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Melanie Cole (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange county. Together, we can keep kids happy and healthy.

I'm Melanie Cole, and I invite you to join us as we discuss helping children lose weight safely. Joining me is Dr. Kate Williamson. She's a pediatrician with Children's Health of Orange County and the immediate past president of the American Academy of Pediatrics Orange County. Dr. Williamson, it's such a pleasure to have you with us. You and I have done podcasts before for the American Academy of Pediatrics. So it's such a pleasure to have you on for CHOC today. And as childhood obesity has increased from a relatively uncommon problem to one of the country's most important public health issues facing our children today, really we're calling this an epidemic, yes? Tell us about what you've seen and noticed as far as the prevalence and societal impact on our communities.

Dr Kate Williamson: Well, Melanie, thank you so much for having me. I'm very happy to be here to talk about this incredibly important topic. And as you've said, we have seen such an increase in the number of kids who are unhealthy and who are overweight. And particularly in the last few years when the pandemic hit and so many kids, pretty much all kids, went to virtual learning and did not get much exercise and did not get out and move their bodies and didn't eat very healthy, this has really, really increased in the last couple of years.

Melanie Cole (Host): I think that goes for all of us. It happened for adults as well. We've heard about the consequences and health risks for adults of obesity. But when it's children, we're seeing things like diabetes type 2 in children that we never saw before. It used to be called adult onset, but now it's not anymore, and even high blood pressure. Speak about some of the consequences and the complications that can arrive that can really follow a child through life if they are obese as a child.

Dr Kate Williamson: Yes. Unfortunately, even at a young age, obesity can really hit hard for kids. So as you mentioned, diabetes, type 2 diabetes specifically, has really increased with the epidemic of obesity. We've also seen a lot of kids with joint issues. You know, things that we wouldn't expect people until much later in life with osteoarthritis type of symptoms, because they are just so heavy on their joints. I've seen very young kids with very high cholesterol levels, which increases their risk for cardiac disease at a younger age. And they will definitely carry that through their lives, unless we can turn that around. And then the other thing which is not so visible is the mental health impact and children who have obesity have a much higher risk of having depression, anxiety, and increased risk of suicide.

Melanie Cole (Host): Well, those are all really important points to make. And Dr. Williamson, if a child has gained weight during the pandemic, or if they were pre-pandemic, how can parents help them lose weight without making them feel bad? As you said, there's a mental health toll that comes with obesity and to whom do the parents turn first? I mean, obviously we look to our pediatricians, the gold standard, helping to raise our children healthy and safe. And then what? What is it like for a parent when a child is overweight and we want to help them to get some of that off?

Dr Kate Williamson: It's such a great question. And it is a very difficult line sometimes for parents to walk, because they want to encourage their kids to be healthy and to lose that weight. But too much of that language or the wrong language can really impact kids and make them feel very terrible about themselves. So it's so important to make sure parents focus on health, not weight.

Oftentimes in my office, I very much recommend to not even talk about weight. Even when I check my kids and they are overweight, I don't talk about the number because the number is not what matters. It is a reflection of what might be an unhealthy weight. I focus on the things that make kids healthy and the things they can do to be healthy.

So I think first starting with that, to take word weight completely out of your language as a parent is so, so important. And then start focusing on the key factors of health. And what I talk about with my patients is there's really four key things that if you do some of these every day, ideally all of them well every day, you're going to be healthy. And that's eating nutritious foods, drinking lots of water, getting exercise and focusing on good sleep.

Sometimes for kids, they can only focus on one at a time. So take that as a win. Start with one thing that they can focus on and slowly increase those goals while the entire time your focus is on health, not weight.

Melanie Cole (Host): What a great important message that you just said, because there is certain language. And certainly, for the mothers out there, we've been programmed to negative self-talk. We look in the mirror and we say, "Oh, look at those thighs. My God, when did I put this weight on," that sort of thing. But we don't want our kids to hear that, not our daughters and not our sons. So when we are helping our children and we're trying to be good role models, getting them involved in cooking, getting them involved in picking these healthy choices for food and even taking walks as families, doing things like that. When we're saying these things, how do you want us to approach it? Because the wording is sometimes the hardest part.

Dr Kate Williamson: Yes. I think it's really important to talk about what it even means to be healthy. Sometimes that's even the place to start. So, you know, we just talked about what we have to do to be healthy, but sometimes just talking about how you feel when you're healthy. And some of my patients are very resistant to change and don't want to eat their vegetables, and so I don't go there, right? So we start with, "Well, what does it feel like when you're healthy? Do you wake up full of energy? Do you feel really strong? Do you feel like your brain's thinking really fast and you can run really fast?" And so I think the first step is really aligning with your children on how they want to be healthy. And I find four and five-year-olds who can be engaged in empowering their own health by saying, "I want to run really fast," and you walk them through that. And you say, "Okay. So what do you have to do to do that?" Okay, well, most kids know that you have to eat vegetables. "Well, I don't like vegetables." "Well, that's okay. Let's start with maybe having one bite a day." And so what I really encourage parents to do is help their children to find their own health goals rather than make them for them. And sometimes it's simply by talking to them about what healthy means and why you want to be healthy and how you can get there. Parents simply needs to sit and listen and be a guide. And it's amazing to watch these kids just talk about, "Okay. I think I can do that." And at the end of the discussion, they have at least one set goal.

Melanie Cole (Host): That's great advice, and you're spot on, because I've seen that myself as an exercise physiologist when working with kids. You can talk to even the littlest kids, just exactly what you just said, Dr. Williamson, and they get excited about it. Now, as we've seen with this epidemic, sometimes you see an overweight child and then you look at the family who are also overweight, so it's a real family goal. But if you have one child who's thinner and doesn't have this weight issue, how do you as a pediatrician work with families as a whole to understand that importance of the good healthy nutrition and exercise when they have children on different parts of that spectrum?

Dr Kate Williamson: I get that question a lot. And I think what's so important is that we recognize that health is health. And whether or not you're thin, maybe just genetically you're meant to be thin or because you've been leading a healthier lifestyle, that doesn't mean you should not be healthy and focus on being healthy, just as much as the person who might need to make changes and lead a healthier lifestyle. So what I tell my patient's parents is do not treat your kids differently based on how they look or their body type. We all need to be healthy. Empower them with those tools to be healthy. Try to guide them as much as you can by showing how you can be healthy and let them run with that. If you treat one child different than another, that has such negative downstream complications that could really affect both of them for the rest of their lives.

Melanie Cole (Host): Certainly, that's true. And can you just give us a brief overview before we wrap up this podcast about some of the treatment options that are out there as parents can talk and learn to cook and get the kids involved, even in shopping? There are all these things we can do as a family, but there are also things that dieticians and our pediatricians can help us with with these children. What are some of the treatment options for kids out there today?

Dr Kate Williamson: Absolutely. And I just want to point out to parents that you do not have to do this alone. So starting with your pediatrician, as as you were saying, Melanie, I could not agree more. Plan to partner with your pediatrician, have them even sometimes help start the conversation if you're having a difficult time and help your child goal set. We all think we know probably a lot about nutrition and we do, but there's so much more we can learn and your pediatrician can help you identify specialists that you may need to see. So nutritionists are fantastic. Just teaching us, "Hey, this is how food works in our body." And you as a parent may know all this, but that nutritionist is for your child. Particularly for teenagers, when parents know so much about nutrition, it might be their teen who really needs to learn it and learn it from somebody who's not their parent.

And the last thing I wanted to put in there is, you know, in the back of our minds, as parents, we might think, "Is there something medically wrong with our child?" And that's when their pediatrician can help figure out, maybe this is a thyroid issue, maybe the child is at risk of type 2 diabetes. We want to make sure we're not missing those kids and we do employ early intervention along with teaching them just how to be healthy.

Melanie Cole (Host): And your best advice as we wrap up for parents listening that are concerned that their child is maybe just a little bit overweight or really on the way to obesity and that the pandemic has really exacerbated this anyway, the sedentary lifestyle, the stress eating, all of those things. What do you tell them pretty much every day ?

Dr Kate Williamson: Focus on health, not weight. And for parents, talk to your pediatrician early and often.

Melanie Cole (Host): That is great advice. Dr. Williamson, what an excellent guest you are. Thank you so much for joining us today. And for more pediatric health and wellness tips, please visit choc.org. Thanks so much for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy. Please also remember to share on your social channels as we're all learning from the experts at CHOC together. I'm Melanie Cole.