The Get Healthy Tampa Bay Podcast

E86: Navigating Pediatric Obesity with Compassion & Care with Dr. Jessica Chacko

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I am thrilled to have Dr. Jessica Chacko, a pediatrician specializing in obesity medicine. In this episode, we delve into the challenges of pediatric obesity, discussing its early signs, impacts on health, and strategies for intervention. Dr. Chacko offers her expert insights on sensitive communication, family involvement in lifestyle changes, and the role of medication in treatment. Tune in to learn effective and compassionate approaches to managing weight and health in children, ensuring a healthier future for our youngest generation.

Dr. Chacko is a board certified pediatrician and a mom of two. She started Blooming Bright Pediatrics, a concierge-style pediatric practice based in Lithia, Florida that provides in-home care. Her practice focuses on physician-patient relationships, whole-patient care, and positive parenting strategies.

0:28 - Introduction and Welcome Dr. Jessica Chacko
0:49 - Dr. Chacko’s Background and Practice
2:39 - Training in Obesity Medicine
3:29 - Discussing Weight with Children: A Pediatrician's Advice
6:16 - Handling Sensitive Conversations Outside the Exam Room
8:19 - Obesity: Symptom or Problem? Exploring Underlying Causes
11:45 - Fun Family Fitness: Integrating Activity with Daily Life
14:37 - Strategies for Handling Treats at Social Events
20:17 - Advocating for Healthier Options in Schools
31:46 - The Role of Medication in Pediatric Obesity Management

Connect with Dr. Chacko
Website: www.BloomgBrightPediatrics.com
Email: info@bloomingbrightpediatrics.com
Phone #: 813-359-1561
Instagram/Facebook/TikTok/YouTube:  @DrJessicaChacko  

Connect with Dr. Kerry Reller
Podcast website: https://gethealthytbpodcast.buzzsprou... 
My linktree: linktr.ee/kerryrellermd
Follow on Facebook: / clearwaterfamilymedicine  
Follow on Instagram: / clearwaterfamilymedicine  
Clearwater Family Medicine and Allergy website: https://sites.google.com/view/clearwa...
Podcast: https://gethealthytbpodcast.buzzsprou... 

Subscribe to the Get Healthy Tampa Bay Podcast on Apple podcasts, Spotify, Amazon music, iheartradio, Stitcher, Google Podcasts, Pandora.

Kerry:

Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have a very special guest, Dr. Jessica Chacko. Welcome to the podcast.

Jessica:

Thank you so much.

Kerry:

Yeah. And you're actually local to the Tampa Bay area. So we're super excited about that. You well, why don't you tell us a little bit about who you are and what you do?

Jessica:

Okay. So like you said, I'm Dr. Jessica Chacko and I am in the Lithia area, which is a little bit further south of you. Close to Brandon and Apollo beach. And I have a pediatric practice. I'm a pediatrician, board certified, and I have a concierge pediatric practice where I do home visits and we have longer extended visits. We can, because I work outside of insurance, so I don't accept insurance. But because of that, we're able to do all kinds of things that you can't do when you're working in an insurance model. Like, we can answer questions over the phone and via text and we can do telehealth and we can chat 10 times in one day. And a lot of times we can take care of stuff outside of me coming in. And then if you need a visit, I come to you. And I've been just started this recently, but been living in this area for about three years. Before that, I came from Miami and I have two amazing little boys, a two year old and a just like newly minted four year old. He turned four about a week ago, a week and a half ago. And so life is busy, but yeah, A lot of fun. And while I've been doing pediatric medicine, I have seen that obesity is such a huge issue and is getting younger and younger and younger. And we're seeing those chronic effects of the other issues that we see come along with obesity like diabetes and fatty liver and all of that. I'm starting to see that in our kids and I'm seeing it more and more and more as I practice more. And so I started practicing obesity medicine about two years ago for pediatric patients as well as adults, because a lot of times when we're treating our kids, we have to treat all of the people that they live with because most kids don't make decisions about what is in the refrigerator or the pantry. So that's just a little bit about me.

Kerry:

Right. So you you do general Peds and then obviously you are kind of specializing in obesity medicine as well. And did you do the training in obesity medicine?

Jessica:

Yes, I've done the training, so I'm board eligible, but I'm not board certified yet. I'm planning on taking it next year.

Kerry:

Awesome. Okay. So, I mean, I think this is great. Like more and more practitioners are learning about it and finding the importance and bringing it into their own practice. So we're super, super excited that everybody's joining in because it's important. Like you said, right? So many more patients are suffering with this that we need to, you know, do good now. So How do you really approach this as a role of the pediatrician? Like, what advice do you have for parents who want to discuss their child's weight with their pediatrician? What do they expect during the conversation usually?

Jessica:

So, this is kind of a little bit of a hot topic because we have, as with all physicians, right, there's like old thinking and newer thinking. So generally speaking now I usually like parents to talk about it without their kid present. So maybe that means a phone call prior to the visit, or maybe that means asking a note to the doctor as soon as they walk in that says, I'd like to talk to you about my child's weight, but please don't talk about it in front of my child. Or maybe a note that says, I don't want to talk about my child's weight. Please don't talk about it in front of my child, or whatever that may be. But oftentimes it's better to talk about it not in front of the kid because kids understand so much, right? Even our young kids who are just sitting there and not paying attention and you think they're playing on their phone, they're hearing everything that we're saying. Every little thing and a lot of times when we're having conversations about people who are in the room and we're like kind of talking as if they're not in the room. We're not nearly as sensitive as we need to be, especially on topics as sensitive as body image and all of that. So I definitely recommend not talking about it with your kid in the room. And then when you do talk about it, talk about what you are concerned about. And definitely sometimes our concerns are just not really concerning, right? Sometimes we worry that our kids are eating too much, but their growth curves are just fine and where we are in those growth curves. is really what we look at the most. We want to make sure we're kind of hovering in our curve. If we go straight up or straight down, that's concerning, but if we're kind of just going up and down a little bit, especially right around before puberty, we tend to gain a little bit of weight, or maybe we lose weight because we got really tall really quick and then we didn't gain weight with it. So sometimes there's nothing to worry about, but If you're concerned, there's probably something to worry about, and it's worth talking to your doctor about it, to see how to go about the process of starting it. And most often times we start talking about just stuff we can do at home as a whole family.

Kerry:

So when they come in, you're waiting for them to bring up the topic. I really like that idea of passing the note. I think that's really helpful. And then honestly, for like the first visit or first Discussion on this topic I think it is quite good to that. You mentioned that you kind of don't want the patient in the room at the time, even when I'm seeing like older patients who come in with their caregiver, because whatever reason, like, you know, sometimes we do it's bad. Like we talk to the caregiver, instead of directly to the patient sometimes. But you're right, they still pick up on everything, especially kids. They absorb every little thing that you can hear and they know what's going on. So that's a really, a really good tactic of just bringing up that conversation before they're even in the room. So do you have like the ability in your practice, you probably have a nice approach that you can do that visit with the parent before if they're available. Yeah,

Jessica:

but even before when I was in an employed position, at the end of the visit, I would just if, if I was concerned, right, if I wasn't concerned, if you know, but if a kid will say gained, I don't know, maybe a 10 year old gained 50 pounds in one year, like we're going to have a conversation. And so then at the end of the visit, you know, maybe we're waiting for vaccines. Maybe we're waiting for something else. But I just say, Hey, mom, Hey, dad, Hey, whomever, can we chat in the other room for a minute? And I just take them to a room far enough away that I know the kid is not going to overhear anything. And then I just say I didn't want to talk about this in front of your kid, but I just want you to let you know that I'm a little concerned about this. Have you noticed is anything going on? And depending on the age, we have different things that we think about, you know, if we have kiddo under the age of five, who's significantly gained weight really, really quickly, we worry about maybe genetic disorders, especially if there's some kind of developmental delays going on. Or maybe we have some kind of like, we call them syndromic faces, right? But that's just a very medical term for some classic examples of differences in our facial structure that may make us think of particular genetic syndromes. If it happens in our older kids, especially when you know, so sometimes obesity is the disease and sometimes it's the symptom, so if I'm taking a look at mom and dad and all the siblings and everyone else is on the much thinner side and with BMI is kind of ranging in that normal to maybe even underweight range, then I might even start thinking about some other issues like depression, anxiety ADHD. I might start thinking about potentially some kind of abuse or something that's causing this kiddo to use food or whatever as a mechanism of managing something else. So, it's important to get the parents input without the kid in the room because you know, maybe they're going to say, Oh yeah, you know, actually I was kind of worried because blah, blah, blah, blah, blah, blah. And they may not say that with the kid in the room or they're talking in these like very vague. Kind of wording where they're trying to make it not obvious to the kid. And then you're like, I don't really know what you're talking about right now. So I definitely recommend that conversation outside of the room.

Kerry:

yeah. I really like also what you just said about how sometimes obesity is the problem or it could be the symptoms. So that's really important to differentiate and tease out as well. Yeah. So how can, how can parents approach the topic of weight with their kids? Once you've had that conversation with them, how do they approach it with their child? So they, it can be constructive and not avoid shame.

Jessica:

Yeah. So I think it depends a little bit on the age of the kiddo, right? So when we're talking about our younger kids, and this, I would say anyone under the teenage years, right? And maybe even that freshman in high school you know, a lot of times, even when they think they don't they learn so much from their parents just from modeling their behavior. So sometimes I think an indirect approach is our best approach. And what I mean by that is just having, and we never want to single a kid out, right? So we have our family meeting and hopefully we have family meetings relatively frequently, whether that's once a month, once a week, once a season, I'm not sure. Or maybe we just call family meetings when we need to, so we have a family meeting and we say, you know what I've been doing some some thinking, and I think that we are not doing the best job as parents providing a healthy environment for you guys, and we are not providing a healthy environment for ourselves. So we're going to make some changes. And these changes are going to be for everyone. And we are going to start talking about or we're going to start having different meals that we're planning. And maybe part of that is we have to have fast food three nights a week just because of work schedules or whatever. So maybe the other nights we're going to try to do something much healthier. But it becomes a family conversation. Like what, what things are you willing to do? And maybe we. If we have older kids, they can say, okay, well, so our 15 year old is going to plan dinner for Tuesday night and our 17 year old is going to plan dinner for Thursday night. And the, the plan has to include fruits and veggies and some kind of healthy protein. But otherwise, it's up to you, you know, they get to plan it. And then encouraging family activities together. So maybe that's walking around the block. Maybe that's having a soccer game on Saturday mornings. Maybe that's doing jumping jacks in the living room or finding a YouTube video of exercises that everyone can do. And that can even be great for our younger kids because, oh my gosh, my toddlers think that working out is so much fun and they will sit there and like lay flat on the floor and like, Mommy, I'm doing pushups, you know, so whatever age it is, we can find appropriate activities and we kind of go from there. And then if we have kiddos who are older and we have concerns, you know, if you have good relationship with your kids, which hopefully you do. And if not, there's definitely ways to nurture it. You can talk to them about it. It's like, huh, are you having any concerns about anything with your body, with health? Any, and then this could just be a regular conversation, like anything you want to talk to the doctor about anything you want to talk to me about. And a lot of times kids will come up with like, yeah, I just wish I could wear the same kind of clothes all my friends wear, you know, or I wish I could stop at the same stores that my friends shop at. And that gives you insight of maybe they're thinking about this and then you know, you can ask more questions, but we want to meet them where they're at because we wouldn't want someone who thinks that their body is beautiful, which it is that there's something wrong with them because that is never an okay thing to give to any person, let alone a kid. So it's really just a matter of we make changes as a whole family and then taking time to talk with your kids about what their concerns are with them, their body, their friends, their social life, whatever

Kerry:

Yeah, I like how you talk about your toddlers. They definitely like to work out and exercise and they're usually jumping off the walls. And I used to really like how they would crawl on top of me when I would work out and stuff. But recently my daughter like got out all her workout stuff and went in the living room to do something. I was like, Oh, what's going on here? This is real good. Then of course she used it as a lead way. Okay. Well, can I watch TV when I'm working out? I'm like, Ooh, okay. I see what you're doing here. But you know, I feel like if shes moving more I said, okay, but it's fun to see them kind of mimic things that we do in the household. And that's the whole point of like, what you're saying, right? They mimic you. You got to set the good example. You can't be doing 1 thing and then telling the kids another thing. So it's really important.

Jessica:

Exactly.

Kerry:

So you kind of mentioned a lot of these things, like answering my questions already, but when it comes to treating pediatric obesity, what are some of the first steps you take? You kind of said you have the family meeting and you're involving the whole family. And I really liked what you said about with the older children kind of making that plan. So it makes it a little bit more fun, right? You're in charge of dinner for this meal and things like that. So that's good. So kind of answered that question, but how about for long term strategies? To help the kids maintain healthy weight, like as they grow any specific things,

Jessica:

Yeah. So I think one of the other things that I love to do with kids is, you know, we have this idea of like, no soda, no cookies, no, no, nothing. And so one thing I like to implement is like, well, maybe we say that we can have like, I mean, I think no soda, but maybe if we're drinking like soda every single day, maybe we switch it to one 16 fluid ounces of soda per week, right? And you give it to the kid and it's like, you can decide, you can drink it all today or you can drink half of it today and half of it tomorrow. Or you can have a few sips of it every day for the next week. It's up to you. The same with cookies. Maybe we have Oreo cookies, maybe that's their favorite and they get to have four Oreo cookies per week or something, right? And they can choose to eat them all at once or they can choose to divvy it up. However, they want, and that teaches them, I think, something super important, like self control, because even as adults, right, we struggle with that. We're kind of used to all or nothing. If it's in my house, I'm going to eat all of it. And if it's not in my house, I won't eat it. And so you know, we, we want to kind of get out of that, because then what happens is when they go to college we have our kids who have like, you know, 22 liter bottles of soda under their bed and every, you know, they have a whole pie of pizza every night for dinner and that kind of things. So I like to model and also let them practice self control in those ways.

Kerry:

So you talk about setting up the environment at home, which is great, but how do they navigate or how do you recommend they navigate going to birthday parties and other events, or how about school where they give tons of snacks and things like that? Like, how do you approach that?

Jessica:

So sometimes what we do, so birthday parties, I feel like special occasions, it's hard in toddlerhood, right? Because we have like birthday parties every single weekend. But we try to mention like, Oh, if we eat too much of this, we get a tummy ache. And then sometimes if you're talking about toddlers or whatever, right. They're sponges. So I was like, Oh, mommy, I have a tummy ache. I was like, Oh, maybe because we had two cupcakes and two pieces of pizza, you know, maybe that was too much of that food for our tummy. And that's why you have a tummy ache. That kind of thing. And not like in a blaming way, but kind of just like a, Hmm, I wonder if that could be it.

Kerry:

Right?

Jessica:

yes, exactly. Exactly. And the same with our older kids, right? And it's a little bit, you know, but maybe it's like, huh, you know, we, we have this goal of trying to eat as healthy as we can, and our goal is to have only like, you know, one kind of dessert y or junk food y thing per week, or maybe two and we had this party, like, last weekend, and now we have another party this weekend. I wonder how we should handle this situation. And sometimes talking about it before the event, it's like, huh, as a family we've been doing a lot of this, kind of overeating, and that happens at the Holidays all the time. It's like, I wonder if there's something we can do to help us manage this situation. Like, maybe we can just have a whole lot of salad first, and then that will make us less hungry, and then we can have a little bit of the yummy stuff. Or maybe we just decide we're gonna indulge this weekend and last weekend, and we are just gonna then do something else to make up for it. Or maybe we're not because this only happens once a year that these three birthdays happen at the same time, and we're just going to let this happen every year. So it's a conversation, but a lot of times talking about it before we get there whether it's our toddlers or our preteens or our teenagers allows us to have some insight in what's going to happen. And it's always, always, always better to come at it with curiosity than to come at it with saying, this is what we're going to do. This is what we're not going to do. It's more like, huh, I wonder how, I wonder how we could manage this because you know, all of us prefer to follow through with plans that are our idea as opposed to someone else's right. And especially when we get into our older kiddos, teenagers if it comes from mom or dad or whoever our caregiver is, it's far less exciting than if we come up with it on our own.

Kerry:

Yeah. So kind of planning with curiosity, but setting some expectations perhaps as well yeah. Yeah. I mean, cause it's, it's everywhere, right? We have, like you said, it's three birthday parties in a row. It's okay. The school decided to you know, give a free treat or something like that, or you're getting it elsewhere. I mean, there's a big thing in our area where everybody gets a giant bag after playing a sport of all sorts of not so great stuff, like sugary drinks and sugary snacks, and then one token Clementine, you know? So, I mean, I don't know. Do you have any comment on how to navigate that?

Jessica:

Oh man, so this is one of the things that I am working towards is just kind of helping some, have some advocacy in our school systems, because it is really hard to encourage our kids to eat healthy when what they're offered at school is cheeseburgers and pizza, and you can get chocolate milk for free, but you have to pay for water like, It is just really hard. And where I was practicing medicine before, I had a lot of families who depended on those school lunches to supplement their grocery bill. So sending them with a healthier school lunch to school was just not an option. And so then, how are you going to tell a kid to not pick pizza and instead pick an apple? Or A yogurt or not to take the free chocolate milk and instead pay for a bottle of water. And it's really hard. So, If the American Academy of Pediatrics and the CDC are recommending all of these things, we really need to be offering these things to people in our public school systems, but that is a fight that still needs to be fought. And then what I would say otherwise is we just talk about how hard it is. And when we are out and about, and maybe when we're out and about in other places like, huh, there's really not that many great things to eat here. I wonder what we could find and we practice it. And a lot of times letting our kids see us struggle. So we have this like, internal conversation, but we have it out loud, man, I think we're going to have to eat at this fast food restaurant today because it's the only thing around. And I wonder what I could find like, no, I don't want this burger. And no, I don't really want French fries, because I know even though it tastes good in my mouth, it's going to make my tummy not feel good. Hmm, I wonder what I could find. Maybe I can have this salad, or maybe I could just have some apples and some yogurt. And you have these conversations kind of out loud. And even your teenagers, they're probably going to think you're just like, Absolutely like crazy like what are you doing mom and rolling their eyes, but they're still getting it right and they're still picking up on it and that kind of becomes their own internal voice and that can help them.

Kerry:

I really like that idea. I've never even considered that. Like, obviously I, you know, have internal struggles in making decisions too. And I think that's, that's a great idea. My kids are five, seven and nine and they are clearly hearing everything I say. So I think that's really interesting to kind of just speak what I'm thinking out loud. Like, Oh, okay. Yeah. But that's, I really liked that. Okay. So you mentioned advocacy and stuff so how can we do things a little bit better, I guess, to teach the schools or teach our community? Like, what sort of things have you have in mind of what we could do for that?

Jessica:

Yeah. It's a tough one right because it all comes down to budgets and and what is like you know, obviously frozen pizza are going to last a heck of a lot longer than like a bushel of apples, right? Or you know, just like chicken cutlets, right? So how do we figure out how to make healthy eating affordable and last long enough to just be in a school lunch cycle. And maybe that means that you know, we have more like farmer's market style things, right? Where we just, you know, have I don't know. I don't exactly know how to make it work, but there's got to be a way, right? And they do it in other countries for sure. There are states that are really focusing on this. I know Maine is one of them. They are really focused on getting healthy school lunches so that we can teach our kids A better way, right? And because in some ways, it's a little bit contradictory, right? We at home and the doctors are telling us that we don't want to have pizza and burgers and soda and all of this stuff. And then this is what is offered by our school who's teaching us everything else. So it's, it's a little bit difficult to figure out and school systems by design are very hard to make changes, right? We don't want any drastic changes when it comes to the education of our children very quickly, right? So it's a, it's a long haul process, but I think talking to them and definitely having other health care providers reach out, especially if obesity medicine specialists reach out and just talk to them about how we can come up with better plans that are still within budget and still within resources. Yeah.

Kerry:

Yeah, I definitely like the idea about pairing with like a farmer's market or something like that. What do you think about the educational standpoint where they put the big sugar things like posters up or show you the bag amount of sugar teaspoons per item and like try to help kids make choices with that, like, you know, the Mountain Dew is X teaspoons and the yogurt is this many or that kind of thing. Do you know what I'm talking about?

Jessica:

I do. I do. I think for kids, really, they are going to model what the adults in their life are doing, right? So if the adults in their life are drinking Mountain Dew, even though there's 10 tablespoons of sugar in it, they probably aren't going to think much of it, right? But if the adults in their life are like, oh, wow, Look at that. There's 10 tablespoons of sugar in that Mountain Dew. Maybe I shouldn't take this Mountain Dew. I'm going to put it back and I'm going to, oh, let's see if we want to find the one that has the least amount of sugar. Oh, look, there's some like unsweetened tea. Maybe I'll have that instead. That kind of a thing. So it really does. Kids, I mean, the younger they are, it's easier to believe, but they want to be just like us, right? When they're little, when they're toddlers, even when they're seven, eight, nine, they still want to be just like us. You know, once we hit 10, 11, 12, they're trying to separate a little bit, but it's not quite the same as our teenagers. And our teenagers still bring all of that stuff that we've kind of set as their groundwork with them, so, if they grew up thinking that, like, soda was way too sweet and didn't really taste very good and gave them a tummy ache, then they're probably not gonna change their mind when they are, you know, 16 and everyone else is guzzling soda. So, I think it's great to get parents on the right page and adults on the right page, but the kids are really mimicking their favorite people.

Kerry:

How do you kind of not create an eating disorder when you're discussing these things with the children

Jessica:

Yeah. Yeah, it's a hard one because it can happen. It can backfire, especially you know, we have a few ages where we are super sensitive and they tend to be the toddler. They're kind of all the ages, right? The toddler years when we're like kind of 2, 3, 4, we are hyper sensitive to criticism. Yeah. And then kind of in that preteen stages when we're like I would say nine, 10, 11, we're hyper sensitive to criticism because of where we are developmentally. And then obviously our teenagers are very, very sensitive to criticism, which is why they act out so much, right? It's not so much that they are trying to be bad kids as they're sort of trying to figure out how to be themselves without having the criticism. And so when we criticize them, it just kind of makes it worse and backfires. So. That's where we go. And I'm sure you do this in your own practice with your adults, right? We kind of meet them where they're at. And so when I have a kid, I'm super worried about like, maybe that kiddo I was telling you about who gained 50 pounds in one year, I might talk to them as, Hey, I noticed that we had kind of a big shift in our, in our weight, which maybe isn't a problem, but maybe it is. And so let's have a conversation about it. Is there something going on for you? You know what do you think this could have been from? Is it that you're just really, really hungry. Is it? You're really, really sad. Like you just ask questions, right? And I try to keep it as open ended as possible. So I probably actually wouldn't say all that. I would probably just be like, so I was just kind of looking at your growth charts. And if it's an older kid, they're kind of going to look at you like bug eyed. Like, oh my gosh, please don't look at my growth charts. And it's like, and you know, I, I see a big change here and you don't even have to say what the change is. Cause they're going to know. And it's like, is it anything you're concerned about? And you can just listen, or you can even just start saying, you know, so this is your visit. This is about your body. You have any thoughts, concerns? And we meet them where they're at. So some kids are going to be like, Yeah, oh my gosh, I gained so much weight, and I really, I don't know what happened, and, you know, I'm trying to lose weight, and I'm trying to do this, that, and the other thing, blah, blah, blah. And then, like, those people are, it's like, okay, so let's, let's figure out some options that are good for you. And that would be a great person, especially if they've gained that much weight, that would be a great person to, let's go ahead and get some blood work, let's go ahead and consider starting medications, let's go ahead and, like, do all of the things. Because they are on board, and their Mental state is good. If they're kind of really reserved like, no, I don't see any changes. I'm not worried about anything. Nothing. No, nothing really changed at all. It's like, okay. Okay. Well, no problem. And then maybe usually what I'll say is like, oh, around this age, I'd like to get some blood work. Let's get some blood work to make sure everything in your body is healthy. And I don't bring anything up, right? Because if they're not ready to talk about it, then me bringing it up is not good. And it might just make them never want to come back to see me again. So then I bring them back and then here the key is to see them frequently, which is part of the reason I went into this concierge start practice because I can check in with my patients twice a week if I needed to. And Usually what happens is when you check in frequently enough and they start to trust you and they know that you're not judging them and you're not trying to fix them and you're not trying to tell them that they're bad or wrong or, you know, doing the, doing bad things, then they start to open up. And once they start to open up, then we can start looking at other things. And all the while their adults at home are like, hey, we're going to make these changes at home, and we're going to do this, that, and the other thing, and this is for the whole family, and we all want to get healthy, and blah, blah, blah, blah, blah. Does that make sense?

Kerry:

Yeah, I mean, I, I guess I'm just trying to figure out when do they, like, flip the switch to not having sort of a normal eating pattern. And if we, I just want to make sure that, you know, what do you make sure not to say kind of thing as well

Jessica:

So, I am never the first person to say that I'm concerned about their weight. and I don't let parents say that either. I want them to be the first person to say it. And a lot of times they will, like, I'm concerned, you know, any concerns that I'm concerned about my, my growth charts, or I'm concerned about my weight, or I'm concerned about my height or whatever. And then you can kind of tease it out, but I'm never the first person to say that. This is a problem. We need to do something about this. Blah, blah, blah, blah, blah, blah. I will talk to mom and dad and I will let mom and dad know that the family needs to make some changes and you know, make sure that everyone is safe. And I might have a private conversation with the kiddo to make sure they're safe, you know unfortunately, sometimes obesity that is just kind of brand new. No one else in the family has it, it can be a symptom of physical abuse, sexual abuse, these kinds of things. So I kind of ask questions to make sure none of that's going on, but I'm never the first one to say, I'm concerned about your weight.

Kerry:

How do you approach like nutrition with the family? Do you teach about protein and like those kinds of things or

Jessica:

Yeah, so

Kerry:

really like

Jessica:

I start pretty vague and there is this 4,3,2,1,0 kind of thing that we talk about in pediatrics. Five is how many fruit servings of fruits and veggies we want every day. four. So four and three are not in every single model. I still like them. Four is how many family meals we have together a week. Three is how many meals a day we should have. Two is how many hours of screen time that we should have max. One is how many hours of exercise we should have and zero is how many sugary drinks. So I go through that. I talk about if we're doing healthy things with our body and if we're doing putting healthy things in our body, everything kind of can work its way out. And that is a way of kind of some stress off of it. And then again, I want to make sure that we're mentally healthy and all of that, but that's usually how I start it. And with kids, big changes quickly. I'm sure you know this with your own kids. It doesn't really go over very well. We kind of have to check in frequently. I think some teenagers can write some teenagers, You know, I'm like, I want to make it to like, cheerleading this year. I want to be on the football team. And I know that like, I'm not going to do great this year because blah, blah, blah, blah I'm overweight and I want to get there and blah, blah. And so they want to go to the gym every day and they want to do this and they can be overexcited. And that's fantastic and fine. And we can get them there, but are like, you know, seven, eight, nine, 10 year olds. Like if we're too pushy with them, they're just going to push right back. Right back. And then they're probably going to internalize that something's wrong with me. I'm bad. I'm not loved. I'm not lovable, whatever. And we certainly don't want them there. And their brains are still developing, right? So it doesn't take, I'm sure, you know, also from your own childhood, right? It doesn't take a big event In the context of the world to make a big impact on a little one. So we want to be really careful about how we phrase things and how quickly we go. So usually I start very slow and we talk about the 543210 rule. And I ask them what changes they think they can make. And maybe the only change they can make is, well, I can't really do an hour of exercise every day because I don't get home from school until blah, blah, blah. I was like, okay, well, what can you do? And I was like, oh, well, maybe you have a pair of stairs in your house. What if you run up and down the stairs like 10 times a day? Can you do that? Oh yeah, I think I can do that. Or maybe we can watch a 10 minute YouTube video where they're dancing a dance that they like, and they can do that. Right. So we start where they can, and then we meet again. And it's like, we get. And maybe what the other thing is, they can have one less sugary drink per day. And then the next time we meet, we kind of see, did you meet your goals? What, what, like that motivational interview, right? Did we meet our goals? What obstacles came in our way? How can we fix this? And we keep going forward. And then what happens when we start doing this is when then kids start to see, a little bit of shift. We know when we're just working on diet and exercise, if we're, our goal is weight loss, we're not going to lose a whole lot, maybe 5 percent of our total body weight. But for kids, they see that and they're like, Oh, this kind of, I mean, everyone, right? Oh, this kind of feels cool. It kind of feels nice to move my body. And then they're more open. And then you have a better relationship with them and they become more open to more changes. And then if needed, if we're in that range of, you know, class two, class three obesity, which is when our BMIs are really, really high. Then we can start looking towards, well, maybe we need some more help here. Maybe we need, this is great. And we can keep doing this as long as you want. And if you decide that you want to do something more, we have that option as well.

Kerry:

I really like this 543210 approach. That's a really good way to do it. I guess one big question. I think a lot of people always have with the new I guess medications and things like that is what, what is your opinion on the role of medications in pediatric obesity?

Jessica:

So I mean, I think it's relatively similar to an adult, right? So I think I personally think obesity is a chronic disease, and it is a chronic disease that leads to lots of other chronic diseases that can shorten our lifespan. And if we are a 10 year old with a chronic disease as opposed to a 50 year old with a chronic disease, how many years we're living with this and have the effects of this chronic disease is just significantly higher. So, I think there is a place for it. In pediatric medicine, we talk about percentiles of BMI. And that's just because our kids are still growing, right? So we don't, not every three year old is the same height. I guess not every like 30 year old is the same height either, but we're growing in relation to ourselves, and so we have to talk about percentiles, and so an average BMI for a kid is somewhere below the 85th percentile, somewhere between the 5th and the 85th percentile, huge range, right? We are talking about obesity or overweight, sorry we are 85 to 95%. And then we are talking about our class two obesity I'm sorry, obesity when we're at 95 percent and above. And then once we get above that 95th percentile, the charts kind of go off. So let me say 120 percent of the 95th percentile, or 140 percent above the 95th percentile. And that would be kind of like, Indicative of someone with a BMI of 35 would be that class 2 or a BMI above 40. So they're, they're pretty high numbers, right? And so maybe that's something like our 150 pound 9 year old or 150 pound 7 year old, right? Where we're like, hmm, this is, everyone is going to know that that's a not a healthy weight for this child. Then we also have to look for things like type 2 diabetes and fatty liver and all of these things that happen in adults they Happen in our kids too. So because of this I think that treating with medications is is very important, but everyone has to be on board, right? Because the medications are injections, which is not going to be easy for everyone. And the most of the medications. So there are other ones, but there's not so many that are approved for our kiddos under the age of 12. And quite honestly, the only one that's really approved is the one that for a genetic disorder. And over the age of 12, we have some options, but I mean, the fenamine and the topiramide, they're not my favorite. They're just have a lot of side effects. And I definitely prefer the GLP ones. I do like the daily GLP one, as opposed to the weekly one. So the liraglutide at least in the beginning, because that way, if there is a severe side effect, we don't have to have our, 12, 13 year old miserable for an entire week or the three or four days. It's just the one day and then we can titrate very, very, very I mean, I start super slow. I sometimes even start lower than that lowest dose and then I may titrate up. even longer than every 30 days. That does help and helps parents too, and sometimes I'll even say like, okay, let's do it for three or four days and then take a couple days off so they can see and feel the difference. Because sometimes when you're trying to make a decision for someone else, it's really hard. And so until you can see that it's benefiting them in their eating patterns and their behaviors and all of this it can be really hard to know if you're doing the right thing. So that's why I often start with the daily dosing. And sometimes I recommend let's do it for three days, and then we'll stop and see if we notice something, or let's do it for one week and then take a week off and see what you see. And kind of go from there.

Kerry:

Yeah, I think that's a really good approach for those that meet those criteria that would be having benefit from medication.

Jessica:

Yeah.

Kerry:

I think that's a good approach. Do you have anything else you want to add today?

Jessica:

Hmm. I think we talked about so many things. No, I think we, we got it really all. I mean one thing just to kind of really reiterate, we want to, and this is true for every human, but for our kids, especially, we never want to make them feel like they're wrong or bad, or they're not Good or they're not like everyone else or there's anything wrong with them, right? And if you hear your kids saying that that might be a good time to ask more questions. So sometimes our kids say subtle things and we don't totally understand like maybe it's like, oh no one at school likes me It's like, huh makes you think that right and sometimes we're just like oh my that's just my eight year old She's so dramatic, but maybe then you know, it's like, huh? What makes you say that and you might actually learn something that you had no idea what's going on. Maybe you learn about bullying. Maybe you learn About you know, everyone's getting I don't know name brand stuff and she doesn't have name brand stuff And sometimes we're not going to give in to our things, but asking the questions really can give insight. And when you are concerned, definitely talk to your doctor about it. And if your doctor walks in the room and says, your kid is obese and we need to do something about it, maybe you should fine a new doctor

Kerry:

yeah. That's very true I don't

Jessica:

like say that. I don't like to speak badly about other people, but you know that's not really helpful, right? It's not really helpful that way to our kids or our adult patients either.

Kerry:

That's definitely good advice. So where can people find you if they want to, be your patient, work with you?

Jessica:

Yeah. If you want me for pediatric, anything pediatric, obesity, medicine, pediatric, just general medicine. You can find me at blooming bright pediatrics dot com. You can find me on instagram and facebook and TikTok as dr jessica Chacko. That's my name. So at dr jessica Chacko and on facebook I have at blooming bright pediatrics. And if you're more interested in the obesity medicine as an adult or a teenager, you can definitely check me out. My business is empowering health solutions and the website is health solutions now. com.

Kerry:

Awesome. Well, we'll try to make sure to include everything in the show notes and thank you so much for your time today. I feel like we took too much of it, but thank you so much for being on the podcast and everybody stay tuned next week for another episode.

Jessica:

This was so much fun. Thanks for having me.

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Dr. Kerry Reller

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