If you’ve ever felt confused, judged, or overwhelmed by how weight is discussed at your child’s doctor’s visits? Whether your child is in a larger body, a smaller body, or somewhere in between this episode is for anyone who wants to raise healthy kids without harmful messaging.

I’m joined by Dr. Tommy Martin, a physician, educator, and passionate advocate for reframing weight and health conversations with compassion and clarity. Together, we explore why BMI was never meant to guide pediatric care, how weight bias shows up in medical settings, and what parents can do to protect their child’s body confidence without ignoring health.

We dive into:

• Why BMI was never meant for individual kids and how outdated growth charts still shape care today

• The lasting harm of weight bias in healthcare, from missed diagnoses to internalized shame as early as age 3

• How to reframe conversations around health without numbers or labels and practical ways to advocate for your child

To connect with Dr. Tommy Martin follow him on Instagram ⁠@dr.tommymartin⁠, check out all his resources at ⁠https://link.me/dr.tommymartin⁠

We’d like to know who is listening! Please fill out our ⁠Listener Survey⁠ to help us improve the show and learn about you!

00:00 – Intro: Why weight conversations in pediatrics matter
02:10 – Meet Dr. Tommy Martin and his backstory
04:50 – Growing up in a larger body and the roots of weight stigma
06:45 – Subtle messages kids absorb at the doctor’s office
09:00 – Hurtful comments from family, peers, and culture
13:45 – Dr. Mona’s story: Smaller body, different pressure
15:30 – The impossible standards of body image
17:00 – Why pediatricians weigh kids and how Dr. Mona reframes it
18:30 – Dr. Tommy’s patient-first approach to weight discussions
21:45 – What BMI gets wrong (and how it still shows up)
25:20 – The harm of casual body comments
27:00 – Genetics, hormones, and the science of food noise
30:00 – The stigma and science behind GLP-1 medications
33:00 – How Dr. Mona talks to families about elevated labs without shame
40:00 – Why she never sets weight goals for kids
43:00 – Helping kids fuel for function, not aesthetics
46:00 – Modeling healthy habits in everyday life
48:00 – Weight bias in healthcare and missed diagnoses
50:00 – Long-term harm of labels like “obese” or “underweight”

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00;00;00;01 – 00;00;17;28

Dr. Tommy Martin

I think we have to be very, very careful with the language and terminology we use. And so even when we’re looking at the growth chart, they say they’re in the 95th percentile. If you say, well, you’re 95% larger than all of your peers, you know, like that automatically just comes off sounding kind of, you know, stigmatizing or bad.

 

00;00;18;01 – 00;00;41;28

Dr. Tommy Martin

And so I think talking to the parents and the patient about the child, about it in a way that these are markers that we look at just to see how you’re growing over time. And right now it shows that you are growing consistently over time. And your growth. You’re growing faster than your peers. And I think that is completely okay.

 

00;00;42;00 – 00;01;08;17

Dr. Mona

Hey, it’s doctor Mona, pediatrician mom friend, the host of the PedsDocTalk podcast, and someone who thinks BMI is, well, overused and not that great, especially in pediatrics. Okay, first our PedsDocTalk Instagram account has hit 1 million followers. Y’all. 1 million. I can’t believe it. I started this podcast in 2020, a year after starting my Instagram, and to see what we’ve been able to create, it just makes me so proud and so happy.

 

00;01;08;17 – 00;01;31;01

Dr. Mona

So really, thank you for being here. Today we’re diving into something I care deeply about. How the way we talk about weight, especially in health care, can shape a child’s body image for years to come. Negative body image, body dysmorphia, disordered eating. It doesn’t just show up out of nowhere. It often starts in an exam room and how clinicians speak about bodies in the way weight is framed as a problem instead of a data point.

 

00;01;31;03 – 00;01;50;08

Dr. Mona

And too often we’re only having these conversations with kids in larger bodies when health has nothing to do with the size alone. I have these conversations with families every day when I see choices that may not support a child’s health what they’re eating, drinking, how they’re sleeping or moving. We talk about it, but the focus is always on health.

 

00;01;50;14 – 00;02;10;19

Dr. Mona

Not the number. Not shame, not outdated metrics like BMI that doesn’t account for genetics, body type or context. Because when we lead with you need to lose weight, we missed the opportunity to build sustainable change. What if instead we said, I notice you’ve been moving more, how’s your energy? Or you’ve been making some really awesome food changes? How are you feeling?

 

00;02;10;22 – 00;02;30;12

Dr. Mona

That’s the difference between fueling growth or fueling shame. I’m joined today by Doctor Tommy Martin, a board certified internal medicine and pediatrics physician and a powerful advocate for body respect and truly supportive health care. You’re going to want to hear this one. And before we jump in, make sure to subscribe and download this episode. Yep, those downloads really matter.

 

00;02;30;15 – 00;02;41;12

Dr. Mona

It’s how the show grows and how these important conversations reach more families who need to hear them. Let’s get into it.

 

00;02;41;14 – 00;02;44;06

Dr. Mona

Thank you. I’m happy that we can finally have you on the show today.

 

00;02;44;09 – 00;02;59;16

Dr. Tommy Martin

Yeah. Doctor. Mona, I it is such an honor and pleasure. Like I said, right before we get on the podcast. I’ve been following you for so long, I feel like I know you and like that we’re best friends. And so it’s so great to finally connect face, but not necessarily face to face, but as close as we can get right now.

 

00;02;59;16 – 00;03;00;29

Dr. Tommy Martin

So thank you so much for having me.

 

00;03;01;02 – 00;03;06;25

Dr. Mona

It feels like this. And the next step is like at a conference or some sort of event we’re going to meet, and we’re gonna be like, hey, we’ve been friends forever.

 

00;03;06;25 – 00;03;10;26

Dr. Tommy Martin

Like, right? And we’ll yeah, we’ll be able to shoot some videos together a real time.

 

00;03;10;28 – 00;03;16;05

Dr. Mona

Yeah. And I know your wife is also a pediatrician, right? Not internal med pediatrics, but pediatric solo.

 

00;03;16;07 – 00;03;19;02

Dr. Tommy Martin

Correct? Yeah. She has her own practice and she does pediatrics.

 

00;03;19;02 – 00;03;38;12

Dr. Mona

So we have that connection, obviously internal med pedes married to a pedes. I’m, you know, obviously married to the E.R. doc. So we’re that doctor couple navigating, being parents, navigating, being physicians in this health care system. And you know, for anyone who’s not familiar with his account, which, by the way, you should be now, and you’re going to pause this and go follow us.

 

00;03;38;14 – 00;04;02;00

Dr. Mona

And all his handles will be on my on my caption. But I just again, I love the way you disseminate information. I love that you talk a lot about health and fitness, which today’s episode, we’re actually talking a lot about the medical bias hurting our kids, body image. You know, we talk a lot about BMI. We talk a lot about these weight based conversations that happen, especially in the outpatient world, in pediatrics and also for adults.

 

00;04;02;07 – 00;04;22;22

Dr. Mona

And I love that you practice what you preach. I love that you are very physically active, that you have this history of, you know, body image. And I know you were in a larger body at one point. I was in a very smaller body. So I think we’re going to be able to have a nice conversation about how those two different things have approached our life and our practice.

 

00;04;22;25 – 00;04;30;10

Dr. Mona

But tell us a little bit more about yourself. What brought you to start to make this content, online and get online and be that presence?

 

00;04;30;12 – 00;04;50;09

Dr. Tommy Martin

Yeah. Of course. You know, I think we can definitely talk a lot about this, having differing, backgrounds, but also kind of maybe some of the same issues. And so, yeah, growing up, I, I really struggled with my weight and my whole truthfully, my whole family still continues to struggle with their weight, and I probably would if I wasn’t as active as I currently am.

 

00;04;50;16 – 00;05;09;08

Dr. Tommy Martin

And so growing up, I, you know, coming from a family of poverty, we didn’t have a lot of money. My neither of my parents graduated high school, but they were like the hardest working people I’ve ever met in my entire life. They’re incredible humans. But with that, you know, there wasn’t a lot of knowledge about what good foods are to eat or healthy and nutritious foods.

 

00;05;09;08 – 00;05;24;27

Dr. Tommy Martin

I don’t like to. I shouldn’t use the word good. I do not like to label foods good or bad, but, you know, nutritious foods. And so a lot of the foods that we ate were very calorically dense. Yeah, and not very nutritionally dense. And so that led to me living in a larger body for the majority of my childhood.

 

00;05;24;29 – 00;05;53;06

Dr. Tommy Martin

And that was extremely hard for me. And so if you look at a lot of my content today, it is advocating for either children or adults that maybe struggle with their weight and that are feeling the stigma and the bias from not only the medical system, but the entire world. Anywhere you look on social media, you can find videos of people who live in a larger body that are getting made fun of or that are having, you know, terrible, terrible comments in their comment section about what they’re doing or how they exercise, what they eat and things of that nature.

 

00;05;53;06 – 00;06;01;20

Dr. Tommy Martin

And so I think the trauma that I experienced as a child has kind of led me into some of the content I create regarding those things.

 

00;06;01;22 – 00;06;22;09

Dr. Mona

Oh, I love when people have a story and use this story for good. It’s one of my favorite things, in this world, right? We have this experience. For me, I think a lot about my birth trauma and that experience and how using that has really shaped my my role as a pediatrician and a mother and how I, how I disseminate education, to new moms who may not, may or may not have trauma.

 

00;06;22;11 – 00;06;44;16

Dr. Mona

What kind of messages did you receive from doctors, family or social? And maybe we can start with that, doctors, because this is, you know, this episode I really want to talk about how the medical system can really negatively impact, body image. And, you know, when we talk about weight, but did you get those, messages from doctors or medical facilities about your weight and, how how that really impacted you?

 

00;06;44;19 – 00;07;06;11

Dr. Tommy Martin

Yeah. Truthfully, I do not believe I personally did, a lot of my doctors encounters, I think we’re probably pretty short and didn’t experience it too much, but I have seen, I think my sister had quite a few comments from physicians that I’ve seen other children have comments for from physicians. And I think one of the things is like when a child goes to the doctor, one of the first things they do is step on the scale, right?

 

00;07;06;11 – 00;07;27;05

Dr. Tommy Martin

I think that immediately just centers the visit around weight, especially if it’s someone that struggles with their weight. If even if the visit isn’t supposed to be about that, just the fact that that’s the first thing in the encounter. Someone who struggles with their weight, that’s probably what their mind is going to go to, right? And already start feeling bad about themselves because they had to weigh the first time, going into the room.

 

00;07;27;05 – 00;07;57;01

Dr. Tommy Martin

And so I think that and then on top of, you know, physicians talking about BMI and a child’s BMI and being in the obese category, or extremely or like overweight, I think all of those, those terminologies in those words can be hurtful even if they’re not meant to be. And then I think the way that a physician talks about them, you know, so instead of talking about, well, you don’t need to eat X, Y and Z or, you know, you shouldn’t be eating that much or just different ways that they go about talking about it can be really stigmatizing.

 

00;07;57;01 – 00;08;10;10

Dr. Tommy Martin

And I think put a lot of the blame on the person. Instead of finding ways to kind of navigate the situation to be more uplifting, rather than blaming the person for their size.

 

00;08;10;12 – 00;08;29;27

Dr. Mona

Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show. Oh yeah, and we’re going to get into some tips that I think you have. I have, and how I envision approaching these conversations in my office. You know, obviously, I think both of us realize that health is important. So it’s not to say that.

 

00;08;29;29 – 00;08;48;10

Dr. Mona

It’s not to say that we are allowing people in smaller bodies, larger bodies, to just do whatever they want with nutrition and not exercise. This is so much more than that. And I think that can sometimes get lost. I think I, you know, I am a very big proponent also on body image and, loving our bodies and teaching how our children from a young age to love our bodies.

 

00;08;48;10 – 00;09;07;22

Dr. Mona

So the phrases we use not only in medical systems but with parents, right. Like how we talk about holidays and how we talk at the dinner table, like all of that really matters because loving yourself, including your body, is such an important thing that kids need to realize. And if any of this messaging gets under our skin like that, you don’t need to be doing this.

 

00;09;07;22 – 00;09;17;00

Dr. Mona

Or why are you doing this? And if it’s a shame filled thing, it becomes we can’t have more of an impact, right? Like when there’s shame in the driver’s seat, driving that education.

 

00;09;17;02 – 00;09;41;10

Dr. Tommy Martin

Yeah, for sure. And I think that it could be a repetitive cycle. Right. So, like, they hear these things, they feel bad about themselves. Then they go to eating as like a comfort measure. They hear more of these things and it just kind of repeats the cycle. But I did want to answer your question about some of the comments that I had as a child that maybe necessarily wasn’t just from a doctor, but from peers, loved ones that maybe they didn’t even realize that they were hurtful, but they were hurtful.

 

00;09;41;16 – 00;10;02;10

Dr. Tommy Martin

And so comments just, as simple as, are you really going to eat that or are you, do you sure you need are you sure that you need another helping? Are you sure you should go up for a second? So those are like comments that maybe my loved ones, my family members would say at events or gatherings and just talking about, like, the quantity of food that I was eating in a dismissive way.

 

00;10;02;15 – 00;10;17;26

Dr. Tommy Martin

And that is hurtful. Or, are you sure you should eat ice cream? Are you sure you should eat a piece of cake? You know, like, whereas if someone in a smaller body is eating a piece of cake or ice cream after dinner, they don’t say a word, right? But as soon as someone larger does, then it’s, you know, this terrible thing.

 

00;10;17;26 – 00;10;35;17

Dr. Tommy Martin

And that’s something we see on social media a lot, as well as when we see these, like what I eat in a day videos. If it’s someone that is in a larger body, regardless, they could eat 99% whole foods, but if they have one treat or something during the day, like the comment section would just be filled with shame and blame about that person’s weight.

 

00;10;35;17 – 00;11;03;05

Dr. Tommy Martin

Because that one thing that they ate. So I would say that those are some of the comments that I receive from my family members, but then from my peers would be, you know, being called fat. If I were to go to, like, say, the pool with my friends and have my shirt off, which I would never do because I was so ashamed, but they would talk about, like, the size of my chest or the size of my stomach, or maybe if I had stretch marks on my stomach and like, just constantly making those comments about my size and about my body.

 

00;11;03;08 – 00;11;22;11

Dr. Mona

And that’s so hurtful. I mean, especially any age, especially from a young age when a child is developing that self-worth and developing that identity, and having that identity tied to their body image. Right. And I know you spoken about that. Like tying worth to appearance is such a harmful thing, not only for weight but also for looks.

 

00;11;22;11 – 00;11;47;00

Dr. Mona

Right? Like, oh, you are just so pretty. You’re so cute. All that stuff. And I mean, kids are cute, right? We say that, but their value should not be tied to like, oh, that pretty dress or you look like this. Like, it’s such a metric about appearance, which can be really harmful. And I mean, my story is obviously from another perspective, knowing that, yes, I want to be very clear before I get into my story that society still does that sort of discrimination about the what you mentioned perfectly.

 

00;11;47;00 – 00;12;08;25

Dr. Mona

Like if a larger body person has an M&M, it’s like, oh, well, if a smaller, a smaller body person does all the same thing has like, oh, look at that balance, right? Yeah, look at that balance that that person is just, you know, getting to enjoy. But you’re right now the what happened being in a smaller frame as well as my husband who’s a male and I’m going to speak to both of our experiences.

 

00;12;08;27 – 00;12;30;00

Dr. Mona

It’s it’s the smaller body ended up at those parties being like, you’re not eating enough, are you okay? Are you stressed? Eat more, eat more. So also in an unhealthy way. I didn’t listen to my fullness cues, right. I started getting disordered eating in that I would eat very high carb, high processed foods. And the thought that that was what’s going to make me gain weight, right?

 

00;12;30;00 – 00;12;45;25

Dr. Mona

So I leaned on a lot of carbs. I didn’t look at the health value of these foods. I would eat like loaded tater tots, thinking, well, this will add on fat to my body, but that’s not good to eat, right? Like we have to think about like, yes, and once in a while it’s fine. But is that my main meal?

 

00;12;45;25 – 00;13;02;20

Dr. Mona

And I look at that. By my 20s I had high cholesterol because of the impact of you need to eat more, you’re not eating enough. You’re so skinny. I still remember, like I did track in high school and the commentary like I got when I won a best like Most Improved award for my coach in front of everybody.

 

00;13;02;20 – 00;13;22;13

Dr. Mona

He’s like making jokes about how I’m surprised the wind didn’t blow her over because of how thin I was. Right. And to the same effect that has a huge impact on how I viewed my body as this week. Not capable body, right? That I was very skinny, like thin. Like I was literally what people would describe as gaunt skin and bones.

 

00;13;22;17 – 00;13;42;10

Dr. Mona

And no boy is ever going to love you because you don’t have any curves. And that I offer this perspective because we, we, we focus a lot on larger bodies. And I think there’s obviously some societal stigma that doesn’t exist for, people in smaller bodies. But kids are listening to those messages, whether you’re in a larger or whether you are in a smaller body.

 

00;13;42;10 – 00;14;02;14

Dr. Mona

And I see it in my office. So it’s really like it’s a very nuanced conversation. But I see those body image struggles all spectrums. Right? And the messages that come across, regardless of any body type, it’s so stressful. Right. And in the younger, in the smaller bodies, it’s the, you need to eat more or the pressure to eat like the finish finish your plate club.

 

00;14;02;19 – 00;14;21;22

Dr. Mona

And I see that in my peers who have petite young children that are like, you got to finish your plate. But we know that that’s not healthy. That’s just as unhealthy as it is to tell someone, well, why are you eating that? Like you shouldn’t be eating that cake. Like controlling what people are putting in and out of their mouth, like when it comes to food and saying, you can eat that.

 

00;14;21;25 – 00;14;43;15

Dr. Mona

And that’s when it goes back to holding these foods to standards, right? Like and in smaller body people, it’s almost like you don’t care because you’re like, just get the calories in. But right now does matter. Like you should be eating protein. You should be having balanced food. I should not be stuffing my body full of chips and and sugar and soda all day, because in that things in the thought that will I need to gain weight.

 

00;14;43;19 – 00;14;53;04

Dr. Mona

And this is what’s going to gain me the weight that’s not healthy weight, right? So that is just a perspective that I love, that we get to talk about, because it’s a spectrum of like, just stop talking to people’s bodies.

 

00;14;53;04 – 00;15;11;03

Dr. Tommy Martin

Like, yeah, when like I could not agree more and I’m so glad that you brought that up because you’re correct. And unfortunately, the society we live in today, like your body, will never be good enough. Right? So like for my journey. So I was very overweight as a kid and then I got made fun of all the time for being fat.

 

00;15;11;04 – 00;15;27;26

Dr. Tommy Martin

I was like, you know what I’m sick of getting made fun of for being fat. I’m going to lose a lot of weight. So over a summer, I went from weighing about 180 pounds down to 129. I think it’s the lowest that I got. So and truthfully unhealthy, like it was very unhealthy. All I ate was grilled chicken and cheese.

 

00;15;27;26 – 00;15;44;08

Dr. Tommy Martin

Like that’s pretty much like what I ate every single day for three meals a day. And I would lift every single day. And so I went from being 180 pounds to 129 and lost a ton of weight. Well then when football started up that fall, my coach said, what in the world happened to you? Like you’re way too small, like you’ll never play football.

 

00;15;44;08 – 00;16;05;23

Dr. Tommy Martin

You can’t play football being that size and and so I was now like, I wasn’t good enough at being larger. Now I’m not good enough being too small so that I was like, okay, then I need to lift weights all the time. And so it just continually shifted the paradigm of me not being good enough. My body being the standard that is set that needs to be of whatever everybody else thinks it needs to be in.

 

00;16;05;23 – 00;16;29;13

Dr. Tommy Martin

I need to strive to achieve that in every time I would achieve it. It was still not good enough. And so I think an important message is that your body does not dictate your worth, and your body does not dictate your value, and do not let societal standards put that value or worth tag on you, and you try to achieve it because it just it will never work, it’ll never happen, and your worth is not tied to your body.

 

00;16;29;15 – 00;16;41;18

Dr. Mona

I think we can end the episode there. What I what a mess. And no, we’re not because I have a lot to talk about, but I. I love that I feel the same way. And I think, you know, that’s why when we were chatting about what to talk about, I was like, tell me, we could talk about, like, so many different things.

 

00;16;41;18 – 00;16;56;13

Dr. Mona

But I love that you always talk about this sort of, you know, how we speak about ourselves and how we speak about our body. I think it’s just so valuable. And this goes down to teaching this from a very young age. Right? And, you know, you brought up at the beginning that the first thing that we do is we get on that scale.

 

00;16;56;16 – 00;17;11;29

Dr. Mona

You know, I not I know a lot of our listeners who may have been pregnant at some point felt that same that same stress, like when you’re pregnant and your body has already changed and you might you yourself may be struggling with the fact that your body looks different, can’t move like you used to move, and all of that.

 

00;17;11;29 – 00;17;27;16

Dr. Mona

And then you get on that scale and you see the 50 pound weight gain or the 20 pound weight gain. There’s so much anxiety and there’s so much feeling of like, well, why is this the first thing that I’m doing when I walk in here? And I want to I want to just really be clear about that in general in pediatrics.

 

00;17;27;16 – 00;17;46;24

Dr. Mona

So like, obviously I’m dealing with kids are up till 21. The the weight weighing is really only useful under the age of like for like or under the weight of like 44 pounds when we need to know weight based dosing. Right. Like that’s just a lot of medications are weight based right. So it’s a nice way for us to know what is it going to be your weight so that we can calculate dosing.

 

00;17;46;26 – 00;18;10;09

Dr. Mona

Really. Besides that I like to look I like to like I like to have that weight to be able to trend what was going on for the child right before. So it’s not like I don’t care if the child is on the 90 percentile. I’m like fifth percentile. I just want to know, are we showing any sort of stark increases, stark drops in the weight because that can be indicative of like thyroid disorders or, you know, an eating disorder or things like that.

 

00;18;10;09 – 00;18;29;29

Dr. Mona

So it’s those drastic things. So we’ll kind of get into in a little bit about like if you don’t want to be weighed, how to approach that. But knowing all of this information, you know, you’re now caring for both kids and adults. So you see the whole spectrum. How did your own childhood experience shape how you talk about weight, health and body image with your patients today?

 

00;18;29;29 – 00;18;34;26

Dr. Mona

And did that look different than how you were trained to talk about weight, with your patients?

 

00;18;34;29 – 00;18;50;25

Dr. Tommy Martin

Yeah, I think it has shaped 1,000% every word that I speak in a visit with, whether that be a child who may be struggling with their weight in their family, or an adult patient who’s struggling with their weight. So there’s a couple things that I do to start with. And that would be, let’s say it’s an adult patient.

 

00;18;50;27 – 00;19;10;29

Dr. Tommy Martin

An adult patient. First I will, you know, talk to them about their visit. One, if they do not want to weigh, if it’s not absolutely pertinent to the visit, then that’s completely up to them. You know, and so I won’t make them weigh their medications are not weight based dosing, you know. And so unless it’s like actually pertinent to the visit, I do not think weighing is absolutely necessary.

 

00;19;11;01 – 00;19;35;00

Dr. Tommy Martin

And then the second part of that would be in disclaimer I do inpatient medicine. So a lot of my stuff doesn’t involve weighing anyway, but weight still may come up in the conversation. So a lot of what I’m talking about is when I was in residency doing outpatient clinics, so then after we talk about why the patient was there for, and whether it has to do with later doesn’t have to do with weight.

 

00;19;35;02 – 00;19;51;20

Dr. Tommy Martin

Once we get to a, you know, a good place for me to talk to them about, let’s say. And are you interested in talking about your weight today or how do you feel about your weight? And depending on the answers to those questions, they may say, I feel great and I do not want to talk about it. And that’s completely okay.

 

00;19;51;20 – 00;20;06;29

Dr. Tommy Martin

Am I response to that? Is that fantastic? If there is ever a time that you want to talk about it, or you feel differently about it and want to know how it could or could not impact your health, I’m more than happy to talk to you about it, but please feel no pressure whatsoever. And so, you know, allowing them to talk about it when they’re ready.

 

00;20;06;29 – 00;20;39;29

Dr. Tommy Martin

And because I feel like physicians pressuring and making patients talk about it when they’re not in the space or headspace to talk about it, I think it’s just more detrimental than helpful. And then for children, I think we have to be very, very careful with the language and terminology we use. And so even when we’re looking at the growth chart, saying that they are, you know, it’s safe to say they’re in the 95th percentile, where if you say, well, you’re 95% larger than all of your peers, you know, like that automatically just comes off sounding kind of, you know, stigmatizing or bad.

 

00;20;40;02 – 00;20;58;14

Dr. Tommy Martin

And so I think talking to the parents and the patient about the child, about it in a way that these are markers that we look at just to see how you’re growing over time. And right now, it shows that you are growing consistently over time and your growth. You’re growing faster than your peers. And I think that is completely okay.

 

00;20;58;15 – 00;21;19;20

Dr. Tommy Martin

And if they’re on their normal trend, then I don’t think there’s other reasons to talk about, you know, diet and exercise. And even though I wouldn’t use those terminology, like if they’re following their trend and they’re consistently large for, height and weight, then that’s probably that they’re naturally a larger person.

 

00;21;19;22 – 00;21;46;11

Dr. Mona

Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show. Oh yeah, and I love that you brought that up, because it is, it is. There’s been many times in my outpatient world because I’m only outpatient, right? That I, I have this mentality like you do. And then I see a patient who’s coming from another clinician in my same practice who’s been told more of this narrative of either being overweight or obese or underweight.

 

00;21;46;11 – 00;22;02;14

Dr. Mona

You know, I talk about both because I see both. And then, a lot of the families are stressed about this, right? Because they’re like, well, what am I supposed to do? Because what’s happening is they put the label and then they’re not giving the health education, which we’ll get into of like, what does this mean? Like, what does it mean if I’m on the higher end?

 

00;22;02;14 – 00;22;23;01

Dr. Mona

And is it even something to be concerned about? Like you said, if that child has always been the 98th percentile and is also a larger, taller body, or just has always been on that weight and is active eating balanced, right. The family habitus is like that. I mean, they’re doing the things right. They’re not over consuming sugar over, you know, sugary drinks, all of that.

 

00;22;23;08 – 00;22;39;20

Dr. Mona

We’re going back to the lifestyle. Right. Like, what is it that we’re doing here? And that can be very stressful from the beginning. And, you know, a lot of you brought up, you know, curves and BMI and I think we could spend a lot, a lot of time talking about that. By the way, I am going to have a YouTube video, if not already.

 

00;22;39;20 – 00;22;56;16

Dr. Mona

You debuted by the time this episode airs about a deeper dive into the percentiles. What they mean BMI but for now, like BMI, is still used in some places, it has major limitations. What do you wish more parents would understand about the limitations of BMI, especially when it comes to growing bodies?

 

00;22;56;18 – 00;23;20;25

Dr. Tommy Martin

Yeah. Of course. So the first thing we need to know is that BMI is not an individual stat, right. So BMI is designed to be used for population studies. And it helps us look at very large groups of people using a standard number to kind of gauge size and distribution throughout a population. Using on an individual person can be like as you said, there’s a lot of variables that make it not the best tool to use.

 

00;23;21;01 – 00;23;40;07

Dr. Tommy Martin

And so BMI is a tool. It is not the only tool. So it is something that we use alongside of multiple other characteristics of the patient and their values and should not be used alone. So some of the limitations would be muscle mass, you know, children or adults that have much larger muscle mass. Their BMI is going to be drastic.

 

00;23;40;08 – 00;24;04;00

Dr. Tommy Martin

It’s going to be extremely, you know, inaccurate, in terms of like their overall health. It also, does not necessarily account for, just larger bodies in general and a fat distribution. And so what I mean by that is like, say that you have someone that is very large, just height, weight and everything. They have a good amount of muscle mass, but they have very low amount of abdominal adipose tissue.

 

00;24;04;05 – 00;24;29;07

Dr. Tommy Martin

Well, their BMI will still likely show that it’s larger, even though their fat distribution does not necessarily show for metabolic disease. So that’s a limitation as well. And so I think BMI is an okay tool. But I don’t think it should be the only tool that we should use. And again it has its limitations. And so when talking to families about it I don’t even know if I mentioned BMI that often, but rather just talk about growth in general.

 

00;24;29;07 – 00;24;57;23

Dr. Tommy Martin

Now, not saying that BMI should never be mentioned or never be talked about. I just think that it’s important to know its limitations. And so as a parent or as you know, someone that’s looking after a child, if your physician is just talking about BMI, it’s completely okay to ask them other questions about how they believe that BMI is affecting their child and if it is, or what other variables make them think that the elevated BMI number could potentially be harmful to the health of the child.

 

00;24;57;26 – 00;25;19;24

Dr. Mona

I love how you frame that, especially talking about the lack of looking at muscle mass. And then we know that from just the the way that it was created back in, I think the I looked it up the 1830s by mathematician, not a physician, the kind of looking again at a ratio. Right. And it doesn’t account for things like muscle mass, which is why sometimes if we talk about how it’s not, it can be racially biased, right?

 

00;25;19;24 – 00;25;38;05

Dr. Mona

Looking at black or African-American bodies, they tend to have a lot more muscle mass just from being blessed with that. And that can trigger up a higher BMI when they don’t have adipose tissue like you said, abdominal obesity, things like that. That can be a predictor for, you know, things down the line like diabetes or cholesterol, things like that.

 

00;25;38;08 – 00;26;04;20

Dr. Mona

And so it really isn’t representative of the entire population. And it sure as heck does not show genetic variability, ethnic variability. And I speak to my Indian crowd because Indian women and Indian kids are very lean, like we are just many of us are built very lean, even if we try to do all the weight lifting, which I’m doing, I’m still very lean and society can say, that’s awesome, that’s great.

 

00;26;04;26 – 00;26;23;23

Dr. Mona

But I still come back underweight, like I’m always listed as underweight. And my kids also are listed as underweight, even though they are so active, you know, going outside. And that also gets that sort of hey scrawny hey that I don’t like that. But again, going back to this terminology that’s equally to me as hurtful as other terminology for kids that get larger bodies.

 

00;26;23;23 – 00;26;37;07

Dr. Mona

Right. And like my final point of all this is, why are we just talking about bodies at all? Like, there’s no need. Like if you have any if something’s coming up in your lips and you’re like, oh, I want to comment on that, how the person looks, just shut it down.

 

00;26;37;09 – 00;26;38;20

Dr. Tommy Martin

And shut it down.

 

00;26;38;21 – 00;26;47;29

Dr. Mona

There is nothing. You’re not adding any value by saying you’re so scrawny. That pie. You should eat this like you don’t have any say. Right.

 

00;26;47;29 – 00;26;48;26

Dr. Tommy Martin

Yeah, I.

 

00;26;48;28 – 00;27;13;29

Dr. Mona

Yeah, I love that even the 2023 AP guidelines, by the way, on obesity, noted that BMI is an imperfect proxy for adipose adiposity and risk and racial ethnic differences in a body composition. So we know, like you said perfectly, that there are limitations to this is it useful? In some cases, yes. Maybe looking at tracking if there’s a very high, you know, obesity concern where we’re trying to really impact health.

 

00;27;13;29 – 00;27;33;25

Dr. Mona

But then it also goes back to how are we having those conversations. We’re not just putting that kid, that person’s value with the BMI or with the number and saying, well, we need to get your BMI or weight down to X, Y, and Z. That’s never going to work. Like it’s like the cardinal rule of me if I’m going to talk about health when parents come in and they’re like, what weight should my child be?

 

00;27;33;25 – 00;27;50;07

Dr. Mona

And I’m like, no, no, no, no, no, we’re not going to talk about that. Yeah, we’re going to talk about health and lifestyle. What are we drinking? What is our what do our meals look like. Do we need a nutritionist. Are you able to move your body speaking about access. Do you have access somewhere to move your body.

 

00;27;50;07 – 00;28;19;24

Dr. Mona

Like do you have access to parks? Because some of my community does not have safe access to outdoor activities. So it’s it’s important to understand context and that like you said earlier to me, that it’s not a sign of failure. It’s not a sign of anything more than sometimes it’s circumstantial that we’re not able to also have the ability to go outside and exercise or access to the healthy, balanced education of nutrition that I think everyone should get about not consuming high sugar drinks.

 

00;28;19;27 – 00;28;31;03

Dr. Mona

And also what is on our plates, right? Are we incorporating proteins and healthy carbs? And it’s not just about let’s do packaged foods, processed foods. And it’s that conversation. I think we need to have more of.

 

00;28;31;05 – 00;28;48;07

Dr. Tommy Martin

Yeah, I, I couldn’t agree more, but I want to ask you a question, but before I do so, I want to make a point that, you know, when we talk about weight in general and body size is something that we should understand as parents, as physicians, and just the general public. Is genetics play a huge role in this?

 

00;28;48;07 – 00;29;18;23

Dr. Tommy Martin

Okay. And so when people say, well, just don’t eat so much or just stop eating that, or, you know, comments like that, well, people have to understand that we’re not all playing on the same playing field in our genetics and our, our hormonal regulation throughout our bodies are very different. And so someone who may not struggle at all to maybe, you know, when they’re full to stop eating, someone else may have an extra extremely hard time to stop eating, even if their body cues are maybe saying that they’re a little bit full in.

 

00;29;18;23 – 00;29;40;23

Dr. Tommy Martin

A lot of that come from genetics. Another kind of hot topic in the obesity space is food noise. We know that some people experience severe food noise, and for people that do not know what that means, that is like this unrelenting noise inside your mind that is making you think of eating food where some people just don’t have that noise, they just do not have those thoughts.

 

00;29;40;25 – 00;29;57;19

Dr. Tommy Martin

And so one example, and I struggle with food noise extremely bad would be, let’s say my wife and I go out to dinner and she doesn’t eat all of her food, but I eat all of mine. My mind cannot stop thinking about eating her food until either it’s taken away off the table or until I eat it, and I will eat it until it’s gone.

 

00;29;57;19 – 00;30;15;11

Dr. Tommy Martin

And some people do not struggle with that at all. And a lot of people who suffer with obesity as a chronic medical disease suffer with that continually. And I remember even as a young child, not being able to stop thinking about food. And so I want people to know that not everyone is playing on the same playing field.

 

00;30;15;15 – 00;30;33;03

Dr. Tommy Martin

And just because your kid struggles with their weight, it does not mean that they lack willpower. It does not mean they lack motivation. It does not mean that something is wrong with them. It just means that their body is made up differently than maybe some of their peers who do not struggle with overeating or regulatory, appetite regulation.

 

00;30;33;06 – 00;30;50;11

Dr. Mona

I you’re the first person who taught me that term. I watched one of your videos and I, I mean, sounds like a term that I should know like that it’s such a simple term, but that food noise term, I was like, oh my gosh. Like, that’s that’s amazing. And I one of the videos I had seen because you’re also very educational about GLP ones, right?

 

00;30;50;11 – 00;31;10;23

Dr. Mona

Like things like, you know, ozempic and, and and Jaro and I, I’m also very, very interested in how beneficial it can be in conjunction with healthy lifestyle for sure. Exercise. And and you talked about that too. And I there’s a lot of stigma around GLP ones, like so much so that I’m like I and it’s interesting that I think I most physicians I know understand the benefit.

 

00;31;10;23 – 00;31;25;04

Dr. Mona

Right. We see it because we either I know a lot of people on it, or I have this education of being like, no, it makes sense when you can maybe shut down that food noise because you I think you would post a video about how that can help. Obviously humans are not for kids, but that’s beyond the point.

 

00;31;25;07 – 00;31;46;16

Dr. Mona

But it is something that’s very useful to understand and destigmatize because it is not like an even playing field. Do you think that food noise, do we have any idea where that food noise may come from? Is that something that comes through maybe an unhealthy relationship with food or people just kind of like developing that? If we don’t have any idea, that’s fine.

 

00;31;46;16 – 00;31;48;16

Dr. Mona

But I’m curious if we know how that can develop.

 

00;31;48;18 – 00;32;11;19

Dr. Tommy Martin

Yeah, research is still going on about it. And we it likely does involve the GLP one. The GLP one like hormone. Yes. In and so we know that some people just at baseline will have more food noise than others. Now there are things that we know can impact that. So lack of sleep increased stress.

 

00;32;11;22 – 00;32;28;14

Dr. Tommy Martin

You know, so like a lifestyle, things can impact that. But that doesn’t tell the whole story because we we know that we still have people who get plenty of sleep, who are not stressed, who exercise regularly and still struggle with food noise and struggle with their weight. And so I think as more research goes on, we all know a lot more about it.

 

00;32;28;17 – 00;32;47;15

Dr. Tommy Martin

But lifestyle changes can help with that. But even if you’re doing everything you know perfectly, some people may still struggle with that. So even when I get enough sleep, which is rare, but even when I get enough sleep and, you know, do all these things and I’m like a stress free person, I still struggle severely with food noise.

 

00;32;47;18 – 00;33;14;02

Dr. Tommy Martin

And so I think as the research goes on, we will learn a lot more about it. But to say, you know, lifestyle modifications should be paramount. That should be the foundation of everything. When we talk about health, medications and other things, surgical procedures, those are down the road when lifestyle modifications fail and when we cannot maintain weight neutrality and a weight that helps with metabolic dysfunction.

 

00;33;14;05 – 00;33;18;22

Dr. Tommy Martin

Then those other resources are available to help achieve a healthy weight.

 

00;33;18;25 – 00;33;36;10

Dr. Mona

Yeah, I love that. And so again, follow Doctor Tommy Martin because again, we’re talking about so much of what’s the advancements in the adult world. Obviously he is inpatient looking at adults and children. But I just love this, you know, breadth of knowledge that he provides. And I cannot wait to learn more through you. I will, if I can get information myself.

 

00;33;36;14 – 00;33;52;25

Dr. Tommy Martin

And I will say it’s a little controversial and I’m not going to we don’t have to go into it because it’s probably getting in the weeds. And I still want to ask you a question, but, GLP one agonist has been studied in children. And so it also shows that they have been safe and efficacious in children.

 

00;33;52;26 – 00;34;30;17

Dr. Tommy Martin

Yeah. And so there are some, places that are early adopters of using GLP one agonist in children. Now, again, there this is very controversial. And so if you’re like, I cannot believe that they’re saying these kids should be on these shots. Well, one know that there are oral options as well. But at the same time, I would just preface this by saying, in what world does it make sense that if we know obesity is a chronic medical disease and we are trying our hardest with diet and lifestyle changes to achieve weight neutrality and a healthy weight, but that we still cannot do it, that we withhold appropriate treatment options from our children

 

00;34;30;17 – 00;34;42;13

Dr. Tommy Martin

when we allow our adults to take them. So that’s the last thing I’ll say. But I will say it’s a controversial topic. More research will be coming out. And don’t let the comments with negativity.

 

00;34;42;15 – 00;35;05;02

Dr. Mona

So I had I didn’t know that. Right? I was like, oh, like that. But that makes sense because again, I see a positive benefit in adults and I see, like I have peers who are on it and I see well, and they’re they’re living happier lives as well. Like, you know, when you when the weight comes off and they’re still able to balance it with the nutrition and with the exercise, they’re happy, like, and I want people to feel happy about their body.

 

00;35;05;08 – 00;35;16;17

Dr. Mona

And I want people to feel healthier. And like you said, obesity is a chronic issue. And if they’ve been doing all the things, it’s an assistant. So let’s get back to, I, I know you have another question, but yeah. Go ahead.

 

00;35;16;20 – 00;35;48;17

Dr. Tommy Martin

What I wanted to ask you is, let’s say that we have a child in our clinic, right? And there weight percentile is much higher than their height percentile. Right. And so that this is showing that maybe this kid is struggling with their weight and it could impact their health later on whether that be elevated, liver enzymes or metabolic dysfunction, elevated A1, C and let’s say that you wanted just to see and the parents are okay getting those labs and the A1 C’s borderline to almost pre-diabetic and the Lfts are slightly bumped a little bit.

 

00;35;48;20 – 00;36;02;04

Dr. Tommy Martin

How do you and I mean, you obviously could turn and ask me this question as well. What are ways that you talk to the family about this? Like, this can be such a hard topic. And then is there an age range where you’re like, you know what, I feel comfortable talking to the child directly about this as well.

 

00;36;02;11 – 00;36;10;00

Dr. Tommy Martin

And the parents or, you know, vice versa. We should probably just talk to the parents about this. I think they’re a little too young to understand what’s going on.

 

00;36;10;02 – 00;36;26;25

Dr. Mona

There’s a few phrases and few things, and you already alluded to it about, like, not approaching it from a shameful way. Right. So this is a huge thing because I often talk about body image and then I get some endocrinologists, some, you know, doctors who are like, how can we just not talk about it like it’s a thing, like it’s their health?

 

00;36;26;25 – 00;36;44;10

Dr. Mona

And I said, this is not about denying that it can become a health issue, like you said, like high cholesterol. You know, obviously heart disease, things like that. So if a child truly has a health concern, meaning I’m worried that we’ve maybe let’s talk about if they’ve gone too high up on from visit to visit. And I saw that a lot in the pandemic over the summer.

 

00;36;44;10 – 00;37;03;12

Dr. Mona

Children who jumped like 40 pounds. Oh my gosh. Yeah. In the summer, because they were home, they weren’t doing anything like active. And I know and the conversation I have first is, hey, and it’s usually talking to both of them and depending on the child’s age, I’m talking to the parent. Maybe like I contact wise and I say, hey, I want to talk about your health, not about weight.

 

00;37;03;12 – 00;37;22;13

Dr. Mona

So the first question is, let’s talk about your health. How are you feeling? And like you know, I talk about like how they feel mentally, physically. That just sets the tone that I care about their physical and mental health. And then I do actually turn the percentile curve to them to show the trends. So because I care more about trends and I do percentiles.

 

00;37;22;13 – 00;37;40;21

Dr. Mona

So then first I say, hey, look, I don’t really care that your child is on this number or this number, but I want to show you how we’ve kind of, grown in the last three months. Right? So in the last three months, we we’ve kind of jumped a little bit here. And my question to you is, do we feel like there’s any changes that have been made, stress.

 

00;37;40;27 – 00;38;04;08

Dr. Mona

Has there been less exercise. Has there been, you know, different type of diet. So we’re opening now the conversation about the lifestyle. Right. So that is what we’re talking about. And then I always talk about how these are important conversations I have with all body types that I think it’s really important, because I find that we tend to think that it’s only the larger body children that are drinking the sugary drinks and right, unhealthy.

 

00;38;04;08 – 00;38;22;18

Dr. Mona

But I can tell you, as someone who is in a smaller body, I needed those conversations to right, like it’s not healthy for me to be drinking sugary drinks and like all that stuff all the time on a regular basis. So I talk about how in any body type, one of the most important thing that I need to hear is, what are we doing to support that health, right.

 

00;38;22;24 – 00;38;43;19

Dr. Mona

And I go back to what we had said. I had said earlier about how some parents are like, what weight do we need to get to? And I say, I don’t have a number. I want your child to get to. What I want to focus on is we are making goals on lifestyle. So if the child is drinking a lot of sugary drinks, right, because that is usually one of the biggest things that I see in children when they talk.

 

00;38;43;19 – 00;39;04;29

Dr. Mona

When we’re talking about nutrition, I say, I know that you love your soda. I don’t say, just get rid of it. I say, I know you love your soda. How can we remove that slowly? Maybe instead of every day we are going to go to every other day. Or maybe we go to special occasions, like when we go out to dinner or a party and we come up with like a team approach of like, how are we going to reduce that volume?

 

00;39;05;06 – 00;39;22;09

Dr. Mona

Or when it comes to food, I’m not a nutritionist, so I always offer nutrition education, like with a specialist. I’m saying one of the beautiful things about this is that we can really get to be able to incorporate some of his or her favorites with all these other foods, right? Because I don’t believe that we go cold turkey and say, get it all out now.

 

00;39;22;12 – 00;39;39;06

Dr. Mona

Do all this now because they had a desire for that. Their food noise, if they have it is going to be like, I need that sugar or I need that cookie. But we talk about what are some baby steps we can make and do we want a nutritionist? And then I talk about how my goal here is health and not numbers.

 

00;39;39;11 – 00;39;59;08

Dr. Mona

My goal is that we can get your child so that we can make sure that their their cholesterol levels go down. And I do believe that we can do that with the healthy, education about nutrition, lifestyle, all of that. And I think when we approach it from a level of, I’m on your team, that I’m not your enemy, I’m not trying to tell you I’m not coming from a place of shame.

 

00;39;59;13 – 00;40;21;07

Dr. Mona

I’m not coming from a place of how come you’re not doing that? It’s from a place of I know you’re capable of doing all these lifestyle changes. And I also incorporate the parents, too. And I say, mom, dad, I want you to get on board with this, too. You know, I think it’s important for your health as well, that we think about, you know, how can we approach the exercise, the nutrition, the drinks that we’re drinking, the snacking.

 

00;40;21;12 – 00;40;40;26

Dr. Mona

Right. Because all of that are little things that we may not think about that can add to the health of us. And I always go back to the fact that I, every clinician, should be having these same conversations with all children, regardless of how their body looks. And I think when it comes in, the stigma comes in, is that we tend to only talk about it if the weight time.

 

00;40;40;29 – 00;40;43;24

Dr. Tommy Martin

But right or severely low or whatever it may be. Right?

 

00;40;43;24 – 00;41;15;13

Dr. Mona

Yeah, yeah, but we should. And even so, going back to the under eat like the underweight philosophy is the forcing of the food. Right. Like the forcing of the food is something I commonly see in lower weighted children, which is not healthy because then they grow up with disordered eating, that they don’t listen to their cues. And so then I see the child who whose family maybe on the larger or the child’s on the larger end, and they are forcing food because culturally, like I think about a lot of my cultural families and I’m going to throw this in my Latina families, they love their children to be well-fed.

 

00;41;15;19 – 00;41;33;08

Dr. Mona

They want their children to that. That’s how they show their love. But I also want to remind them that love can be showed in different ways, but that we also have to not force them to finish their plate or force them, and then they’re coming in. Some of those kids are coming in with larger bodies and dealing with childhood obesity or diabetes from a young age.

 

00;41;33;08 – 00;41;52;02

Dr. Mona

So this is not a conversation about that. We don’t care about the health. I absolutely care about diabetes at a young age. High cholesterol, heart disease down the line. But it’s approaching from a place of less shame. It’s having that team made approach on what are we going to do and what’s our next step like our we’re going to do like reduction of, sugary drinks.

 

00;41;52;07 – 00;42;13;07

Dr. Mona

I want to see you guys in three months. We may weigh you, but I want to be clear that this is not the goal to get down to a certain weight. So please do not weigh yourself at home. Please don’t fixate on the fact that I didn’t lose the weight in two weeks, because that is when, as you and I both know, with weight loss, that is when the psychology comes in and you think that you failed and then you go back to your old ways, right?

 

00;42;13;15 – 00;42;28;23

Dr. Mona

Oh my God, I’ve been making all these changes and I’m still the same weight or I gained weight. This is a failure. And then now you’re like effort. I’m going to go back to doing what I was doing. And I always say focus on the big steps here. You know, focus on we are going to get reduce this.

 

00;42;28;23 – 00;42;50;09

Dr. Mona

We are going to increase our physical activity. Here are some indoor physical activity, things that we can do. And the biggest gripe I have about all this is that in general pediatrics, I know all this information, but I don’t have all the time in the world to be able to educate this, which is why I have podcasts like this is why I had to read it, because I was like, I know what I want to tell these families.

 

00;42;50;09 – 00;43;05;15

Dr. Mona

Yeah, I want to educate them on lifestyle and what that means to me. You know, it doesn’t mean you’re on a number on a scale that is like, awesome. You met that weight because that’s when failure is going to. And I’ve had so many situations where parents are like, I need to get him down to a certain weight.

 

00;43;05;15 – 00;43;28;22

Dr. Mona

I’m like, I’m not going to help you do that, but I can help you is how are we going to approach lifestyle and how are we going to re establish a healthy relationship with food for that child in front of you? Because that, to me, is what’s going to help the most in body image, right? That the child doesn’t look at food as an enemy, it looks at food as this is what’s going to heal my body, or this is what’s going to make me feel good, because sugar is yummy.

 

00;43;28;22 – 00;43;45;18

Dr. Mona

Like I don’t want the kid to remove cakes and sweets because I love cakes and sweets. And I think when we vilify and like you said, put things as good and bad and platforms we create this sort of mentality that, yeah, you’re this way with your body because you ate this. And that’s such a stigma and it’s so hurtful.

 

00;43;45;24 – 00;44;10;04

Dr. Tommy Martin

Yeah, yeah. There’s so many things you said that that I think were just so, so valuable. One big takeaway that I just loved was like the the example of someone drinking soda and instead of like completely eliminating it, you know, having it every other day or having it as, you know, when you go out to dinner or something like that, because, you know, what that does is what people do not realize is if that is something that you’re having every day, even just that reduction is going to make a huge difference.

 

00;44;10;04 – 00;44;30;01

Dr. Tommy Martin

Like, yeah, it’s you don’t have to make these like black and white, cold turkey decisions like small changes can have an astronomical impact in your life. And so I just love that example and something that I also ask my kiddos and even adults for that matters. What would you like your body to be able to do? Yeah.

 

00;44;30;03 – 00;44;58;13

Dr. Tommy Martin

And depending, you know, a lot of kids will I want to be good at soccer. I want to be good at football. I want to, you know, do these things. I want to be able to, you know, run real fast or whatever it may be, and then to talk about, you know, their, nutrition habits and their exercise habits to achieve certain goals in that, to make their body do incredible things rather than reducing their body to a certain size or gaining their body to a certain size, rather fueling it to be able to perform in the way they want it to.

 

00;44;58;18 – 00;45;31;10

Dr. Tommy Martin

And not only in just athletics. It could be in school. Are you feeling tired all the time in school? Are you, you know, having to take a nap as soon as you get home? Or do you not feel good throughout the day? And so making sure that we’re thinking of our body and like, how can we help our body perform the best in academics and athletics and performance and all of these things, and then approaching it from, well, is there anything in your current nutrition that you feel maybe isn’t fueling it, or giving it the nutrients it needs to perform the way that you want it to, and then allowing them to kind of

 

00;45;31;10 – 00;45;46;12

Dr. Tommy Martin

tell me what those things may be, and then asking them, are there ways that you think we could change it to help fuel your body better? And they may have no idea. And that’s where we have the opportunity to talk to them about the benefits of fruits and vegetables and protein and lean meats and things of that nature.

 

00;45;46;20 – 00;46;12;05

Dr. Tommy Martin

The other aspect I always bring up when we’re talking about lifestyle changes is sleep. And I’m a hypocrite in saying this because I do not get enough sleep. But, at a young age and all throughout childhood, adolescence, going into college and even as an adult, sleep is extremely important for hunger regulation and for recovery. And if we’re not getting an adequate good sleep, it is definitely going to throw off our hunger hormones, ghrelin and leptin.

 

00;46;12;12 – 00;46;22;11

Dr. Tommy Martin

And when those are out of whack, you can try as hard as you want, but it could be nearly impossible to maintain weight neutrality and control your eating.

 

00;46;22;13 – 00;46;44;16

Dr. Mona

Now, let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show. Oh yeah, I love what you say about that. And for my, you know, one for all the parents listening, one of the biggest things is how we speak about that. Like whenever my son is sick, whenever my son is dealing with something and then he starts to feel better, I always remind him, like, do you know why you’re feeling better?

 

00;46;44;22 – 00;47;02;23

Dr. Mona

It’s because you slept. It’s because you ate a very like you ate a very diet, right? Meaning it’s like reminding them that we are feeling better in illness and health because of the things that we do for our life, so that he always understands that, sleep is important. Eating varieties important. You know, obviously these things are real.

 

00;47;02;24 – 00;47;17;21

Dr. Mona

So it’s it’s I love that you say that because it is about what do you want your body to do, the functionality. And, you know, I’m very into functional fitness. So my I have a personal trainer. I’m very blessed to have him. And we focus on function like how is your body capable of moving? What are you able to do?

 

00;47;17;21 – 00;47;40;01

Dr. Mona

Versus he doesn’t want scales. He we don’t do weight weigh ins. There is no like esthetic demands. But that ended up coming if that made sense. Like through the lifestyle and the focusing on the body function and how it makes me feel, it’s really healthy and you know, it’s it is. I’m not I believe and I know this, but eating processed foods every day is not going to make us feel good.

 

00;47;40;01 – 00;48;01;00

Dr. Mona

And I think anyone can say that. Like if you are eating processed foods every single day, you are not going to feel as energetic clear as eating a very diet every day, right? Like if you’re not drinking water, you’re going to feel that same thing. But focusing on like, I love this, I love eating my Takis, or I love eating my Flamin Hot Cheetos, but some days I’m not going to eat it because I want to get something different.

 

00;48;01;00 – 00;48;20;10

Dr. Mona

And like our approach matters to like how we destigmatize that with our time. Let’s I have a question for you about, like how how other ways that you think this weight bias shows up in health care settings. We talked about how the BMI, but do you think it shows up in any other way, like in terms of like how we talk to the families or the stigma or things like that?

 

00;48;20;13 – 00;48;42;26

Dr. Tommy Martin

Oh, 1,000%. I think unfortunately, because of the stigma that society has given people living in a larger body or a much smaller body that can shape the entire conversation. So, for example, let’s say that we have a kid that comes in with knee pain and this kid happens to be in the 99th percentile. Whether it be true or not true.

 

00;48;42;29 – 00;49;08;10

Dr. Tommy Martin

And for a kid, I’d say maybe not true. The I think that physicians would have bias to say, well, if you lose weight, maybe your knees would, you know, like I’ve heard that so often. Or if you lose weight, maybe your back wouldn’t hurt. And, you know, I think physicians anchoring on those, concepts are not only extremely stigmatizing and not fair to the patients, but it’s also a great way to miss something serious.

 

00;49;08;17 – 00;49;34;01

Dr. Tommy Martin

You know what? If it was a septic arthritis in the knee or, you know, like, what if they tore their ACL, meniscus or whatever it may be, but we are just like, well, if you lose some weight, you know, you could get that off. And so I think unfortunately, weight bias infiltrates every aspect of health care. And I think that unless you check your bias and really evaluate if you do have a bias towards those who may be living in a larger body, then you will not be able to provide the best care.

 

00;49;34;04 – 00;49;56;04

Dr. Mona

Yeah. And I think I’m going to link this, but there was a 2012 study in obesity reviews like a journal that physicians spend less time providing less education, showing less respect for patients with higher body weights. And this has been shown in pediatrics too. And you said it perfectly. And a lot of the times, the assumption and misconception, I think, coming from some of these clinicians is that they’re not going to change or what’s the purpose, right.

 

00;49;56;04 – 00;50;16;01

Dr. Mona

Like, what are we going to do here? So not only like you said, are we missing valuable things that we are dismissive of, of like, hey, this could be something more. And you’re also not providing that education. I do it because I want to educate all my families, but that is a huge, huge loss to the patient doctor relationship and also just to the health of the of the person.

 

00;50;16;07 – 00;50;20;04

Dr. Mona

I mean, I’ll say, and then they’re less likely to seek care in the future, right?

 

00;50;20;06 – 00;50;32;29

Dr. Tommy Martin

And when in reality these patients probably need more of our time, right? Yes. They are already feeling stigmatized and not wanted and not worthy by the entire world. Then to feel that by their doctor like, that’s not okay.

 

00;50;33;01 – 00;50;54;07

Dr. Mona

Yeah. And then my last big, kind of topic is these harms of these labels in general, like you obviously talked about how it can create a we talked about how it can create an unhealthy relationship with food. Anything else you’d want to add to the harms of these labels, like obese or underweight? As it, you know, whether it’s from the medical community or whether it’s from just society.

 

00;50;54;10 – 00;51;13;06

Dr. Tommy Martin

Yeah. I think you and I both kid. I hate to speak for you, but just based off what you’ve said so far, one example would be body dysmorphia. Right? And so I talked about my weight as a child being very large. And even though I’m fit and active now and stay relatively lean, because of my activity level, I still struggle with that.

 

00;51;13;06 – 00;51;30;11

Dr. Tommy Martin

Right? Like, it’s it’s insane. But I go to the beach with my family and I’m apprehensive to take my shirt off at the beach. Right? Like in what world does that make sense? That, you know, that I had to be judged so hard as a kid that I still deal with some of that trauma today. Right. And so I think that is a huge aspect of it.

 

00;51;30;11 – 00;51;54;29

Dr. Tommy Martin

And whether it be a larger body or smaller body, like I have had patients who may be living in a thinner body, who will wear very baggy clothes because they don’t want people to comment on how thin they are, you know. And so I think that body dysmorphia, is a, could be a result of that. And then also, anxiety and depression, we see those rates go much higher in people who deal with these issues as well.

 

00;51;55;06 – 00;52;09;13

Dr. Tommy Martin

And so I think it it impacts our, like our entire health, not just our physical health, but our mental health, our emotional health, our social health. So I think it impacts every avenue of health, and it has to be something that we work towards improving.

 

00;52;09;15 – 00;52;25;07

Dr. Mona

And, you know, I pulled some stats and data because I was very interested in this topic. And, one of the things I saw is that children as young as three years of age internalize weight based stereotypes, which is why I think we’re having this conversation about the medical system, because a lot of this is coming from the medical system.

 

00;52;25;07 – 00;52;49;00

Dr. Mona

When we talk about percentiles, talk about we talk about nutrition in the office to a parent who then can pass that on. Right? So, for example, if a parent’s coming in hearing from a respected person, like a doctor, like your child is overweight, your child is underweight, your child is X, Y, and Z is a label. Then the parent can start to do things at mealtimes and you like restricting or brushing all the things that we’re talking about.

 

00;52;49;06 – 00;53;06;01

Dr. Mona

And again, that can contribute to the unhealthy relationship with food. You talked about the depression disordered eating, which yes, that is absolutely reality. And I’m going to attach all these links of, data that supports this. We talked about delayed care because if there’s a stigma right, like that, they’re not going to want to show up to these visits.

 

00;53;06;04 – 00;53;32;00

Dr. Mona

And then my thing always goes back to that psychology. If I’m actually going to want to make an impact in someone’s life for health, I got to not shame them to start the conversation. Right? Like, right is common sense in anything. In anything. I mean it to me, it seems natural. But if I’m going to get through anybody to call them names and say, well, you don’t do this or you’re this, whether it’s about vaccines, whether it’s about weight, whether it’s about whatever approach we’re doing, shame is not the answer.

 

00;53;32;00 – 00;53;58;15

Dr. Mona

It’s collaboration. It’s, hey, I’m on your team here. And, you know, I, I have some little phrases that we can throw in on, like how, you know, you can kind of empower yourself in the waiting room and, you know, like when you’re going to these visits and I want to throw these in too, like, if you are finding yourself in the situation where you are trying as a parent to create a healthy body image and your doctor may do a lot of something different, remember that you can advocate for that.

 

00;53;58;21 – 00;54;18;15

Dr. Mona

You can say things like, I prefer we avoid terms like obese or overweight in front of my child. We’re working on supporting body confidence at home. What other markers are you seeing in my child’s growth or labs that gives you concern or reassurance, like what are the good things? Can we talk about the good things? And then sometimes doctors, you know, bring up things like wait in front of the child.

 

00;54;18;15 – 00;54;34;01

Dr. Mona

So if they do, you can talk to your child before or after in case that was unexpected and say, I want you to know that your body’s not the problem. And we’re going to focus on how you feel, not just your numbers. Right. Like and that should be something that we as medical professionals should also be doing.

 

00;54;34;01 – 00;54;54;24

Dr. Mona

So I hope that people listening are not just parents, but also medical professionals, because I have seen this and I’m like, no, no, no, no, no, I’m taking I’m taking this overweight thing off your chart. Like, I don’t want this on your chart because we’re not that we’re there’s no label needed here. Like, you’re not overweight. You’re this is your body and it’s you’re doing the things we need to do.

 

00;54;54;28 – 00;55;03;21

Dr. Mona

If there is an issue of high cholesterol, I will have to mark that down. And but it means that we’re going to work towards it with a lifestyle, you know. And I think that’s okay.

 

00;55;03;23 – 00;55;20;24

Dr. Tommy Martin

Yeah. That’s that’s I think so important. And one last thing I want to say to the parents is that one of the number one ways that you could help your child, and it has nothing to do with you talking about their weight or their size, but is by you actively living out the lifestyle and doing it together as a family.

 

00;55;20;24 – 00;55;48;02

Dr. Tommy Martin

And so whether that be that you guys go on a family walk together or you guys cook a dinner together and you teach them that you’re cooking vegetables and you guys are eating fruit in lean meats, not fried in oils and things of that nature that you guys do this as a family and you make it fun together so that then you guys create this healthy lifestyle that not only is going to benefit your child’s health, but also your family’s health, your partner’s health, and hopefully do it, in a way that you guys all enjoy and thrive together.

 

00;55;48;05 – 00;56;04;21

Dr. Mona

I love that it is. It is a family approach, like the modeling. All of it. Well, that was going to be my last question about the final uplifting message. So would that be your final uplifting message or anything else that you would like to tell our listeners, before they go on with their day and feel empowered to talk about health and not numbers?

 

00;56;04;24 – 00;56;23;27

Dr. Tommy Martin

Yes, of course, I think my uplifting message would just be what I would tell my ten year old self, and that is that, your value and your worth is not tied up into your weight, your size, the number on a scale or the size of your genes. It’s not tied up in what the world may say to you or how society labels you.

 

00;56;23;29 – 00;56;47;07

Dr. Tommy Martin

So please ignore all of those comments that you may hear. Focus on what your body can do, and challenge your body to do things that you’re maybe unsure if you can do. And then you’ll be. You’ll surprise yourself when you strive towards those and accomplish them. Because I promise that you are so much more, powerful and stronger, than you could ever imagine and definitely stronger than what this world has told you.

 

00;56;47;10 – 00;56;56;02

Dr. Tommy Martin

So do not listen to the labels. Do not allow the weight or scale to define your worth, and know that you are extremely, extremely valuable and capable.

 

00;56;56;05 – 00;57;10;08

Dr. Mona

I feel that so strongly and I just love this conversation. I know we’re going to have more episodes. I know you have a podcast, but tell us where everyone can go to stay connected, including your socials again, and also your show, your new podcast. So tell us.

 

00;57;10;08 – 00;57;29;27

Dr. Tommy Martin

Why. Yeah, of course. Mona, thank you so much for having me. So if you want to stay closer, connected with myself and what I do on social media, my handles are just doctor Dot, Tommy Martin pretty much on every single platform. And then I have a podcast that just came out two weeks ago called We Are Human, where we dive into the, the lives of those who work in health care but do not allow healthcare to define them.

 

00;57;29;27 – 00;57;39;00

Dr. Tommy Martin

So highlighting their passions and what they pursue outside of medicine while staying human in medicine and would love to connect with you guys. So I hope to see you guys on my channels.

 

00;57;39;03 – 00;57;58;05

Dr. Mona

I will be attaching all of that in our show notes. And again, you really must follow Doctor Tommy. Like I said, not only is he good at educating, but he’s just a happy person. And I know life is tough. I mean, that’s what I like. Doctor Tommy is not immune to life struggles, but he just gives the world a lot of positivity, even when he talks about hard things.

 

00;57;58;05 – 00;58;16;29

Dr. Mona

And I try to do the same thing as well. And so I love seeing fellow physicians really trying to uplift people with positivity, being real when we need to be real, but also showing life struggles and really empowering not only adults, but children being a medical, you know, internal medicine and pediatric doctor. So thank you, Tommy. I am just so excited we could connect today.

 

00;58;17;02 – 00;58;22;01

Dr. Tommy Martin

Hey, Sam, thanks for having me. Mona.

 

00;58;22;03 – 00;58;40;02

Dr. Mona

That is a wrap on today’s conversation, and I hope it left you thinking about how we talked to our kids, how we define health, and how much of those early messages can shape a child’s self-worth. We can do better as clinicians, as parents, as a culture, because bodies aren’t always a problem to fix, their homes to take care of.

 

00;58;40;02 – 00;59;05;17

Dr. Mona

And when we shift the focus from size to self-care, from BMI to health and lifestyle choices, from shame to support, we help kids grow up with confidence, compassion, and a much healthier relationship with themselves. If this episode resonated with you, share it with a friend. Tag me @thePedsDocTalkpodcast and @PedsDocTalk tag doctor, Dr. Dot, Tommy, Tommy Y.

 

00;59;05;18 – 00;59;23;01

Dr. Mona

Martin and most importantly, download and subscribe. It truly helps the show grow and keeps these important topics on the table. Until next time, stay clean, stay curious and keep doing the work. Thank you for being here and for being committed to this parenting every week. I’ll catch you all next time.