Diet culture is still prominent in 2022 and I welcome Diana Rice, a registered Dietician and owner of Tiny Seed Family Nutrition to discuss how we should approach conversations about weight and health for our kids.

We discuss:

• Why “eat less and move more” is problematic advice
• Why dieting is never the answer
• How we can approach conversations about health with a health mindset versus a weight-goal mindset

To find out more about Diana Rice and Tiny Seed Family Nutrition, visit her website at Tinyseednutrition.com, where you can find 1:1 coaching sessions, monthly text-based coaching memberships and much more.

00;00;01;00 – 00;00;26;25

Diana Rice

Weight in and of itself is not a problem. I mean, if it’s cardiovascular function or something on their blood values, that is out of range. If something in the dietary pattern is heavier on one nutrient and lower on the other, these are all individual things, you know, what is the person actually, what are their complaints? You know, maybe they don’t have any complaints about, you know, their cardiovascular function or whatever that is.

 

00;00;26;28 – 00;00;48;24

Dr. Mona

Hello, everyone. Welcome back to the show. I continue to get to talk to the most amazing guests on my podcast, and today is going to be a no different. We get to have conversations about parenthood, child health development, parental mindset, and so much more. So thank you so much for tuning in and being here and all of the reviews and love you show the PedsDocTalk podcast.

 

00;00;48;26 – 00;01;13;20

Dr. Mona

Today’s guest is Diana Rice. She is a registered dietitian and podcast host, owner of Tiny Seed Family Nutrition, which provides weight inclusive nutrition education and guidance for families. And she’s on Instagram as anti.diet.kids helping families with nutrition and weight inclusive education. Thank you so much for joining me today, Diana.

 

00;01;13;22 – 00;01;16;00

Diana Rice

It’s my pleasure. Thanks so much for the invitation.

 

00;01;16;03 – 00;01;37;25

Dr. Mona

And we are talking about approaching conversations about our child’s weight and help in a productive way. This is a topic that’s so important to me, because I do believe that as physicians who do talk to a lot of families about percentiles and weight, it could be approached in a more sensitive manner that actually leads to more quote unquote results.

 

00;01;37;25 – 00;01;55;02

Dr. Mona

What I mean by results is we want to have the child understand health and not numbers, in my opinion. Like, why are we doing these things versus, oh, you need to lose X amount of weight. And I think a lot of weight loss becomes goal focused on numbers when we really should be approaching it a different way. So I’m so excited that we can get to chat about this.

 

00;01;55;09 – 00;02;01;14

Dr. Mona

But before we get started, tell me more about yourself, why you do the work that you do and what brought you to do that?

 

00;02;01;17 – 00;02;26;03

Diana Rice

Yeah. Great question. So, I’m a registered dietitian. And that is the credential that, you know, nutrition professionals who are medical professionals generally have here in the US. And I pursued becoming a dietitian. It wasn’t my first career. I actually worked in media for a bit, and I got so interested in just writing about food and, you know, family feeding and things like that.

 

00;02;26;03 – 00;02;44;28

Diana Rice

But I decided to go down the rabbit hole. I was going back to school and becoming a dietitian, and even though I didn’t have my own kids at the time, I now have two kids, two little girls. But I didn’t have my own kids at the time. I was still, I don’t know what it was. I had such a heart for family nutrition, and I always knew that I wanted to go into it.

 

00;02;45;00 – 00;03;09;05

Diana Rice

My dietetic internship, which is a year that we do, under supervised training of other dietitians, I was able to, you know, pick, rotations that would allow me to learn more about family health. And, you know, yada, yada, yada. I started working in this field, had my own kids. I didn’t focus quite so much on, this term, weight inclusivity that you and I have been using so far.

 

00;03;09;07 – 00;03;35;18

Diana Rice

Until, the past couple years, maybe the past five years, which is when, I started learning more and more and more about the harms of weight stigma, which I’m sure is something that we’re going to talk about in just how very dangerous this is for kids to grow up in homes where the focus is on, weight loss or dieting or good food, bad food.

 

00;03;35;20 – 00;04;05;20

Diana Rice

This all became actually very new information to me as I became a parent and started talking to other parents. Because, interestingly, it is not the environment that I grew up with myself. I think that my own parents, my mom in particular, themselves, grew up in diet focused homes. And, you know, even though this is a couple decades, before it got trendy, I wanted, just to put an end to that and just never talked about good food, bad food or dieting or anything, when I was growing up.

 

00;04;05;20 – 00;04;24;11

Diana Rice

So I ended up growing up with a very healthy relationship with food and am able, like the way I talk to my own kids about, you know, whether it’s soda, candy or vegetables, I feel like I’m able to do it in a very natural way. That doesn’t come nearly as naturally to people who didn’t have that immense privilege.

 

00;04;24;13 – 00;04;44;09

Diana Rice

So I feel like that is my role is, you know, helping parents change their language around food, you know, learn ways that are going to be more constructive for their kids. And then also, from a medical and scientific perspective, unpack some of the learning that they’ve done so far of body size is so important. You can’t let your kids get fat.

 

00;04;44;09 – 00;05;07;09

Diana Rice

All this stuff sort of unpack that and really get to the root of, raising healthy, thriving kids. And that’s why it’s so important to me is that I really, really, really believe, that this path of, you know, anti diet weight inclusivity is the way forward to raise really well-adjusted kids who have a good relationship with food in their bodies, which is ultimately going to do so much for their health.

 

00;05;07;12 – 00;05;23;08

Dr. Mona

Oh, I love it. And I love that we’re talking about what we’re talking about, which is sort of how we have these conversations about weight and other. One of the questions I have for you is, you know, there are certain situations where we have to talk about it, right, like in terms of a medical concern. So we want to be very understanding of that.

 

00;05;23;08 – 00;05;40;23

Dr. Mona

So I posted about this on my Instagram like, oh, say a few months ago. And then people definitely understood. But a lot of medical professionals, especially people who are in endocrinology or people who are in, you know, adult medicine or pediatric medicine are like, we have to tell them, like they have to hear that they’re obese. They have to hear that they’re overweight.

 

00;05;40;23 – 00;05;56;26

Dr. Mona

Like they’re going to, you know, there’s a lot of medical issues. And I’m like, I get what you’re saying. I do respect that. We want to like to understand that we’re not allowing anyone to just not care about their overall health, but terminology. Right. The way we speak about it, I think, does matter from a psychological perspective, too.

 

00;05;56;29 – 00;06;14;10

Dr. Mona

And I, you know, I’ve worked at two different practices, as a practicing physician and one practice we never really discussed or label BMI. And then the other practice I met, it was like one of those things that they would chart, review and say, hey, you didn’t comment on the BMI, you didn’t log, you know, documented or coded, right?

 

00;06;14;17 – 00;06;33;12

Dr. Mona

And I’m like, I don’t want to code it like it’s we talked, you know, we may have talked about it, but it’s not an issue to me. Like it’s BMI already. I don’t love is for pediatrics or in general. But it’s a great conversation to have. And I guess my first question is how we, as a medical community can change how we approach weight discussion.

 

00;06;33;12 – 00;06;47;05

Dr. Mona

You know, what is the, I guess, what is the not so great ways or the risk of a clinician focusing on a child’s weight during an appointment? Is there a right way that we can speak about this? How can we approach it in a sensitive way and wellness? It’s.

 

00;06;47;08 – 00;07;10;17

Diana Rice

Yeah. So, from my perspective, I think that making weight the problem, like you’re saying, like, how can we we have to tell them that they’re obese, is, instead of whatever else is going on with the health of the child or the adult is actually quite unfair to the individual in terms of them receiving excellent medical care.

 

00;07;10;19 – 00;07;30;29

Diana Rice

You know, weight in and of itself is not a problem. I mean, if it’s cardiovascular function or something on their blood values that is out of range. If something in the dietary pattern is heavier on one nutrient and lower on the other, these are all individual things, you know, what is the person actually, what are their complaints?

 

00;07;30;29 – 00;07;55;00

Diana Rice

You know, maybe they don’t have any complaints about, you know, their cardiovascular function or whatever that is. So focusing on weight alone, which we actually have quite a lot of evidence that it’s not a very modifiable factor. There is not a whole lot that we can do, apart from, you know, bariatric surgery or some of these weight loss drugs that really produces sustained weight loss.

 

00;07;55;03 – 00;08;27;20

Diana Rice

Focusing on that is really unfair to the individual instead of delivering medical care. Yeah. For the actual issues and medical concerns that they’re facing. And most of the time, those medical concerns have interventions independent of weight loss that are far more sustainable than, attempting to diet and carry far less risk because attempting to diet for weight loss is the number one predictor of a child developing an eating disorder or an adult developing an eating disorder.

 

00;08;27;23 – 00;08;49;21

Diana Rice

The other risk is that we get into this cycle of yo yo dieting, weight, cycling. Even kids can experience this. And that’s, you know, any adult who’s ever attempted Weight Watchers or whatever has probably noticed you. The weight comes off and then you can’t sustain the diet anymore and it comes back on again. And what we see is that it actually comes back on, to a higher degree.

 

00;08;49;21 – 00;09;05;06

Diana Rice

We gain more weight than we lost in the first place, which, is a protective biological mechanism. When your body thinks that you’re experiencing a fam and it’s like, well, I know one thing I can do to survive in it, store more fat cells. But the problem with that is that it’s not just about the number on the scale.

 

00;09;05;13 – 00;09;32;11

Diana Rice

There are so many physiological consequences. It harms our cardiovascular function, our kidney function. And so actually, a lot of the problems that we attribute to larger body size can actually be traced to this yo yo dieting and the havoc that that wreaks on our metabolism. And it’s just incredibly unfair to subjected child to that purely based on a number that we see on the scale.

 

00;09;32;13 – 00;09;41;13

Diana Rice

And instead of giving them medical care that they need, it’s it’s almost like so ridiculous even say, like, of course it’s the medical care that they need.

 

00;09;41;16 – 00;10;12;03

Dr. Mona

Well, you know, talking about stigma, talking about how the medical community approaches this. I always say, like, you’ll have a family in the room and there is a stigma that someone who is on the lower end of the percentile is not having technically the same conversations about what they’re eating and exercise. As someone who’s on the higher percentile, when in actuality every family, regardless of what they look like, you know, most of the weight on the scale nutrition, exercise, sleep, health these are all conversations that should be had with every family, right?

 

00;10;12;03 – 00;10;31;23

Dr. Mona

But what happens? And I see this often, and it’s also what I saw in my training. And also just, you know, and like I said in my current practice is that those conversations are happening more with people who are on the higher percentile. And that is a stigma, right? Because you’re assuming that that family is not taking care of their health or whatever you’re thinking, versus we should be having this.

 

00;10;31;23 – 00;10;50;23

Dr. Mona

Like you said, this is a part of health conversation, right? Like, are we, like you said, perfectly, are we getting varied nutrients? Right. Meaning are you trying to get stuff from different food groups or are you exercising? Are you prioritizing water over sugary drinks? Like these are conversations whether you were on the fifth percentile or the 99th percentile, which is really important.

 

00;10;50;23 – 00;11;16;03

Dr. Mona

And from a stigma perspective, what I often see is that we do not have those conversations, or a lot of physicians are not having those conversations with children who are on the lower percentiles, and then they’re not getting the education on this sort of health mindset in terms of approach to food and health mindset. And that, to me is a big problem because we are using image, we are using numbers on a scale to dictate our guidance when it really should be.

 

00;11;16;03 – 00;11;21;24

Dr. Mona

This is something that every family should be getting, regardless of the number on the scale and the percentile that child’s on.

 

00;11;21;26 – 00;11;36;27

Diana Rice

Yeah, it’s really unfair, to both ends of the spectrum. Of course, people in the larger bodies are subject to the most stigma here. But weight stigma does not help anyone, doesn’t help anybody, does weight. And it just also does not help any individual in our society thrive.

 

00;11;36;29 – 00;11;55;12

Dr. Mona

Oh, absolutely. And I love that you’re talking about both ends because I do see it. You know, I see obviously I know that there is absolutely more societal stigma for those on the higher end of weight, percentiles and stuff like that. But I also see a lot of weight stigma for leaner. I give an example of like leaner teenage boys coming into my office.

 

00;11;55;12 – 00;12;14;02

Dr. Mona

Like they also struggle a lot with body image. They also struggle a lot with weight and disordered eating. You know, they end up trying to put on weight with cat like stuff that they find online and different things, and it’s because of the pressure they feel of having to look like a bodybuilder, you know? And a lot of that is still present in 2022 when we’re recording this episode.

 

00;12;14;02 – 00;12;36;27

Dr. Mona

So like I said, I just think it’s so important now, you know, the question I kind of alluded to earlier is that when I talked about this on my Instagram, a lot of health professionals were like, hey, you know, childhood obesity is a really big concern, so I’m going to talk about it. But what I want to ask you is, from your experience, why shouldn’t we be helping kids lose weight by dieting?

 

00;12;36;27 – 00;12;54;19

Dr. Mona

And do you also feel like we want to say, hey, you’re obese, you need to do something about it? Like, how do we approach these conversations if we are feeling like there is a concern, not about the weight. I’m talking about the lifestyle, right? The health mindset. How do we have these conversations to actually see change?

 

00;12;54;22 – 00;13;16;09

Diana Rice

Yeah. Well, so first of all, I want to clarify that the words overweight and obesity are considered very stigmatizing in the, health in every size community. And when I use them, I use them with quotes. Or I put an asterix in some of the vowels. Because there is a lot of evidence that hearing the word at all, hearing your doctor say you’re obese and you need to do something about it, is very stigmatizing to a person.

 

00;13;16;09 – 00;13;42;20

Diana Rice

And, shame never produces lasting change. No researcher will ever show us that being shamed to do something will produce positive health outcomes. So, the word comes from the Latin having eaten one’s self, you know, to extreme or something like that. And that’s just not always the case. It’s stigma. Absolutely, that, you know, we’re thinking that any person in a very large body is having 12 bags of potato chips and 20 sodas a day.

 

00;13;42;20 – 00;14;07;21

Diana Rice

It’s not true. Plenty of people either didn’t have, positive feeding dynamics growing up, which is something that I’m going to talk about. We cannot separate the impact of poverty on body size. And if you only have access to certain type of calories, what that may do to your ultimate body size. I talked about weight cycling and how even the attempts to diet will lead a person to carry even more weight on their body.

 

00;14;07;23 – 00;14;27;26

Diana Rice

The word in and of itself is very stigmatizing, and it’s simply not true that people need to eat less and exercise more. That’s that’s not the solution. Solution is far more complex, and it lies in systemic change. You know, getting people more access to, high quality, affordable foods, whether it’s like walkable neighborhoods, things like that, that’s part of it.

 

00;14;27;26 – 00;14;48;17

Diana Rice

But it’s also just not stigmatizing people so much. And if they are genetically predisposed to be in a larger body, letting that be the same, as you know, I have a genetic risk of breast cancer. It just is what it is. You know, I’m not shaming myself for it. I am taking lifestyle measures to do what I can, but it just is what it is.

 

00;14;48;17 – 00;15;20;18

Diana Rice

And it’s the body that I was born into. So I think that, what’s really important when we think about the, quote, childhood obesity epidemic or crisis is that we can never separate our concern about kids being fat from our overall cultural anti fat bias and anti fat bias is a form of prejudice, the exact same way that discriminating against people on the basis of their race or their gender identity or their sexuality is and there is never, ever going to be a positive outcome from any of that.

 

00;15;20;18 – 00;15;34;04

Diana Rice

Right? Like that hardly needs to be said. Like we need to put an end to all of this and we get real tripped up when it comes to weight because unlike, you know, saying like, of course, we shouldn’t discriminate on the basis of race when it comes to weight. We’re like, well, but it’s for their health. It’s for your health.

 

00;15;34;04 – 00;15;54;11

Diana Rice

It’s not discrimination, it’s for your health. Unfortunately, this is really a cultural message that we have learned. And you learned in medical school. I learned it in dietitian school, but it’s not actually fully rooted in science because the science is never actually looking. I mean, some of it is starting to right now, but the science is rarely looking at the harm of weight stigma.

 

00;15;54;11 – 00;16;27;03

Diana Rice

It’s so it’s not just that weight cycling, but weight stigma produces a stress burden we call allostatic load, which is sort of the cumulative physiological burden of chronic stress and life events. You’re also much more likely to have a high allostatic load. If you are, or a single mom like anything where you don’t have the support that you need and you are stressed, this is going to take a physiological toll on your body and part of that is going to be additional weight gain, among many other things that are going to contribute to poor health.

 

00;16;27;03 – 00;16;54;15

Diana Rice

And we’re not helping people with that. We’re saying eat less, move more, which just contributes to even more stress when the person doesn’t have the resources to do that, and when that might not even be effective in the first place. Like, why are we not delivering actual health care to individuals and just simplifying it to boiling it down to have some self-control and eat less like that’s just not a message that is ever really going to produce change.

 

00;16;54;15 – 00;17;15;02

Diana Rice

And I think what we’re not even down to is health care avoidance. If someone thinks that if they show up at the doctor and the doctor feels some moral obligation to tell them that they’re fat, like people know that, they may not know that there are things they can do to support their body, regardless of their size. And they probably do not have a physician who’s going to help them with that.

 

00;17;15;09 – 00;17;36;19

Diana Rice

But if you think that if you’re going to show up at your doctor’s appointment or your kid’s doctor’s appointment and just get harangued about the kid’s weight, you’re not going to go at all. And then you could miss issues that the kid or yourself is actually experiencing. And again, that’s not good health care. So we really dug ourselves into a hole on this, I think.

 

00;17;36;19 – 00;17;58;15

Diana Rice

And I think that with kids in particular, it’s not that there isn’t something off, but I prefer to think of it as a childhood feeding crisis, in that our parents had the time and energy to put regular family meals on the table with balanced nutrients, with vegetables, with repeated exposures. So the kids could learn to accept more variety.

 

00;17;58;20 – 00;18;26;06

Diana Rice

Our parents so caught up in their own good food, bad food mentality and attempts to diet and lose weight that they’re passing this on to the kids. And the kids are, you know, restricting themselves from certain foods and bingeing on them later, like there’s so many different things. And again, going back to access to high quality foods and the cost that comes from it, there’s so many different things that go into, are these kids developing a healthy relationship with food?

 

00;18;26;13 – 00;18;42;04

Diana Rice

I don’t want to say that we need to get them all healthy relationships of food, to get their body sizes to be smaller. That’s not the point. The point is that when you have a healthy relationship with food, when you are consistently getting the nutrients you need to grow and thrive, your health outcomes will be better regardless of your body size.

 

00;18;42;06 – 00;18;56;29

Dr. Mona

Right? And that’s it goes back to what we were talking about beginning. Like the goal isn’t for everyone to look the same in terms of being the 50th percentile. Like, you know, I mean, like, that’s not the goal. The goal is that you are creating, like you said, a mindset of this is my health. Like you said, cardiovascular health.

 

00;18;57;06 – 00;19;18;16

Dr. Mona

I’m able to move my body to, you know, feel good. You know, like all these things. It’s not the number. And I agree, we tend to still fall back on that. You know, I’ve had a lot of families come see me after seeing other clinicians who you said it perfectly like they were afraid to see that person because they just felt like, well, I don’t want to go and be told that I’m not doing anything right and be like, almost yelled at for X, Y, and Z, you know?

 

00;19;18;16 – 00;19;44;12

Dr. Mona

And that’s not a constructive way of chatting about anything. And I’ll talk to them about their health mindset. Right. Like the family is doing a lot of great things. And I’m like, that’s just genetics. Like you’re on the higher percentile, but that’s okay. Like we’re not trying to make you a size two. That’s not what we need. I mean different like now it’s just so frustrating because like you said, it’s still 2022 and it is just a very unfortunate mindset.

 

00;19;44;12 – 00;20;02;24

Dr. Mona

And we see it culturally. You know, we see it a lot of, generational trauma is still there that parents may be trying to make the changes. Like you work with a lot of people in our generation, but maybe their parents are still like in the peanut gallery, like talking about their children and grandchildren. And it’s like everyone’s just trying to break through, even if they’re trying to do it.

 

00;20;02;24 – 00;20;23;23

Dr. Mona

It’s like there’s still so much stigma behind all of this in terms of what percentile or what weight is deemed appropriate for society. And it’s just tragedy, because I agree with you completely that it doesn’t allow for any sort of discussion on health mindset. You know, when you go into someone and immediately they’re like, well, you’re overweight or obese, you got to do this.

 

00;20;23;25 – 00;20;43;03

Dr. Mona

I agree with you. Like that terminology is filled with shame. It’s filled with anti fat bias. And it’s just it doesn’t serve any purpose to me. So I agree. Like I don’t like using that terminology. I rather have discussions on what the families doing. Like you said with nutrition and all of that. And obviously you brought up an amazing point about poverty.

 

00;20;43;04 – 00;20;57;16

Dr. Mona

You brought a meeting point about lack of access to exercise. You know, it’s very easy to say, well, why aren’t you getting 30 minutes a day? Well, maybe they don’t live in a neighborhood that has safety where they can go outside. You know, maybe they don’t have a public park that’s accessible, you know.

 

00;20;57;22 – 00;21;03;13

Diana Rice

Or maybe the parent works two jobs and, you know, the kid is safer indoors, like lots of M&Ms.

 

00;21;03;16 – 00;21;20;10

Dr. Mona

And then with that, people just assume, like, well, you’re not healthy because you look x, Y, and Z. So, you know, it’s just it’s not like it is a very difficult situation. And like you said beautifully that it can also lead back to that sort of bingeing because you just feel like, okay, I’m trying to lose weight. It didn’t work.

 

00;21;20;10 – 00;21;26;06

Dr. Mona

Or maybe you lost the weight and like you said, survival response. You gain it back. Oh well, I’m a failure. Didn’t work. It’s like a psychological thing.

 

00;21;26;06 – 00;21;28;08

Diana Rice

Oh yeah, I feel discouraged.

 

00;21;28;08 – 00;21;49;21

Dr. Mona

And so then you start bingeing again and then it’s the cycle repeats itself. I see it a lot with adults too. I know that like adults who are thinking that they need to lose X amount by a certain time, get fit into their wedding dress X, Y, and Z. It’s like it’s a tragedy. Like truly. And I love and applaud the work you do for children because it starts so young, with how parents approach and how the health care community approaches this as well.

 

00;21;49;28 – 00;22;13;24

Diana Rice

Yeah, absolutely. And I think it’s also important to point out, it’s a tragedy. It’s also oppression. It is oppression that is rooted, actually in white supremacy, if we go, far enough back, the a great read on this is steering the black body from, Professor Sabrina strings. And we see that, you know, the Europeans have found that, if their bodies were naturally smaller than the Africans.

 

00;22;14;00 – 00;22;38;13

Diana Rice

And so that must demonstrate superiority. Right. And so, this and this is going on for hundreds of years that, the closer we are to thinness, the closer we are to whiteness. And, in this perpetual cycle of starving ourselves and trying to achieve that, well, if you’re starving, you’re not going to be able to, I don’t know, get a college degree, apply for a job like all these things that might improve your quality of life.

 

00;22;38;18 – 00;22;54;03

Diana Rice

Because we’re so stuck in this cycle of not giving our bodies what they need. Right. And what does that allow for? Well, the people who are empowered to continue to be empowering people who are oppressed to continue to be oppressed. So it’s tragic, but it’s also incredibly unjust. And I don’t think enough people know about that.

 

00;22;54;06 – 00;23;13;19

Dr. Mona

Well, even BMI, I think that I would but talks about that. Right. So yeah, I’d love to read that because BMI is absolutely racially triggering. And I guess because we are assuming that, yeah, your BMI is 90th percentile. And I will be honest, a lot of my African American black population does have a higher BMI. Not everybody. Okay.

 

00;23;13;21 – 00;23;19;21

Dr. Mona

But if we want to do a better comparison, quote unquote, we would compare people to the same ethnic group. But even that, why are we comparing people?

 

00;23;19;23 – 00;23;23;14

Diana Rice

Yes. Yeah. Yeah. This is there anybody like no.

 

00;23;23;14 – 00;23;41;20

Dr. Mona

Need to compare because there’s what is the standard we’re holding people. It’s so frustrating to me because we’re holding people on these percentiles. You know, and I talked I want to really briefly for anyone who is unfamiliar with what I talk about, percentiles. Percentiles should be used in a medical setting to look at trends. Meaning I want to see how you’re trending from the last time I saw you.

 

00;23;41;20 – 00;23;57;07

Dr. Mona

So for example, if you’re in my visit and you were the 85th percentile at the last visit, and now you have dropped to the 20th, or now that you have gone off to the 100th, that’s a big weight gain or weight loss. So the conversations are going to be, how are you doing overall? How is your stress level?

 

00;23;57;12 – 00;24;07;25

Dr. Mona

What are you doing in terms of exercise, all of that? What are you doing in terms of nutrition? Like there’s so many different things happening there, but it’s not a oh, you’re the hundredth percentile. So automatically there’s an issue or.

 

00;24;08;00 – 00;24;08;11

Diana Rice

Units.

 

00;24;08;11 – 00;24;35;28

Dr. Mona

Of percentile automatically an issue, which I think we often talk about in visits. Right. Like parents, even, kids who have failure to thrive, quote unquote, right. Their children come in lower percentiles. I’m Indian, Indian people are super lean. Most of our children are on the fifth to 10th percentile. And that’s very common, you know? And so a lot of my Indian families will DM me on my Instagram and be like, hey, my doctor saying that my kid is too skinny and they need to eat like this, you know, healthy fats.

 

00;24;35;28 – 00;24;54;19

Dr. Mona

And I’m like, but you’re also very thin. Like, you know, are they trending? Like we need to look at it as trends. So if anyone’s not familiar, your percentile is a good gauge. Like I like percentiles. Yeah show me trends. But it should not be that we are using that as a grade. Right? Like oh, so 95th is better or worse than 80th or 50th.

 

00;24;54;19 – 00;25;10;19

Dr. Mona

That’s not how it should be. Your goal is not to get to a certain percentile ever. Your goal is to really just have it be a overall indication of trends on how much weight we’re gaining, how much weight we’re losing. And it can set up a trigger for me of like, oh, we’re losing a lot of weight from the last visit.

 

00;25;10;19 – 00;25;32;24

Dr. Mona

Is that intentional? Was that accidental? Could this be something medical? Right. And even for weight gain, to be honest, like sometimes I do see 3,040 pounds in a year and I’m thinking, is this a hypothyroid situation? Is it something in the gut, like, do we need to intervene more here? And that goes back to the medical picture. Like you said, this is a big picture of having conversations about their overall well-being.

 

00;25;32;27 – 00;25;51;20

Diana Rice

Yeah, I did the exact same thing in my practice. Growth charts are very important in my practice. And isn’t it funny? Like, you know, the very nature of percentiles is that various people are going to be at various points and to try to get from one to, another intentionally defies the very nature of percentile. But I totally agree.

 

00;25;51;20 – 00;26;14;19

Diana Rice

When I see a big jump in one direction or another, because I’m not assessing for hypothyroidism or anything like that, what I’m always looking for is there, any kind of drastic change in the child’s feeding dynamics or social situations? You know, parents got divorced, started a new school, global pandemic, you know, did anything happen to perhaps trigger the child?

 

00;26;14;21 – 00;26;37;01

Diana Rice

You know, body image concerns are absolutely at play here. Emotional eating because of lack of a constructive outlet for their feelings, things like that. Did anything happen in the child’s life to trigger their eating in one way or the other, whether it’s, you know, stress and anxiety leading to poor appetite or, you know, leading to, binge eating or whether there’s a body image concern or potential eating disorder.

 

00;26;37;03 – 00;27;03;13

Diana Rice

There’s 95% of the time maybe there’s going to be something like that. And instead of going to for a lower weight child, like put butter on everything for a higher weight child, go on a restrictive diet. Both of those ignore the issue. We have to correct whatever the actual issue is. And so, so, so many times it comes back to the child in the family not having the social support that they need to cope with whatever else is going on.

 

00;27;03;21 – 00;27;27;02

Diana Rice

And then, you know, sort of the cherry on top is all of the messages from diet, culture of good food, bad food. Eat This, Not That. That gets people just so stressed out about what their kids are eating, what they’re eating. The foods are available in the home, and we can’t forget that restriction. You know, if a family says, you know, no chips, no soda, no candy in my house, and if those are important foods to the kid, they will feel restricted.

 

00;27;27;02 – 00;27;47;08

Diana Rice

They will find a way to get access to them. And they will probably binge on them when they do. And then it turns into a whole cycle of shame if I have no control around food, you know, making food the issue, which is really just a Band-Aid for whatever the social issues are, whether it’s intentional bias or not having a constructive emotional outlet, for your feelings other than emotional eating.

 

00;27;47;11 – 00;27;51;00

Diana Rice

Yeah. And and again, we’re not doing anybody any favors here.

 

00;27;51;02 – 00;28;15;11

Dr. Mona

Yeah. Listen, my husband’s a New York doctor, and I’ve been very open about this on my social media channel, but he is fed into a lot of this diet culture, you know, organic. You can’t have certain things. And I tell him flat out, I’m like, listen, you. Because he gets upset when I bring in certain foods. I’m like, I’m telling you right now that if I don’t bring this food into the house and have it in moderation, which I’m capable of doing as an adult now, and I’m very proud of myself, I’m going to find it and I’m going to eat it in my car.

 

00;28;15;11 – 00;28;35;00

Dr. Mona

So we have two options here. We can either have it in the house and I’m going to eat it in moderation. I’m talking about things like chips and ice cream. Okay. These are things that serve a purpose in my life. Like you say, like I love it. I think it’s wonderful. I think when we talk about moderation, like I get a tub of ice cream and I’m able to let it last two, three weeks and I take it out in a bowl and I eat it and I enjoy it, and I feel happy.

 

00;28;35;00 – 00;28;50;04

Dr. Mona

And that’s awesome with food, right? And kids, you’re right. Kids could do that. But I’m very clear that yes, if you do not allow, like you said, that that moderation or that access, you’re right. They’re going to go to a birthday party and they’re going to go like wild, and they’re just going to feel like, oh my gosh, give me the dopamine right now.

 

00;28;50;04 – 00;29;19;23

Dr. Mona

Like, give me this rush for that. I’ve been lacking. I love that moderation talk. And that kind of brings me to my I guess, my last question. So if a child’s weight is trending high or low, like I mentioned about like in some concerns in terms of like really steep increases in weight, we can talk about that. So what if interventions or conversations are positive and helpful that can actually help them have that health mindset versus a weight goal mindset weight loss mindset in terms of getting to a number.

 

00;29;19;26 – 00;29;48;22

Diana Rice

Yeah, absolutely. So the first thing I think that we need to recognize is that parents are going to need a lot more support than they can probably get in a 15 minute visit with their pediatrician course and things like this. Which is why I hope that every pediatrician has, a, registered dietitian or other, even a family therapist who specializes in feeding and feeding dynamics and can refer the family to additional counseling, with that additional person.

 

00;29;48;24 – 00;30;13;21

Diana Rice

You know, I see some of my families for an hour every other week, you know, if their insurance plan will cover that. And it’s, a lot like mental health counseling, which I think, you know, especially with Covid, we’re recognizing that, like, more people need mental health counseling. And I think in particular, with the way that most people in the US did not grow up with positive eating dynamics, we kind of all need some extra support on this, too.

 

00;30;13;23 – 00;30;48;20

Diana Rice

So the kinds of things that I cover with my family is when we see the weight trending high or low is I don’t go straight to eat less, move more. I actually don’t usually address the specifics of what food is going on the plate in the first couple sessions at all. What I’m looking for is this kid eating consistently throughout the day breakfast, lunch, dinner, and perhaps, you know, afternoon snack, evening snack, maybe even a morning snack, depending on what the situation is, are the foods, particular mix of protein, fat and carbohydrates.

 

00;30;48;20 – 00;31;04;03

Diana Rice

So I’m not going to tell you sort of brown rice and not white rice. I don’t think that’s culturally sensitive. I’m going to say, is there a carbohydrate on the plate? Because, you know, these are just it’s just a fact of human nature that to grow and thrive, kids need protein, fat, carbohydrates, and then we can get into macronutrients.

 

00;31;04;03 – 00;31;22;04

Diana Rice

But that’s something, you know, that’s a bridge across a little bit later on. I’m always looking for whether the child has access to preferred foods, like you were saying, like, doesn’t have to be every last thing in the house is chips or candy, but does a child have enough access to that on the one hand, so they don’t feel restricted, which can lead to bingeing, which can lead to higher body size?

 

00;31;22;10 – 00;31;44;24

Diana Rice

On the other hand, for kids in smaller body sizes and bigger body sizes as well, if the foods that are available don’t feel safe to them either. Maybe there’s a sensory issue or they have selective eating. For whatever reason, their intake may be too low because there’s not enough safe foods for them, or their intake of whatever is safe enough for them may be too high, and that may be contributing to part of the issue.

 

00;31;44;24 – 00;32;06;20

Diana Rice

So does the child feel safe around food, and are the parents responsive? Feeding? Are the parents going out of their way to learn what the child’s needs are and provide those foods in a structured way, so that the child just feels safe and natural around foods. I always want to know, how, the parents are talking about food in the house.

 

00;32;06;22 – 00;32;25;16

Diana Rice

You know, I said, you know, the good food, bad food mentality a couple of times. I don’t recommend that at all. Even what you’re talking about, when you use moderation for yourself, it is not because you learned potato chips. Bad broccoli. Good. I want parents to see more support on this, because this is not something that you’re getting from, you know, media messages.

 

00;32;25;19 – 00;32;50;12

Diana Rice

I use a concept called gentle nutrition with my families, which is that there are no no good or bad foods, but are foods you’re going to make us feel differently. And it’s really and different people are going to feel differently with different foods. So it’s really about getting in touch with, well, how do I feel when I eat only candy, when I eat only potato chips, and when there’s a lot of shame coming into the conversation, which is good food, bad food, that kind of overrides our ability to understand what’s going on in our bodies.

 

00;32;50;12 – 00;33;08;17

Diana Rice

So how are parents talking about food in the house? Is the kid able to follow their own appetite? Is there any pressure? Pressure in feeding is never, ever, ever going to work out. Whether it is you need to take three more bites of your broccoli, or you need to stop eating the rice and have some chicken or whatever it is.

 

00;33;08;19 – 00;33;21;13

Diana Rice

You know, pressuring feeding is never going to work out. I always want kids to learn to trust their own appetite so that they can do what you’re describing when you’re as an adult of like, yeah, I’m gonna have some ice cream. Like, I don’t need or want to have the whole pint. It can stay in my freezer.

 

00;33;21;13 – 00;33;34;28

Diana Rice

I’m not going to obsess about it because I’m going to have some tomorrow. That’s going to be delicious, too. Yes. This is relying on your own internal body signals. And what you have learned about nutrition of like, and ice cream is not going to be the only thing I eat. I am going to eat vegetables. I am going to eat whole grains.

 

00;33;34;28 – 00;33;52;28

Diana Rice

You know, because I’ve learned this about nutrition. There’s no, morality associated with it one way or the other. It’s just foods that I enjoy. And of course, you’re going to enjoy it in a way that makes sense for your family and your cultural values. And I’m going to do it in a different way, and I’m certainly not going to come in and dictate, how somebody else needs to do it other than like, is there protein and carb involved?

 

00;33;53;01 – 00;34;16;19

Diana Rice

So definitely how parents are talking about the food you mentioned water over soda. Things like is the child snacking throughout the day on it’s usually simple carbs and things like sodas, sports drinks. It’s not that those foods in and of themselves need to be demonized, but how can we put more structure around them? You know, if the child likes a particular snack, can we serve it with a meal with that protein, fat, and carbs?

 

00;34;16;19 – 00;34;39;08

Diana Rice

If the child would feel restricted if they never got to have soda, can we say, okay, you know, we have soda, once a day or once a week with dinner, whatever works for the family, you know? But instead of, sort of snacking on it all day long, which is terrible for oral health. Also, you know, not a dentist, but, and it’s going to interrupt their appetite for the nourishing foods that are likely available at meals.

 

00;34;39;11 – 00;34;58;05

Diana Rice

But then my next question is, are they available at meals? Because parents do need to step in as the caregiver and provide these foods consistently throughout the day. And, you know, a lot of times people think that like to raise intuitive eaters. The kids need to be in charge of their own food decisions. If they want to go to the pantry and grab a bag of chips, they should be able to.

 

00;34;58;05 – 00;35;16;25

Diana Rice

And I do think that, like, a teenager should have the skills to make that decision, but not for younger kids. Like, what’s really good for younger kids is to know that the parent is the provider. The parent puts a roof over their house, the parent provides the clothes, and the parent provides the food, but does it in in a responsive way so that the child feels like their needs are getting met.

 

00;35;16;28 – 00;35;38;28

Diana Rice

So these are all interventions that I work with families on. And then once all that is in place, we might talk about exposures to more vegetables or, you know, joyful movement. Like, what is a way, you know, if a kid doesn’t like sports, what about a family walk or a bike ride, right? But I don’t actually get to those interventions until we really have the positive feeding dynamics in place, because it’s putting the cart before the horse.

 

00;35;38;28 – 00;35;54;25

Diana Rice

It’s saying like, okay, well, you know, you need to eat more vegetables. Well, if the kid is afraid of vegetables or if the parent doesn’t know how to prepare them, or, you know, if they’re just not a culturally appropriate food for the family, then that advice is not going to land and it’s not going to produce sustainable change.

 

00;35;54;28 – 00;36;18;25

Diana Rice

So I like to help families kind of get into a groove with their feeding dynamics first and then, you know, all the baby steps of things that we’ve heard before. You know, exercise five servings, vegetables a day. But I really think people have to be in a good place for that to be received. And then once all that’s going on, if the child’s body size still hasn’t changed, but I can assess that they are meeting their nutrition needs.

 

00;36;18;27 – 00;36;22;18

Diana Rice

Then, you know, I was expecting a doctor saying, I don’t think we have a problem here.

 

00;36;22;18 – 00;36;41;10

Dr. Mona

Yes. Yeah, I love that because again, the goal is not the number. Like it’s it really is, like you said. And you’re telling me that we can’t do that in a 15 minute pediatric session? I mean, obviously, yes. You’re right. Like I love it. I love what you just said. Everything is right on part. And it makes me like it makes me kind of sad sometimes because this is all stuff that I love talking about.

 

00;36;41;10 – 00;36;57;00

Dr. Mona

But of course, you are right on that. We do not have enough time. And that’s the point, right? We’re supposed to refer when needed. It does break my heart a little bit that a lot of the times in my community, I, you know, I do have a large Medicaid population, and I’m trying to get them in with, nutritionists and or dietitians.

 

00;36;57;00 – 00;37;12;25

Dr. Mona

It’s much more difficult for me. And I it’s hard because a lot I do feel like you do need to have more of these conversations about all the things that you mentioned, especially, you know, talking about, you know, access, talking about what are the parent’s views on vegetables, what are they eating like, what are they putting on their plates also?

 

00;37;12;28 – 00;37;37;06

Dr. Mona

And then also, just like the access to everything that we mentioned. So such great tips had I loved this conversation so much. Like it is such an important one. And I just wish that you know everyone who listens shares it with everyone, because this is just such a important thing that we all need to kind of be more aware about whether we are health care professional, a parent, whether this is it doesn’t seem like this will ever be a quote unquote issue for us.

 

00;37;37;06 – 00;37;48;11

Dr. Mona

It’s important to create some understanding of how we communicate when we talk about weight. Why are we even talking about numbers and all that, you know? Yeah. What would be your final message for everyone listening today?

 

00;37;48;13 – 00;38;10;20

Diana Rice

Oh, well, that, if you feel like something is not going well with all of the things that we’ve described, I hate to put more in parents courts because I know we’re also overwhelmed, but it really does start with you as the parent, working on your own mindset about these things and perhaps your own relationship with food.

 

00;38;10;28 – 00;38;28;20

Diana Rice

Because that’s going to be the number one factor that is going to influence your kids. And we really need to rely on, something I call our own intuitive eating voice, which is, you know, we’d say if your kid’s asking for a snack and they already had one instead of just black and white. No, we already had snack time to say, oh, you know, like I don’t.

 

00;38;28;20 – 00;38;45;01

Diana Rice

They didn’t actually eat that much today. They probably do want to snack. And, you know, versus just sort of like no snacks are bad or whatever it is. So it really does. This is why I work with both kids and adults in my practice. It really does help, for the parent to start to wrap their head around, these kinds of things.

 

00;38;45;05 – 00;39;01;05

Diana Rice

Maybe do some additional reading. I mentioned that one, but here in the my body, I’d be happy to send you, other books you could link to in your show notes to get started on all of this. Because I really, I like you’re saying, you know, and that generational cycle, I really do think that we can, but it starts with us as the parents doing the work.

 

00;39;01;07 – 00;39;10;10

Dr. Mona

Absolutely. And, yes, definitely send me those links. And where can my listeners find you in terms of repeating your Instagram handle resources? All of that information?

 

00;39;10;13 – 00;39;31;15

Diana Rice

Yeah. My Instagram handle is anti diet kids. So anti-LGBT kids. I’m also on Facebook at the same name. And I have a free Facebook group called Raising Anti Diet Kids which I’ll send you the link to, which is a great place for parents who are just getting started on this journey to, you know, unpack, like what they learned from their own families and what they want to do instead.

 

00;39;31;15 – 00;39;54;23

Diana Rice

But if they don’t have the support to do it, you know, questions like that. I’m always posting, you know, more more resources, like, you know, articles that come out about how, you know, science is harming us all and, you know, things about feeding kids. I’m always posting those in there. My website is Tiny Seed nutrition.com, and I do work with parents nationwide for coaching.

 

00;39;54;26 – 00;40;15;05

Diana Rice

And then within Oklahoma, where I’m located, I provide medical nutrition therapy, which is often a service that is covered by insurance. As you mentioned, I’m a podcast host and I have a show called The Messy Intersection, and I’ve called it that because I am trying to address this very, very messy place where we don’t have support, especially when we become moms.

 

00;40;15;05 – 00;40;33;23

Diana Rice

Our own bodies change, our own, you know, ability to, I don’t know, meal prep and, you know, go out to dinner with, you know, on a romantic dinner date. All these things change, and we’re trying to figure out how to feed a child in a way that will, both produce a healthy physiological child and a child with a healthy relationship with food.

 

00;40;33;23 – 00;40;49;29

Diana Rice

And we’re navigating all of this very messy place, where we really don’t have a ton of support. So I talk a lot about intuitive eating on there, raising intuitive eaters, feeding dynamics that I’ve mentioned so much. I talk a lot about that on the show. And so I hope that listeners will check that out as well.

 

00;40;50;01 – 00;41;05;13

Dr. Mona

Oh, I can’t wait to link all of this. And truly, Diana, this was a pleasure. Like I said at the beginning, that I get to talk to such amazing guests and you are obviously one of those people. It’s just so refreshing the way you speak about this in such a compassionate way, the way you’re trying to really change the world.

 

00;41;05;13 – 00;41;12;28

Dr. Mona

It’s just so nice to see. And, you know, the Facebook group, your website, obviously all the resources you give just such an honor. So thank you again for joining us.

 

00;41;13;01 – 00;41;16;28

Diana Rice

Thank you so much. I really appreciate that so much. And I love the work that you’re doing as well.

 

00;41;17;00 – 00;41;31;21

Dr. Mona

And for everyone listening, if you love this episode, which I really love it. Like I said, I get to talk to these amazing guests, but sometimes I’m just like, oh my gosh, this is like amazing. So if you love this episode as much as I love reporting it with Diana, I want you to leave a review. Call Diana out.

 

00;41;31;21 – 00;41;48;13

Dr. Mona

You know, Paula and her diet. Kids say how much you love this information, and of course you have to share it on Instagram Stories. Tag both me and her so we can reshare it as well. And more people can discover this episode. And I can’t wait to welcome another guest next time. Thank you for tuning in for this week’s episode.

 

00;41;48;13 – 00;42;02;02

Dr. Mona

As always, please leave a review. Share this episode with a friend. Share it on your social media. Make sure to follow me at PedsDocTalk on Instagram and subscribe to my YouTube channel PedsDocTalk TV. We’ll talk to you soon.