Making an Impact: Dr. Lisa Tritto’s Innovative Approach to Childhood Obesity in Direct Primary Care

In this episode of the My DPC Story Podcast, Dr. Lisa Tritto shares her inspiring journey from general pediatrics to specializing in pediatric obesity medicine through the Direct Primary Care (DPC) model. As the first physician at Evora for Kids in St. Louis, Dr. Tritto discusses why DPC reignited her passion for medicine, allowing for longer, more meaningful patient visits and personalized weight management care for children and adolescents. She dives into her advanced training in pediatric obesity, the challenges of traditional insurance-based models, and how DPC empowers her to make a real impact on families’ health. Discover tips for building a successful DPC pediatric practice, navigating complex patient needs, and the importance of compassionate, evidence-based weight care. Whether you’re a pediatrician, DPC physician, or a parent seeking holistic weight management for your child, this episode offers practical insights and resources. Perfect for those exploring Direct Primary Care, pediatric obesity medicine, or innovative approaches to child wellness.

Save $100 on your Hint Summit 2026 ticket through October 31st and join the chorus of direct care leaders shaping tomorrow.

Register HERE for the Physician Attendees ONLY RiseUP Summit brought to you by FlexMed Staff & My DPC Story!

Get your DPC Resources HERE at mydpcstory.com!

Transcript

Dr. Maryal Concepcion : 0:43

Direct Primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the my DPC story podcast, where each week. You will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle conception family physician, DPC, owner, and former fee for Service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct Primary care.

Dr. Lisa Tritto: 1:31

DPC for me has reinvigorated my love of medicine and helping people and really feeling like I'm making an impact. Having control over my life and practicing the way I think works best for me and my patients. I'm Dr. Lisa Reto with Vora for Kids, and this is my DPC story.

Dr. Maryal Concepcion : 1:57

Dr. Lisa Tritto is a pediatrician with advanced expertise in childhood and adolescent weight and wellness care after more than 20 years in general pediatrics. She completed a fellowship in pediatric obesity medicine at the University of Minnesota, making her one of the few physicians in the country with this specialized training. Dr. Tritto has now dedicated her practice exclusively to pediatric weight management, where she blends evidence-based medicine with a compassionate, non-judgmental approach that helps children and families build sustainable habits and improve long-term health. She earned her medical degree from St. Louis University and trained in pediatrics at Case Western Reserves, rainbow Babies, and Children's Hospital. Beyond the clinic, Dr. Tritto has served as a coach for girls on the run, raised funds running the Chicago Marathon, and enjoys hiking, cooking, traveling, and cheering on her favorite sports teams. Originally from California. She now calls St. Louis home. Welcome to the podcast, Dr. Reto. Hi. Nice to be here. So I love this. We were just going over pronunciation of names before we started recording, and I will say Dr. Lisa Reto, like Cheeto was amazing and helpful for me, but I also think it's super appropriate and ironic for this conversation because we're talking about pediatrics. I know lots of Cheeto talks that I've had in pediatric visits, but also about how you have gone from pediatrics to specializing in pediatrics, in obesity medicine in in particular with Vora. And so I will say that if you have not listened to Dr. Becky Lin's episode Vora started a very long time ago, and Dr. Reto has been with Aurora now for almost a year. We're approaching a year this December. Mm-hmm. And so it's so exciting to see the growth of the practice through your lens. So again, thank you so much for joining us today. Sure. My pleasure. I wanted to start with your background because you went to school in California where I'm podcasting from, and then you left California. And so I'm wondering if you could talk to us about how your journey even brought you to the Midwest right now, where you are today.

Dr. Lisa Tritto: 3:58

Yeah. Yeah, I grew up in California, in the Bay Area and went to college there and left for medical school. I came to here to St. Louis, St. Louis University with the intention of going right back to California. But I met a boy and you know how that goes. And he was from the Midwest and so I pretty much ended up in the Midwest for the rest of my, well, my life more than half of my life now. And for a variety of reasons. I've sort of been in a couple different states throughout my career, and now I've, I've actually just returned back to St. Louis just about a year ago now, where one of my kids lives here. So. I love

Dr. Maryal Concepcion : 4:39

that. Yeah.

Dr. Lisa Tritto: 4:40

And

Dr. Maryal Concepcion : 4:40

I, I love the you, you know the story, ya meet a boy. That's definitely what happened with, with my husband and I, except he was from California, so it worked out. But oh, good for you. I, so when, when we think about how you have gone into pediatric specialty, I love people like Dr. Mina Jula poll, pediatric dermatologists have been on the podcast before. But I wanna highlight that prior to being a specialist, you were a generalist and seeing things at different medical centers like Rush Medical Center, as well as in Cleveland. And so I'm wondering if you can tell us about, when you started practicing up until last December, when you, when you joined Aurora, I'm wondering what were the things that you saw that ultimately made you make the transition to DPC.

Dr. Lisa Tritto: 5:27

Yeah, I've, I've had the opportunity to work in a variety of different settings. So I was in sort of a university affiliated practice and my patient population was from rural to suburban. And then I was in Chicago at Rush, and then that was more urban. And I, I was fairly happy in my, my group practice, it was university affiliated because the doctors did own their, own the practice. And so we were able to make some of our own decisions. But then I, when I went to the academic setting, the the layers of bureaucracy and lack of control over my schedule, just, kind of did it for me. Things like, they would want your schedule to be full, full, full, full, full. And then you couldn't see a kid with an ear infection. And thankfully at this point in my career, I was like, no, this is not acceptable. We cannot practice this way. At the same time, I was going to other, through some other life transitions, and I had been interested in weight management for a long time, had been frustrated with not being able to help my patients very well, and I, and I learned about this fellowship opportunity in Minnesota. And so then I went to another Midwest state for a year and did my training there. And then, like I said, ended up back here in St. Louis. So, so I just think about, you

Dr. Maryal Concepcion : 6:50

know, the the, the laughter to, to release the, the steam of frustration when we think about those memories about what our patients and ourselves have gone through. Because it's like. You can't do anything but laugh or cry sometimes and at the ridiculousness of it. But I, I wonder if you can tell us specifically when it comes to health of kids. Absolutely. Obesity, medicine, weight management bullying, all of the things happen, especially in pediatrics. Experiences that we have as kids are so formative in how we are as adults in the world. And I'm just wondering if you can, give us examples of a. How you really turn to this fellowship to be able to make a difference in kids' lives when it comes to healthy bodies, when it comes to trying to do better for your patients, because what you were seeing was not sufficient for them. To, to be in a space where you can talk about health and your, like how many minutes per patient, right.

Dr. Lisa Tritto: 7:53

Yeah. Ab absolutely. I, I would say in general pediatric practice, of course time was always, always a factor. And this is this is a topic that takes a lot of time and that's also why I've chosen this DPC type of route. Because I can spend, I spend about 90 minutes with my, my patient for the first time going through their medical records, their life story, their bullying story, their. Whatever their social dynamics, it's a very deep dive. I feel like I know them very well by the time by the time they leave. In the space and time that I had in general pediatrics, I just could not, I, I could not allow the amount of time that I needed to do sort of the deep dive and see what's going on in these kids' lives, or I couldn't get them in soon enough for follow up or, any of those things. I couldn't carve out time specifically for dealing for dealing with weight. Those were the kind of things that happened.

Dr. Maryal Concepcion : 10:16

What was it about this fellowship that drew you to Minnesota versus not doing a fellowship?

Dr. Lisa Tritto: 10:22

Yeah. The, the whole science and field of obesity is so fascinating and complex and I really felt like I wanted that, that level of the level of education to help understand, but that hands-on experience with people that are doing it every day, that's what that fellowship provided to me. I probably could have pieced it together and it would've taken me a long time to feel as confident in what I do on my own. It probably would've taken a few years, but this opportunity just like to be intensive is why I chose to do it. I the University of Minnesota puts on a CME conference every year specific on pediatric obesity, and I had to tend to that. And that was sort of where I, decided I really would like to go to go and just really learn it and dedicate myself and not try to do both

Dr. Maryal Concepcion : 11:20

incredible and so needed just because. Pediatric obesity is such an such an issue, but also an issue that's guaranteed to get worse, given that if people are going to have restrictions on food accessibility. I think I mentioned this on the podcast recently, but in our county very rural 4,000 people are getting CalFresh benefits. So fresh food benefits and 1500 of those people are going to lose their benefits as of February of 2026. Yeah. And then on top of that, the rest of them are going to have to do proof of work, et cetera, et cetera, proof of citizenship, whatever the, the BS is of the, the day. Yeah. But I will say that when it comes to, wanting to eat Whole Foods and things. It's like, is that an option? Will that be an option in the future? Is definitely something that I, I didn't have to think as hard about prior to yeah. The changes that are coming. So let me ask you here, when you talk about this fellowship and when you talk about how you were able to have super concentrated education on pediatric obesity mm-hmm. I'm wondering how did you leave fellowship? Because it's almost like DPC, once you see it, you can't unsee it. And so I'm wondering, once you saw the way that you could practice in fellowship, how soon after did you, start itching for something like DPC?

Dr. Lisa Tritto: 12:45

I knew, I knew before I even went into fellowship that that was, well, I, I was pretty sure that was what I would wanna do when I came out and sort of be able to do it in my own way. And in fellowship we did, we were allowed, we were allowed a, a fair amount of time, but the the opportunity to have follow ups at a timely manner, WA was very limited. And it's that way at all of the pediatric weight centers around the country. Extremely long wait to get in and not enough time to spend with your patients. Yeah.

Dr. Maryal Concepcion : 13:22

And can you tell us about some of the patients who you would see? Because I think about, Dr. Andy Burkowski, he's the, the quaternary specialist that the people who have restless leg syndrome. In particular, we'll go to different clinics at Cleveland and Mayo, I believe, and then they go to him. So I, I'm thinking about when we have pediatric obesity in the family practice clinic in the general pediatrician clinic who are the patients that you would see and what would, what would get them to you? Like, would it be certain things that were screened for to get them to your fellowship clinics? Or was it just general, concern about pediatric obesity? From general physicians?

Dr. Lisa Tritto: 14:03

Yeah. I think the majority of the patients were having problems related to weight. So pre-diabetes liver disease. Depression, anxiety, just weight could not stop gaining weight. That would be a lot of our referrals and, but there would be some families that sought us out on their own and who felt actually dismissed by their general doctor or shamed or, just unhappy with their primary care experience and sought us out on their own. We did have a very large Medicaid population up there too. I mean, obesity does, it is more prevalent in a, an underserved community. Absolutely,

Dr. Maryal Concepcion : 14:54

definitely. And I'm wondering when you talk about how even in fellowship it was, sometimes it was difficult to get the follow-ups. And I'm wondering if you could bring us to, maybe a, a patient example or where you had done, good work conversation with the family and the patient, and then because of follow up not being what it needed to be the, the differences that you had hoped for were not being made.

Dr. Lisa Tritto: 15:22

Right. It, it can be hard. Particular if they're on medication and we need to follow for side effects, we, what we would end up doing is a lot of, myChart messaging and spent an extraordinary amount of time trying to manage side effects and so on in between visits. Or they would run out of their medication and not realize that they could call, call and get a refill and they come to us however many months later have gone off and gained weight again and that sort of thing. So, that is, that is definitely one of the restrictions because, we are now prescribing medications like this GLP one that really need close monitoring and mm-hmm. Write a prescription for that and say, see you in three or four months. That's just not good medicine, yeah.

Dr. Maryal Concepcion : 16:27

And just as we're talking about GLP ones, I'm wondering what is the accessibility. For a GLP one in the pediatric population, if you are a Medicaid Medi-Cal patient versus someone who's privately insured. Because in the adult world, it's definitely an ongoing struggle, no matter how many gold, triple platinum insurance plans a person has.

Dr. Lisa Tritto: 16:49

Yeah. It is definitely state dependent. We were fortunate in Minnesota that Medicaid did cover them, although sometimes the hoops were pretty, there were a lot of hoops to jump through. Yes, we cover them, but we're gonna deny, deny, deny. We had to appeal, appeal, appeal until they were eventually cover. Here in Missouri, actually, just at the beginning of this year, they became approved in a weird way. Like they want us to use the A brand that's, that would be off, off label for kids. Mm-hmm. But they will cover them without a prior authorization even, which is amazing. So it is very state dependent and from what I understand in California, that California has been very good about coverage for kids at least. I don't know about adults.

Dr. Maryal Concepcion : 17:36

as you say this, I, I am just like, I wonder what the PBM politics are behind the oh yeah. The availability of me medicines in Missouri versus other states. It's crazy. Yeah. So when it comes to you leaning into fellowship, you going to fellowship did you have any, pressure from your prior colleagues or just, people you went to medical school or residency with? To stay in general pediatrics? Because I, I think about in the, the, I think about the comparison of people who are, in the fee for service world that they'll say things like, oh, well, if you leave to do DPC, you're gonna create a shortage. And so I'm wondering if you got any similar pressures from going between general pediatrics and specializing in pediatrics in your world.

Dr. Lisa Tritto: 18:24

No, no, I didn't, but I wasn't asking for anybody's opinion either. And, and, and I, and, and I, I, I do, I do sometimes struggle with, should I be doing more for, certain populations, but I also will look back and say, I've, I've been doing pediatrics for over 20 years and I have served those populations and I can find ways to help in, in other avenues. So, for example, I'll do, one day a month where I will see anybody regardless of their ability to pay or I'm on a lot of committees in the, in the commu, in the community. And I'm like reaching out and trying to educate people on social media and whatever. So I feel like I'm still making, making a contribution

Dr. Maryal Concepcion : 19:12

that way. I love that it's very much in alignment with the culture of Aurora that Dr. Becklin talked about when she was on. But also, just that you're gonna be in a mental space where you can feel good about the care you're giving your patients, as well as that you can have time. Not that it's a, it's a it's a duty to, to volunteer to do anything, but it's like if you get excited to, and you have the bandwidth to a fricking men. Right. So That's awesome. And I, I wonder now, when you leaned into DPC, we're recording this close to one year of you being at Vora. Was the, and I don't know this, so this is, this is a, a definitely honest question. Was Vora for kids in existence before you came on at Aurora as well?

Dr. Lisa Tritto: 19:59

No, it was started for me. Yeah, I met, I met Becky and I was actually, I wasn't quite sure how I was gonna start my practice when I met her at the St. Louis Obesity Society meeting when I first moved there. And then she called me a couple weeks later and she says, Hey, why don't you join us? And I thought, oh, this is amazing. You've already figured out how to do everything and I'll just slot right in. And so she, I was very fortunate that I was able to come into a system that was already in place where they, they knew how to market and they, they knew how to make a webpage. All of that was so completely foreign to me. I probably would've still been trying to figure it out. such a learning curve. Yeah. Yeah,

Dr. Maryal Concepcion : 20:46

totally. And I think it's awesome because especially Dr. Dr. Becklin does does marketing like that, that is a thing that she loves also. So in addition to clinical practice, like just speaks to my heart when, when we get to do lots of different things that we love. But I'm wondering because this is a very real space that a lot of people are finding, and that they don't have to start their DPCs from the ground up. Talk to us more about what you saw in Aurora building off of what you mentioned that made you more confident in, hey, like this type of practice could actually work in that, I'm not taking insurance and I can spend time with my patients. Because it, it is sadly, it is really challenging and foreign sometimes to, to have people, see DPC and they understand DPC, like tho those are two different things,

Dr. Lisa Tritto: 21:35

right? What she has built here is really just, inspiring. She started by herself and then she her patients needed perimenopause and menopause care. So she learned about that and got certified and then they needed weight management. So then she learned about that and got her obesity medicine certification and then they need a dietician. So she brought on her own dietician'cause she couldn't get anybody in. And then they need a therapy. So she, then she brought in a therapist and now we have that. We have an internal medicine doc, we have a psychiatrist, we have a chiropractor, we have a personal trainer. It's just like this, she's definitely a success story. She started, the practice is a little over five years old now. She had started it. She tried to, she's tried to start it in February of 2020. And you know what, what happened in March of 2020? Pretty

Dr. Maryal Concepcion : 22:26

pretty hard to forget that one for sure. But yes, I definitely, again, encourage anybody who has not definitely go listen to the, the, the history of Aurora when Dr. Becky Lynn came on as the, the solo doc. So I absolutely love that. This is, a fast forward into the future when it comes to in December of 2024 when you started it's my understanding that you started with 10 patients, were there ever any concerns about how rapid you would be growing? Because like you're mentioning, it's so needed for a kid and their family to have the ability to talk with a doctor, with the time that you provide now when it comes to weight and when it comes to health. And so I'm just wondering, was that ever a concern for you because your services are so needed? Right. It was

Dr. Lisa Tritto: 23:13

still a concern because I, what I didn't know is, how willing people or able people would be to, to pay out of pocket and not use their insurance. I definitely, I know that there's a need, and my other concerns were I hadn't lived in St. Louis in a very long time, and so I don't have the connections that I had in Cleveland or Chicago where there, I just, like, for example, Cleveland, I felt like I knew every general pediatrician and I would have had a pra, a full practice in no time. But here I have had to work really hard on making connections in the, in the community. So I mean, I did, fear, like, will I be busy enough to, pay the bills and it's still growing. I'm not where I need to be yet, but I do, I'll do some other things to sort of, supplement my income, like. Tele, and a few other little side gigs.

Dr. Maryal Concepcion : 24:08

When it comes to expanding your reach in the community where you are now in St. Louis, how are you going about making community connections so that people are aware of your services? And so people, especially in the healthcare realm, are aware of you and referring people to you as an option?

Dr. Lisa Tritto: 24:26

Mm-hmm. I like on foot going, walking into general pediatric offices, leaving materials attending grand rounds at one of the local children's hospitals. I connected with some people there. And really in any space where my patients potential patients might exist, I I've had a great connection with the, mental health community because probably 95% of my patients carry at least one diagnosis in the mental health realm. Eating disorders community. There's some, there's some telehealth network groups that do pediatric weight management and so on. So that, those are sort of my things. And then face, then face through Facebook as well.

Dr. Maryal Concepcion : 25:13

I'm wondering if you Can also talk to us about word of mouth downstream effects from people who have been to Vora and now they realize that, oh, there's a service that my kids could partake in as well.

Dr. Lisa Tritto: 25:26

Sure, yeah, definitely. I've had patients, new patients that are children of parents here. Yeah.

Dr. Maryal Concepcion : 25:32

That's fantastic. And yeah, it's, it's so funny when a person who knows of one of our patients comes the, the onboarding call's very different in, in, in our experience. It's like we can skip to the, skip to the good part like the song says because they already know what they are looking for when they take that call. That's awesome. Yeah. And how about when you mention your, you're doing telemedicine, you also offer multi-state telehealth when it comes to your practice at Aurora. So tell us about who do you have on your panel when it comes to in-person patients versus those you take care of in other states? Virtually.

Dr. Lisa Tritto: 26:09

I have been struggling to connect in the other states, so most of, I only have a couple of patients that are entirely remote, so for the majority of the, they are coming in, I may do telehealth visits. If there's somebody I've been following over time, I might not make them come in every month. Or they have, kids that are very busy with school. And then I do have a couple that are just completely remote. Yeah.

Dr. Maryal Concepcion : 26:34

And please tell us, for listeners out there who are wondering like, where can I send my patients? How can I get in touch with Dr. Reto? What states are you licensed in? So, under your practice right now?

Dr. Lisa Tritto: 26:46

Yeah. Illinois, Indiana Minnesota, Missouri and Ohio. Those are all the five states I've lived in since I left California.

Dr. Maryal Concepcion : 26:57

I'm just totally throwing this out there, but I vote that you go to the Ohio DPCN summit in February of 2026. All right. And, and talk there, especially because I didn't know about that. Yes. Yeah. Yeah. It, it's a, it's a great place for the Ohio DPC community to connect. Okay. So, for those of you also who didn't know please check it out. And people like Dr. Lily White and Dr. Pat Jonas are the organizers of that one. Okay. Awesome. On your website you have a picture of the Grand Canyon. I have a great story to share about that, but I will leave that for a different podcast different day. But I just think about what has DPC, changed for you in your life on the day to day?

Dr. Lisa Tritto: 27:36

Yeah, I mean, just the ability to. Schedule a doctor's appointment or actually have lunch with a friend where I can just, lock off some time and not have to do that six weeks in advance or eight weeks in advance. That type of, that kind of flexibility and my schedule is really great and I really can make, make the schedule whatever I want it to be. And that's, that part has been just amazing.

Dr. Maryal Concepcion : 28:03

Incredible. And I, I hope that it makes people, especially those who are planning or starting out or within their first year just reflect on their own time that they're able to spend doing whatever the heck they want. I was texting with Dr. Deanna Berry this morning and I was like, Hey, do you wanna do you wanna connect now? I'm walking our dog and she's like, I'm going into yoga. And I'm like, I love that we're doing self-care over here. So yes. Because we can. So, absolutely. It's amazing to hear that you've experienced that as well. Yeah. And just being able to fill our cups, it's amazing. So when, when it comes to you mentioning the opportunities that is that a patient has at Aurora, because there's so many different branches of, of ways to deliver care even though your. At, at vora for kids, do your patients also have access to the nutritionist, to the therapist to add an even more robust holistic layer to the care that you are delivering?

Dr. Lisa Tritto: 29:03

Yes. Our dieticians do see kids, and we have a therapist who does also see kids, and she's really great. She actually used to work in the school system, and so, yeah, so she's an awesome, like, resource for us.

Dr. Maryal Concepcion : 29:17

And how does that work in terms of making sure that the patient, the notes are not, lost between hospital EHRs or, if you can find something or not? Because you guys are your own ecosystem. How do you guys collaborate for a patient?

Dr. Lisa Tritto: 29:33

We just talk to each other. Imagine that. Wow, we don't write a, a, a 20 minute instant message to one another. No Tiger text going on. No, no, that, and that's, that's another thing that I love is that, our patients will sign a thing that allow us to communicate by email with them. And so it's so much easier to communicate with patients and for them to have access to us and for me to quickly relay some information to them. So just, yeah.

Dr. Maryal Concepcion : 30:08

I love it. And tell us about the general day in your practice because you, you, again, you get to determine how much time each patient needs for their visits with you.

Dr. Lisa Tritto: 30:18

Yeah, I mean, like I said, my first visit, my initial visit with them is about 90 minutes long, and then my follow-ups are 45 minutes. So, that's pretty much what it looks like. It's, it's the family comes in having, already completed like questionnaires and we make sure that they're done before they actually arrive. That's another thing that would never happen in a bigger practice. We can, we have the staff that can, keep texting and reminding them until they, until they do it, and that makes the visit go so much more smoothly. Yeah.

Dr. Maryal Concepcion : 30:51

That's awesome. And what does your schedule look like throughout the week?

Dr. Lisa Tritto: 30:55

My schedule, I start late on Mondays. I take Monday mornings off and Friday afternoons are off. That way if I wanna travel somewhere for the weekend, I've got some more flexibility in my schedule. Otherwise it's more, it's nine to five ish, but I will adjust for patients. So I have. A regular, a regular patient and like, she's probably the same girl that I do the telehealth with, that she know she's in volleyball till six o'clock every night. So once in a while I'll just do a, follow up with her remotely maybe from home even because I, I can and, and mean my life is different now. My children are older, so like doing an evening appointment is like no big, no big deal anymore.

Dr. Maryal Concepcion : 31:39

I love that. But I will say, I got my sign idea by appointment only from Dr. Janine Roddas who had that on her door. But I will say Dr. Reto just dropped a great one, like nine to five ish. That's freaking amazing. So, yes, I, I love that. It's a great, it's a, it's another idea to write that on your assign for those of you doing DVC out there. I love it. So let's talk about how comorbidities also play into the health of your patients, specifically when it comes to neurodiversity and A DHD. I'm wondering how do your appointments, pivot or move with a patient who has a comorbidity where you might need more appointments with them if you know there is a mental health crisis going on or something? Because it's not just like. The typical, well, we see you and then we'll see you in how many months later if you come back, type of thing anymore.

Dr. Lisa Tritto: 32:34

Right, right. Yeah, so I mean, this is where, when I say I'm not doing general pediatrics anymore, I guess I'm really lying because I am still doing general pediatric. It's, it's just that, so, so for example, A DHD many, many patients, especially the younger ones come in, they have a DHD and they have obesity, or they have autism, they have obesity, or they have all, they have all three. And so sometimes I am they've never been diagnosed or their general pediatrician doesn't do that, and I have plenty of experience with that. So then we may have them come back, I'd have'em come back. I have somebody this week who was a new patient and mom thinks he might have a DHD. And so I'm just doing their evaluation and they're coming in in two weeks and they'll have a, we'll have it figured out probably by then. So, yeah. And then I had the flexibility in my schedule to do that right? Where as before, it probably would be three months before I had an appointment where I could do a full A DHD evaluation. And then if there's like an, an urgent situation, like, if a patient who's on a medication is causing her a lot of, she's complaining about her, stomach hurting all the time, and we don't know if it's her medication or not. They, I can just tell them, come, come in today, tomorrow, whatever, have lots of contact with the parent and decide, what needs to be done. So that's been, that's been really nice to be able to do that too. And.

Dr. Maryal Concepcion : 33:52

Just because, we, we see our patients typically just having a completely different outlook on their healthcare once they become a DPC member because they don't have the stressors the same as they did in fee for service, in terms of trying to get in, trying to get in with the same person every time. Right. Fill in the blank. There's lots of differences between DBC and fee for service, but when it comes to your practice, have you had to reinforce boundaries with patients? And if so, how do you do that? Because definitely we've heard on the podcast where some patients, there'll be quote unquote high utilizers and, messaging every 10 minutes because they can. But have you had an example of a high utilizer or somebody in your practice where you've had to set boundaries?

Dr. Lisa Tritto: 34:37

I think because I'm still building, I've been a bit more lenient. And so, for example, I had a patient that I was seeing for weight management, but then they were taking a trip to Africa and could I please just do their, their travel medicine visit? And I did. And then they were moving and could I just please fill out her physical form because you've been examining her every month? And I did. So, I think if I were busier, I probably would've had to like kind of draw the line on what I would do, sort of outside of their usual, agreement of what we're doing.

Dr. Maryal Concepcion : 35:08

What are your favorite resources that you recommend for physicians to lean into, to also recommend to their patients? If, they're seeing a pediatric patient who is struggling with obesity as well as possibly other comorbidities

Dr. Lisa Tritto: 35:22

I do, on my website, I have a blog where I, I have discussions about a lot of these topics like reducing like internal bias and shame and stigma and how to talk about. Bodies and health instead of weight. I have a lot of that on the website blog. And then I do have some YouTube videos where they were more most of them were community talks, although there was one directed towards physicians. And, but there's good information in there for everybody about, some, some of the basics about obesity as a disease. And I think sometimes if we can understand that, that that biochemistry, that physiology, it can help us be much more sympathetic to our patients or empathetic to our patients and less judgy, so to speak. So those are, those are great resources. And then there are a, a few CME kind of resources around, like from University of Minnesota where I train, they do that conference every year. And American Academy of Pediatrics has a nice. Website on it's called the Institute for Healthy Weight, something like that.

Dr. Maryal Concepcion : 36:27

When you think about pediatric obesity medicine I wonder what is probably one of the biggest things that you think is misunderstood about the specialty? Because you've, you're doing general pediatrics, like you said. Yeah. You continue to do along with specializing in obesity management for kids.

Dr. Lisa Tritto: 36:47

I think one of the big misconceptions is that it's very prescriptive that they're going to be told exactly what to eat and how much to weigh. And actually just last night, I, I was on this panel with eating disorders specialists. And so we were talking about how we approach a child, with weight and they were really surprised about how I talk about things and how it really is more leaning towards a intuitive eating model and even a health at every size model because we don't set a goal, we don't expect everybody to get into the, quote, normal BMI range. We just need to get them out of health consequences and feeling better. We don't, not everybody can. Not everybody's gonna make it to that in a healthful way. So, I think that's the biggest misconception is that, that people come in here and they leave with your, being told that they're 30 pounds overweight and that they need to count calories. Like, I think that's what people don't realize. Yeah.

Dr. Maryal Concepcion : 37:50

And I will say too, I, I, this is like, as I'm excited to hear your. Addition to the Aurora story, I just, I, I would love to be able to, pull it back to the future, ride in a DeLorean and like, hear how these kids' lives are totally transformed because of how you're talking with them and how you're talking with their families. So I just like, I I, I, I know that that's coming. We can't write in the DeLorean today, but it's, it's so awesome the impact you're making. So when you think about other physicians who are listening and who are either, in pediatrics where the A API would say is not as vocally supportive of the DPC model compared to like the A A FP at this time. Hope that changes. What would you say to pediatricians, especially who are thinking about DPC or for those, for those who are pediatricians looking to do specialty pediatrics, just like you have,

Dr. Lisa Tritto: 38:47

You won't regret it. I think it might take a minute to kind of get up to where you need to be, but you can still be making an impact and you, and, and, and maybe even a more effective impact when you're seeing fewer, seeing fewer patients.\

Dr. Maryal Concepcion : 39:03

I love that. Thank you for listening to another episode of my DBC story. If you enjoyed it, please leave a five star review on your favorite podcast platform. It helps others find the show, have a question about direct primary care. Leave me a voicemail. You might hear it answered in a future episode. Follow us on socials at the handle at my D DPC story and join DPC didactics our monthly deep dive into your questions and challenges. Links are@mydpcstory.com for exclusive content you won't hear anywhere else. Join our Patreon. Find the link in the show notes or search for my DPC story on patreon.com for DPC news on the daily. Check out DPC news.com. Until next week, this is Marielle conception.