Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast, episode number 43. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hey everyone, thank you so much for joining me today. I am looking forward to sharing this episode with you. I have a guest with me and we are talking all about pediatric obesity. Before we get into the episode though, I want to invite you to share my podcast with someone who you think will benefit, whether it's a friend, a family member, a colleague. If you know someone who's been looking to lose weight for the last time, I would love to help them out. So please go ahead and share this episode, share this podcast with someone who you think might benefit, and let's dive into today's episode. Dr. Mehra, thank you so much for joining me today. To my listeners, I have a guest with me today, Dr. Rinku Mehra. She is a pediatric endocrinologist and obesity medicine specialist, and I am so excited to share her knowledge with you talking about adolescent and childhood obesity. Dr. Mehra, thank you for joining us. Dr. Rinku Mehra: Thank you so much for having me. I really appreciate it. Dr. Sarah Stombaugh: Yeah, absolutely. So, I know I gave you just a little bit of an introduction, but tell us a little bit more about yourself and your specialty and how you found yourself practicing in endocrinology and obesity medicine. Dr. Rinku Mehra: Yeah, so I am a pediatric endocrinologist. I finished my training in 2007 and really I've been working in academic centers and in private practice for many years, really focusing on childhood endocrine disorders and half of all childhood endocrine issues are diabetes and a lot of childhood endocrine disorders are also related to weight gain and obesity. For example, PCOS. And so after about 15 years I really started to think about what we could do to prevent childhood diabetes. And especially with the COVID-19 pandemic, we saw an explosion of cases of childhood diabetes, whereas we were not seeing as many before, but we were seeing an uptick in PCOS. We were seeing an uptick in type two diabetes, high cholesterol and we were getting a lot of referrals and consultations for that. And so I decided that I wanted to focus my practice really on childhood obesity and diabetes prevention really and so that's the space that I'm currently focusing my attention on. Dr. Sarah Stombaugh: Yeah, absolutely. Thank you for sharing that. And just to clarify for my listeners, I know as an endocrinologist you treat both type one and type two diabetes, but when you talk about the uptick of cases and everything, I assume you're referring to type two diabetes or am I assuming incorrectly? Dr. Rinku Mehra: Yeah, so I'm talking about the uptick in type two diabetes. I mean, we did see an increase in type one diabetes also, and we thought maybe that was related to the virus itself. But when we talk about prevention and prevention of, you know, diabetes, when I talk about that, I'm mainly focused on type two diabetes. Dr. Sarah Stombaugh: Okay. Absolutely. Thank you for clarifying that. So tell me, when a patient comes into your clinic, are they typically coming to you with a diagnosis of diabetes or are they coming to you just for obesity? Some combination of the two. Tell me about someone, how someone ends up in front of you. Dr. Rinku Mehra: Yeah, so usually it's a combination of both. I mean, I see all endocrine conditions in children, but my primary focus in my practice now has been to, to try to get more patients with weight gain, PCOS, and type two diabetes in. And so usually when they come to see me, they either are worried about their weight, the parent is worried about their weight, or the child or adolescent is, or they've already been given a diagnosis of pre-diabetes or type two diabetes or a girl has irregular menstrual cycles and she has concerns where there's a history in the family of PCOS and she's gaining weight, and so they're concerned about some of those things as well. Dr. Sarah Stombaugh: Yeah, absolutely. And as you were saying, and as we are learning in medicine, is that so many of these different conditions are related to insulin resistance and related to obesity. And so tell me a little bit about that though. When you think about pediatric obesity, what are the conditions, you know, certainly we've talked about type two diabetes and PCOS. What are some of the other risks that are associated with childhood obesity? Dr. Rinku Mehra: So childhood obesity has significant risks that can have a long lasting impact on our children. And really, you know, I've talked about type two diabetes, but the other concerns are heart disease. And so we're seeing, you know, children who have extra weight they can have a higher risk of developing high blood pressure, high cholesterol and increased risk of heart disease later, later on in life. So that's a concern as well. Some of these children are also having sleep apnea, and that's a significant concern. Dr. Sarah Stombaugh: Sure. Dr. Rinku Mehra: As well, whereas we were not seeing that as often. So it's due to the extra weight, putting extra pressure on the respiratory system or the breathing system. And so we have concerns with that some children who come to see me have joint problems, so they have, you know, orthopedic issues as well. They can't walk, they're having, you know, knee pain or leg pain. And that's a concern and then if we look at, you know, the GI system, they have fatty liver, and so, you know, that's a problem. So liver inflammation is an issue. Another reason, you know, you, you asked me why people would come to see me. Another reason I see patients in my clinic which is related to obesity, is early puberty. So we're seeing a lot of young boys and girls but mainly girls with early breast development and growth spurts early on and early menstrual periods. And we did see an explosion of that also during the COVID-19 pandemic, mainly because of obesity and we've seen that really across the board and across the US. So that's, that's a concern as well. And then the other, the other reason I worry about it also is because increased weight is also leading to mental health concerns. So there are, you know, these children are more susceptible to low self-esteem. They're getting bullied in school, and they have a lot of anxiety and depression related to their body image because of that. And then, you know, and the girls who are going through early puberty, they also have body image issues because they don't look like their peers or in girls who have PCOS, they're worried about increased acne or increased facial hair, and that's also leading to self-esteem issues. So there's a whole host of conditions that we're worried about with extra weight in children. Dr. Sarah Stombaugh: Yeah, absolutely. And as you think about self-esteem, I think one of the most important things is that as a physician, when you're addressing patients and talking to them about their weight, that you're doing that in a respectful manner. And so I would love to hear from you, when you're talking to a child and talking to their family about weight, how are you bringing that up in a way that is sensitive to, to the child's self-esteem and to their you know, to their mental health around that? Dr. Rinku Mehra: Yeah. So, you know, I think what, you know, we as physicians and I, as a pediatrician, have long learned is that we really want to involve the child in the discussion as well but we really wanna be listening to the child and listen actively and really allow the child and their families to, to address their concerns. I want my patients to be in a judgment free zone. And often I talk to 'em about the risk factors for, you know, obesity also are genetic. I mean, there's genetic risk factors and there's environmental risk factors, and there's a lot of things that we don't understand about obesity and weight gain ourselves. So one child may have an easy time losing weight, whereas another may not, and we just don't understand all the genetics behind it. And so oftentimes it's important to recognize that and to say that we wanna focus on health overall and we wanna use age appropriate language for the children and focus on them being healthy and active and really avoid blaming the child or blaming their family with regards to the weight gain and I think, you know, what I focus on is really meeting them where they are. So we talk a lot about, you know, their lifestyle, their environment, genetics. I mean, oftentimes there's family members who have had type two diabetes putting the patient at increased risk, whether there's family members who have sleep apnea or PCOS, and that increases the risk and we can't control who our family is, we can't control who we were born to. And so I really try to be empathetic to that. I also try to shift my attention away from appearance. So we all come in different, you know, body shapes and body sizes and what we really wanna focus on is not the shape of our body, but overall how healthy our body is. And does our body allow us to run and jump like we want to, does our body allow us to lift weights as heavy as we want to? Does our body allow us to be as flexible as we want to or swim as fast? And so we sort of tried to address some of those goals for each family or each child. And then, you know, talk a little bit about what their family dynamics are, how their meal times are structured, you know, are there changes that they're willing to make? but really offering more education and support is, is really what I've found to be helpful with some of these families to see, you know, what our end goal is and how do we get there. Dr. Sarah Stombaugh: Yeah, absolutely. Give me an example of some of the educational points that are, that you'd be sharing with anyone. If you were to give us you know, top advice that you would share with families when they're trying to help support their child in their weight loss or achieving their health goals. Tell me about some of that advice that you like to give. Dr. Rinku Mehra: So, you know, it's very interesting. I'm a pediatric endocrinologist. I'm certified in obesity medicine. I have two children. And when my children were born, nobody once told me what the right portion sizes for my children were gonna be. Dr. Sarah Stombaugh: Right. Dr. Rinku Mehra: So nobody talked to me about, you know, how much food I should be giving my children, how much protein, how much carbohydrate, you know, how much fat, what activity levels they needed to do. And I took my children to pediatric visits religiously. And I'm not, you know, saying that there's any, you know, thing wrong with it, but I think there's so much information that's online. And then as pediatricians, maybe as a pediatrician, my pediatrician thought I knew all that information and I didn't. And so I say that because, you know, I really recognize that as parents, we have so many things going on with our children and we just don't, sometimes don't even know what, you know, what the appropriate portion sizes are. So I discuss that firsthand, like, what is the right portion size for a toddler or for a school-aged child, what should their plate look like? And so we really focus on some of the basics of the portions and the types of food they should be eating. You know, why do we not want to offer juice for our children? Because it adds, you know, extra calories and there's a lot of misinformation in the community, you know about some of that as well. And then we talk about, you know, physical activity goals. And I don't want kids running a marathon. I mean I really think that we need to have some, you know, set goals for physical activity, but even playing outside is important and limiting screen times because those also are contributing to weight gain. And so we really start with some of the basic guidelines. And I, you know, we had to reemphasize that and I talked to 'em about the, you know, healthy plate option, what should a plate look like? Questions I often get asked are, you know, my kids not, you know, not eating anything or not eating much, and they're still getting, gaining weight. And then we look at the portions of the food and they are adult sized portions. And so I think it's, you know, important to understand what the right portion size is for, for kids and you know, what are good sources of protein for kids and what are good sources of carbohydrates and in children, I think it's difficult because there are picky eaters. There are kids who don't eat well and you know, sometimes parents are struggling. And so I think, you know, we sort of talk about some of that as to how to overcome some of those things as well. Dr. Sarah Stombaugh: Yeah. I think, you know, it's interesting how many parallels of course there are between the adult world and pediatric world in some of these same things. And we don't necessarily, right, have this advice about what is an appropriate portion, these different amount of foods. I feel like in the, you know, teeny tiny baby era, there's a lot of conversation around breastfeeding and formula and sometimes amounts are given there. But yeah, even beyond that, what does it mean for a child to be eating healthy? And even just some of the language that we use as parents, I have young children as well, and so we're so conscientious about how we are approaching new foods and how we're making it fun and having dinner time together. And, you know, we're always praising our kids for using their taste buds to try new food. That's our big thing when we're trying to do new things is I'm so proud of you for using your taste buds to try that new food, whether they loved it, whether they hated it. Because it's interesting, a lot of what I see, I'm a family medicine physician by training, and I'm tending at this point in my practice, I'm seeing primarily adults in my practice and the behaviors that we develop in children that our families have cultural beliefs around, or our family dynamic around what are appropriate foods, how do we talk about foods and how some of those behaviors adapted in childhood then just continue with us forever. Dr. Rinku Mehra: Right. Dr. Sarah Stombaugh: Until we've given, either given ourselves or for whatever reason, we question, oh, was that really the right way? I'm surprised how often, you know, people are members of the Clean Plate Club. And so their parents had said to them as kids, oh, you have to eat everything on your plate or eat everything before you can have dessert. Are you having conversations with families around some of those belief systems and psychological thought processes as well? Dr. Rinku Mehra: Yes, I am. And I mean, you know, the, the issue is that you're so right. I mean, that is cultural. And I really talk to parents and their kids about learning to recognize their own cues, right? So if you're full, you're full, like we can save some of that food for later, you can have it later. You can have it, you know, maybe later this afternoon for a snack or, or tomorrow. And so we really try to focus on some of that is to learning their own internal cues and listening to themselves. And we have a hard time with that in my family too. I mean, my kids are full sometimes and we say, okay, we're done with eating that. But it's like one bite left and what do you do with that last bite? Right? Dr. Sarah Stombaugh: Right. Dr. Rinku Mehra: Food, do you save it? Do you toss it? And there's all these, you know, other beliefs around there, but we really sometimes say, I've gotten used to telling my kids now, like, if you're full, that's okay. We just stop. And because I want them to really understand their own body's cues as far as their hunger and their signals of satiety or fullness as well. Dr. Sarah Stombaugh: Yeah, absolutely. Because I feel like the human brain plays a trick on us as soon as we see a portion sitting in front of us, whether it's really the appropriate portion for us or too large of a portion for us. We eat the whole thing, not really paying attention. And then all of a sudden afterwards, maybe when we're too full, we're uncomfortably full, it's like, Ooh, I probably shouldn't have eaten that much. And so how do we bring that mindfulness earlier on? And I think when we train ourselves, you know, children, you know, there can be some variation of that for a lot of reasons, but children can be born with that natural ability. But then as parents, sometimes we are encouraging just one more bite or try this or try that, and it can make it a little bit hard. We lose that a little bit over time. So I love that you're working on tuning back into some of those natural signals. Dr. Rinku Mehra: Right. And we also focus on the plate size. I mean, you mentioned that, but the plate size can be smaller. So yes, there's actually been studies that have shown that if you present an adult or a child with either a large plate of food or the same amount of food on a smaller plate they actually think that when you put that amount of food in a larger plate, that it's less food and so they'll get seconds. Dr. Sarah Stombaugh: Yes. Dr. Rinku Mehra: Yeah. And so, you know, there's part of, you know, training the brain and the eyes to say, well, this is what the right portion of food should look like. And so if you put that food in a smaller plate, you feel like that's a lot of food, and I'm gonna be full with this. Dr. Sarah Stombaugh: Yeah, absolutely. Yeah. I love, I love that and it definitely, it definitely works when you are sort of retraining your mind around some of those things. Tell me about when the family says to you, my kids are really picky eater and I'm really having trouble getting them to eat certain foods. What are some of the advice points you give to them in that situation? Dr. Rinku Mehra: Yeah, I mean, that's a really tough one. And you know, I've lived through that myself in my house and a lot of it is just having them retry some of the food, like you said, and being proud of them for some of the food choices that they're making and if they say they don't like it, you know, say we don't like it yet, we may like it, you know, yeah. Tomorrow, or we may like it later today, it would may like it next week, but really trying to offer the food as often as possible and as frequently as possible the other part of that is eating the meal together and showing, you know, setting an example for the children yourself. So you know, you're trying certain foods and enjoying those foods that you're eating and making, you know, making a conscious effort to let your children know that you like those types of food or, you know, it usually happens with vegetables. I often see that people don't, you know, kids don't really like to eat certain vegetables. And so reintroducing that food, being an example for the child, being proud of them for trying the different types of food, even if it's one piece or allowing them, you know, the toddlers to play with the food and smell it and touch it and lick it. And having all, you know, all the sensory experiences with the food to allow them to, to get comfortable with the food because it's so scary to try something that you don't know what it's gonna do to your body, how it's gonna make your mouth feel, all that. So I think it's important to keep reintroducing that and sometimes playing games with the toddlers to, to help them to do that and they can get a little bit messy, but I think that that sometimes works for 'em. Dr. Sarah Stombaugh: Yeah. No, I think you're, I mean, absolutely just right as anything in toddlerhood is there's a lot of independence there and so wanting to feel like they have control over the situation. And so if it's just them playing with it, that might be a huge win. And you know, I think sometimes we look at wins is did the food go in the mouth, get chewed and swallowed? But when you look at introducing foods in childhood, a lot of times the win is just did they tolerate the plate sitting or the food sitting on their plate? Did they tolerate it sitting, touching another food on their plate? You know, did they tolerate touching it themselves? You know, reaching out and putting a finger on it? And, and so each of those things is made me a movement towards eventually putting it in their mouth and giving it a try. And I love what you were saying about vegetables, because I think so often we as adults may not be eating as many vegetables as we should. And you know, I've, at least in my days of primary care when I was working with families that sometimes there would be one child in the family who struggled with their weight and the rest of the family, despite having very similar eating habits, may not have struggled in as significant or struggled at all. And so sometimes they were trying to get the one child to eat differently, follow a special plan, whether that was food or exercise or both. And so really embracing as a whole family, yes, these are things we should all doing in order to benefit our health, and how can we do this together rather than someone being singled out or being shamed in any way for, for their weight. Dr. Rinku Mehra: Right. I think that's very important. And that's, and that's very common actually. That concern is very common. So there's many households where you have one child who's a super picky eater where the parents are saying, let's just get whatever in him that we can and that could be, you know, processed food, junk food, you know, not really a focus on fruits and veggies and then another child who struggles with their weight and the focus is all on, well, you should be eating healthy and you can't have that and you shouldn't be eating this. Dr. Sarah Stombaugh: Right. Dr. Rinku Mehra: And it tends to not work at all. And so I think the big focus should be on having, you know, everybody eat the same types of food, not keeping that other food in the house even. Dr. Sarah Stombaugh: Right. Dr. Rinku Mehra: Because it's tempting and it's a temptation for the child who can't have it. And so I think it's really, you know, we've worked together with the whole family dynamic to see what is it that's going on in the home. Dr. Sarah Stombaugh: Absolutely. Well, and the foods that you're talking about, the reality is they're not good for any of us. Whether someone has a healthy weight or has, is at an overweight value? It doesn't really matter. You know, we shouldn't really be drinking or eating some of these highly processed foods, so they're not really serving any of our bodies. Dr. Rinku Mehra: Right. And I think that's important to recognize that this is something for the whole family to be healthy, the whole family to lead a active lifestyle. Really, I talk also to my patients about having the whole family, you know, exercise together or pick an activity together, even if it's just going for a walk together in the evening. I think that's helpful. Or you know, playing soccer together or doing some kind of activity, going on a hike. Because I think it's important for the whole family to recognize that they all, everybody has to do the same thing and, and this lifestyle changes are a family process that, that everyone needs to be involved in. Dr. Sarah Stombaugh: Yeah. And the reality is, even if there is just one child who is dealing with weight issues at that time, we're probably doing a lot of preventative medicine for the rest of the family when we're implementing these sort of things. So I always feel pretty good about that. Dr. Rinku Mehra: Right, exactly. I agree. Dr. Sarah Stombaugh: Yeah. Lemme ask you in the last couple of minutes here, is there anything we haven't talked about that you really wanna make sure to share with my listeners? Things that are really important about childhood obesity and treatment of it? Dr. Rinku Mehra: Yeah, so I mean, I really got interested in preventing childhood obesity because of all the statistics that I've read that really say, you know, in the next 10 to 15 years we're going to have, you know, billions of cases of childhood diabetes. And so I wanna focus on prevention. So I think the statistic was 1.3 billion by 2050 cases of childhood diabetes. And so when you look at that most of those people who are gonna get diabetes by 2050 are children, you know, now. Dr. Sarah Stombaugh: Right. Dr. Rinku Mehra: And so I, you know, I wanna focus on that. A lot of the questions that I get and, and really it's, you know, across the, the country across the world really on questions with regards to childhood obesity come from some information that I feel that is just lacking as far as, you know, there's just a lot lack of information that's evidence-based. With regards to what's contributing to obesity and diabetes and PCOS. And so I worked on for the last six months, I've been working on a course that I am gonna release next week on pediatric obesity. And I do discuss a lot of the common questions I get, but I also talk about hormonal conditions that contribute to obesity. And so, you know, there isn't really enough time in the podcast to discuss it, but there's so many factors that are involved. And I just want people to know that it's not their fault. It's not, you know, the family's fault. It's really that we need to start focusing and making some small changes over time. But diabetes can be prevented some of these other conditions like sleep apnea and joint problems. They can also be prevented if we take, you know, an approach early on and the earlier the better. And so I want people to understand that, that that's really what our focus should be, is not really being on, you know, we don't want everyone to be, you know, a, a certain weight, but we want everyone, we want our children to be healthy and prevent long-term complications associated with weight gain. Dr. Sarah Stombaugh: Yeah, absolutely. And tell me if one of my listeners, or many of my listeners, if they wanted to learn more about you, if they were interested in this course that you were talking about, how could they learn more about you? Where can they find you? Dr. Rinku Mehra: Yeah, so I am on social media. I try to post a lot of evidence-based information there. So I'm on Instagram at Dr. R Mehra and then I see patients in four states. Right now I see patients in Virginia, Maryland, Iowa, and Florida. And my clinic is, they can find me at www dot Mehra Clinic, so it's M-E-H-R-A is my last name, clinic. And on there there's also information about the course, which is called the Mehra method. So it's M-E-T-H-O-D, so the Mehra method which is yeah, dot com, which is my weight management course. And it's about 45 modules right now. And growing. And I have recipes, you know, in the modules and I have a lot of the discussion that we had today about, you know, portions and what does that mean. I also do group coaching with my course as well for families and parents. Because I think there's just so much information that is needed, really needed for everyone. Dr. Sarah Stombaugh: Absolutely. Yeah. That's great. I will put all of those links in the show notes so my listeners can check those out there. Thank you so much for joining me today. This was really fun to talk about. Dr. Rinku Mehra: Yes. Thank you for having me. I appreciate it.