Pediatric Obesity with Dr. Lisa Tritto
Have you ever wondered what’s really going on when a child struggles with obesity—not just physically, but emotionally and socially too?
In today’s episode, we’re talking about pediatric obesity and the complex, often misunderstood challenges kids face when it comes to weight. It’s not just about eating too much or not moving enough. There are deeper layers that often get overlooked.
Joining me is Dr. Lisa Tritto, a board-certified pediatrician and obesity specialist. She practices at Evora for Kids in St. Louis, Missouri, and brings over 20 years of experience in general pediatrics. She also completed a one-year fellowship in pediatric obesity at the University of Minnesota, which is something only a few clinicians in the country have done.
With her expertise, we’re taking a closer look at what really shapes pediatric obesity, how it’s tracked and addressed, which medications are commonly used, and how nutrition advice can actually support kids instead of shaming them. We also talk about how to discuss weight with children in a way that protects their relationship with food and their self-esteem.
To hear the full conversation and learn how we can better support kids facing these challenges, tune in to the latest episode.
What Really Shapes Pediatric Obesity?
Pediatric obesity is a growing concern and it’s not as simple as it might seem. The reasons behind it are layered, shaped by a mix of biology, environment, and lifestyle. With more focus now on improving the health of both kids and adults, it’s worth taking a closer look at what’s really driving this trend.
One thing that often gets overlooked is how much biology is involved. Our bodies are naturally built to hold onto weight more than to lose it. This made sense in the past, when food wasn’t always available and our systems were designed to store energy for survival. But today, that same biological wiring works against us. Some kids are just more genetically predisposed to gain weight—especially if there’s a family history of obesity or certain medical conditions. And when those genetics are combined with an environment full of calorie-dense, super tasty foods and less physical activity, it can be really hard to manage.
What ends up happening is that kids who are more biologically sensitive to weight gain are simply more affected by the world around them. It’s not about willpower or poor choices. In fact, many of these kids are eating and moving just like their peers but they get different results. That’s something families need to hear more often: it’s not their fault. The way someone’s body responds to food and lifestyle is deeply influenced by biology.
You can see the same thing happening in households. Maybe two parents are eating the same meals and following the same routines, but one gains weight more easily than the other. Some bodies are just better at storing energy. It’s a survival trait that’s become a real challenge in our modern world.
When it comes to children, there’s also a common belief that they’ll eventually “outgrow the extra weight.” And while some kids might shift their weight as they hit puberty or go through growth spurts, research shows that around 80 percent of kids with overweight or obesity will carry that into adulthood. So for most, it’s not just a phase. Especially for those at the higher end of the growth chart, change usually doesn’t happen without support.
Another big myth is that the answer is as simple as “eat less and move more.” That kind of advice sounds straightforward, but it totally misses the point. It ignores the fact that biology, environment, and mental health all play a role. And there’s often this unfair assumption that parents just aren’t doing enough. But in reality, so many families are doing their best in a society that doesn’t make healthy living easy.
To really understand pediatric obesity, we need to bring more compassion and science into the conversation. Blaming kids or parents doesn’t help anyone. What we need is support, better tools, and an understanding that every body works differently.
When to Be Concerned: Reading the Growth Curve in Pediatric Obesity
Recognizing when a child’s weight could become a long-term concern can be tricky, but there are signs that help guide the way. One of the most important tools pediatricians use is the growth curve. By tracking patterns over time, it's possible to identify early warning signals that a child may be facing ongoing weight challenges.
Some children consistently track along the higher end of the weight curve. While that in itself isn't always alarming, a more concerning pattern is when there's a sudden upward shift, when the curve starts climbing steeply rather than following a steady trajectory. This kind of rapid weight gain can be a strong indicator that the child may face longer-term struggles with obesity.
Another subtle but important sign lies in early childhood growth patterns. Typically, children experience a natural dip in their body mass index (BMI) around the ages of four or five—a trend that’s often referred to as a “Nike swoosh” due to its shape on the chart. If that dip doesn’t occur and the curve continues to rise instead, it’s often a signal that weight issues may develop or persist.
Obesity that begins before the age of five is particularly concerning. Early onset increases the likelihood that a child will carry excess weight into adolescence and adulthood. In fact, around 80% of children with obesity will continue to have obesity as adults. While some children may naturally shift their growth trajectory over time, most won’t. That’s why it’s important not to take a wait-and-see approach.
Instead of hoping kids will “grow out of it,” identifying these early signs allows for more timely and supportive interventions. Recognizing the patterns on a growth chart is not about labeling—it’s about giving families the chance to act early and give their children the best possible foundation for long-term health.
How Pediatric Obesity Is Addressed: A Collaborative, Individualized Approach
When families come in for help with pediatric obesity, the process starts with a deep dive into the child’s health history. This includes reviewing medical records, growth charts, and identifying any contributing factors, some of which families may not even be aware of. For example, a child whose mother had diabetes during pregnancy is at higher risk of developing obesity. Conditions like ADHD, anxiety, or depression can also play a role in weight challenges, and it’s important to factor those in.
From there, a full physical exam is done, followed by a conversation to understand the child’s lifestyle and eating patterns. This isn’t an interrogation. Instead, the goal is to walk through what a typical day looks like. Parents fill out questionnaires, and if the child is 12 or older, they do too. By the time the appointment is underway, there’s already a clear picture of what’s going on.
The focus is not on overhauling everything at once. There’s no rigid diet plan or unrealistic list of rules. Instead, the process is collaborative. Together, the provider, child, and parent identify small, doable changes based on the child’s current habits whether related to food, physical activity, or daily routines. These goals are ones the child helps set and agrees to. At follow-up visits, they’re asked to recall what they committed to, which helps build accountability and confidence.
Ultimately, the goal is progress, not perfection. It’s about building small wins, supporting the child’s health, and creating a plan that works in real life not just on paper.
Medications Commonly Used in Pediatric Obesity Treatment
When it comes to treating pediatric obesity, medications can be a helpful tool, especially for kids 12 and up. For this age group, options like semaglutide (Wegovy), phentermine, and Qsymia (a mix of phentermine and topiramate) are often used. These medications help regulate appetite, reduce cravings, and support the lifestyle changes that are already in motion.
For younger kids under 12, things get a little more nuanced. There are fewer FDA-approved medications for obesity in this age group, but sometimes doctors turn to off-label options. These are medications approved for other conditions but can still be safe and helpful. One example is topiramate, which is usually used for seizures or migraines and is FDA-approved for children as young as two. While it’s not typically prescribed to kids that young for obesity, it’s often considered for older children because it can help reduce cravings and promote fullness.
Another medication that sometimes plays a role, especially in kids with ADHD, is Vyvanse. It’s approved to treat both ADHD and binge eating disorder in adults, and there’s a clear overlap between ADHD and obesity. Kids with ADHD are more likely to struggle with obesity, and vice versa. So in cases where a child has both, Vyvanse can be a game changer. It helps with focus and also supports appetite control and reduces impulsive eating.
In the end, the decision to use medication is made thoughtfully and always based on the child’s full medical picture. When paired with lifestyle changes and strong family support, these medications can really help move things in the right direction.
Nutrition Advice for Kids with Obesity
Helping kids with obesity isn’t about strict diets or cutting out entire food groups. The real goal is to build sustainable, healthy habits they can stick with as they grow up. One tool that makes this easier is the plate method. It’s simple and visual: half the plate goes to fruits and vegetables, a quarter to protein, and the last quarter to carbohydrates. It doesn’t have to be perfect, especially at the start. The idea is to give families something doable to work toward over time.
Another big part of the conversation is about what kids are drinking. Cutting back on sugar-sweetened beverages is often one of the first steps things like soda, juice, or sweetened teas. Milk is typically the exception, but the general idea is to avoid getting unnecessary calories from drinks.
In terms of food, the focus is on reducing simple sugars and overly processed carbs while still keeping all food groups in the picture. There’s no need to eliminate entire categories of food, and approaches like keto or intermittent fasting aren’t recommended for children. These methods can lead to over-restriction, which often causes overeating later in the day. It’s a cycle that’s especially hard on kids and doesn’t support a healthy relationship with food.
That’s why calorie counting isn’t usually part of the plan either. While we might talk about general portion sizes or snack choices, asking kids to track every calorie just isn’t realistic or healthy. The goal is to build habits they can maintain for life, not follow a temporary set of rules that feel punishing or overly rigid.
Food shouldn’t feel like a source of stress or shame. And while some of these ideas may seem simple, they matter. They help families create routines that are both supportive and sustainable—without putting too much pressure on the child to be perfect.
Talking to Kids About Weight—Without Harming Their Relationship with Food
One of the biggest concerns when addressing obesity in children is the potential risk of developing disordered eating. Parents and caregivers often wonder: Can trying to help actually make things worse? The answer is—not if it’s done with care, evidence, and the right kind of support.
Kids are not more likely to develop an eating disorder when they’re guided by a trained pediatric obesity specialist. In fact, research shows the opposite. Left on their own, kids may resort to dangerous strategies like skipping meals, fasting, or using laxatives in an attempt to lose weight. But when they have access to someone who provides medically sound and compassionate guidance, they’re far less likely to go down that path.
This is why the way we talk about weight matters so much. In clinical care, weight is often not the focus of the conversation. Instead of setting weight goals or pointing out numbers on a scale, the discussion centers around health: improving energy, addressing specific conditions like prediabetes or fatty liver, and simply helping the child feel good in their body. These are the types of goals that resonate with kids and are far more impactful than a number on a scale.
Language is kept neutral and supportive. No one is blamed. Not the child and certainly not the parent. Families often carry guilt, feeling like their child’s weight is somehow their fault. But the truth is, obesity is influenced by many factors, from genetics to environment. Blame doesn’t help anyone, and shame has no place in care.
To help prevent disordered eating, screening is built into the process. From the start, families are asked questions about eating habits, body image, and patterns that might raise red flags. These screenings help providers understand what level of monitoring and support each child might need, and they make sure any concerns are addressed early.
Most importantly, the approach is designed to protect a child’s sense of self. There’s no calorie counting, no judgment, and no rigid rules. The goal is to support the child’s health and confidence—not to control or restrict. When done right, weight care for kids is about helping them grow into a healthy relationship with food and their bodies, one that lasts into adulthood.
And for families who need support, it’s important to know: you’re not alone, and this isn’t your fault. There are resources, specialists, and compassionate care available to walk with you—step by step—until you find what works for your child.
Thanks for sticking with me through this deep dive into pediatric obesity. There’s a lot to unpack, but understanding these challenges can really change how we support kids and families.
If you want to hear the full chat with Dr. Lisa Tritto and learn more about how to help kids feel better in their bodies and lives, check out this episode.
Just click the link to listen and join the conversation!
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