by introducing that kind of literature to kids at a very young age, again, not only does it normalize that people come in all different sizes and shapes, but also then if kids do start to see other kids being bullied because of different body sizes or they experience that themselves.

They can recognize that like, Hey, that's not okay, right? Like that's not something that should be normalized. Like bullying people because of their different body says it should not be normalized in our society. It's not okay. It's never okay, right? So, I think that that can be really helpful.

Dr Mike Patrick: Yeah. Yeah.

And Matt, from your perspective, have do you have examples of success? And as you, as you, uh, counsel and, uh, advise families on pediatric obesity.

Dr Matthew Paponetti: Yes. Yeah, absolutely. I think just a couple of kinds of instances that, that ring in my mind with that is for the younger kids, you know, when you have a kid, especially post COVID who never got the chance to get involved in sports or, or, you know, any kinds of structured physical activities.

And, you know, part of my, my intervention is showing families what's around and what's available in their community, talking about free play, different things like that. Yeah. And then having a family come back and said, oh, I signed up for that program that you told me about and now my kid, he wants to move more.

He wants to play outside. He sleeps better and he's not fighting with me at home about some other thing. So really cool to see that impact that just like all I did was show them, hey, this rec center has a 10 soccer program you can join. And then those are all the benefits that follow. And then kind of thinking a little bit older for the adolescents who You know, I think there's a lot of teenagers who don't have a good home for physical activity.

You know, they, they aren't able to make their, their high school sports teams and some of the rec leagues start to disappear. So, a lot of times what we'll try to work on is, you know, how do we build your confidence with strength training in a gym setting, you know, planet fitness does, does free memberships for teenagers.

So usually, it's like the start of summer. I'll work with kids on how we get you comfortable with strength training in a, in a gym setting. And, you know, a lot of times I'll have kids and teenagers really nervous about that idea and we'll have a session or two in here where we practice strength training.

We talk through what that looks like, what they should feel, you know, how to progress different things like that. And then they go in, try and come back and it's like, I feel so much better for all these different reasons. And now I'm comfortable in a gym. And I think, man, like, yeah. If you're not comfortable in that gym setting, who knows what kind of physical activity that's going to bring you for the next year, the next 10 years and beyond.

So those are, I think for me are just like the coolest, coolest moments in the center.

Dr Mike Patrick: You know, one thing that really strikes me with, with both of what you're saying is that there are going to be local resources that families might not be aware exist. And that's another reason really to collaborate with your primary care doctor or with a center like the center for healthy weight and nutrition.

Uh, here in central Ohio, of course, we have listeners all over the country and your local children's hospital probably has something, a program that is similar. So it is, it is fantastic to reach out and, uh, get, get help collaboration. And you'll probably find out local resources that you did not even know were available to help you out.

Because again, Uh, this is a community effort and we really have to You Embrace all of the ways our community can help us, but it's not going to happen unless you know what's out there and by again, collaborating with your, your primary care provider with a center like our healthy weight nutrition can go a long way to getting families the support that they need locally.

Dr Matthew Paponetti: Yeah, you're exactly right. It doesn't take a ton of time to go to go digging. And I swear every, every week I find a new program that I didn't know about. So, there's things out there. It's just. Kind of digging in for a half hour and seeing what's in your neighborhood.

Dr Mike Patrick: Yeah, and when you find resources when you do go in and talk with your provider and they say hey Can I talk to you about weight and look at your growth chart?

You may be able to suggest your provider resources that you have discovered that maybe they don't know about and then you can help each other because then they can use, you know, the knowledge of those resources to counsel other families in the practice. And so, we can all help each other in discovering what is, what is out there.

All right. Well, again, we are going to have lots of links in the show notes. So, I encourage folks to head over to PediaCast. org. Look for episode 562 and we'll have all of those resources in the show notes for you. And once again, Dr. Matthew Paponetti with Sports and Orthopedic Physical Therapy at Nationwide Children's and Dr.

Eileen Chavez with Pediatric Psychology at Nationwide Children's, thank you both so much for stopping by and chatting with us today.

Dr Matthew Paponetti: Yeah, thank you so much for the opportunity, Dr. Mike, and of course, if any listeners, you know, have questions or healthcare providers have questions, our center is So happy to talk and to share resources and ideas.

So don't hesitate.

Dr Eileen Chaves: Thank you so much for having us. Dr Mike I echo totally what Matt said feel free to reach out to us. We are always happy to meet people and to help people

Dr Mike Patrick: We are back with just enough time to say thanks, once again, to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. Also, thank you to our guests this week, Dr. Matthew Paponetti. with Sports and Orthopedic Physical Therapy at Nationwide Children's Hospital and Dr.

Eileen Chavez, Pediatric Psychologist at Nationwide Children's, and both of them are with the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital. Don't forget you can find us wherever podcasts are found. We're in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, YouTube.

And most other podcast apps for iOS and Android. Our landing site is PediaCast. org. You'll find our entire archive of past programs there, along with show notes for each of the episodes, our terms of use agreement, and that handy contact page, if you would like to suggest a future topic for the program.

Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show, and we love connecting with you on social media. You'll find us on Facebook, Instagram threads, LinkedIn, and Twitter. x simply search for PediaCast. We also have another podcast from Nationwide Children's.

That one's called PediaCast CME, which stands for continuing medical education. It's similar to this program. We do turn the science up a couple notches and offer free. Continuing medical education credit for those who listen. And that includes physicians, of course, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists, and since Nationwide Children's is jointly accredited by all of those professional organizations.

It's likely we offer the exact credits you need to fulfill your state's continuing medical education requirements. Shows and details are available at the landing site for that program, PediaCastCME. org. You can also listen wherever podcasts are found. Simply search for PediaCastCME. Thanks again for stopping by and until next time, this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids. So long, everybody.

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