26. Weighty Conversations w/ Parents: The "Yes AND" approach with Dr. Peggy Greco

Any conversations that involve *weight* can be really challenging and require a really thoughtful approach. This week, we chat with Dr. Peggy Greco, pediatric psychologist who specializes in eating disorders,  about how to talk with parents when 

• you're concerned about their child's health and weight OR
•  the parent is *overly* concerned about their child's weight. 

We discuss how to- use the "Yes AND" approach to :
- address parental fears and feelings about their child's weight
- AND shift the conversation from weight to health

We also talk about the importance of
- reflecting on your own experiences with weight, food, eating, etc.
- connecting with a larger team to care for kids with eating disorders, obesity

Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds

Transcript

Dr. Elise Fallucco: 0:21

Welcome backto PsychEdh for Peds, the child mental health podcast for pediatric clinicians- helping you help kids. I'm your host, Dr. Elise Fallucco, child psychiatrist and mom. Last week, we talked about how to have challenging conversations with teens and children when you're concerned about their health and they're at extreme ends on the weight spectrum. This week, we're shifting the focus from talking to teens to now talking with parents when you're concerned about their child's health, either they're on the extreme, low end of the growth curve or on the higher end and also conversations in the opposite range where the child appears to be very healthy however, the parent seems to be overly concerned about their weight. Any conversations that involve weight can be really challenging and require a thoughtful approach. And so that's why I'm delighted to be able to talk about this subject with my friend and colleague, Dr. Peggy Greco, pediatric psychologist who specializes in eating disorders. First question for Dr. Peggy Greco. So, do you have any tips for how to talk to parents when you're concerned about their child's health and more specifically, they're either significantly underweight or overweight.

Dr. Peggy Greco: 1:32

A couple of things to keep in mind about parents. One is that parents are afraid that their child is unhealthy on some level, whether it's restricting or whether it's being overweight that there's concern. That concern can show itself in a lot of different ways. So it doesn't necessarily mean that the concern translates into, I want to do everything possible to help it may be I'm going to be defensive and resistant cause I'm scared and I want to almost wish this away. So to know that that fear is there. There's also a loss of control. All of us as parents like to have control. And when you think about our kids' behavior and eating habits through their childhood, we have a lot of control and as they get older, we lose some of that control. But it's a very specific way in which you can't force your child to eat. You can't make this better. That is really hard to come to terms with. And

Dr. Elise Fallucco: 2:24

it's got to make you feel as a parent, like, I want to help so badly, but I feel like my hands are tied behind my back and I don't know what to say, but it feels like nothing I say or nothing I do is helpful.

Dr. Peggy Greco: 2:38

And I think for the pediatrician, a couple of things are important with parents. One is to recognize that their initial reactions to your expression of concern about weight, whether it's restricting or overweight to know that the fear that they're feeling the lack of control may mean that they need a little time to adjust to the information you're giving them. I think the second thing for pediatricians to know is that parents can be your best ally and partner with you in re-establishing health. And again, we're focusing on health, not on weight. give them specific guidance in terms of what do they do at home to emphasize health, not weight. You can say we're all talking about healthy eating choices have healthy foods available. We're not going to talk about numbers or weight

Dr. Elise Fallucco: 3:23

to recap you talked about how challenging it is to be the parent of a child who's struggling with an eating disorder. And how as a parent, you can feel really helpless. And so it's important to recognize that going in the room. And also to expect that they may need a little bit more time to process this information. Part of our role as pediatric clinicians is to model this attitude of the emphasis is on health and not weight and shifting the conversation away from weight and towards health. So we've talked about how to talk to parents when you're concerned about the child's health especially if it involves their weight, but often the opposite happens where the parents concerned about the child's weight and you know that the child is healthy. For example we had a teenage girl who was overweight, but otherwise healthy. The mom kept bringing up I'm really concerned about her weight. You know that she's going to get bullied, that this is a. An issue. How do you address sort of a disconnect when you have a child in your practice who may be overweight, but is otherwise healthy. But the parent is very concerned that this is a problem. And perhaps is sending lots of negative messages to the child herself about her value. And how it relates to her weight.

Dr. Peggy Greco: 4:34

In fact, I had a family referred to my practice just for that concern that the child was overall healthy, a little overweight but the family was over-focused on weight and appearance and was very unhappy. For the pediatrician the focus is always on health. Your job is not to convince the parent that there's not a weight concern. You do not have to dissuade them from their belief that the weight is not okay. You instead can reassure about health as far as all of the objective ways and perhaps subjective ways, their child is healthy. And that you do not have health concerns. You might get a sense if you can easily shift the conversation away from weight from the parent being unhappy to health that the parent may benefit from seeing somebody. And you don't have to make that suggestion specific in terms of, I think you need to see somebody about this. But instead you can say. Weight and health issues are very complex and often there's a lot that's going on in family and there may be benefit to seeing somebody and talking through. Some of these issues often as was the case for the family that was referred to me. There were some fears, concerns, influencing that very strong need to have control and have a family that looked a certain way, but I wouldn't expect a pediatrician to uncover that in their office.

Dr. Elise Fallucco: 5:59

If I were to deconstruct what you're saying into two steps. You're validating what the parents are bringing up to some extent you're saying yes. And yes, I see that you are concerned about weight. And I'm shifting the focus to health

Dr. Peggy Greco: 6:14

exactly. Yes. You're not going to fight them on that. You're acknowledging you're hearing them. And you're shifting that energy to a different focus that of health.

Dr. Elise Fallucco: 6:26

And this yes. And approach is. Exactly what you're recommending that the pediatricians do and multiple other scenarios. So with the teen who's struggling with restricted intake, being underweight You're not getting hung up on whether or not this is an eating disorder. Yes. I hear that. You don't think that you as a teenager have a problem. And we're concerned about your overall health and so we're going to recommend that you see a nutritionist or these other

Dr. Peggy Greco: 6:52

people. You're also not getting hung up in weight. So there's not a magic weight for anyone. There's not a specific weight. They need to be. And so a teens will often try to pull in professionals into I'm fine at a hundred pounds. And two, yes, a N. Yes, that may be true in let's double check and make sure your body's healthy at whatever weight you'd like to be. That's what we'll focus on.

Dr. Elise Fallucco: 7:17

Working with. Children and families who are struggling with eating disorders can be very challenging, even as mental health professionals and specialists. And so any tips you have or advice for the pediatric clinicians in the community who are taking care of these kids?

Dr. Peggy Greco: 7:34

Absolutely. Two things. One is that we don't often think about what we bring to the table. So it's worth thinking about how you were raised in relationship to food, what your current relationship is to your body size and appearance. And. All the amazing things your body can do. Because that is part of how you'll react to the family. The more you understand yourself and have insight. The less likely that will intrude upon. Your therapeutic relationship with the family. Some examples of how that might intrude would be for those who have had eating issues in the past, or maybe restricted in the past, believing that it's okay. For a little while or it's okay to be a little bit on the thin side. So there's a lot of different ways in which your past influences how you interact with families. The second thing I was going to mention. Is to know that you cannot do this alone. This Is a big job. And any significant eating issue is going to take a team of professionals. So to keep in mind, you can only do what you can do. You've got colleagues who can help and together you'll get the family where they need to be.

Dr. Elise Fallucco: 8:43

Excellent. Don't suffer alone. As a final take home message. I think what we've talked about is using the yes and approach. So yes. Validate what the parent is saying or what the teen is saying or what they're feeling or experiencing that is real. Yes. You are concerned that your child is overweight. Yes. You're concerned that your child's going to get bullied because of his or her weight. And then you pivot to the, and, and this is what I can tell you about his or her health. And more importantly, here are the practical things. The next steps we need to take to try to improve your child's health. Knowing that these conversations are tricky and can be more emotionally taxing than some others, make sure to self reflect on where you're coming from. Make sure to take care of yourself as always and try to do the best you can to stay connected to a team of professionals, including psyched for Peds.. Thank you so much again, friend of the show.

Dr. Peggy Greco: 9:41

So welcome, loved being here with you all.

Dr. Elise Fallucco: 9:45

If you have any questions, concerns, or thoughts, please send us a chat. Or an email at info at psyched. The number four paeds.com or just go on the website. Psyched, the number four paeds.com. Leave us a message about questions you have about clinical issues in your practice. Thanks for joining and thanks as always for all the hard work you do every day to help take care of kids and teens with mental health problems. See you next time.