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Internal medicine-pediatric physician Chrissie Ott discusses her article “When the pediatrician is the parent: a personal reckoning with childhood obesity.” Chrissie shares the deeply personal story of her own child’s struggles with weight, the bullying and shame that compounded them, and the tension she felt balancing her medical knowledge with her role as a parent. She explains how reframing obesity as a relapsing, remitting neurobehavioral metabolic disease shifted her perspective, leading to a decision to pursue GLP-1 therapy in addition to lifestyle support. Chrissie candidly describes the relief of moving from blame to action, the transformation in her child’s health and self-esteem, and her own decision to pursue board certification in obesity medicine. Listeners will learn about the challenges of navigating childhood obesity compassionately, the evolving role of medical treatment, and the importance of protecting dignity and autonomy while supporting kids in larger bodies.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Chrissie Ott. She’s a pediatrician. Today’s KevinMD article is “When a pediatrician is a parent: a personal reckoning with childhood obesity.” Chrissie, welcome to the show.

Chrissie Ott: Thanks so much for having me, Kevin.

Kevin Pho: All right, so let’s briefly share your story and then share the KevinMD article that you wrote for us today.

Chrissie Ott: Yeah, absolutely. So I’m a med-peds doc based in Portland, Oregon. I have worked in primary care, in hospital medicine, and now long-term care for kids with medical complexity. I have a background in nutrition and integrative medicine, and so all of that would make me think that I was uniquely qualified to address pediatric obesity when it occurred in my own family, but I was wrong.

Kevin Pho: So tell us more about the story that you articulated in your article.

Chrissie Ott: Yeah, I decided to write this article, and it was a bit of a surprise to me, but after years of feeling stuck and unsatisfied with treatment options for my sweet child, and just confused—wanting like all parents to help without harming, to not be part of bias and stigma, but also having a really deep concern as a medical professional and knowledge about all of the health risks associated with a highly elevated BMI, rapid weight gain, or weight cycling. It just felt like the counseling that we were getting in routine pediatric visits was not adequate, was not moving the needle.

And there were so many ways, Kevin, to get it wrong. And I was like, if I’m paralyzed at this juncture as a person with a background in nutrition, pediatrics, and coaching, I don’t know who’s getting it right. So let me dig deeper. I felt like there was an aha moment where I realized, “Oh, oh, oh, this is a metabolic condition.” I often stop short of calling it a disease, which the Obesity Medical Association and other professional organizations absolutely do recognize as a disease. I prefer the word “condition” because I have a little bit of a foot in the Health at Every Size world and a foot in this, “We actually need to treat a medical condition with a medical solution.”

In my own family, I have a child who’s almost 12, and we’ve been through different phases where there was hyperphagia. I didn’t have that word readily available to me, but I knew that my own response to her dysregulated eating was telling me something is wrong. Stopping her didn’t feel right. Restricting food doesn’t feel at all right. Or encouraging her to exercise from a place of my own confusion and distress also felt just off. How do we do this with a child whose satiety signals are actually unreliable? And for what it’s worth, she also is a child with an ADHD diagnosis. So her dopamine reward system, her impulse control, and her executive function are all impacted by this confluence of factors. So I just found myself at a really high-level parenting confusion moment, even as a medical professional.

This thought that we have a medical condition here that requires more than a behavioral intervention reminds me of this analogy: We don’t tell people with hypothyroidism to drink more coffee and put on more sweaters. We offer them a root-cause solution. I just began for the first time to understand there’s a root cause here. It’s a pathophysiology. Her brain and her body are set up to be out of balance. There is now actually a medical intervention that’s FDA approved and could help her. So I just decided I’m going to find somebody who can help, and that’s where all of this begins.

Kevin Pho: You said that your response to your daughter’s hyperphagia felt off. Tell me some of the tension that you were feeling at that moment, given the traditional education that most internal medicine and pediatrics physicians have up until that point.

Chrissie Ott: Yes. For many years in primary care, I was preaching Ellyn Satter’s usually very good advice, which is parents are there to decide what food is available and the children should take the lead in whether or not to eat and how much to eat so that we continue to develop trust in our own bodies’ satiety signals. But what Ellyn Satter, amazing dietician and teacher and author, did not necessarily consider in my humble opinion was the children who have genetic, polygenic, or monogenic setups for obesity syndromes, especially in a food landscape full of highly palatable, habit-forming, ultra-processed foods that are harming bodies and eating habits at a very high rate, coinciding with screens ubiquitously entering our lives.

The tension that I felt with my daughter’s hyperphagia was that I am very devoted to her emotional well-being above most all other things, which is not to say I get it right all the time, for sure. But I did not want to harm her dignity. And also, I am the adult who needs to put some brakes on, right? If my child is running into the street, I will stop her by any means necessary, even if that means yelling or physically stopping her. So it was feeling like that tension, but because we have so much emotional baggage and material around food habits, eating habits, body sizes, and weight, I was trying to hold the, “I don’t want to oppress my child’s body. She can be whatever size she wants,” but also, “This behavior, I can see this behavior is out of control and it’s not just emotional eating, it’s actually that she has no brakes.”

Kevin Pho: So tell us what happened next after you reframed your daughter’s hyperphagia and termed it as a condition. What happened next in the story?

Chrissie Ott: I got curious about a medical intervention for a medical problem. I had been at least aware enough of that for a year that we’d been on a waitlist for a healthy lifestyle clinic, which is our tertiary care provider here, and it is primarily focused on behavioral interventions. But as a former nutrition person, I am well versed in healthy eating and healthy lifestyle habits. That wasn’t our primary deficit in this household. We did not have lots of soda or fast food habits. However, even with that, we couldn’t get in. We were on a waitlist for a year.

I wasn’t aware of anybody in my area actively practicing obesity medicine for pediatrics. The one person who I knew of had retired, and I just was realizing this is such an unmet need. So I found an adult obesity medicine provider who was willing to see my daughter, and we talked about the pros and cons and the risks of intervening and not intervening. We ended up going on a slow, steady journey of, “Let us try this approved oral medication for a while and then let us also add some structured exercise and let us also talk about a healthy plate and healthy lifestyle habits, of course, at the same time.”

And then eventually we added a GLP-1 and have been increasing it according to the increased schedule. That has made the biggest difference. I have seen my child’s hyperphagia actually regress back into more of an average appetite, not a suppressed appetite. She still very much loves and enjoys food. I can see that she actually has brakes now. She can say, “Oh, I don’t want to finish that. I’m full.” I’m always on the lookout for restrictive patterns because the last thing I want to do is also provide input that would cause my child to go down a road of restrictive behaviors or valuing thinness over well-being. No, that is not where we’re headed. But trying to find a place where we can work with her physiology to support trustworthy, reliable satiety signals, that I am excited about. I think there are so many kids out there and families who must be in similar conditions and who are like, “What can we do? We don’t want to be restrictive to our child, but we’re also seeing and knowing that there’s something out of whack here that we need to intervene with.”

Kevin Pho: So take us a little bit into those discussions. You said your child was an adolescent, I think you mentioned 12 years old or so. Take us into the discussions about starting a GLP-1 agonist in her. What was it like with the discussion with the adult obesity medicine physician and what were those discussions like with your daughter?

Chrissie Ott: Great question. In this age group, what we need is assent, an informed assent rather than consent. So the TL;DR version is that she was very much on board. The background information is that she has been the victim of weight-based victimization or bullying at school off and on for a few years, and it has really impacted her social growth. Her understanding of herself is whether or not she was desirable. So I’m naming fat shaming and stigma, which is not in itself a reason to undergo medical treatment in my estimation. However, it is a part of the landscape that I think needs to be named because it was impacting her emotional well-being in a very, very deep way. She was shy, she was withdrawn, she was not taking social risks.

We asked her, “If I could connect you with a doctor who specialized in weight loss, is that something you’d be interested in?” And she was like, “Oh my gosh, yes, yes Mom, I really want to meet them. When can I meet them? Can I go tomorrow?” And so we met the doctor and we talked about options, included her in the conversation. As our listeners all know, GLP-1s are injectable. My kid, like most 11-, 12-year-olds, is not a fan of shots. And so for this kid to be aligned with taking a shot once a week in her belly, I can’t even tell you how much she must have wanted change in her body. Again, monitoring for, “Are we reacting to stigma alone or are we also doing a service to work with her physiology?” and, “How can we balance this both-and, thread the needle of being a safe space for people to be in whatever size body they need to be in, and also offer health-affirming medical treatment that results in weight loss when it also makes sense?”

Kevin Pho: Now, how has that journey gone and how long has your daughter been on a GLP-1?

Chrissie Ott: She has been on a GLP-1 for about three months now. She has lost about twelve pounds. She has noticed changes in her body and she’s very pleased with it. She feels more confident. She is celebrating herself in the mirror. I joke that my child is what Jack Black would be if he inhabited a tween girl’s body. And so she’s just hilariously celebrating herself all of the time, even more than she did before. I see her taking social risks and just feeling proud of her new strength and speed on the softball field. She’s really into it, and her lab work shows improvement as well.

Kevin Pho: So I prescribe GLP-1s in my adult patients. And as you know, these are longer term medications and in adults the weight does tend to come back after stopping these medications. So prescribing it to someone who is 12 or 13 years old and knowing that it has to be long term, how did you address that facet of that therapy?

Chrissie Ott: I think that that is probably a partially to-be-determined component of our journey. I do think that over time we will have more options. I think that over time, gradually reducing the dose while also upregulating those healthy lifestyle interventions, also accepting that the treatment of the propensity to obesity is much like treating some other chronic conditions that may require some level of lifelong treatment and titration. I don’t know the answer yet. I’m really game to find out and also quite averse to blindly following Big Pharma’s lead all of the time.

I uttered my disgust as part of the article. So two years ago when the FDA approved GLP-1s down to age 12, I was angry. I felt protective of those kids. I thought they would be victimized by this Big Pharma reach, and I think that’s one of the most surprising things is that I find myself flipped on the other side today going, “I am so grateful that this tool has entered my daughter’s life at this time.” I don’t know what the future holds, but I am open to leading the way and being part of the solution.

Kevin Pho: Do you still feel like there’s a stigma against GLP-1s in patients that young? Do you feel that there are a lot of parents and pediatricians for that matter who feel how you initially felt?

Chrissie Ott: I think stigma and fear both. So I just had an exchange with a highly regarded dietician in my community who is a Health at Every Size proponent and I think feels passionately that this is a wrong choice. I’ve had one or two other commenters who felt protective towards my child and felt like this was a wrong choice. I honor our difference in this way, and that’s OK. I have been more surprised by the flood of physician parents who reached out and said, “Thank you so much for writing this. This describes our situation so much.”

In the clinical environment, I think our pediatrician colleagues and adolescent medicine colleagues, it’s new. It’s new, and we are taught to not be comfortable for a while with what’s new for good reason. This may change over time, naturally. I think it takes a lot of bravery to step into this, and honestly, there’s so much to know that it really makes sense to find a diplomate of obesity medicine in your community who is a pediatrician or familiar with prescribing for kids on the younger end of the adolescent spectrum. Not all of us can travel to a tertiary care center to find that. And some of this may be only accessible through virtual health visits. One of the ways I’m hoping to help that problem is to partner with primary care clinics to help them expand their range of comfort in treating obesity with the full scope of tools at our disposal. I don’t know how that’s going to work out yet, but I think that helping primary care docs expand their comfort is a step in the right direction. And just also modeling it and getting more data and more anecdotal and documented experience about safety and efficacy. I can’t wait to get more data.

Kevin Pho: So you said two things that caught my attention. Number one is that you had an outpouring of people who reached out to you saying, “Thank you for writing about this, and we are in a similar situation to where you are.” But you also said that you were literally judged by people who said that you were making the wrong choice. Tell us the advice that you can give to these parents who may be in that situation and want to start a GLP-1, but they’re inevitably going to be facing some judgment if they make that decision.

Chrissie Ott: Yeah, I think that being really clear about your intentions, like being anchored in your decision, will help. So maybe don’t do it until you’re really clear about your intentions that you really feel like you have thought through. This is not a decision to take lightly, I don’t think. I also believe in getting an opinion from somebody who has this expertise, somebody who’s studied it specifically. So whether that is a referral from your pediatrician’s office or you find somebody online, there’s a great resource for clinicians and families alike. Obesitymedicine.org has an area for pediatric resources, and then obesitymedicineproviders.com is a place where you can find people who are certified in obesity medicine, and it’s of course searchable by your zip code, and then you can kind of narrow it down. I recommend having at least an initial visit to explore with these folks. Admittedly, pediatric providers are harder to find, but there are some resources out there and kids can thrive at many different sizes, but I love the future in which they have access to effective tools.

Kevin Pho: We’re talking to Chrissie Ott. She’s an internal medicine and pediatrics physician. Today’s KevinMD article is “When the pediatrician is the parent: a personal reckoning with childhood obesity.” Chrissie, let’s end with some take-home messages for the KevinMD audience.

Chrissie Ott: Absolutely. If you’re feeling unsure about how to help kids in your life or your practice with health concerns related to weight, there are important tools beyond the behavioral and lifestyle strategies. It is a both-and situation. Find someone to support you, get more information, and don’t stop asking the questions until the right answer has landed.

Kevin Pho: Chrissie, thank you so much for sharing your story, time and insight, and thanks again for coming on the show.

Chrissie Ott: My pleasure. Thank you for having me.