Piyush Srivastava, MD: Hey, everyone. Namaste. I'm Dr. Piyush Srivastava. I'm a pediatrician at Parkland Health Center in Farmington, and I'm glad to be here to talk about the topic close to my heart.

Melanie Cole, MS: According to the Centers for Disease Control and Prevention, the CDC, the obesity rate among U. S. children and teens has more than tripled since 1980. We're delving into the complex realities of our childhood obesity epidemic today on MomDocs, the podcast from St. Louis Children's Hospital. I'm Melanie Cole.

Dr. Srivastava, this is such a complex topic. It's a topic that is also near and dear to my heart as an exercise physiologist. I've been working with kids for about 35 years. So I'd like you to start by speaking to parents and listeners. We are calling this an epidemic. Yes, I'd like you to speak about that intro that I just gave about how it's tripled.

Tell us about the prevalence and what you've seen as the societal impact on our communities.

Piyush Srivastava, MD: Definitely, it is a big, epidemic which is going on right now. And just to give everyone a perspective, the current population in U. S. is approximately, let's say, 332 million. out of that, children less than 18 years are approximately 75 million as per the CDC data. Now, out of this 75 million kids, which is one fourth of our population, by the way, almost 20 million are affected by obesity.

And when you are suffering with obesity so early on in your life, Every single part of your body is going to get affected at some point in your entire life duration. So it is a big concern and, it should be talked about without any shame. It should be talked openly and, both physician and the family member should come together, to do something about it.

Melanie Cole, MS: I agree with you. So how do we measure this in children? Is it different than in adults? With children, we see children that are overweight a little bit or a lot. Tell us how it's measured so parents know.

Piyush Srivastava, MD: so obesity, childhood obesity is typically defined as having BMI of more than or equal to 95th percentile for age and sex. So whenever you go to your pediatrician, he will show you the growth charts for weight and height. If your BMI is more than 95th percentile for the age and sex of the child, that is typically defined as obesity.

Now, severe obesity is defined as BMI of more than equal to 120 percent of the 95th percentile. So, Even beyond 95th percentile, we have categories like 50%, a hundred percent, one 20%, one 50%. So if you are more than one 20% of the 95th percentile, you come under the category of severe obesity. Now, there is different ways of measuring obesity.

The most common of all of that is B M I, which is the universal practical standard, but it has its own like pro and cons. Now the gold standard for measurement of body composition is the DEXA scan or the dual energy x ray absorptiometry. It is expensive, so it is not used as commonly.

Melanie Cole, MS: Doctor, this is, as I said before, a very complex issue with so many causes as we look to some of those. It's bigger than any of us can describe on one podcast or even 10 of them. If you were to pinpoint some of the main causes as we're looking to not solve this problem, but at least work on it a little bit, as I see it, we've been cutting gym and recess and we've been, there's problems with the built environment and the.

sidewalks and kids can't play in the parks as safely anymore. I mean, it's huge issue. What do you see are some of the issues that maybe within the home we can tackle right away?

Piyush Srivastava, MD: that's a fantastic question. First and foremost, there are so many things you can do at your home, to combat the issues which are related to obesity or even weight gain in general. The basic things what you can do is work on your sleep wake hygiene. That is one very basic and the first thing which I always tell all of my kids and the parents who come, for the appointments.

Work on the sleep hygiene because if your sleep is off, Everything will be off. You will be binge eating more. You will snack more at night. Your mood and behavior will be affected. if you have, any kind of comorbidities like ADHD, anxiety, depression, all of that will be through the roof. That's number one thing what you can do at home.

Number two, very, very important thing what you can do is be mindful. When I say that, I mean that when you are going for grocery shopping, when you are eating, you have to be mindful. You have to be a little, strict and mindful about what you shop and bring to the house. Because kids will eat what you buy and they will follow what you are doing.

And it's very interesting to know that at least half of our habits, whether it is related to food or lifestyle, comes from our parents. So if parents can become a good example of leading a healthy lifestyle, things can start changing right from the home.

Melanie Cole, MS: Now, as we think of the comorbid conditions that come along with childhood obesity, we never used to call it adult onset or diabetes type two. it's now really, we're seeing it in kids, doctor, right? We're seeing this diabetes, we're seeing high blood pressure, things that we only saw in adults back in the past.

But as we think of all these comorbid conditions that it goes along with, one of the big ones I personally have seen and I think of first is the mental health aspect and the self esteem. Now, what do you want parents to know about that part of this and why that's important to recognize and how we speak to our children, how we work with them about their weight issues, All surrounds that mental health issue.

Piyush Srivastava, MD: Absolutely, absolutely. That's very important. in addition to the physical and the metabolic consequences, which we all know, which are associated with obesity, obesity is also associated with poor, psychological and emotional health. it is directly associated with. increased stress, depressive symptoms, and low self esteem. Now you know, in Indian philosophy, interestingly, it is said, as is the food, so is the thought. So the kind of food which we eat has a direct impact on our mental and emotional state of health. And if you go by 2022, there was a study, it was a meta analysis of 28 studies, which found a positive association between, obesity and body dissatisfaction and low self esteem.

So even in my clinic in rural Midwest, almost all the kids suffering from obesity also suffer from some kind of mental and behavioral health problem. they are anywhere between one to four medications, for the same. And what I have noticed in my experience and practice is the way it works is like a cycle.

Someone is sedentary, they have sedentary habits. We are not doing as much of exercise and physical activity. Now, exercise is a big and major, factor which helps in release of dopamine and serotonin in our brain. So when we do not have enough serotonin and dopamine our brain, we start feeling bored.

We start feeling low. Our mood is off. we are feeling, depressed. And then we start finding ways to increase that serotonin and dopamine. So how can I find it? The best and easy way to find that serotonin or dopamine is either by food, or by alcohol, or by drugs. food is the easiest way out. It's the most easily available method to increase your dopamine and serotonin, especially foods which are rich in simple sugars like soda, cookies, muffins, fatty foods like fries, chips, and salty foods.

All those three. can release dopamine and serotonin in your brain. So you keep on eating, you don't exercise, you gain weight, then it goes on to increasing your sedentary habit. And then again, your serotonin dopamine is low. So it keeps on going into that cycle. And at some point when we are intervening, we have to break the cycle.

So that's how obesity is linked to the mental health changes, behavioral changes. And this is the pathophysiology, which is there and which we need to work on. What

Melanie Cole, MS: Now I'd like you to speak to parents as a pediatrician doctor about how you speak to the children and to the parents because as sensitive of an issue as this is, some parents don't want to hear it. I've seen that myself and some parents don't want to hear it, or if you look at the parents, they may be obese as well.

And as you said, this can work together in families both to get that way and to get past it. So tell me how you What words you use, how you speak to parents and children so that we can look to our children and speak to them through this thoughtful, mindful way.

Piyush Srivastava, MD: Definitely, that's the most important thing to approach. If we approach this whole thing in a sensitive manner, we will have more success in any kind of intervention. So what I usually tell the parents is do not focus on the weight number, do not get fixated on the number itself, because then people start.

to starve themselves or do some kind of crash diet. They will lose like few pounds. They'll be happy. And then they'll be back to their own previous lifestyle, which they were doing and all of it comes back and sometimes even more. So what I always focus and stress upon is focus on the lifestyle. When the lifestyle will be correct, the weight loss will be the by product of your correct or good lifestyle.

Now, the question arises, what changes in lifestyle can we make? So, as I said, we can work on the sleep, at least seven to nine hours of uninterrupted sleep. That will be really helpful in resetting or rebooting our brain, just like computer, it needs rest. So we need to, give importance to the sleep.

The second thing is the physical activity, one to two hours of Any kind of physical activity and start with whatever you can do around locally in your house or in your community. It could be walking, running. playing. If there is a local gym, you can join that. If there is a swimming pool nearby, you can join that.

If there is any ninja classes, martial arts classes, you can join that. So some kind of physical activity has to be there to improve the muscle health and the hormonal health which results from the muscle health in the long term. And the third thing which I also mentioned was, I tell them, give them some ideas regarding mindful shopping and mindful eating.

and I also tell them, to work on the eating pattern. Like if someone is stressed out, if someone is bored, don't... immediately go on to like getting a snack and munching on some chips, cookies, muffins. so those are some of the tips and tricks which I share with my parents here.

Melanie Cole, MS: This is really such an important topic, doctor, and I know that it's something you and I certainly can't solve in this episode, but wrap it up for us by offering your best. Advice. You see children every single day. You guys are the gold standard pediatricians. You're the ones that are there to help us raise our children happy and healthy and safe.

Tell us what you tell parents every single day about this obesity epidemic and ways, little ways, role model ways, cooking ways, family, getting involved together ways, anything you want to tell us about. This childhood obesity epidemic and what we can do right now and take away from this episode to help our children.

Piyush Srivastava, MD: Definitely. So when we treat or talk about, obesity, we treat it like a chronic disease. And when we treat it like a chronic disease, we have the goal that whatever treatment strategy or whatever intervention, lifestyle intervention we are going to do, that will continue for a long term. And when I say long term, I'm talking about It's not something like a fever or a pain in which you immediately give some medicine and it will be corrected in like next few days or two weeks.

So, I always... have this, realistic, time period, which I give to parents that it will take a long time and we'll do one step at a time. Now, there are a lot of strategies which we can, share with parents. There are non pharmacological strategies like motivational interviewing, in which we engage with parents.

We focus on what's the problem and we help them gain the insight. And once they gain that insight, we plan along with the. parent, and the child together. In addition to motivational interviewing, we can also do intensive health behavior and lifestyle treatment, in which in some places there are multidisciplinary team like St.

Louis Children's Hospital, where there is a dietician, a social worker, a psychologist, a obesity medicine specialist, who all will sit together with the parent and they will discuss what changes they can make in the lifestyle. then there has to be some kind of, literacy, pertaining to reading the food labels, behavior modification has to be there.

Like if someone is doing stress eating, binge eating, that has to be addressed. If someone is stressed out, that is a big trigger for weight gain. So that has to be addressed. Eating pattern, physical activity, positive social connection, which is very, very important. These days, we are not sitting together, around the mealtime, and talking to each other.

Rather, there is some TV or some iPad or phone open. So I always encourage parents to have at least one meal together in which there is no screen on and they are talking to each other. So building that positive social connection is very important. And, when we work on the lifestyle, we work on the lifestyle of the family as a whole rather than just individual.

So these are the non pharmacological modification and in the pharmacological side, we have a couple of medications which we can use and in the severe or resistant form of obesity, there is also option of, gastrectomy or Roux en Y procedure, bariatric surgery. So those things are also available.

But those are only available and offered on individual basis, case by case, and it is not something, which is prescribed in a reflex. Like if you have obesity, okay, this is the medicine. If you have obesity, okay, this surgery is the treatment. So this is how, as you said, it's a big topic and it cannot be covered in one small podcast, but these are the gist as to how we approach obesity and how, together as a team, we, help the child gain the full, potential it deserves.

Melanie Cole, MS: Beautifully said. Doctor, thank you so much for joining us today. For more advice and articles, please check out the MomDocs website at childrensmd. org. And that wraps up another episode of Mom Docs with St. Louis Children's Hospital. If you found this podcast informative, please share on your social media, your social channels, because we are all learning from the experts at St.

Louis Children's Hospital together. And this was such an important topic. I hope that you'll share it and tune in for more. This is Melanie Cole. Thanks so much for listening.