Kids' Wellness Matters Podcast Ep. 28: Supporting Your Kid's Healthy Weight

In recent years, science has shown us that obesity is a common health condition and it really goes beyond just nutrition and physical activity or just calories and calories out. There's so much more to it. In this episode, Maheen Quadri, MD, a pediatrician and obesity medicine specialist at Lurie Children's, shares her insights into the multifaceted nature of childhood obesity, including genetic, environmental, and behavioral factors. Dr. Quadri offers practical tips for families, shares insights on the latest research, and highlights resources for promoting healthier habits among children.

 “One of the things that has helped me as a parent of a toddler is thinking about creating a ‘Yes’ environment. Not having to say ‘no’ all the time. So, think carefully about what you have out and what you don't. And I think about what foods are available, too. Avoiding conflict around food. Thinking about, ‘okay what foods do I feel comfortable with my child eating as they want and having those available?’ And maybe thinking about the foods that, okay, maybe this is something that we will eat out together on a Friday night, but maybe we won't have it in the house.” 

- Dr. Maheen Quadri

Show Notes 

• Dr. Quadri  says caregivers and medical professionals need to recognize their own biases around weight and emphasizes the importance of details to make clinics more inclusive to children experience obesity.  

• While BMI is a tool used to measure overall health, it is not perfect and should not be too heavily focused on by parents. 

• Early intervention can positively impact the long-term health of a patient and help with weight management into adulthood. 

• Contributing factors to childhood obesity include changes in modern food production, access to outdoors and being active, and poor sleep.  

• Science and medicine has advanced greatly in the past decade and now many more treatments are available to young people with GLP-1 and other highly effective medications carefully prescribed for patients. 

• Various surgeries can be effective in treating patients including bariatric surgery and sleeve  gastrectomies. 

• Parents seeking resources on this topic can visit the American Academy of Pediatrics’ website healthychildren.org and myplate.gov for helpful guidelines and information. 

Transcript 

[00:00:00] Nina Alfieri: Welcome to Kids' Wellness Matters. I am Dr. Nina Alfieri. 

[00:00:07] Rob Sanchez: And I'm Dr. Rob Sanchez. We are both parents and pediatricians at the world renowned, Ann & Robert H. Lurie Children's Hospital of Chicago. 

[00:00:15] Nina Alfieri: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adults because kids' wellness matters. Today we're talking about childhood obesity, an issue that so many families are trying to navigate today. 

[00:00:33] Rob Sanchez: In recent years, science has shown us that obesity is a common health condition and it really goes beyond just nutrition and physical activity or just calories and calories out. There's so much more to it. In this episode, we're thrilled to be joined by Dr. Maheen Quadri. She's a pediatrician and obesity medicine specialist here at Lurie Children's. She brings both compassion and really real clinical expertise to this complex issue. She has so much experience with families that she brings this episode and she's gonna talk about the different factors that play a role in childhood obesity and why every positive change matters regardless of a number on the scale. 

[00:01:05] Nina Alfieri: I'm thrilled to hear this episode not only because she's a close colleague of ours in our clinic, but I also love that her message in the episode is not about perfection. It's about progress and really meeting kids and families where they're at to help address their concerns. I also think the episode is really broadly applicable because honestly, we can all use a better understanding of habits that we can target to be healthier. So I'm really here to hear her perspective and things that parents can do to help put health first and address obesity without shame or judgment. 

[00:01:36] Rob Sanchez: Dr. Quadri sees patients at our Uptown clinic and through our pediatric wellness and weight management program, working with children as young as two through teenagers. She's here to walk us through the latest evidence-based approaches to weight management, including when medications like GLP drugs or bariatric surgery might be appropriate. Welcome, Maheen. So excited to have you and to hear all of your expertise. And tell me about your approach to managing childhood obesity. You know, this is a very difficult topic for many patients and families. How do you make sure your approach to weight management is both effective and compassionate? 

[00:02:08] Dr. Maheen Quadri: Yeah. Well thank you so much for starting out with this question, by kind of acknowledging that it can be a really difficult topic. I think unfortunately, you know, weight bias and stigma are definitely very real. We see them in many different parts of society, certainly in the media, social media that our kids are exposed to, and then unfortunately from within medicine itself. I think it's important for us to sort of recognize our own biases so that we can work on challenging some of the strategies that we think about in our wellness clinic is thinking about what an inclusive space like, looks like and feels like. So that starts out with being very literal. So is our waiting room comfortable for our patients and their families? Our exam rooms are the tables and our exam rooms, our equipment, the gowns that we have. Sort of all of those things. And then I think another big piece is thinking about choosing our words carefully. And, if it's okay, I was hoping to kind of talk about some of the words that we might use, and share some definitions. 

[00:03:09] Rob Sanchez: I think we absolutely should. I mean, even as you talk about just how important, just these small details things that might be overlooked, the fact that, you know, your work and the clinicians who you work with, pay attention to that. It really demonstrates just that care that families and patients need in these types of situations. Absolutely, let's dive in. You know, sometimes the words obesity and obese themselves can feel, you know, negative and kind of triggering for patients and their families. And so I did want to clarify that when we are using those terms today or, you know, if you maybe see them in your child's chart, for example. If you look at the electronic medical record from a medical perspective it's really just a descriptor based on your child's BMI. BMI stands for Body Mass Index. It's a number that's based on a formula that was developed in the 1800s. 

[00:03:56] Dr. Maheen Quadri: It's really meant to be used as kind of a screening tool to just sort of, try to figure out, oh, are there patients where maybe we should check their blood work a little bit sooner than we would typically do. How I explain it to patients and families is, it's just one number. It's not the most important number about you or about your health. And so I hope that people don't, you know, get too hung up on it. But it can be challenging and I think that there's some good work being done to kind of revisit, you know, how we use this number in medicine. 

[00:04:25] Rob Sanchez: We really try to focus on health and keeping the inside of our bodies healthy. I've worked in our clinic now for over a decade. Over time I've really come to look at it. Our goal is really not necessarily to impact a patient's weight or their BMI, but it's really that weight management or weight loss is more of a tool to improve your overall metabolic health. And just, you know, setting kids up for a long and healthy life basically.  When we talk about the long term, it's important for us to consider age and when to intervene and things like that. You know, our pediatric wellness and weight management program sees patients as young as two years old, all the way up through age 18. Can you talk to us about why it's important to intervene early when it comes to this topic of obesity? 

[00:05:09] Dr. Maheen Quadri: There are lots of good studies that have shown that for patients who gain weight sort of more quickly than they're getting taller. Seems like that early weight gain and kind of quick gain puts kids at risk for having a higher BMI during childhood. And we know that then puts kids at risk for having a higher BMI into adulthood. There's this idea that we talk about in obesity medicine of the brain set point. And I kind of think about it as like the thermostat on the wall where your brain has an idea of what it thinks you should weigh. And for patients who have gained weight a little bit more quickly during their early years, we know that that sort of interferes a little bit, maybe with kind of what their set point is. And so that can sometimes contribute to difficulty later with managing weight depending on, sort of that interplay of, you know, somebody's individual genes and then, what their life looks like otherwise too. 

[00:06:09] Rob Sanchez: That makes so much sense, especially with that analogy of the thermostat setting and how that might be set up for later on in life. And we've touched on a little bit of some of those conditions that we might be thinking about in adulthood. Sometimes, you know, as a parent of young children, it's hard to even imagine that far ahead. But, I was wondering perhaps could you even go into more detail about what some of those conditions are that you have those correlations to later on in life that were really focused on, addressing early on to prevent in the future. I imagine those are things related to blood pressure or blood sugar. Can you speak to those a little bit? 

[00:06:38] Dr. Maheen Quadri: Absolutely. Yeah. We tend to think about it in two main buckets. So there's conditions that are related to the hormone signaling and the changes in our body that happen when they're sort of like excess weight basically, specifically adipose tissue or fat tissue. Those are things like you mentioned, so high blood pressure cholesterol issues. Issues with regulating our blood sugar, so prediabetes or diabetes. Sometimes the liver can get impacted by sort of excess adipose tissue that gets stored in the liver. Sometimes there can be issues with polycystic ovarian syndrome or PCOS. So that's kind of also related and can cause some period issues and sometimes issues with fertility later on in life. And then there's sort of another bucket of conditions that can be related to the physical impact sometimes of the body sort of carrying more weight. And so those might be issues with sleep apnea, for example. Sometimes some conditions are just impacted, so asthma sometimes can be a little bit harder to manage and treat for patients with an elevated BMI. Sometimes musculoskeletal pain, so pain and other issues like that. It's important when we think about helping people with managing their weight tailoring sort of our recommendations or some of our guidance around some of the, you know, what we call comorbidities in medicine. So things that sort of track along with that I do also though wanna, share that there is this idea of metabolically healthy obesity that for some people they can, you know, technically have a BMI that would put them in the, you know, obese quote unquote category. But, when you check their labs, they look great. And that's wonderful. You know, like that's our goal is to help people get into that range. And I do think it's important to think about not just that BMI number itself, but kind of that whole picture of someone's overall health. 

[00:08:30] Rob Sanchez: No, I think that makes sense, especially when you tie into how we utilize the BMI as a tool itself, that might be a point towards other types of screening labs. I know when I've referred families to your clinic to get support for them, I'll often do some lab work ahead of time and I kind of introduced it as that is that, you know, these are not definitive, it's a good indication that we should rule these out or assess for how these things are going so that then we can offer that extra support if needed, if any of those levels are off. And it could be that those are totally normal. I've definitely had that happen with some families, but it can be scary, I think as a parent, but I think also, I hope, you know, empowering to know that, hey, these are real things that I can help address for my child as they go on in their lives. 

[00:09:08] Dr. Maheen Quadri: Yeah. Yeah. And I think the great news about a lot of these conditions is that they often can improve with changes in lifestyle, but also, reducing weight itself can have an impact. 

[00:09:20] Rob Sanchez: And obviously we're having this conversation just in the backdrop of the reality of the statistics and numbers that are often brought up related to our youth. The statistics themselves are pretty eye-opening – about one in five American kids having obesity according to the CDC. In your work, what are some of the biggest hurdles you see for kids who are trying to manage their habits and lifestyles with their weight? 

[00:09:43] Dr. Maheen Quadri: I think it's a combination of the research in this field has really, you know, progressed so much in the last decade and there's such a strong genetic component. And that is sort of out of our control, right? So kids are starting at a certain point. And then sometimes I kind of think about it as, you know, our modern world has just progressed so rapidly and our bodies and the way that sort of evolution has shaped us over time. It just hasn't had a chance to catch up. The food that's available to us. I think there's a lot of work now looking at the impact of processed and altered processed foods and what that might be doing for us, you know, for all of us, not just kids. I think a lot of our kids are living in neighborhoods where, you know, it can be a little bit harder to be active outside or inside. Sleep is another thing that is so important and so tied to our overall health but definitely to how our body manages weight. And I feel like especially when I talk to teenagers we just put a lot of pressure on them as far as all the different achievements that we're hoping for them. And at some point that starts to interfere with sleep. And then it's certainly, I think the use of screens is like a thing that we're all sort of navigating, right? And I don't wanna completely bash screen time because, there can be a lot of benefits and I think it can be a way to connect with people, but thinking about how, how does that fit into the rest of our life. 

 [00:11:11] Rob Sanchez: I imagine when you have these visits, when you start to ask families, Hey, you know, any conditions that run in the family? What is your day to day life like at home? How is sleep? I imagine like with families, you're getting this larger picture of all those various factors that could be impacting this area of their lives. 

[00:11:26] Dr. Maheen Quadri: And that's actually one of the things I really love about our work is that we get to know our families so well. And so much of it is just kind of, helping people with sort of troubleshooting, you know, things that they might already wanna work on. But, just kind of helping them figure out those small kinds of tweaks that they can make. I often will tell people, you know, I don't want you to feel like this is an inquisition, right? We're asking all these questions and it can feel a little overwhelming, but it's really more just that all we can do is kind of control what's in our sort of sphere and our scope. And so it's not to make people feel like they should have been doing something differently, but it's more just kind of thinking about, okay. It sounds like you really wanna prioritize getting your family outside. Let's think about some ways that we can help you with that. Let's kind of brainstorm together. 

[00:12:16] Rob Sanchez: Yeah, I feel like it's one of those things where it strikes up the nature that I'm sure all of us, you know, all families really wanna be healthier. So while it can feel like a lot of questions, sometimes it takes that kind of reflection and sometimes documentation to go through and see, oh, actually have you considered this? And that's where you can maybe get a lot of buy-in and a lot of kinds of changes. At the root of all that I'm sure is getting that engagement, getting that buy-in from not just the child, the individual, but probably the whole family. I'd love for you to speak to, you know, how crucial is it to get the whole family involved? What difference do you see when there is that level of family engagement on a topic such as this? 

[00:12:51] Dr. Maheen Quadri: I think that can make such a big difference just in terms of helping an individual child not feel singled out in any way. You know, like these are changes we're all making together as a family. One of the things that has helped me as a parent of a toddler is thinking about creating a Yes environment, right? Not having to say no all the time. So think carefully about what you have out and what you don't. And I think about what foods are available so sometimes thinking about avoiding conflict around food. Thinking about it, okay, what foods do I feel comfortable with my child eating, sort of as they want? And having those available. And maybe thinking about the foods that, okay, maybe this is something that we will eat out together on a Friday night, but maybe we won't have it in the house. I think the other big thing in terms of family support is creating that space of acceptance and unconditional love. Having that start from home. There's a really nice book called How to Raise an Intuitive Eater where they talk about this. About creating that space where that child feels like, this doesn't have to, you know, define how I think of myself as a person. And I think part of that too comes from modeling, right? So thinking about us as parents, how we talk about ourselves and what we're eating. As a nineties baby, I definitely grew up around what I now realize was kind of a toxic diet culture, And some of our parents, they're also kind of trying to unwind some of that for themselves. So those are the ways I think in which we can support our kids from that family perspective. 

[00:14:22] Rob Sanchez: I think that makes sense. And I reflect on that a lot too. 

 The modeling that you've mentioned there when it comes to, you know, nutritional aspects or the foods that are around the house. That's really key. But I imagine it's all in that same vein of coming from a place of support, like you said, finding ways that you can model that and the stuff that you wanna see. I mean, I imagine those are the kind of discussions that you like to have in a clinic as you get that buy-in from families. 

[00:14:44] Dr. Maheen Quadri: And the other thing, you know, one of our dieticians that used to work in our clinic would say that I really liked to eat in the light. So whatever you're eating just kind of enjoy it and if you feel in the moment or reflect afterwards that maybe you feel like it wasn't the healthiest choice, like that's okay. You know, just kind of accept it and then move on. And, you know, one of the challenges that some of our families bring up is kids sometimes feeling like they have to like, hide what they're eating or sneak eating. And you know, we try as much as we can to sort of maintain that idea of just, to eat in the light. 

[00:15:15] Rob Sanchez: I like that a lot. I'll definitely keep that in mind. As you kind of mentioned, you talked about growing up in a different time. Obviously things have changed over time and so has the guidance around this topic. I wanted to ask, you know, how have you seen the guidance around pediatric obesity and weight management evolve over the years? 

[00:15:31] Dr. Maheen Quadri: Like we were saying before, I do think there's been a lot of really interesting research in this area to try to understand a lot of the complex kind of signaling that happens between our brain and our stomach and adipose tissue itself. Just all the different organs in our body and how that impacts our weight, but also how hungry we feel at any given time. And then also a concept called satiety. Which, seems like it should be the same thing as hunger, but it's a little bit of a different pathway in terms of how quickly we feel full and how full we feel. And so I think this is great, because I hope that this work is challenging some of the notions that I know I grew up around, which is kind of this calories and calories out, sort of like mentality or model. And really thinking about it more as again, like we talked about, making changes to improve your overall health and not necessarily, you know, oh, I need to lose X amount of weight by a certain time, those kinds of goals. The research has also led us to think about the ways that medications can be used to help patients manage their weight. And so that's definitely been a big change that I've seen, you know, since I've started practicing in this field. And then the role of bariatric procedures and how they can fit into sort of the approach that we can offer our patients with a more significantly elevated BMIs. 

[00:16:54] Rob Sanchez: I mean, I remember in medical school they just started talking about identifying some of these, feedback loops that introduce this notion that, you know, really challenge those ideas. How much put in, how much you put out, you know, how much you walk, how much you eat, like of course it's more complicated than that because our lives and our bodies and the way it all ties together are more complicated than that, and I know there's a lot of excitement with these advent of new medications and opportunities there, that there's a lot of focus on that and so I wanna get a chance to delve into a little bit more. There's several weight management medications you know, kind of making headlines, that have been approved by the FDA for children. Can you tell me about some of the most popular ones, things that listeners may have heard of, you know, such as Wegovy, Ozempic, things like that. And what do we know about these medications and their safety in children and how they might be used? 

[00:17:38] Dr. Maheen Quadri: Yeah, so I do think that this area has gotten a lot more sort of media coverage and interest more recently. Understandably, a lot of parents have a lot of worries and concerns about the idea of using medicines to help their child manage their weight in the first place. Like no matter what the medicine is. I completely understand that, and you, when we started using medications I think all of us who work in this area, we also kinda had to wrap our heads around the idea of it. And sometimes I think about the analogy of other chronic conditions that we treat. So I think about asthma for example. If someone came in with trouble managing their asthma, sure we would tell them, oh, maybe, you know, shouldn't be around cigarette smoke, or maybe this allergen is making your asthma worse. But we wouldn't just send them home and tell them like, oh, just breathe better. Or, you know, for our kids who have really bad eczema, we often will offer them a medicine to help with the itching itself, right? So not just the creams and everything, but like a medicine that you can take by mouth. Because when your skin itches, you wanna scratch it. And so for some of our patients sometimes the medicines can help with taking away that sort of constant hunger that they might be experiencing. Helping them feel more full during the day. And sometimes also reducing food noise, which is this idea that, you know for some people making decisions around food, or thinking about you know the foods that they're going to eat that day can just take over a lot of their  brain sort of bandwidth. I often think, gosh, when we tell kids, oh, you need to brush your teeth twice a day. Like, that's only something you have to do twice a day, but you have to make decisions around food all the time, right? So many times in a day. And so it can feel quite exhausting. And so that's kind of how I think about the medicines is that they can be just one tool in sort of like our kind of toolbox of what we can offer in terms of the support that we can give kids and families who are working on weight management.  As far as the medicine options that are out there, the GLP-1 medicines like Wegovy and Ozempic, I think they've definitely gotten a lot of interest. But when we think about the medicines that we use in our clinics, we're still more often using the oral medication options that are available to us. Some examples are Metformin, to help people with diabetes Topiramate which is a medicine that sometimes we might use for patients with migraine headaches or seizures. And then Phentermine which is considered like a stimulant medicine. So it works on a certain part of our brain to sort of change hunger cues. And then there are some combination medicines out there. So one of them is called Qsymia and that's a combination of Topiramate plus Phentermine. And then sometimes we use some medicines off label, for example the stimulant Vyvanse. Sometimes we use that in our clinic too. And most of these medicines primarily work like we talked about, reducing hunger and helping people feel more full. Some of these medicines also might have some additional benefits for glucose, blood sugar, metabolism rates. So Metformin for example. Now the GLP-1 medicines work by, I sort of think about it like they simulate the state that our body is in right after we've eaten. So they kind of, send signals to our brain and to other parts of our body to make us feel like we just ate, like we should be full. And so that's where sometimes some of the side effects that we see with these medicines also come from. So for some people it can cause some stomach upset, some nausea, occasionally vomiting. There are some other more serious side effects to think about too, so much less common. But, there's sometimes instances like pancreatitis, so pancreas inflammation sometimes the stomach gets sort of stuck. So gastroparesis or the small bowel getting stuck. So small bowel obstruction. There's sort of a theoretical risk related to a certain type of thyroid cancer. So we ask about the family history of that. So I think any medicine, you kind of have to think about the costs versus the benefits. And you know, in this situation we're often thinking about the risks of the medicine versus the risks of, you know, continuing to be at risk for diabetes, for example. Or, you know, for kids who are struggling with high blood pressure, you know thinking about those implications too. 

[00:21:53] Rob Sanchez: I really like how you frame that and, I imagine those conversations are difficult to really introduce and talk about with families. There might be some who are really interested in it and wanna know more about it. There might be others that are more hesitant. You know, how do you decide when to consider one of these medications as part of a treatment plan and what are some of the things that you talk about with families that really should happen before you recommend that route and how they go forward with those steps. 

[00:22:16] Dr. Maheen Quadri: Yeah, I think individualizing our plan is so important. For example you know, sometimes I have patients who are going long periods of the day without eating. particularly teenagers who maybe aren't eating breakfast and then maybe they don't really wanna eat lunch either. And those are patients where, you know, I might be a little more hesitant to give them a medicine that's gonna sort of further suppress their intake over the course of the day. So sometimes I'll talk about okay, maybe let's think about how you feel about breakfast? Let's kind of, strategize and talk about maybe that's something we could work on. And then maybe let's kind of think about, would these medicines be the best fit for you? The American Academy of Pediatrics, put out a set of guidelines a few years ago to help us all as pediatricians, figure out how best to help our patients with weight management. And once someone is above, again, kind of going back to that BMI concept and number, you know, once someone is in the sort of obesity category based on their BMI for patients who are 12 and older, it can be a medicine at that time. And I think, you know, in the past we used to feel like, oh, you know, you should have done X number of months of lifestyle changes. How you're eating and moving your body and sleeping and all of those things. But sometimes I worry that by setting it up that way, it's almost like we make people feel like they failed almost. Oh, I couldn't do it on my own, so now I need this medicine. And I hope that kids and adults don't feel that way. Because the reality is kind of going back to what we talked about, that set point, that thermostat analogy. This is really hard. It's just sort of how our brains are, kind of wired and our bodies are wired. So it's a hard process of this sort of weight management journey and sometimes it can feel a little demoralizing. I think so, thinking about medications early is a shift in how we approach weight management now. 

[00:24:09] Rob Sanchez: Yeah, and I think that's really key. Despite, you know, just having the usefulness of these medications. There can still be barriers even to getting access to them. You know, we focus a little bit on some of the newer medications. Sometimes those new medications can be expensive. They often might not be covered by insurance. When we talk about access, how concerning is access to these things as an issue? Especially when we think about communities where obesity rates might be higher, as a population level, you know, how concerned is it that access might be an issue? 

[00:24:37] Dr. Maheen Quadri: Yeah it's really such a struggle right now because I'm noticing an increase in patients coming to our clinic specifically interested in some of these newer medicines like the GLP-1 medicines. And it just is so heartbreaking to have to tell people based on your insurance, I can tell you that it's just not gonna be covered. That just feels awful, and I think sometimes there's this perception that oh, these medications are being so widely used and just handed out kind of, willy-nilly. And those of us, who are more routinely prescribing them, are really trying to be very thoughtful about, you know, when we recommend them and how. There is a lot of great work being done on a state by state level to try to get better coverage particularly by state Medicaid plans. And so I feel hopeful that I will move forward. But I think that's really gonna be a key, sort of marker of progress in this field. 

[00:25:29] Rob Sanchez: It's great to know that there's advocacy efforts being put in place for those who could really benefit from them. It gives me hope that we can continue to have that. And I think, yeah, challenges that perception that this is something that's being done without much thought. No, it's something that's very intentional, very thoughtful, and often involves a lot of careful conversations with families and clinics and longitudinal kinds of care plans that are set up. When we talk about those care plans at the more significant end of it, especially for cases with significantly elevated BMIs or kind of more the severe end of the obesity spectrum, it might be needed to do procedures. And I wanted to talk about that as well. And kind of introduce that topic about what might make someone a candidate for these procedures. When medical or behavioral weight loss efforts or healthy changes haven't been successful for patients, especially for severe obesity. You know, bariatric surgery may be the right choice for health improvement, weight loss. What makes a child a good candidate for bariatric surgery? 

[00:26:22] Dr. Maheen Quadri: I think again, this is one of the ways in which science has really progressed. In the last few years we have more and more studies showing that bariatric procedures in adolescents can be safe and very effective. There's also some interesting data that Teenagers undergoing the procedure might have maybe even more benefit than adults in terms of for example patients who have diabetes type two diabetes, sort of related to, you know, obesity that remission or I don't wanna say cure, but, a reversal of that can actually be better, for teenagers. I think understandably, it brings up a lot of questions and worries. Again the specific type of gastric procedure that's more commonly done in adolescents and is the one that we do here at Lurie, for example, is a sleeve gastrectomy. So that's where a certain portion of the stomach is removed with the idea being that it reduces the amount of food that you can have in your stomach at any one time. But we actually think that the way it really helps and really works is that it removes some of the cells in our stomach that produce the hormones that make us feel more hungry. So it's kind of changing some of that signaling between the brain and the stomach. In terms of thinking about who might be a good candidate, usually we start thinking around like 12 or 13. Would be generally the earliest age. I think there's some centers where there might be some flexibility there or certain cases where there might be some you know, it's not a hard and fast cutoff for most clinics. And then thinking about the BMI number itself. We talk about percentiles knowing that, you know, each kid is sort of growing at a different pace and has a different height, et cetera. So, we look at their BMI number and specifically we look at sort of the percent of the 95th percentile. So that number, if it's above 140, or if a patient might not be quite at that level, but if they're already starting to have a lot of medical issues related to their obesity, then they might be a good candidate as well. I think the other piece that we think about is. What does frequent check-in require? So I usually like monthly appointments. For most programs it's usually at least six months prior to the surgery and often insurance companies will also have their own requirements in terms of whether they'll cover it or not, and kind of like the progress that they're seeing on that end as well. 

[00:28:43] Rob Sanchez: Yeah, I mean it can be a procedure that has significant outcomes, but again, it's something that requires a really big commitment. As you talk to families about that procedure, what are some of the questions that you get or how do you introduce it? Because I imagine it's something that you don't bring up on the first visit, right? These are probably families that you've been working with. What are some of the preconceived notions that people bring into clinics that you like to talk about? 

[00:29:05] Dr. Maheen Quadri: I think because this area of medicine has evolved a lot the safety has really improved quite a bit. And sometimes for our patient's parents they might have heard of, you know, scary stories from family members or friends who may have had more significant versions of bariatric surgery. So the surgery is done more often in adults than in kids. They might have had experiences themselves. I have started talking about it more just as a way to make sure that I'm not bringing preconceived notions into like, who I think might be interested. Because I have had some families where they sort of feel like, well, medicines kind of feel like a decision between are we gonna think about being on these medicines for a very long time, or is surgery, maybe a little bit more of a long-term solution. And we do try to mention it to patients where they would be eligible, sort of based on, you know, their age and other criteria. And just to sort of make sure that there's no bias in terms of how we're offering it or presenting it. I do think that was another sort of element of the newer AAP guidelines in terms of thinking about making bariatric procedures more accessible for all patients. That's something that we can do on our end is just to sort of, provide information and certainly not pressure any of our patients, but just let them know that's, again thinking about that toolkit, that's another tool for them to consider. 

[00:30:32] Rob Sanchez: And for families or patients that do kind of pursue that procedure. What is the recovery process like? What can they anticipate what life might be like after that procedure? I imagine there's a lot of follow up. 

[00:30:41] Dr. Maheen Quadri: For most patients the procedure if we're talking about a sleeve gastrectomy, for most patients that can be done laparoscopically. So that would involve, you know, kind of making some smaller cuts in the wall of the abdomen and then kind of using some equipment to go in and remove the part of the stomach that the surgeon thinks would be appropriate for this patient. And so the recovery because it's done that way can be less involved than, more traditional, big open incision type surgeries. And so, within a few weeks patients can hopefully be back to most of their routine activities, so maybe gonna school things like that. It might be a little bit longer before they would be able to do, you know, sports or other, more involved activities. We pay close attention to how they're absorbing nutrients from their food. Right. Since we know that kind of gets impacted by the surgery itself. So there's lab work that we follow to make sure that their vitamin levels are okay. And often it involves a variety of different supplements that they might be asked to take. And then, it's basically kind of thinking about it as sort of a lifelong commitment to overall health and a lot of the things that are good for all of us, I guess. 

[00:31:51] Rob Sanchez: It really illustrates the fact that even though it's one big procedure it still continues on after that. You know, making sure to stay engaged with providers is gonna help follow up with them and ensure those healthy lifestyle changes. Maheen I know you've had so much impact on the lives of families and patients that see you at Lurie Children's. Enlighten us a little bit more just into your experience of things that might be helpful for parents out there listening and might have questions or concerns. 

[00:32:15] Dr. Maheen Quadri: First, thinking about your primary care doctor is really your champion and your advocate in this work. You know, I think we're doing a lot better job as the science of obesity progresses. I think the way that we're teaching our trainees about it is really improving. And I know I've worked with so many primary care doctors who are really interested in this topic and really wanna help families in a really, compassionate way. I think that there's a lot of community resources. Thinking about local community organizations that might have opportunities for your kids to be active and in a social way , like neighborhood and religious organizations can sometimes be a really nice source of support. As far as food and nutrition resources online. Places that I like to suggest are the HealthyChildren. org website. So that's the kind of parent website of the American Academy of Pediatrics. They have a really helpful section on this topic. And then MyPlate. gov has helpful resources. What I really like is that they've tried to revamp a lot of their guidance to be more inclusive of different types of food for different types of Americans. Because I think it's really important to honor the place that food has in our lives and that overlap with food and culture. I never want any of our families to feel like there's certain foods that are important to them that they would have to give up on or completely exclude. I think that's really important. And then I think like my sort of overall big takeaway would be that we can all be healthier at any size. And so even if, you know, you're making changes together as a family and you're not seeing the impact in terms of maybe changes in weight or BMI. Please don't feel discouraged because I think there's so much to celebrate in making those changes themselves. Because ultimately they're helping keep the inside of your child's body healthy which is what we care about the most and the most important thing. 

 [00:34:09] Rob Sanchez: The other thing I was gonna add is, that asking your doctor any suggestions for nutrition referral if you think that would be helpful or if there are wellness or, you know, weight management programs in your area hope your listeners will find them to be helpful spaces. 

I think if they're anything like the provider that you are for the families who get to treat, I think they'll definitely receive the benefits of that kind of care. Maheen thank you for talking with us today for reminding us of just how, multifactorial and how much of a bigger picture this topic really covers and just educating us and sharing about different opportunities. Thank you so much for being with us today. 

[00:34:45] Dr. Maheen Quadri: Thank you so much for having me, this was so fun. 

Thanks for listening to Kids' Wellness Matters. For more information on this episode and all things kids wellness, please visit luriechildrens.org.