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Obesity in Children

Dr. Megan Shelton discusses how to determine if your child is overweight or obsese, how and when to address your child's weight with your child and pediatrician, and shares how parents can promote healthy eating habits as well as encourage exercise.
Obesity in Children
Megan Shelton, MD
Dr. Shelton specializes in the assessment and treatment of children and adolescents coping with an acute or chronic medical condition. She has a particular interest in pain management, as well as treating anxiety, depression, or adherence difficulties related to a medical condition. She also treats children and adolescents who are experiencing sleep disorders or anxiety.

Dr. Megan Shelton (Guest): Hi, I’m Dr. Megan Shelton and I’m a pediatric psychologist and a Mom Doc at St. Louis Children’s Hospital.

Melanie Cole (Host): Childhood obesity has increased from a relatively uncommon problem, to one of the most important public health problems facing our children today. This is Mom Docs, the podcast from St. Louis Children’s Hospital. I’m Melanie Cole, and today we’re talking about childhood obesity. Dr. Shelton, I am a very passionate advocate for this particular topic, as I’m an exercise physiologist and I have been working with children for 30 years. Tell us a little bit about the state of childhood obesity today and explain to the parents listening what is the definition of obesity in children?

Dr. Shelton: Sure, so unfortunately we know that obesity rates have been rising in children over the past 20 to 30 years, so it’s becoming more and more of a focus for pediatric healthcare providers and us as behavioral health providers and psychologists. So when we’re looking at what defines obesity, we usually look at what’s called a body mass index, and that’s a way to measure children compared to other children their age and same sex and we take into account a child’s weight and height so that we can compare children across themselves and so when we look at that body mass index, or BMI for short, we look at the percentiles. And so obesity is characterized as a BMI of 95th percentile or above, and when we think about children who are overweight, we look at a range of 85th percentile to 94th percentile.

Host: So not necessarily taking into account muscle mass and BMI has its issues. You as a pediatric psychologist, help parents to kind of deal with if they have a child that happens to be overweight. So what do you want them to know first of all to do from the get go to keep their weight at that health level?

Dr. Shelton: Sure, so we really talked with families about starting healthy habits, very, very early, as young as toddlerhood, and so we really talk with families about developing smart eating habits, and then moving often and having an active lifestyle. So a lot of the things that we talk with families about are making these changes together, first of all. What we know is that being health often is best when we’re doing it as a family and that no single person in the family is made to feel that they’re doing something different than somebody else. We can all work on being healthy together, and so one of the ways that we really address parents who have concerns about their child’s weight is we use the words talking about being healthy as opposed to specifically talking about weight and things like that, although that’s one of the outcomes of being healthy. So we talk about providing balanced meals and snacks to kiddos. Eating meals at scheduled times and snacks. So one of the problems that we often see is that kids just kind of snack throughout the day, what we call grazing, and we certainly know that it’s harder to keep track of how much a child might be eating throughout the day, so we really talk about having a good meal and snack structure. We talk about limiting eating in front of the TV because sometimes we don’t pay attention to how much we’re eating if we’re distracted, eating as a family, having just pleasant fun conversations during mealtime to make it a family affair, and then we also really talk about avoiding food as rewards for kiddos, so that we can teach kiddos other ways to be rewarded and to limit that as a reward because we often then set ourselves up for that becoming a pattern or a conditioned response that we expect food as a reward and that can lead to overeating as well. So those are some of the healthy eating habits we talk about, just instilling in kiddos from the time they’re toddlers, and then of course the other thing I mentioned is just having an active lifestyle where you’re on the move.

Host: And that’s great advice, good points all as far as starting so early. Do you think, and have you seen in your practice, Dr. Shelton, that parents know their child is obese, and I love that you said we talk about healthy lifestyle, not overweight, losing weight, those kinds of words, especially with our girls, but do you think that parents recognize this? Do you think that they are noticing it? And if they are, when do they see their pediatrician about this?

Dr. Shelton: So I mean I certainly in my practice, see families after they have shared a concern. So I do think a lot of parents are recognizing this concern for their children, and I think that’s particularly true after a physician, whether it’s the pediatrician or a subspecialist has started to see signs of other medical issues that might go along with weight. So I certainly also see parents who don’t seem confused about why it’s a problem or what we need to do about it, but I certainly think at any point talking about healthy habits with a pediatrician especially is really important. So especially if they see their kiddos struggling with healthy eating or with exercise or being active, I think it’s great for parents to be proactive in addressing these things with pediatricians because pediatricians can get families to other important support resources like dietitians or access behavioral health providers to help families make those changes and sustain those changes, because we also know that habit change is hard, and so we as the behavioral health providers can help support families in making those changes that seem challenging. Especially money is a barrier, or just lifestyle, work schedule of parents, school schedules, activity schedules, it can feel really challenging to make some of the changes we recommend, so I think the earlier and more proactive families can be in having these conversations with medical providers the better.

Host: So tell us then how pediatric psychologists assist in this child’s weight loss journey. I know that some practices and medical homes today are really including so many different things. They’re including a nutritionist, or a dietitian, they’re including an exercise physiologist – they’re really making this a great medical home for our kiddos. Where do you fit into that picture?

Dr. Shelton: Sure, absolutely. So like I said, you know a lot of times when you’re talking with a pediatrician, or you’re talking with a dietitian, they are giving you specific ideas and recommendations about what you can change to be healthy from an eating and an activity perspective, and really as the psychologist, we really come in and help the family be able to implement that because oftentimes what we talk a lot about with families is even though a goal set by a pediatrician or a dietitian might seem really important to both the kiddo and the parent, that doesn’t always mean people feel ready to do that or confident about doing that. So we really work with families on helping them feel ready to make those changes, and sometimes the changes feel really overwhelming or really big, and so we really try to break those goals down even. We talk a lot about what’s called smart goals. So we really want to help families set up goals that are very specific in that we can measure over time and feel realistic and achievable to a family. If a goal does not feel achievable, it’s going to be really hard to rally around that goal and get going with it. So we want to make families feel confident that they can make those changes, and then we work with them to set up those behavioral goals and ways to problem solve barriers that get in the way of those things or things that feel challenging so that we can help them be successful. So that’s the primary way that we support health behavior changes for healthy living and eating. The other thing that we do is we really look for any other underlying signs or problems that might be contributing to issues with health or weight. So what we know is that kiddos who struggle with depression or anxiety, sometimes are at increased risk for weight problems and managing their eating because a lot of kiddos and adults honestly can turn to food as a way to cope with disgusting or big, intensive feelings. So a lot of people will refer to that as comfort eating. So another way that we really play a primary role is working on any of those kids of coping mechanisms that involve food as a way to manage other problems. So we work on coping strategies for managing, feels of sadness or anxiety or frustration so that food isn’t the only way that people are comforting themselves. Another thing that we really work on is what people will call boredom eating, that mindless eating when we don’t have anything better to do. So we do a lot of problem solving to help families find some replacement behaviors for eating that can help them work towards those healthy lifestyle goals.

Host: What great advice, Dr. Shelton. So as we summarize and wrap up here, give us your best advice for parents about childhood obesity, this epidemic that we’re seeing and how they can work with their child and work with the pediatric psychologist and all the other providers to help their child without making them feel terrible because that is really – as parents, Dr. Shelton, every word we say has the ability to hurt or build up our children, so give us your best advice.

Dr. Shelton: Absolutely, again I think being proactive and being willing to have open dialogues in your family about health living, healthy eating, being active, again that role modeling from parents is really, really important so I think that sets the stage for families to be able to talk about this in a way that doesn’t feel or kids don’t feel judged or shamed about what’s going on with their health or their weight, so I think being proactive. I also just think really being supportive and encouraging. One of the things that we talk with lots of families about is trying not to be critical or judgmental. So things – I think all parents probably say, “oh are you sure you want to eat that?” or “maybe we should try something different,” and although we’re trying to motivate and help, kids don’t always interpret it the same way, so we always talk about focusing on what a kiddo is doing to work on change and praising them and supporting them that way, which would be a better motivator for them than trying to take it from the other approach. So I really just think that open dialogue and supportive, encouraging communication and then again doing this a family, not making any one person in the family feel like they’re doing it alone or that they’re the only one with a problem. We could all stand to work on being healthy in different ways, so I think doing it together is the best way to go.

Host: Great advice, great information. Thank you so much. This is such a huge topic and so important. Thank you again for joining us. This is Mom Docs with St. Louis Children’s Hospital. Head on over to our website at to get connected with one of our providers. If you found this podcast informative, please share it on your social media with friends and with other parents that you know and be sure to check out all the other helpful podcasts in our library and until next time, this is Melanie Cole.