Approaching Weight Management with Teens with Dr. Karla Lester

Welcome back to another episode of the podcast. Today, I have a really great interview that I wanna share with you. I guarantee that you are going to learn so much from listening to this interview today. I have on pediatrician and coach Dr. Carla Lester, we are going to talk a lot about how you can support people in your life. We're talking about the perspective of helping children, but honestly, I think this really could apply to anyone in your life.

We talk a lot about how you can best support them. But not cause more harm. As you do that, if there are things that are involving health or weight concerns, we're really gonna dig into this more. A lot of how to kind of deconstruct some of this diet culture that you might have been brought up with. You might not even know that these things are running under the surface. I think it's really great how. we dig into it.

And a lot of these are topics that I, myself, am always trying to educate myself more on. And I think that it's really only helpful the more we talk about it. And I think a, a very interesting thing that we talk about, it's this polarization between the body positivity movement and then verse quote unquote people that just wanna lose weight and how there can really. In the middle, this loving approach of also taking action on your health.

And so we kind of talk about where that middle is and then she just gives some really good thoughts and ways to approach the relationship that parents can have with children. How. You don't cause and you don't control things, how that can kind of be a principle that you can use and the body's not something to fix and you are not broken. And you can notice when you have different triggers and when you get activated, but that ultimately you can act from a different place then.

So if these are things that. are intriguing to you. If you maybe have this tension starting to develop in your life where you love your child, you really wanna help them, but you don't know best how to approach it, what to do, I think you are really gonna love this. And then of course, we touch on medications what are her thoughts on that for. The pediatric population, we touch on that as well.

If you are loving this, some of you have been leaving the absolutely most amazing reviews where you're listening, and I really wanna encourage you, if you've not already done that, please do that. It really helps us to get this message out so that more people can find this great information. Am so excited today that we have Dr. Carla. We are going to have an amazing conversation today.

Dr. Carla, I have followed you for a long time on social and I feel like, you know when you follow people for a long time and you feel like you know them, Yes. So I felt like you had so many great things that I felt a lot of my audience really needed to hear and learn from. So can you start with just telling people, who you are and how you help people? Just a little bit of your back. Oh, well thanks for having me. I'm Carla Lester. I'm a pediatrician and I've been one for a long time.

I call myself a community pediatrician and I'm a obesity medicine board certified, and I'm also certified life coach. I'm also a founding member of the society, metabolic health practitioner. So I've been working to address the childhood obesity epidemic. For, 20 years of my pediatric career, I've kind of done everything you can do as a pediatrician to address it in the community and also on state and national levels, and I'm really proud of that work.

I've also gone through my own, weight loss journey. And I, left my high level job in 2019 to get back to my original, mission and vision when I started my nonprofit teach a Kid to Fish in 2007, which was creating community solutions for children's health. Cuz I was at a children's hospital. I'm like, we're not getting anywhere and we weren't having enough impact. So, I decided to leave.

I became a life coach, took my obesity medicine boards and launched I M E community, which is where you can find me and I coach. And then I'm also launching a metabolic telehealth practice that's licensed in 10 states. And I'm on TikTok I am so happy that everybody is gonna get this level of help from you because something that I know you bring up a lot is that there is a lot of complexity with weight management in the pediatric arena.

And I feel that you handle it with such grace and there's so much nuance here and I hope that that's something that we can delve into. And I know we're gonna talk about that a little bit later. Some of your thoughts about the newer me, medications that are approved for adolescents, things like that. What, I'm wondering if we can start though, cause I think this is very relevant to people that listen to me.

I think that a lot of parents really struggle with what's going on with their kids as far as weight management, and something that I think is very present is that a lot of us were brought up in diet culture, and so it's hard for us to have a different relationship with our kids. I'm wondering kind of what your take on when there's this movement on one side that says body positive. Just love yourself where you're at, you're perfect.

And then on the other side, we sit there as physicians and we know that some metabolic consequences might be coming if certain things are not addressed. How do you help parents sort of were they're struggling where they're future forecasting what might happen to their kids, but at the same time, we don't want to cause damage to our kids. How do you help parents with. Well, that's my whole platform and my philosophy is let's meet in the middle.

When I started IME community, I had, it was at the same time a Aubrey Gordon had written a really amazing opinion article based on her experience as a patient published in the New York Times, talking about. The war, the fight against childhood obesity has been a war on children. And she had a powerful experience of going to the doctor and talking about, them, talking about the B M I and then that's, you know, put her on a path of restriction and when the parents. get that information.

Obviously, there's a lot of guilt and shame and so they go home and what do they do? They try to fix and solve and control, and they get rigid and they're stuck in diet culture. And so we're not having helpful conversations to really support the parents to be able to make healthy habit changes. And then we're just focusing on B M I and weight loss and.

I was like so moved by her article, but in the American Academy of Pediatric section on obesity listserv, which amazing colleagues there, who I've known forever, amazing child advocates were saying, we need to write a rebuttal against this. You know, there are health issues and it's like, That's not what she's saying. You know, this is her story. So I wrote an article for Kevin MD and it was, let's meet in the middle so you can, I was like, why are these mutually exclusive?

You can be body positive and feel good about yourself. Self-love superpower, and in fact, that's what it takes. And going through my own coaching and learning all the work of Dr. Kristen Nav about self-compassion, we think that we have to, you know, Negative and perfectionistic and grind out goals and happiness is, is at the finish line. And that's what diet culture teaches us and parents are really stuck in it. So I found that through.

Coaching and doing workshops with parents that they're really stuck in it. I've had to do a lot of work with parents. It's been beautiful work and it's very nuanced, but it's really awesome when I can kind of thread that needle and we can start to meet in the middle and really focus on reversing insulin resistance, taking positive action, even small steps toward health and redefining health is the first step.

So it's been a lot of work on my part to deconstruct that for myself and to come up with my philosophy. And, one of the things is I, I tell parents, you know, you're not stuck. And they, they feel a lot of responsibility for their child's weight and.

is a big problem because they'll say, oh, they had a growth issue when they were younger and maybe they had reflux and they were vomiting all the time and they actually had poor growth. And I'm like,

Okay. You know, could that have been a contributing factor? Oh, maybe they even have genetic obesity syndrome that hasn't been diagnosed. They were on steroids for asthma exacerbations, and these parents are just living with this diet culture that it's all their fault. And, it just keeps 'em stuck, not able to help. And then they think they have, Change up everything in the, you know, with what their kid's eating. And then, you know, all these, all of our kids are on screens.

All, I mean, I have three kids and my son's 16. He is on screens all the time. And, It's a tough balance. And so it's like, it feels very overwhelming and defeating as a parent to stay stuck in that. It's so interesting when you're bringing this up because it's, there's multiple ways that we get into the place that we're at. and it's so comforting for me to hear you talk about it in this way. What contributed, what did it look like? What, what does life look like?

How can we make steps forward where it's not, your kid needs to get down to this certain size. It's like, what are actual goals? What's contributing? It is so complex is the name I always come down to, right? Yeah. Which is, people want this really easy answer and ultimately when I hear you talk, it's. It's gonna take a minute for us to really sit down and talk and figure out what's going on. It's likely not gonna be quote unquote solved.

Maybe it's not actually something that needs to be solved in the way in which you think it does. Because I think they all think there's a certain formula. Let's say there is a parent that they're struggling with this. They realize, okay, I think I've been told by the doctor that my kid needs to lose weight. That's usually what it looks like, right? They, they get this number, they tell them. What can they practically go home and start to do to work on this in a different way?

Well, I wrote a healthy conversation script that you can, parents can use, they can get on my website. It's called Cut the Cringe. So we have to be able to have these conversations cuz what they're worried about is causing an eating disorder. Right. And most of the kids are struggling with. And mental health issues, you know, and bullying, maybe school phobia. And so the parents are like in the mix of just trying to get their kid to go to school every day.

And so, they don't wanna focus on the weight. They really don't know how. To approach it and they don't know. They're concerned about their kids' health and they do recognize that this could be, you know, their opportunity to help their child, especially if they're a teen before they're off out into the world on their own, making their own food decisions. And so they feel a lot of. Scarcity of opportunity and it's kind of like they're in panic mode is what I find a lot.

And so I wrote a script of how to actually talk to your child and it was like a, he unhealthy, you know, way to approach it even if the, which is more compliance based where the mom is like kind of fix and solve. And she started out right, they went to the doctor and she started out right with her daughter. And then she kind of like got lost, which we do all the time. Cuz she was in the fix and solve. All parents, we wanna be, we're completionist.

I'm the biggest completionist like I wanna be done. Like, I'm sorry, we've already addressed that. I'm done. I've reached the summit. You know? So it's like, okay, I want the solution, I want the how. And then I think sometimes parents when they come to me, they think I'm gatekeeping. You know, that, like, just tell me exactly what to do.

But I will tell you, I've done this work for, you know, 20 years and in any program working with doctors, any parents, any patients, and anyone on TikTok, whenever they say, just tell us what to do, they ghost you. They're. It doesn't work. Working on the relational health first, which is a part of health, that will allow the parent. To actually become the coach, because I can't coach everyone I can't scale this up. And that's the important thing.

So I want them to not get to fix and solve and say, okay, we're gonna sign you up here, or, okay, we're gonna go on this GLP1 medication, or, okay, we're just gonna change everything up that we're eating because that'll last a day and won't work. Or they blame the kid. It's like, oh, here, I'm doing all these things. you know, and we're coaches, so we know they're blaming, that's emotional child and they're blaming the kid. So we work on relational health and we work on listening and showing up.

I was coaching a mom the other day and, the family's gonna be working with me. I'm really excited about it. And the, the child, she, this comes up all the time. I could script this out. They hate their body. So all day long they have almost like a trauma response to this body judging. Whether they're checking themselves in the mirror, they're getting ready. They don't wanna make clothes that fit. They hate their clothes, they don't wanna go to something. They have so much anxiety.

And when I'm coaching the teen, she's like, it feels like fight. Like I wanna fight So she and her mom are in this pattern and her mom's like, I can't believe that we're in this place. We've always had a great relationship. She's an awesome mom. You know, so she wants to fix and solve it and. and what I'm telling her and what she's on board with is really exciting. Both of 'em are on board with, let's let put, take our foot off the gas of the self-judgment.

and then, and can you recognize when you're activated and we're setting boundaries and we're actually scripting out and doing meta rehearsal, pre-visualization on those actual interactions. And mom's taking responsibility for the comments that she says about. Either weight or cuz a mom doesn't have any weight issues. So this is, this is the problem. This sets up the disparity. And that's a common thing too. Parents reach out to me, I can't relate. I can't relate. I'm like, yes you can.

You're a human. You can relate to the perfectionism. You can relate to self-judgment. That's what this is. This is not about body or weight. That's beautiful. Like anyone can relate because I think that exists too, right? Where it's always, oh, I'm not in their exact position, and you never need to be in the exact position. And that's their, that's the parent's fat phobia. that's the parent's anti-fat bias. I can't relate to that. I'm like, yeah, you can.

And it's your kid, so you're gonna work too. Um, can you say more about that? So is it cuz that that's a very, simple example that you gave up, but do you see fat phobia and bias show up in other ways? Because I, I think it's really rampant, but can you kind of define it and give us some examples? Yeah, I mean, well the almond mom, I just went viral basically and got all these interviews on almonds, because it's so prevalent.

So. Can you, sorry, can you start off telling people what an almond mom is? Cuz again, a lot of people listening, they might not know at all what you're talking about. Yeah. An almond mom is a, I mean, the term became popularized with Yolanda Hadid and then on TikTok. But yo almond moms are moms who are stuck in diet culture. They have this, fat phobia they're pursuing. Thin privilege and framing it up as pursuing health. They promote restrictive eating practices to their children.

And, they oftentimes believe that their child's weight is a reflection on them and their parenting. And so Yolanda Hadid, who's a supermodel, her daughter Gigi and Bella, our brother's Supermodels, she was on The Real Housewives and somebody on TikTok s. Compiled a clip, a bunch of clips of Yolanda's videos where she was promoting her, almond mom practices to Gigi.

And so then there was a time when Gigi was weak and she called her mom and she was at a runway show in Milan or something like that, and she was like, I feel so weak. I feel like I'm gonna pass out. And her mom said, just eat two almonds and chew them slowly. And she was like, Gigi was like, I've only eaten like half an almond today. And so her mom's like, just chew up, chew two almonds really slowly. And then, when viral and TikTok, cuz so many people have had almond moms.

So the common things are, you know, nothing tastes as good as skinny feels. And. You know, a moment on the lips forever on the hips, and it's like funny but they actually believe that their children will be better. I mean, it's that kind of diet Ry thing. So it is that thin privilege. And now we're seeing Gwyneth Paltrow promoting is really excessive, really wonky things that she profits from. So that's kind of the interplay of toxic.

Toxic capitalism and almond moms then p. Okay, so that's good. So we kind of set the stage for people. Maybe you're listening and I just wanna say that this is something, actually, me and Dr. Carla talked about this before we got on. I said, Dr. Carla, you're gonna have to educate me on a lot of things because I feel like I'm always learning. I don't know that. Yeah. I'm the most educated and biased and stigma and how a lot of these things pop up.

And you said such a nice comment, you said, I just educated myself along the road. And I feel like all of us, even if you're listening, if you maybe have said some of these comments to your kids, maybe you've done some of these things. We're all human. We don't know. We don't know what we don't know. And the, the script that we're playing in. So coming back to that, so people understand now more kind of what that definition is. Mm-hmm.

so. More parents are, I wouldn't say they're, you know, almond moms. There's almond dads, there's almond doctors, obviously almond celebrities. More people are stuck in it. And it's a spectrum than we think. And it's, you know, it's generational and I'm excited that people wanna. Want to, you know, cut this and, and, deconstruct it and do the work.

But they have a really hard time giving it up because they want their child to have the social capital of thinness and they want their child to have that proximity. to that thin privilege. And so maybe they had it. And maybe they have an unhealed eating disorder. I think a lot of almond moms, a lot of parents actually have untreated unhealed, disordered eating.

And I see that in some of the parents I'm coaching and, I'm trying to work with them to, I can't, you know, treat that obviously, but so that they don't. What happens is when our actions come from our feelings that come from our thoughts and the beliefs that they have, that they have internalized when they don't do that work to create powerful awareness around some of the, those toxic diet culture beliefs that they're staying attached to, like paint on a wall.

When they don't do that work, what happens is the actions that come from it are that they shame their kid about food and they're in their kid's eating lane, which causes a lot of problems. The teens I coach are really open about that. The teens really question everything that they eat and, that causes obviously binging later. And then, the parents may have good intentions, but they'll say something about, are you gonna wear that? Are you sure you wanna wear that?

Cuz they're worried, even though their kid may be body confident going out with their friends, they're worried that, their midriff is showing. And they'll say she's, she's the biggest one of her friends. I hear that a lot and so I'm like, that's toxic diet culture. That's that kind of proximity to thinness. So the first thing I always do is say, body diversity is a fact. We're gonna celebrate it. You don't cause and you don't control. Some parents don't like that. They want to cause and.

But I say it's reality. You do not cause and you do not control. Especially now when they're an adolescent, their body is not something to fix it or solve. They are not you. And sometimes I have to say, they are unbroken. She is unbroken, like to shake 'em out of it, and then we move forward.

Stay out of their notice when you're activated as a parent, when you're, you fixed a meal and they're going to the cabinet after they just date or they are, going to, sorry, my dog has heart failure in the car So if they're, if they're going to the cabinet after you just ate, you may be triggered. You find junk food rapper. Maybe you shame them, you know? And I literally, it's this kind of, I call it like a micro coaching that we do these. Okay. You said so many mic drops here.

So number one, here's the main thing I'm getting outta here. I'm getting that the parents themselves need to start with awareness. Forget about your child for a second. You need to do some work

that's gonna be needed on ground zero, which is you. Yes. And when you said you're, you don't cause and you don't control. Boom. I mean, I'm, I'm hearing that I'm realizing, yeah, every single thing that happens to your child is not necessarily because you caused it. Right. I mean, n in no way. And why don't do this with their body size, I mean Exactly. And you said here, the body is not something to fix. What a powerful place that you could realize.

I mean, I got, I got a lot of these comments growing up too from my parents, and again, Super well-meaning both physicians, the most loving family ever. I can't even tell you how loving. Right? Yeah. If there are these comments I can think and they did not know that that comment would have that impact or that I would remember it all this time, we literally don't know what we don't know.

So how empowering the fact that someone's even listening to this episode right now and that you might start to be able to engage in some of this. And then you also said you are not broken. Broken and noticing when you're activated. I feel like people could just take those. We're gonna need to get these out in like a reel on social that parents can see this and just start to think about it. Yeah. And they, thank you for sharing that. And uh, you know, I'm sorry for your trauma.

I mean, obviously your parents had good intentions. But I think, even with good intentions, we can cause harm.

And so one of the things that I've had to do as a doctor who's been working in this, arena for the last couple decades and gone through it myself, is that, I had to deconstruct all this myself and so I worked with the body positive and was a part of the training and became a facilitator so that I can, help people with the components of body positivity and at the same time use my metabolic health approach and self-love superpower and it's really working.

It's awesome, but I was stunned at, you know, when I learned all this and I. I have to acknowledge some of the harm that I have caused, and I had to do that too, with a coach I worked with, with my own kids and our interactions. And once you, as a parent can let go of some of your ego about being right, and when I was coaching the mom the other day, She, had said that her daughter came down, they had had breakfast, and mom was working, and then her daughter came down a couple hours later.

She said, I'm making lunch. Do you want to eat with me? And the mom was triggered, you know, and she, she said, I just, we just stayed two hours ago and so I'm not hungry, but I'll eat in an hour. And then the daughter went off on. and she said, see it's comments like that that make, and this is such a common scenario, I'm fine with sharing it cuz this happens every day. And almost every person I work with could share this story. But, that was a, you know, just like a trigger for the daughter.

And the mom was like, our relationship is ruined. I don't know what to do and she hates her body and she's not gonna do all these things. And so I said, Hey, apologize to her. and I scripted it out for her. I said, can you apologize and use the word apologize and say, I apologize for what I said earlier. I understand you're upset and the the comments I made, you know, contributed to that, or something like that. I can't remember exactly what I said and then let it go. Don't defend.

and be okay if she's in a negative head space and doesn't wanna go to something cuz she doesn't like her clothes or her body today. Be okay with it. Yeah. You know, the thing I wanna stress too is that I don't think there's like a getting this right and perfect. Yeah. And so I think it's the tools that you're talking about where it's like, I'm sure that there are things I've heard in the past that in no way maybe meant anything to anyone else, but it's how my brain took it in.

And so that's why it's like we need these tools of being willing to apologize, willing to listen, willing to be open, to do it differently because everybody's gonna be different. There's, there are no two people where the dynamic is gonna be the same. Yeah, exactly. And there's no summit. I mean, we're never, I mean, you know, sometimes I'll be like, I've done all this work, you know, with my kids and, and, and then we were in Europe and I got ticked off. They were being rude.

And I have boundaries now. I've, you know, set those and I got up and left, you know, this beautiful restaurant in Provence, you know, and I'm like, I'm outta here. And I went and walked around town and I ate the food Later. I was like, I'm not gonna be around. And my kids are like in college, and then my son is 16, you know? So it's like I was out of there. And so as parents too, for that mom too, I said, we have to have boun. You have to have boundaries.

So maybe there's times when you're activated or you don't want to get into the fight with her. that you say, I understand you're upset, but I'm gonna leave the room. Let me know if you wanna talk about it later. Right? And have a physical boundary and emotional boundary for yourself too as a parent. Cuz you're not gonna, fix and solve it. Be okay with like, kind of drop being the one to drop the reins walk out of the room because it, it is really hard for you too.

And, and if people are listening, I mean boundaries. I just wanna say for a second, they're really if then statements. So it's, if this happens, then I will do whatever. They're not threats. They're not things where other people have to change what they're doing. It's what you decide is loving for yourself. And so I think those are conversations that. Are so powerful for you to look through your own manual of what those things are and how you could execute on your own boundaries.

You don't need to be changing everyone else around you. Relationships I just find are so complicated. I dunno if you find that as well, but so much nuance. Nuance in the details. But I like how you brought up, there's no summit. It's not like when we reach there, it's amazing when their weight's there, when they agree with me, when everyone's compliant in the situation, likely not gonna happen. That that, that they're there, that perfect place. It's not coming. Can we release that thought?

And then life usually gets a lot easier. Yeah, exactly. Cuz then you get into fixing control and then they get obsessed with their kid's body size and that's just no fun. And so I, you know, of course with, you know, judgment and shaming, I'll tell the parents, you know, recognize when you're judging that you are, that's, you know, do that u-turn because you're judging yourself. And so that's a you thing. and, that has nothing to do with their body.

And, and also just to acknowledge that if you continue with those patterns, you're gonna cause harm. So once we're able to kind of just lighten up on that, which, which happens pretty quickly, and most parents are super willing, to, to do that, it's a relief to them. And. Also know like, oh my gosh, I get to work with this expert who's a pediatrician and a doctor, been it herself, a mom who can then help us, like take some positive actions toward health.

And that's when I start to usually work with the teens. If it's coaching to, we just, we talk about health. we talk about how to, like, they know more about nutrition than most doctors do. And we talk about insulin resistance and we, I've been disappointed that a lot of the doctors don't, even though it's not a medical visit. A lot of the doctors, you know, the parents will share with me that.

They have said nothing at all, even though they've gone in for their annual, like, well, child or physical, they will have not talked at all or had a discussion about. These health issues or screened for eating disorders or, even ask permission to talk about weight or B m I and, or done any lab work at all. Yeah. And so they'll say, oh, what would you do? And so then we work together to get them the lab workup that they.

Yeah. I think actually the research is quite interesting that a lot of healthcare providers have a fear of actually addressing it. They don't know the correct language to use. What language is less stigmatizing? I think this is, frankly, if you're someone that's in the medical field, I think getting the Obesity Medicine board certification, why it's helpful. one of the big things you learn is just how to talk to people.

And you'd think that as doctors we would have that down, but this is an area where it's, it's almost like a hot potato in the sense that you've gotta know how to handle it properly. Otherwise, people are very triggered. And so I think people don't know how to engage and then they end up suffering even more, right? Because they're, they're less engaged compared to maybe someone in a smaller body.

They're, they're getting all the health things all the time, and they're not ever having that addressed. So I think it's a tricky area. And one thing you brought up that I really like, is that something that, that I say this all the time, it's yes and yes. You can have body positivity and all these things, but I can't ignore all the metabolic realities as well.

Yeah. And so I think they really come together and this kind of segues nice and wondering what your thoughts are on some of these new guidelines for medications as far as, what ages it can be prescribed and people kind of thinking, well, it's just gonna be a medication and that's it. Kind of what are your. Thoughts in that arena with the Newark guidelines that have come out for. Well, thanks for asking about that. That's an important and timely topic.

So yeah, the American Academy of Pediatrics came out with the clinical practice guidelines for the evaluation and treatment of children and adolescents with obesity. And so with Covid and. I mean, we've seen the rates of severe obesity increasing in, um, children and adolescents. And with Covid it's gone up even more So over time, you know, we haven't been able to turn the needle when you're looking at large population data. So what they suggested was there was some.

Some trials coming out of the GLP one, agonists medic, anti-obesity medications in teens, and so they looked very promising. The medical side of things are pediatric weight management, programs I created. One was medical director for one. Here in Nebraska, we have not had a lot of tools and so a lot of the, they're within children's hospitals. Usually there is a lot of push for their contribution margin, no profits, profit margin, but push toward bariatric surgery for adolescents.

And so we, you know, the US. P S T F recommends the evidence base shows you need 26 to 52 hours at least of contact hours. Comprehensive behavioral support within two to 12 months to significantly decrease B m I and comorbidities. So how are you gonna get that going to a clinic once every, you know, two to three months is how often we would see them. And we tried to provide those supports with the fitness program, but it was really hard, to get those hours in.

So we haven't been able to really implement lifestyle, Modi modifications and support. We haven't worked with the parents. We focus so much on B M I and just wait. So now, Medications come out and they hadn't updated the clinical practice guidelines for a while, and so then they were very much, do not Pasco, be very aggressive. Let's you know, still focus on B M I, which I was really disappointed with. These are great pediatricians who created them. but, I think it's a missed opportunity.

And then move to like children 12 plus, even at the first visit upon diagnosis with any class of obesity. Offer the GLP one medications and then children six to 11, if they're class two and three obesity and if they have a comorbidity offer these medications. I was seeing, the almond mom trends and then I'm on TikTok. They are not.

And I, see the, the nuances of the medications and seeing in the parents that I coach and I had a really viral video, talking about what I'm really concerned about are. Practice guidelines of the G O P one medications and almond moms. And I just, and then now we're seeing all this stuff on social media with this kind of pushing extreme thinness, the celebrities in Ozempic. And it just, I think it's a perfect storm of concern.

So, I mean, there's some, obviously some really good things, in the guidelines, but, I wrote an article about using the weight loss medications and that there are considerations to take. I mean, we need to be. More cognizant and screening for eating disorders. We need to address insulin resistance. There was not much in there except under certain comorbidities like fatty liver disease or type two diabetes or P C O S about insulin resistance.

And if you follow me, you know, I'm all about metabolic health and that, we shouldn't be. And also they advocated again for lower calorie and calorie restriction, which. Always harmful is just diets. And so I was worried about the harm that it would cause and a lot of pediatricians spoke up against that. So I think, you know, guidelines, you can just. Pick and choose kind of what's helpful and what isn't.

But I don't think in the end when we talked about this earlier, the feasibility of a primary care pediatrician being able to, these medications are not being covered easily. And the idea that we're going to be able to, you know, unmask be able to prescribe these medications and, you know, the cost, there's not gonna be, it's, I think it creates more health disparities too. I'm worried about that. So I have a lot of concerns. Yeah. You brought up a lot of really good ones.

And starting for a second with the, with the health disparities, the cost, the fact that it's not covered for many, the fact that those other supports are not in place. I had recently on my podcast, pediatric endocrinologist, Dr. Tammy Hannon, and she talked about the same thing, which is. It's really a lot of these tertiary care centers that maybe have the ability to execute on some of this. Exactly.

So, and then you don't thank the Lord, there'll be hopefully more programs like yours, but again, not everybody lives in the states that you service. You're only gonna be able to help so many. Yeah. So it's this tricky scenario where I know she made a comment, we're not gonna out medication this. Right. It's a, it's something that society's gonna have to grapple. I always say maybe it's a tool, but like you said, are we screening for eating disorders? Do we have other supports in place?

Are parents getting some of the help that they need? It's just not gonna be solved with a one prescription and a five minute visit. That's just not how this is gonna go down. I wish it was, I wish it was that simple, but it's not unfortunately. The ethics of putting a child on something that they're going to have to be on long term right.

Is, you know, and what's that message that the parent and the doctor are sending to the, the other thing is, I was at the, the tertiary care, you know, center leading the charge there and. They don't share anything with you. I mean, I learned about with the coaching and we do nothing with the parents at all in those tertiary care programs. So I knew nothing about, how to support the parents with the change.

I knew nothing about, helping them get rid of their diet culture so that they can, cuz one of the things is, teens and the parents struggle with is like, oh, I'm gonna add in protein at breakfast. Oh, but that's not enough. It's not enough if it's not like everything. And so we get, we get them out of that, you know, and they need accessibility too, instead of like every two to three months. One of the things we have to get out of is the singular.

And that, and, and that there's a quick, and that there's a fix. And, the other thing about teens is when you have them like I do and have raised them, and also coaching, I coaching them there, there's so many who would never take it, take those meds. And they'll speak up. They'll be like, no. And then there's others that are, they're gonna be very helpful and they'll get 'em covered and great. I'm glad that we have these tools, along with, metabolic bariatric surgery if it's needed or.

other medications along with, all the other supports that have to happen. Yeah. I like how you said no singular fix, and I always say the right tool at the right time. I think it really ebbs and flows as far as what's actually needed for the person in front of me at that moment. Mm-hmm. and I know you probably have this too, as a physician, when I'm talking to people, we're not doing everything all at once. There are certain things that are kind of top of mind, more prominent at that moment.

But it doesn't mean we might not try other things in the future or that there's not a lot of diversity there. And I think obviously I, I also do coaching in my practice and I think that if they're not getting some of those tools for how to let urges and cravings go and how to be more loving to themselves, I mean, there's just, there's a lot that I think goes into it. But it's interesting that I don't know that that's available to everyone.

And so, one question I have is, where do you think is the best. For someone to try to find a healthcare provider that can help them with this, cuz not everyone can work with me and you. Do you have any resources that you point them to to find a pediatric doctor that can do this if they're not able to work with you? Well, there aren't a lot of us.

I mean, you and I know, like any of the training that we've gotten, especially, you know, I know this, we've had to fund it ourselves or it's been Yeah. And no one, you know, no one talks. We've actually never talked about that. Yeah. So people should know this. Our institutions would not pay for it as a problem. Never.

Even though I was like hired, I. A half a million dollars of my nonprofit assets to Children's here in Nebraska to create the whole continuum of care for childhood obesity and advocacy. I mean, that was, and I worked with the A A P on Project Echo. I mean, it was just unbelievable. I didn't even bring it up to them because I knew they wouldn't, and I did it after I left. You know, I went through my obesity medicine board, so you can go to the abom.org.

The American Academy of Pediatrics has the Institute for Healthy Weight. I don't know that they have a list of providers, but maybe, obviously, you know, children's hospitals, health systems, it, it's usually a children's hospital that will have a tertiary, weight management program. Sometimes they have wait lists. Think that obviously, if. Wanting to pursue the GLP one medications or consider those, those are great, stops.

Other than that, to be honest, there isn't a whole lot obviously specialists. Some are still stuck in calories and calories out. But if your child has. Hopefully their pediatrician's working up for comorbidities and seeing if they have type two diabetes or pre-diabetes or P C O S or fatty liver disease, or. Um, metabolic syndrome, hypertension, all the things.

Get that support, from a specialist to make sure that those are, we wanna target the comorbidities and those health issues cuz we want to, especially with pediatric obesity, with any age of a person, we have to treat the comorbidities first. So like with obstructive sleep apnea, we have to be sleeping well in order to be able to take on. Healthy habits, during the day and for our bodies also to heal.

So I think all primary care can do a better job of asking permission to talk about it, having discussions that are open and making it, framing it up as a health discussion and not about. Targeting comorbidities and then doing some, you know, they can get motivational interviewing training, which I did that and that was helpful.

It's not nearly as profound as coaching or powerful, but it is really helpful to get more like shared decision making around like what's your next best step, and then some communication.

So if you have a good relationship with your pediatrician or family doc, You could probably do it a lot within that primary care setting, but there isn't a directory of people, and I'm the only one I know who's doing, you know, metabolic telehealth or children adolescents, Yeah, I've tried to answer the same questions on the adult route and I'm, I'm gonna put in the show notes underneath here.

I'll put the links, everything that you were talking about as well as some that, that I think are some better directories. But you know what, the funny thing I say, one of them I really. and I can't even get myself listed on it, so I'm like, I don't know who to talk to here. Yeah, I know I'm perfect with what you're talking about, but I don't know how to get on this, so, mm-hmm.

So it's unfortunate that it's almost one of these scenarios where if you see someone on social, you know, you see a doctor, you like their philosophy, at least you know what you might be getting when you go there, which otherwise it's kind of, unfortunately, you need to make that appointment. You need to see their philosophy, which is sometimes very hard. Energy expense, time, all of it. You have to do that route, unfortunately, sometimes.

Yeah. So lemme just say here in the name of, respecting Your Time, I have just learned so much from you today and I know that there are gonna be people out there that wanna learn how to work more with you, where to find you. Can you tell us all of the things you have going on and where people can find you. That's great. Thank you. i e community.com. So I e so the power of the individual look in the mirror, say, I am e So fully love and accept yourself now.

And then the power of the community is my, website. So go there, i m e community.com and there's a lot of information there. I have links to my. A YouTube, podcast. I'm on TikTok, Dr. Carla md, and I am in community. I'm on Instagram, Facebook, all those places. But I have coaching, opportunities, which you can find on the website. So I do a 30 minute, consult. And that's really super helpful. So we can see kind of what are the, what's really going on. Every person is completely different.

there are no canned approaches. So that's a way to start. And then I can work individually with you and I have a healthier self. group coaching program. So I'm relaunching that in June, which I'm really excited about. I love it. It's my 12 week reverse for insulin resistance challenge and that's for teens and parent and their parents. Then I have a metabolic telehealth for children and adolescents. So that's Dr. Carla with a k md.com. And that's, my metabolic telehealth practice.

Its licensed in 10 states, so you can work with me there. I see children five and then on up to age 21. I am. So first of all, I'm so excited for anyone that lives in those states that gets to work with you because your approach is so comprehensive and such a nourishing approach that I, I'm like, gosh, if I needed this help, I would wanna be in those states, you know? So that's, I'm so excited for all of them. So I'm gonna make sure to have all of those links down below here.

And I know that there were even more topics that I'd wanted to address today. So I hope in the future we can have you back. We can kind of do a part two because I feel you just have so much to share. So thank you again. Oh, well thank you. And I love all your stuff. You know, I'm a huge fan, Thanks.