The World Health Organization describes childhood obesity as “one of the most serious public health challenges of the 21st century.” Overweight kids are more likely to struggle with health, emotional and behavioral problems. But many potential solutions–from dieting and counseling to medical interventions–raise difficult cultural and emotional taboos for parents and health professionals. We examine the challenge of combating childhood obesity.

Guests

  • Dara-Lynn Weiss author, "The Heavy: A Mother, A Daughter, A Diet"
  • Eleanor Mackey child psychologist, Children's National Medical Center
  • David Kessler, MD former commissioner of the US Food and Drug Administration; author, "Your Food is Fooling You: How Your Brain is Hijacked by Sugar, Fat, and Salt"; pediatrician

Transcript

  • 13:06:41

    MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Late last year, a handful of American cities reported that their childhood obesity rates were going down. The numbers were small, a 3 percent drop in L.A., 5.5 percent in New York, but significant after decades of rising rates that put kids at greater risk for heart disease, stroke and diabetes.

  • 13:07:16

    MR. KOJO NNAMDIBut behind those percentage points are millions of kids and countless family members and caregivers struggling with emotional, psychological and cultural norms that can make it difficult to know where to even start when it comes to achieving and maintaining a healthy weight.

  • 13:07:33

    MR. KOJO NNAMDIHere to help us navigate this difficult topic and joining us in studio is Eleanor Mackey. She is a general child psychologist with Children's National Medical Center and a member of the Children's Obesity Institute there. She works with children and teens who struggle with eating and weight concerns. Eleanor Mackey, thank you for joining us.

  • 13:07:57

    MS. ELEANOR MACKEYThank you for having me.

  • 13:07:57

    NNAMDIAlso with us is Dr. David Kessler. He is a former commissioner of the U.S. Food and Drug Administration. He's a pediatrician and author most recently of a young reader's edition of his book "The End of Overeating," titled "Your Food is Fooling You: How Your Brain is Hijacked by Sugar, Fat, and Salt." David Kessler, thank you for joining us.

  • 13:08:21

    DR. DAVID KESSLERThank you for having me.

  • 13:08:22

    NNAMDIAlso joining us from studios in New York is Dara-Lynn Weiss. She is a freelance writer and producer, also the author of the new memoir, "The Heavy: A Mother, A Daughter, A Diet." Dara-Lynn Weiss, thank you for joining us.

  • 13:08:35

    MS. DARA-LYNN WEISSThanks for having me.

  • 13:08:35

    NNAMDIDr. Kessler, let me start with you. You may be most familiar to our listeners as former head of the FDA, but you began your career as a pediatrician. How has the nation's struggle with and attitude toward childhood obesity changed over the course of your life and in your own practice?

  • 13:08:58

    KESSLERI can tell you from a personal experience because not only have I dealt with this as a pediatrician, but I've dealt with this myself. I probably gained and lost my body weight over my lifetime, you know, several folds. I mean, I have suits in every size so this is very real to me.

  • 13:09:25

    KESSLERAnd, you know, we saw a change in this country. It began over the last three, four decades. I mean, it used to be, you know, you entered your adult years. You were relatively stable with your weight throughout those years. You lost a, you know, you gained a few pounds till your 40s and 50s. You lost a few pounds in your senior years, but weight was relatively stable.

  • 13:09:55

    KESSLERToday, you enter your adult years 20 pounds, on average, heavier. So this is a problem that begins in childhood and it continues to occur in adolescence and it can't be genetic because genetics doesn't change over three, four decades.

  • 13:10:16

    NNAMDIEleanor Mackey, we tend to think of obesity as a physical issue and there are associated health risks, high blood pressure, diabetes, other ailments, meaning that the emotional aspect is sometimes overlooked. Why is it important to take psychology into account?

  • 13:10:34

    MACKEYI think it's important on many levels. First of all, your brain and your body are one. What you feel physically affects you psychologically and vice versa and we know how intertwined the two are so you really can't talk about one without the other.

  • 13:10:48

    MACKEYAnd when it comes to children in adolescence who are struggling with their weight, we find that kids with obesity tend to have more difficulty with peer relationships, more experiences in mental health difficulties like anxiety and like depression. A lot of the kids we see in our clinics struggle, for example, with social phobias because they're so worried about what other people think of them and rightfully so.

  • 13:11:09

    MACKEYWe judge others all the time based on their weight. So it's important to look at the mental health of these kids as well because certainly kids who are struggling with mental health issues are going to have a harder time taking care of themselves physically.

  • 13:11:22

    NNAMDIAnd now for a more personal kind of experience, Dara-Lynn Weiss, about 12.5 million children in the U.S. are obese and at one point, your daughter was among them. Tell us when you first knew you had to take serious action and what you decided to do.

  • 13:11:35

    WEISSWell, I would say we followed the lead of our pediatrician. My daughter was a normal-sized infant and toddler and it wasn't until her sort of early school years that she started to become overweight. And I didn't know at what point it really became obesity and at what point it required intervention and I responded very much to our pediatrician's guidance in that area because it's such a fraught decision to make, to determine that your child needs to change the way she eats and is it at unhealthy weight.

  • 13:12:10

    WEISSAnd I think that may be true of a lot of parents with obese children. You don't quite realize when that line has been crossed. However, it was when she was at the age of six that the pediatrician said, you know, this problem that we've been observing over the preceding few years is really not going away and getting better on its own. You need to try to make a change and I did try on my own, very clumsily and ineffectively.

  • 13:12:38

    WEISSAnd it was a year later when my daughter Bea turned seven and we went back to the pediatrician. And in the intervening year, she had gained 23 pounds, which was really not a healthy rate of gain that I said I needed to get the help of a professional and we went to a childhood obesity specialist and started a really formal program to address her weight issue.

  • 13:13:01

    NNAMDILast spring, an essay you wrote about putting your daughter on a diet ran in full and the reaction was swift. In retrospect, do you think the context dictated some of that response where it was written?

  • 13:13:15

    WEISSSure. I think, you know, Vogue is a fashion magazine and it's a magazine that is part of this idealized image of the female body that so many women struggle with and, you know, had it been in a parenting magazine, I think it would have been received in a different way. But I felt the story was important to tell. I was happy to have an outlet to tell it in, but I think you're correct to assume that it's a tricky place to talk about weight, especially that of a child.

  • 13:13:50

    NNAMDIIn case you'd like to join the conversation about combating childhood obesity, you can call us at 800-433-8850 or send email to kojo@wamu.org. Were you overweight as a child? How did your parents address that issue or if you have a child who is struggling with his or her weight, how are you helping that child? You can also go to our website, kojoshow.org, and join the conversation there. Send us a tweet @kojoshow, but the number again, 800-433-8850.

  • 13:14:17

    NNAMDIEleanor Mackey, when parents and doctors have tried to get a child's weight under control and nothing seems to work, they just might be candidates for a program like the IDEAL Clinic at the Children's Obesity Institute. What age range of kids do you work with and how do they come to be referred to you and your colleagues?

  • 13:14:35

    MACKEYWe work with kids all the way from--probably our youngest is about two to our oldest, usually about in their late teens, sometimes early 20s. And our program is a multi-disciplinary team so we have pediatricians, cardiologists, dieticians, the psychology team and what we're there to do is to try and work with kids and families on a lot of different levels.

  • 13:14:59

    MACKEYWhat Ms. Weiss was describing of trying to go to experts to ask for help, a lot of these families come via their pediatricians. Some come because they find us on the internet and are really concerned about their child's weight. Or often the child or teenager has expressed concern and wants a change.

  • 13:15:13

    MACKEYSo when they come to us, what we do is we take a really thorough history and we try and work as a team with the parents. They are the experts in their own child. We are the experts in some of the behavior change and the types of behaviors they should change. And we're there to try and help work as a team to make sure that the child gets on a healthier track.

  • 13:15:32

    NNAMDIDavid Kessler, you wrote about the addictive properties of certain foods. Is this an issue we have to address, like we might fight efforts or like we might have efforts to quit smoking or breaking a drug habit?

  • 13:15:47

    KESSLERYou know, it's interesting you used the word addictive.

  • 13:15:52

    NNAMDIYes.

  • 13:15:52

    KESSLERWhat I would rather have people understand is that what's going on here involves our learning, memory, habit and motivational circuits of our brains. I mean, how did we get here? What we did was we took fat, sugar and salt and we put it on every corner. We made it available 24/7. We made it socially acceptable to eat anytime.

  • 13:16:20

    KESSLERWe add the emotional gloss of advertising. You can do it with your friends. Walk into any food court in any mall in the United States and we're living in a food carnival. So you know, we use the word--you can use the word addiction. I would rather people understand that this is really conditioned and driven behavior that's at the root of what's going on.

  • 13:16:48

    NNAMDIEleanor Mackey, parents bring a lot of our own baggage, if you will, to this issue but I guess, so do medical professionals. How do you advise all involved parties to work past or to work with their own experiences?

  • 13:17:03

    MACKEYI think that's a really good point and I think that parents and professionals need to be aware of their own experiences and think long and hard about what things have been for them. When we talk to families, when I've talked to other people that I know about what their experience has been like, they often talk about the inner-generational transmission of ideas and values.

  • 13:17:24

    MACKEYSo messages they got from their mothers, they felt very strongly as they grew up and either made a conscious decision to do something different with their own children or find themselves following in the same footsteps. And oftentimes you had people going to extremes.

  • 13:17:36

    MACKEYFor example, I've had people tell me that their own mothers were so weight-conscious and they did not like that at all and it didn't feel good to them that they tried to be quite the opposite with their children and then realized that that wasn't necessarily very healthy either, that all kids are at risk for obesity and kids can fall into weight problems without you even realizing it.

  • 13:17:58

    MACKEYAnd making sure that you walk a fine line, which is very hard to find between not being overly obsessed with it, but by being conscious enough and of helping your children to identify how important it is to keep themselves healthy and to be motivated to keep themselves healthy.

  • 13:18:13

    NNAMDIDara-Lynn, you've been upfront about your own struggles with weight and body image at different points in your life. How did that experience inform how you helped your daughter?

  • 13:18:23

    WEISSWell, at first, I think it precluded my helping her very much at all. I was so concerned that she would grow up with issues around food or body image that I just hoped that this would never be an issue for her and that we would just eat when we were hungry and grow at a healthy rate.

  • 13:18:42

    WEISSAnd we never spoke of food with any kind of value judgment. We never commented on weight. It was just a silent issue in our home and I think what it took was the realization that there was another concern, which is that she would be obese, not just you know the scenario I had experienced, which was being at a healthy weight, but being sort of plagued by insecurity and obsessiveness around those issues.

  • 13:19:09

    WEISSAnd that's what it took to make me realize I was doing her a huge disservice by kind of letting her find her own way around food and nutrition and weight. But I was very apprehensive about saying anything. I felt the risks of burdening her with issues around this topic was so great, but eventually I felt I had no choice. I really had to figure out a way to start that conversation.

  • 13:19:37

    NNAMDIDr. Kessler, as a pediatrician, how did you advise parents when they had concerns about children's weight and what policies do you think are most effective in a bigger picture look at this?

  • 13:19:49

    KESSLERLet's understand one thing from the beginning. You know why don't diets work? I mean, of course, they work. I mean, of course, you can take away food for 30 days, 60 days, 90 days and kids and adults will lose weight. But if you understand that at the root of this problem, I mean, it's our neural circuits that are really getting adapted. And what's going on is we put all these foods and food cues in our environment. So every -- I can't walk more than 10' outside of this studio and not have some kind of food or food cue hit me. And that arouses -- that stimulates my brain. It focuses my attention -- that's how we're designed.

  • 13:20:44

    KESSLERUnless we change those neuro circuits -- I mean, once they've gotten adapted so that I respond to those food cues, you know, or get into this cycle of this cue arousal, increased attention, thoughts of wanting this momentary bliss. You know, then the next time I get cued I do it again and I strengthen those neuro circuits. Unless we lay down new neuro circuitry we're never going to resolve the problem because I'll lose the weight, I'll diet but I go back into my environment after I've lost the weight. And what happens? I gain the weight back.

  • 13:21:21

    KESSLERSo I have to lay down new neuro circuitry. How do I do that? I mean, that's really a question of -- that's new learning. That's changing what I want. That's new motivational circuitry. If it's just a question of deprivation, sure I can do it in a short term but it's not going to work. we're talking about learning for a lifetime.

  • 13:21:45

    NNAMDILet's talk with Ara (sp?) in Fairfax, Va. who may have some insight on this. Ara, you're on the air. Go ahead, please.

  • 13:21:53

    ARAYes. I just want to explain how my social fear and depression was so strong when I was in my teens that at 17 before I went to college I lost 60 pounds in four months. And I did it by just eating everything in the morning and starving the rest of the day and at work. And I kept it off for ten years by not eating beef, not eating cheese and only eating mostly bread, believe it or not. I was on a carb diet -- not anti-carb, I was on a carb diet which controlled my appetite. And of course the fear of the social stigma helped me keep my weight off for ten years.

  • 13:22:29

    NNAMDIAnd how do you keep it off now?

  • 13:22:31

    ARAWell, unfortunately and fortunately, I'm happily married so I gained it back.

  • 13:22:39

    NNAMDIWell, this brings me back to Dr. Kessler's issue and I'd like also to talk to Dara-Lynn about specifically the diet you went on. But it seems as if, Dr. Kessler, you're making the point that it's how we have to reorganize our brains, if you will. So we're going to take a short break. When we come back we'll continue this conversation. Of course you can still join it by calling 800-433-8850. What has and what has not helped your family when it comes to maintaining a healthy lifestyle, 800-433-8850? I'm Kojo Nnamdi.

  • 13:24:49

    NNAMDIWelcome back to our conversation on combating childhood obesity. We're talking with Eleanor Mackey. She is a PhD, a general child psychologist with Children's National Medical Center and a member of Children's Obesity Institute there. She works with children and teens who struggle with eating and with weight concerns. Also talking with Dara-Lynn Weiss. She's a freelance writer and producer who's also the author of the new memoir "The Heavy: A Mother, A Daughter, A Diet.

  • 13:25:15

    NNAMDIAnd Dr. David Kessler is former commissioner of the U.S. Food and Drug Administration. He's a pediatrician and author most recently of a young reader's edition of his book "The End of Overeating" titled "Your Food is Fooling You: How Your Brain is Hijacked by Sugar, Fat and Salt." We're also talking with those of you who call 800-433-8850 with your questions and comments. Dara-Lynn Weiss, could you talk more specifically about the diet that you and your daughter together went on?

  • 13:25:44

    WEISSSure. It was essentially a calorie-based diet. It didn't cut out any particular food groups. It didn't, you know, require a huge shift in lifestyle. She was basically allowed to -- you know, all foods were okay. She was kind of given a budget -- well, all of us were because all four members of our family did it together -- we were each kind of told how much we could eat at each meal and snack.

  • 13:26:09

    WEISSAnd they were -- the food amounts were represented in green lights, which kind of translated into units of calories, but was in a more kind of kid-friendly format. And we would know that, you know, a slice of pizza has three green lights and, you know, fruit is free. You know, there's no green lights associated with it. You could have as much as you want. And we followed that. So for each meal and snack she had some fruit or vegetable and, you know, however many green lights she was allotted.

  • 13:26:41

    NNAMDIWe got this email from Kopel (sp?) in Tacoma Park, David Kessler, who writes, "Our daughter's gaining weigh much faster than she should. At nine she's wearing size 12 clothes, which are designed to fit an average 12-year-old. We have always eaten well at home. We find candy wrappers and empty soft drink bottles -- did you know there's a Jolly Rancher flavored soda -- in her backpack and lunch bags. We're worried that she is stealing from the family as well as her friends to support this sugar habit.

  • 13:27:05

    NNAMDIWe are seeing a therapist once a week but haven't seen much change in about two months. What should we be doing?"

  • 13:27:14

    KESSLERYou know, it's -- you know, I would mislead people if I didn't -- you know, we didn't say upfront that, you know, these are real struggles, especially once that neuro circuitry gets laid down. You know, we can talk about where and when -- it's probably very early on in childhood. But here's a child already that sugar, fat and salt is around everywhere. If you approach it so that, you know, there are -- it's viewed by the child as you can't do this, you can't have this, the child feels deprived. It's not going to work.

  • 13:28:01

    KESSLERYou have to change how you view food. It's not about viewing the child, it's not about the weight. It's about the food. And the question is, you know, what does the child want? Sure, that fat, sugar and salt tastes good but what's -- you mentioned in the very beginning of the program, you talked about the social cultural, the norms. What is it that I value? What is that I want? How do I see food? I mean, if I look at these huge portions of food that are just so highly processed, I mean, I look at it today and I say, I don't really want that.

  • 13:28:40

    KESSLERAnd I think -- you know, what's the one thing -- certainly when you get into adolescents that an adolescent wants more than anything else, they want their independence. They want to be able to make decisions for themselves. And if you can explain to young people how their brains literally are being hijacked, it's not of their own making. It's the fact that we've -- if you look -- we've taken this fat, sugar and salt and we put it in front of them. And how their brains are getting activated and how they can take control. But it has to be something the child wants. It can't be something that you've lectured or you're saying you can't.

  • 13:29:20

    NNAMDIEleanor Mackey, same question to you.

  • 13:29:22

    MACKEYYes. Well, I really applaud this parent for deciding to take their child to a therapist. Two months certainly is a good amount of time but it's not quite enough time to be able to see necessarily huge results but something to talk to the therapist about. We see that eating in secret is something that a lot of kids do and it's a problem because it definitely takes the shame and elevates it.

  • 13:29:46

    MACKEYSo kids who are eating in secret usually do it because they are ashamed of what they're doing. And there are a lot of emotions that come along with that. And the emotions often cause them to want to do more of it because that shame makes them feel bad. What do they do when they feel bad? They go to something comforting. That food can be comforting. So we have to break that cycle. So it's very important to do something like seek out therapy to help that child work through what it is that's going on in their lives.

  • 13:30:10

    MACKEYIs there something that precipitates these episodes, something that happens at school with a friend to stress them out? Is there some other way that they can cope better? But these children are often very embarrassed by this situation and so it's helpful for parents to work with a professional to help their child work through some of those feelings.

  • 13:30:27

    NNAMDIDara-Lynn, it's my understanding that your daughter, despite being just seven years old, was mature enough to want to change?

  • 13:30:35

    WEISSShe really did. And, you know, she amazes me every day, so I can't explain exactly what possessed her to be so motivated to participate in this. And which is not to say we did not fight every day and sometimes every meal about what she wanted to eat versus what she should eat and, you know, what was on her plate. But she'd certainly -- you know, all children have the opportunity to sabotage a parent's best efforts to feed them properly and she really never took advantage of that.

  • 13:31:08

    WEISSAnd I feel it's because she did want to be healthy, whatever that meant to her, whether that meant not getting comments from kids at school or looking more like her peers or just feeling more fit. You know, I don't know in her heart what she understood being healthier to be, but I think there was something that she wanted to achieve in that way. And it wasn't just listening to mommy because mommy said so. Because how many kids can be expected to do that? But that she really took it on as something she was part of.

  • 13:31:42

    NNAMDIHere's Leeann in Washington, D.C. Leeann, you're on the air. Go ahead, please. Hi Leeann. Are you there?

  • 13:31:50

    LEEANNI'm here, yes.

  • 13:31:51

    NNAMDIGo right ahead. You're on the air.

  • 13:31:55

    LEEANNI'd just like to reiterate the importance of the parents' decisions when providing food in the household that there be high quality, highly nutritious fresh fruits and vegetables other than these preservative-filled and processed foods. And also that this issue of childhood obesity isn't only concerning the dietary habits of the child, but also the level of activity that they have. And that has changed over the years. So the dietary habits of the parents could've been quite suitable for the lifestyles that they were living. But passing those same dietary habits onto the children who were experiencing a lot less activity could lead to an issue of obesity.

  • 13:32:35

    NNAMDIAnd Dr. Kessler, they're passing on those habits to their children, as you say, in a slightly different environment because the parents may not have been bombarded in quite the same way with sugar and salt.

  • 13:32:49

    KESSLERI think that's right. Certainly when I was growing up as a child back in the 1950s and 1960s we had this problem relatively under control. You know, what was different then? When you think about it, you know, when did we eat when we were growing up? We used to eat at mealtimes. And what happened in the United States? We've taken down those boundaries so we eat all the time.

  • 13:33:21

    KESSLERI mean, look at the French. Until recently the French have not gained weight. What changed? I mean, they would never eat in their cars. They would never eat -- there would never be food at work or at school or in lecture halls or in classrooms. Today we -- you know, the social norm is that we can eat anytime, anyplace. You know that tag line for one of the fast food places, you know, advertising the fourth meal.

  • 13:33:54

    NNAMDILeeann, thank you very much for your call. Eleanor, some groups are affected by this issue more than others and that some cultures have historically viewed extra weight as a sign of prosperity. Is part of the reason it's difficult for us to talk about this, that we don't have one shared reference point that we're all coming from?

  • 13:34:15

    MACKEYI think definitely your cultural background, whatever that may be, whether it's specific to your family culture or a broader cultural norm affects the way you see food, affects the way you see your body size. And some of those can actually be protective. You know, being comfortable in your own skin and being proud of your body is good. That actually has been linked to being more willing to take care of yourself and keep yourself healthy.

  • 13:34:37

    MACKEYBut it definitely does mean that some of the discussions that we have with parents in our clinic are a little bit more difficult because they see, especially children, you want to see these robust healthy children. And parents worry that their children aren't gaining enough weight or they're too small. Or oftentimes grandparents will come in and say, oh you're starving that poor child. Please feed that child. Or grandparents will sabotage parents' efforts by slipping extra food in.

  • 13:34:59

    MACKEYI mean, certainly food does make kids happy. High-fat foods, high-sweet foods make them happy and so a lot of people want to see that. I think too when we are dealing with these health disparities among cultures, we definitely need to make sure we're paying attention as a society to the way we're set up. When Dr. Kessler talks about the food advertising, well, it certainly depends on the area that you live in too.

  • 13:35:23

    MACKEYI mean, you know, if you're from a wealthier neighborhood where if you aren't bombarded or if your Whole Foods is around the corner rather than a convenient store, the difference in messaging that you get, the opportunities for healthy food are very different. The opportunities to exercise in a safe environment are very different. So these disparities on an environmental level truly do affect the health of the people who live in each of these communities, and something that we need to be aware of when we're helping people try to find strategies to get healthier.

  • 13:35:50

    NNAMDIBack to the telephones. Here now is Machala in Silver Spring, Md. Machala, you're on the air. Go ahead, please.

  • 13:36:00

    MACHALAHi. I'm calling because I wanted to talk about the phenomena of drastic weight-loss shows that are now being targeted at teens for specifically obese teens. And that, you know, the dangers of having them encourage extreme dating and not focus on healthy body image and having a relationship to food. and I know there's a recent one that I won't specifically mention, but, yeah...

  • 13:36:32

    NNAMDII'll mention it, "The Biggest Loser."

  • 13:36:35

    MACHALAYes. That's what I meant.

  • 13:36:38

    NNAMDIYes. "The Biggest Loser" has been focusing on teens recently. And Dr. Kessler, what is your view of the promotion of drastic weight loss, especially among teens?

  • 13:36:48

    KESSLERI think the science shows that drastic weight loss, for most people, will work in the short term, but it won't keep the weight off. I think one thing to pay tribute today, especially after yesterday, I think the one person who has gotten this exactly right is the First Lady. I think she has just been pitch perfect on this issue. And I think what you see is that there's no being judgmental. It's about celebrating healthy food. It's about celebrating exercise.

  • 13:37:36

    KESSLERWhat we've not talked about yet is how do we immunize our children growing up. We've only talked about -- when you talk about drastic weight loss, that's when, you know, we fail. What we haven't quite figured out, and what I think is absolutely essential, I mean, is what can we do to prevent this. I mean, the greatest gift you can give a young person, I think, for their health long term is to be able to assure that those neuro circuits, that physiology doesn't get turned on to this constant cycle of wanting and needing food all the time. And how do we immunize our children? That's the question.

  • 13:38:23

    NNAMDIAnd Dara-Lynn Weiss, speaking of drastic weight-loss programs like "The Biggest Loser," one of the things we often assume about childhood obesity is that there has to be an obvious fix. If only a family will change one thing, its diet or another, start exercising together. Part of your challenge was that the obvious fix, if you will, was missing. How did that complicate the issue for you and for your family?

  • 13:38:49

    WEISSWell, I had hoped that there would be an easy fix and I remember when I first was trying to figure out how to approach the problem, I would read things like, you know, the number one contributor to childhood obesity is sugary beverages. And that was just something that my children never drank. And it was not, you know, a videogame culture they were living in, and, you know, a fast food diet that they were on.

  • 13:39:13

    WEISSAnd it made it harder because I had to look at what was a relatively healthy lifestyle and indeed, one that allows my son, a year younger than my daughter Bea, to maintain a healthy weight, that what about her was causing her to become obese, even though her environment really did not have a factor that you could point to.

  • 13:39:35

    WEISSWhat I think was the biggest difficulty once I decided, well, given that I think we just have to focus on, you know, what is the amount of food she should be eating and making sure that's at the correct level, is that everyone else looking at me thought there was some easy fix that I was somehow missing. And that I was putting my daughter on this diet instead of taking her for a bike ride or making sure she didn't play video games all day or things that just were not really relevant to our situation.

  • 13:40:04

    WEISSAnd I think the judgment and assumptions of other parents make this issue more complicated for parents of obese children who are dealing with a very, very complex set of factors that could be contributing to their child's condition.

  • 13:40:19

    NNAMDIEleanor Mackay, within a family, generations of pudgy toddlers have grown into slim teens. At what point should families either ignore or rethink those patterns?

  • 13:40:32

    MACKEYWell, I think it's important to recognize that every child should be targeting health from the very second that they're born. So what Dr. Kessler was talking about in terms of prevention, every parent should be concerned about this. It shouldn't even be whether your kid's in the 85 percentile or the 20th percentile, you should be making sure that you're developing a healthy relationship with food from day one.

  • 13:40:58

    MACKEYAnd there definitely are going to be individuals for whom this is more difficult or easier depending on the temperament, depending on the lifestyle, but I think that parents should constantly be in conversations with their pediatricians. The beauty of our well-child visits set up at this point is that kids check in on a pretty regular basis with their pediatrician. When you start seeing kids jump percentiles so that they're, you know, started out at the 25th and all of a sudden are jumping to the 50th, 75th, in a short amount of time, that's something that you might want to be aware of.

  • 13:41:28

    MACKEYIf your kid is hovering at the higher percentiles, definitely be aware. But I think event taking all that information away, thinking about how you can make healthy relationships with food, and I think this is very difficult to do, and a lot of our conventional wisdom, and the wisdom handed down from our parents, we're finding out is probably not the right way to approach it.

  • 13:41:47

    NNAMDIGot to talk a short break. When we come back, we'll continue this conversation that you can join if you send us an email to kojo@wamu.org or call us at 800-433-8850. Do you think the government should be more actively addressing childhood obesity through soda taxes, serving sizes and the like, or is that going too far? 800-433-8850. You can send us a tweet @kojoshow. I'm Kojo Nnamdi.

  • 13:43:53

    NNAMDIWe're having a conversation on combating childhood obesity. We're talking with Dara-Lynn Weiss. She's a freelance writer and producer, the author of new memoir, "The Heavy: A Mother, A Daughter, A Diet." Eleanor Mackey is a general child psychologist with Children's National Medical Center and a member of the Children's Obesity Institute there. She works with children and teens who struggle with eating and weight concerns.

  • 13:44:16

    KESSLERAnd Dr. David Kessler is a former commissioner of the U.S. Food and Drug Administration. He's a pediatrician and author most recently of a young reader's edition of his book "The End of Overeating," titled "Your Food is Fooling You: How Your Brain is Hijacked by Sugar, Fat, and Salt." David Kessler, one of your big pushes while at the FDA was for clearer nutrition labels on packaged goods. Do you think we're making smarter decisions because of that information, or do you think it could be still clearer?

  • 13:44:50

    KESSLERYou're referring to those nutrition facts...

  • 13:44:53

    NNAMDIYep.

  • 13:44:54

    KESSLER...on the back, the percent or your daily value of sugar, cholesterol, fat. I think that was a good step in the right direction. Back in the 199s, a lot of people read it, a lot of people find it useful. The problem with that, is that all the numbers can look good. You know, it takes a very sort of reductionistic view, you know, it's what's the macronutrients. How much fat, how much sugar, how much salt is in the food. But there's a basic question, I think, even before you look at the nutrition facts.

  • 13:45:40

    KESSLERI mean, is what you're eating real food? I mean, what happened in the United States? I mean, back in the 1930s and 1940s, in order to feed a hungry nation, you know, the food industry learned to process food. A lot of advantages, shipping food over longer distance, the economics, food safety, the shelf life of food, but what does processing really mean? It meant taking, you know, the hydration out so you can ship it over long distances, but it also meant taking anything that was objectionable out of the food, and food has become so highly processed, and along the way the food industry learned how to make processed food very stimulating.

  • 13:46:26

    KESSLERSo they loaded and layered fat, sugar, and salt into that food. So the first question that the nutrition facts is not going to tell you is whether what you're eating is real food or not.

  • 13:46:40

    NNAMDIOnto Maria in Reston, Va. Maria, your turn.

  • 13:46:45

    MARIAThank you for taking my call. And I just wanted to mention that I have an eight-month-old daughter and I've been feeding her real food since she was five months old, and I'm making her food. I'm not buying it at the grocery store. And anytime I make the food, my first impulse is to make vegetables and fruits and whatnot and put sugar and fat in there. And then I remind myself, you know, she doesn't know better. She will love it naturally as it is when I steam it, and I can just keep it as healthy, you know, as it is in nature.

  • 13:47:26

    MARIAAnd it works. She's fine, you know, and she doesn't know extra sugar, she doesn't know extra salt. She doesn't know anything like that, and it is very hard for a mother when you love junk food, because you want to spoil your child and you want the best for them and you want them to be happy, and we are trying to keep them happy the way we are happy with a bunch of junk food.

  • 13:47:55

    NNAMDIYou know, Maria, we also got an email from Elizabeth who writes, "Based on science and our family's personal experience, I'm a big believer in breastfeeding to keep children slim. It seems that others I know have set points from formula," to which you say what, Dr. Kessler?

  • 13:48:13

    KESSLERI think that point is a well-taken point, and there's a lot of science behind that, because if you look in even our infant formula, it's highly sweetened. So breastfeeding is great, and I think, you know, that last caller...

  • 13:48:30

    NNAMDIMaria.

  • 13:48:30

    KESSLER...may have really hit the nail on the head. I don't think we have all the data in yet, but when I was talking earlier, how do you immunize a child, how do you assure the neural circuits get set down so that child wants to eat healthy for the rest of their life, I think what that parent is doing, you know, that may be the key.

  • 13:48:54

    NNAMDIYour turn.

  • 13:48:56

    MACKEYI just wanted to add to that that I am a parent of two young daughters as well, a four year old and a 10 month old, and I think Maria's point is excellent. I think Dr. Kessler's point is excellent. I just also want to put out there...

  • 13:49:07

    NNAMDIBut there are social pressures.

  • 13:49:08

    MACKEYExactly. And it's really hard to be a parent. You're busy. You're trying to get your food on the table the best that you can, the fastest that you can. Trying to balance work with breastfeeding a child can be very challenging for instance. So I want to make sure that all these messages go out there, but also that women hear that of course it's difficult and not to feel this immense guilt. I think parents so honestly want to do the best for their children.

  • 13:49:33

    NNAMDIDara-Lynn, this is an issue that lies clearly at the intersection of two issues that inspire much angst in our society, parenting and weight. You knew you were opening yourself up to criticism in sharing your story. Which reactions did you expect, and what has surprised you?

  • 13:49:51

    WEISSHaving gone through the process with my daughter, and continuing to go through it, I was certainly aware that people, as we talked about, I think there are very sort of simple approaches to solving childhood obesity and react in a very shocked way when you resort to something like calorie cutting or, you know, trying to get an obese child to actually lose weight rather than just make subtle lifestyle improvements that might contribute to a healthier lifestyle overall.

  • 13:50:23

    WEISSSo I expected the conversations about processed food versus organic food, about the role of exercise, about whether to discuss this topic with the child at all, whether to intervene at such a young age. I was surprised by the assumptions made about me and my motivations and the process that my daughter and I went through that I think people took quite large leaps from what I had written and decided that I had fat-shamed my daughter, that I wanted her to be thin, and that I was somehow, you know, ashamed of her and bullied her and abused her, and these were things that were so shockingly different from anything that resembled my reality, that I almost couldn't take them personally, but they were very upsetting to think that anyone would make that interpretation based on my story.

  • 13:51:24

    NNAMDII should remember -- remind our listeners that tomorrow on Food Wednesday, we'll get a chef's perspective on school lunches for kids when we talk with sustainable food gurus Alice Waters and Cathal Armstrong in the noon hour tomorrow. So you might want to check us out then. Here now is Daniel in Rockville, Md. Daniel, you're on the air. Go ahead, please.

  • 13:51:48

    DANIELHi, Kojo. Thank you for taking my call. One of the things that I think is really important for people to understand is that if you just focus on diet then you will most likely get nowhere. A lot of the literature -- medical literature that I've read, basically you have success rates in the five percent range for people who just work on diets. What's, I think, more important, and I think one of the reasons why it's become more of problem in society is the fact that we don't exercise as much, and not even just exercise, but we don't walk around our neighborhoods anymore.

  • 13:52:19

    DANIELWe don't walk around places anymore nearly as much as we used to. And that, I think, is a big problem in itself, and I think -- my last point is that something really important is to look at the health at every size movement. Just because you're skinny does not make you healthy, and just because you're fat does not make you unhealthy. But if you're cholesterol is good, if your blood pressure is good, if other signs are good, you can be overweight and still be healthy, and it's important for people to know that about themselves.

  • 13:52:46

    NNAMDII'd like you to comment on that, David Kessler, about being overweight and healthy.

  • 13:52:52

    KESSLERI think the thing that -- if we get one message from this hour, is it's not about the weight. It should be about the food.

  • 13:53:05

    NNAMDIAnd...

  • 13:53:05

    KESSLERIf the issue becomes, you know, my weight, if the issue becomes my behaviors, if the issues becomes my child, if the issue is how do I view myself, those issues, you know, are fraught with difficulty. Where I think we can change our social norm -- where I hope we change our social norm, is how do we look at what we're eating. Sure the caller is right about, you know, exercise. But, you know, take a candy bar. Let's say it has 250, 300 calories. I can eat it, what, I can eat it in two, three minutes.

  • 13:53:42

    KESSLERI mean, to work that 300 calories off would take me, what, 45 minutes, an hour? I mean, there's an imbalance there. The issue really has to be what we're eating, how much, and when we're eating. It's about the food. It's not about the weight.

  • 13:54:01

    NNAMDIThank you very much for your call, Daniel. Eleanor Mackey, you say that kids are just one part of the family and that ideal solutions involve everyone in that family. How can families start, and why is it so important to get everyone on board early?

  • 13:54:14

    MACKEYWell, I think it is important, because as the one caller pointed out, health is health for everybody, it doesn't matter your size. And one of the things that Dara-Lynn pointed out was that her whole family did this together. That's really important so that it doesn't single out a child, make them feel ashamed, make them feel that there's a problem with them or a problem with their weight.

  • 13:54:31

    MACKEYEvery family should say to themselves we want to be healthy. We value ourselves, we value our children, we should be healthy, so we should be doing things like doing family activities that involve exercise, doing family activities that don't involve food, doing celebrations with things other than food. Thinking about some of the easy things that we may be able to change, drinking more water, having vegetables at every meal, things that they can do together as a family makes it something that embraces the whole family's health and doesn't single anyone out for feeling like there's something wrong with them.

  • 13:55:03

    NNAMDIDara-Lynn, even within a family, weight can be a topic that either no one wants to talk about or that's an emotional minefield if you do talk about. In your experience, trying to be open about your family's diet, did you run into a lot of reluctance from others?

  • 13:55:18

    WEISSPeople are very uncomfortable talking about this topic, I think. And, you know, it is just as individual as food choice and lifestyle choice is the way families talk and the topics that they feel comfortable discussing. And, you know, we brought this up in our family in a way that was comfortable for us. I think it would have been considered to be far too open for a lot of other families. It might have been, you know, considered a little too soft for other families.

  • 13:55:46

    WEISSSo, it's hard to judge, you know, the point to which you can be open about it, you know, in any other environment other than your own family.

  • 13:56:01

    NNAMDIHere's Linda in Silver Spring, Md. Linda, you're on the air. Go ahead, please.

  • 13:56:05

    LINDAThanks, Kojo. I'm not talking about childhood obesity, but I've struggled with weight all my life, and I got into a clinical trial when my BMI hit 30, that used a combination of Naltrexone and Wellbutrin over 16 months, and what happened was -- and it's just like Dr. Kessler said, it was like my neurons changed. I no longer wanted that fast food. I no longer had to stop and get pizza. It was not that important anymore, and I started eating healthy food, and the weight came off so easily it was unbelievable. So I agree with him that it is -- a lot of it is what's going on inside our brains.

  • 13:56:52

    NNAMDIDr. Kessler?

  • 13:56:55

    KESSLERI think it's our brains, but it's also what's in front of us. It's not just the fact that my brain is reacting to all these food and food cues, and our circuits are getting hijacked. It's what we've done to our environment. It's how that environment has changed over the last four or five decades, that I can eat any time, that food is so highly processed that portions have become so huge. I mean, this is going to take a major change in social norms. This is going to change what we -- it really goes to the heart of what we value as a society of how we look at food.

  • 13:57:41

    NNAMDIAnd that's going to have to be the final comment. Linda, thank you very much for your call. Dr. David Kessler is a former commissioner of the U.S. Food and Drug Administration. He's a pediatrician and author most recently of a young reader's edition of his book "The End of Overeating," It's titled "Your Food is Fooling You: How Your Brain is Hijacked by Sugar, Fat, and Salt."

  • 13:57:59

    NNAMDIEleanor Mackey is a general child psychologist with Children's National Medical Center and a member of the Children's Obesity Institute there. She works with children and teens who struggle with eating and weight concerns. And Dara-Lynn Weiss is a freelance writer and producer. She's also the author of the new memoir, "The Heavy: A Mother, A Daughter, A Diet." Thank you fall for joining us, and thank you all for listening. I'm Kojo Nnamdi.

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