How to Help a Child With Obesity Without Shame or Diet Culture

Childhood obesity affects nearly 1 in 5 children in the United States, yet many parents feel afraid, ashamed, or overwhelmed when discussing weight and health with their children. In this honest and compassionate episode of MomDoc Talk, pediatrician Dr. Kristen Cook breaks down what pediatric obesity actually means, why BMI is both useful and flawed, and how parents can support their child’s health without shame, fear, or harmful diet culture messaging.

Dr. Cook explains the medical risks associated with childhood obesity, including type 2 diabetes, sleep apnea, fatty liver disease, joint problems, mental health struggles, and cardiovascular complications. She also shares practical ways families can create healthier habits together while protecting a child’s confidence and self-worth.

Most importantly, this episode helps parents move away from blame and toward supportive, sustainable lifestyle changes that focus on overall wellness, movement, emotional health, and family connection.

What You’ll Learn

• What pediatric obesity actually means medically
• Why BMI is helpful but imperfect
• The difference between being “fat” and having obesity
• Why shame and diet culture can harm children
• Medical complications linked to childhood obesity
• How obesity impacts mental health and self-esteem
• Healthy language to use when discussing weight with kids
• Small habit changes that can improve family health
• Why movement should never be used as punishment
• Ways to encourage healthy eating without labeling foods “good” or “bad”
• Tips for reducing sedentary screen time realistically
• How parents can model healthy habits at home

Order Dr. Kristen Cook’s Book

Parenting Redefined: A Guide to Understanding and Nurturing Your Child's Behavior to Help Them Thrive

If you enjoy Mom Doc Talk and want practical, evidence-based parenting guidance with compassion, science-backed strategies, and real-world parenting support, grab your copy here:

Parenting Redefined on Amazon

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Podcast Disclaimer

The information presented in this podcast is for educational and informational purposes only. It is not a substitution for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider for medical concerns. All of the opinions are of Dr. Kristen Cook and do not reflect the opinions of her employer nor the hospitals she is affiliated with. The authors and publishers of this podcast do not assume any responsibility for errors, omissions, or consequences of using the information provided.

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Transcript

0:33

Welcome to Mom Doc Talk with Dr. Kristen Cook, where real-life parenting meets medical expertise. I'm your host, a pediatrician with over a decade of experience, and just like you, a parent navigating the ups and downs of raising good human beings. With stories from my own experiences of mom, lessons in child development, and insights based on scientific evidence, I'm here to share practical strategies that work. Let's dive into this journey together and make parenting feel a little more peaceful and a lot more rewarding. Hi, and welcome back to Mom Doc Talk with Dr. Kristen Cook. I'm your host, a pediatrician with over 15 years of clinical experience and a busy medical practice. Today I'm talking about something that affects millions of families, but is often wrapped in shame, confusion, and misinformation. Pediatric obesity. I'll be honest, it's a topic that I dislike addressing. Why? Because it is difficult to separate medical facts from societal opinion. The truth is that being fat is not the same thing as being obese. I'll explain what I mean by that soon. I recently saw a 5-year-old for a well-child exam. Her mom looked at me and asked, "So when are we having the FAT talk?" This was a child who was obese, and I appreciated how frank her mom was. I told her that I never talk with my patients about being fat. Rather, I focus on the medical complications of obesity while being cognizant of the stereotypes that come with that diagnosis. I never, ever say the word "FAT." I never, ever tell a child that they need to lose weight or go on a diet. When it is appropriate, I will recommend screening for potential medical complications. That's just my approach. I also recognize that many physicians have a different, less thoughtful approach. They tell their patients to eat less and move more, as if it was that simple. They perpetuate misinformation that 3,000 calories always equals a pound. Some are dismissive, and others are way too blunt. This makes me sad, especially because doctors are not nutritionists. They are not personal trainers. Unless they have completed a fellowship in the medical management of obesity, they are providing advice that is probably based on their personal opinion. Here's the essence of the problem. As a society, we have associated being thin with being healthy and attractive, and being bigger with being unhealthy and unattractive. The word "fat" and "obese" have become synonymous when in fact they are very different concepts. This has led to parents being hesitant to discuss their child's weight with their pediatrician. And I completely understand this hesitancy. They do not want to risk damaging their child's self-esteem. If their child is being bullied for their weight, they do not want to bring additional attention to the medical issue that is causing their child significant distress. I understand, and I empathize with these concerns. Yet ignoring pediatric obesity in order to protect our child's psyche does not protect their future health or well-being. I want to begin by saying that pediatric obesity is not about blaming parents. This is not about labeling kids. This is about understanding health and empowering families. Today I'm going to break down how common this medical condition really is, the definition of obesity, why body mass index, or BMI, is helpful, but also flawed, the real health risks that obesity can cause, and most importantly, what you can actually do as a parent. Let's start with the facts. About 1 in 5 children in the United States has obesity. That's roughly 14 to 15 million kids. It's important to note that pediatric obesity rates have tripled since the 1970s. It's also important to note that there are higher rates of pediatric obesity in certain populations. This is due to the lack of access to healthy and affordable food, cultural beliefs about food and obesity, and socioeconomic factors. So what exactly makes a child meet diagnostic criteria for being obese? In children, obesity is defined using BMI percentiles, not raw numbers. And again, BMI is the abbreviation for body mass index. It is a mathematical measurement of weight divided by height. We then take that number and plot it to a growth chart. Growth charts are standardized tools that track a child's height and weight over time. They are intended to assess how well a child is growing. Growth charts use percentiles. For example, if a child plots at the 50th percentile for weight, that means that they are of average weight. By definition, a healthy weight is in the 5th to 85th percentile on the BMI growth chart. Overweight is in the 85th to 95th percentile. Obesity is 100 to 119th percent of the 95th percentile. And severe obesity is greater than 120 percent of the 95th percentile. At times, BMI can be a useful tool. It tracks trends over time, it is easy to calculate, and it may help identify risk early. Yet BMI is not a perfect measure of health. BMI does not distinguish fat tissue from muscle, and muscle tissue is denser than fat. It does not show fat distribution. Fatty tissue that is located around the organs is much more metabolically active and therefore unhealthier. Furthermore, BMI does not account for genetics, body composition, or pueroral changes. For example, a muscular athlete and a sedentary child could have the same BMI. I like to view BMI as a starting point. Now let's discuss the medical complications of pediatric obesity. Because this is the information that really matters. I want to be very clear. I am not trying to scare you. I just want you to have the information. Let's start with the cardiovascular risks or the risks to the heart and to the circulatory system. They include high blood pressure, elevated cholesterol, and early artery changes. These conditions can increase the risk of having a heart attack, a stroke, and dementia, which are potentially deadly. They can damage the kidneys and even cause blindness. Another medical complication of pediatric obesity is type 2 diabetes mellitus. This condition is caused by insulin resistance. Insulin is a hormone that helps move glucose from the bloodstream into the cells of the body. When we eat, we introduce glucose to our bodies. Glucose, the building block of carbohydrates, is used by the cells for energy. When someone has type 2 diabetes, the ability to move the glucose from the blood into the cells is compromised, which increases blood glucose levels. This can lead to blindness, kidney damage, stroke, nerve damage, glaucoma, cataracts, and Alzheimer's disease. Next up is breathing problems. Sleep apnea can occur, which is when someone stops breathing frequently while they are sleeping. Symptoms include loud snoring, headaches that occur in the morning, and excessive daytime sleepiness. Shortness of breath with exertion is not uncommon, and it is not due to asthma. It is a child who attempts to run faster than their body can get oxygen moving efficiently throughout their body. This is called deconditioning. In addition, pediatric obesity can lead to orthopedic issues, including joint pain and back pain. A more serious condition called slipped capital femoral epiphysis can occur. This happens when the round top of a child's femur, or upper leg bone, slides out of alignment with the rest of that bone. This causes the bone to fit poorly in the hip socket. This condition often requires urgent surgery. Now let's talk about an organ that most parents don't think about, the liver. Pediatric obesity can cause a condition called metabolic dysfunction associated staitotopic liver disease. It's a mouthful. This condition was previously called non-alcoholic fatty disease of the liver. In this condition, excessive fat levels build up in the liver. In kids, this condition may not have any symptoms. But as the condition progresses, it can cause abdominal pain, jaundice, nausea, itchy skin, swelling of the legs, and easy bruising. In addition, pediatric obesity can affect hormone levels. It can lead to early puberty in children, which can cause short stature, meaning children who will be much shorter as adults than they were intended to be. And finally, I want to talk about mental health disorders that can develop due to pediatric obesity. Anxiety disorders, depressive disorders, eating disorders, low self-esteem. Sometimes the emotional impact of pediatric obesity is even more significant than the physical implications. It's important to be cognizant of the symptoms. Is your child isolating themselves? Have they lost interest in activities that they used to enjoy? Are they struggling with sleep? Has their appetite changed? This list is not exhaustive, but it's a place to start. In addition, language matters. If your child is struggling with their weight, please avoid telling them, "You need to lose weight," or, "You are going to develop diabetes and die unless you make some changes." Instead, consider saying, "Let's help your body feel strong," or, "Let's focus on habits that can help you feel your best." You also need to be careful about what you say about yourself. If your child hears you calling yourself or someone else fat, they may internalize it. This is exactly what happened when I was six years old. I accidentally saw my mom looking at herself in the mirror, grabbing her abdomen, and saying, "You're so fat!" My mom was a size 2 at the time, and I thought my mom was beautiful, and she was. But she thought that she was fat, so I must be fat as well. At least that's what my little six-year-old brain told me. I guarantee you, no matter your size, your children think that you are beautiful, so please watch what you say around them. In our home, the F word is not allowed. I said this out loud a few weeks ago, and Savannah told me, "Yeah, right, Mom. We all say F-U-C-K all the time." And I responded, "Not that F word, my love. F-U-C-K is a wonderful word, in my opinion. I'm talking about the word fat, which is not welcome in our home." Now, you don't have to have the same belief about swear words that I do, but I do hope you try to keep the word fat out of your everyday vocabulary. Moving on, how do we help our children who are struggling with obesity? First, we take the judgment out. We focus on scientific facts. We do not shame. We do not blame. We do not label any food as good or bad. We focus on habits, not the number on the scale. We provide access to healthy food and cook healthy meals for our families. At the same time, we do not force our children to eat anything. We encourage our children to drink plenty of water. We recognize that we need to keep junk food, including juice, out of the house. We take the initiative to model healthy eating habits for our children. We encourage our children to eat when they are hungry and stop eating when they are full. In addition, we make movement a normal, consistent part of the day, not a punishment. Consider taking nightly walks as a family, or having dance parties in the kitchen, or going to the park several times a week. Make sure to focus on the joy of physical activity. It is so important to try to help your child find a way to enjoy moving their body. This may take some trial and error. Enroll your child in swim lessons. Encourage their interest in playing soccer. Teach them how to ride a bike. My husband loves to coach baseball, softball, and football. And I'll be honest, he's really good at it. I love coming home from work to see my husband and my kids in the backyard hitting off a tee or throwing pitches. Not only are my kids moving their bodies, but they are also improving their skills in the sports that they love, and they are connecting with Chad. That's a win on so many levels. Do you or your partner need to coach a sport to promote movement in your home? Of course not. I don't coach any of my kids' sports, but I love to exercise. I try to work out five days a week. While my kids don't watch me exercise, they know how much I enjoy it. In addition, it is important to set boundaries when it comes to sedentary activities. Watching YouTube or TikTok, playing video games, or watching TV are not the healthiest activities. They are not inherently bad if parents impose time limits on the amount of time that kids engage in those activities. I advise the parents in my medical practice to encourage 10-15 minute activity breaks for every 45 minutes of sedentary activities. Do I have any scientific evidence for this? No. But it makes sense to me. Finally, monitor the societal messages that your child is internalizing. Make sure to point out evidence of Photoshop and filters. Help your child understand that their self-worth has nothing to do with their weight or their appearance. Praise them for the effort that they demonstrate rather than the outcome of their actions. Teach them that exercise is about moving their body in ways that they enjoy rather than as a tool to lose weight. Trying to address a child's obesity can seem overwhelming and isolating, but it doesn't have to be. Remember that this is not about a child being fat. It's not about their appearance. It's about a child who has a chronic medical condition. Break it down. You don't need to overhaul your entire life. Small, consistent changes matter. But ensure that those changes apply to everyone in the home. Because if you treat a child differently, they will notice. I suggest that you change one habit every three to four weeks. Maybe it is a rule that no one in the house is allowed to eat when using an electronic device. This is typically the first recommendation I make to the families in my medical practice. People tend to overeat when they're distracted. Here are some other suggestions. Stop buying soda. Let your child choose a physical activity to do together as a family, such as taking a walk or going for a bike ride. Involve kids in the process of making dinner. Addressing pediatric obesity is not about perfection. It's about direction. Yet at the same time, if your child has been diagnosed with obesity, please do not ignore it. Trust me, you will be doing more harm than good. Educate yourself. Support your child. And if this episode of Mom Doc Talk with Dr. Kristen Koch resonated with you, please share it with a friend. Thank you for spending time with me today. Until next time, do your best to parent the child you have, not the one you want. The podcast content of Mom Doc Talk with Dr. Kristen Koch is for informational purposes only. It is not intended to diagnose or treat any medical condition. Always consult your health care providers for medical advice. Thanks for listening to Mom Doc Talk, where we explore the world of parenting with a little bit of science and a whole lot of heart. If this episode resonated with you, please consider sharing it with a friend. Don't forget to subscribe and review this episode as it helps me reach more parents like you. I'd love to connect on social media. You can find me at momdoctalk_kcmd.