The Various Roles in Managing Childhood Obesity

An Interview with Dr. Leigh Ettinger

Childhood obesity is a growing problem all over the world. It is already a huge problem in the US. A child is considered obese when they have too much body fat based on Body Mass Index (BMI) measurements at the 95th percentile or higher. The American Academy of Pediatrics (AAP) estimates there are currently 14.4 million kids living with obesity in the USA.

Childhood obesity can lead to a range of serious health problems, both in childhood and later in life. To learn more about the condition, its causes, and treatment, I spoke with Childhood Obesity Specialist, Dr. Leigh Ettinger, MD, MS, FAAP, ABOM. He was able to explain the causes, outcomes, and new guidelines for the treatment of obesity just released by the American Academy of Pediatrics. What he had to say was eye-opening. Dr. Ettinger started his practice in Pediatric medicine, specializing in kidney problems since 2004. In 2014, he started eating WFPB and saw wonderful and positive results. In 2021, Dr. Etttinger obtained board certification in Childhood Obesity medicine and retooled his practice, bringing the power of whole plant foods to benefit his Childhood Obesity patients. Now he incorporates telemedicine, intensive education, and a plant-based diet in his plans of care. He also offers e-course to families who want to learn more about the plant-based diet for children.

Causes of Childhood Obesity

Dr. Ettinger explained that as a disease, obesity seems very simple. We have all heard “eat less and move more.” However, the truth is that the causes of childhood obesity are complex and
multi-faceted and involve a combination of genetic, environmental, and lifestyle factors. In addition, systemic racism and social and political problems further complicate the picture,
putting low-income people and people of color at higher risk for developing the disease. Some of the most common causes of childhood obesity include:

Genetics: Recently, genetics have come up more often as a primary cause of obesity. There is evidence that genetics can play a role in childhood obesity, as certain genes have been linked to increased disease risk. However, Dr. Ettinger explained that genetics alone do not cause obesity, “When we say genetics are responsible for obesity, it seems to say the person is stuck and has no power to control the disease or the outcomes.” In his practice, Dr. Ettinger takes a different tack. He empowers his patients to take back control of their health as much as possible. He explained, “It is not that obesity is a result of genetics passed on from one generation to the next. Humans have evolved to love calorie-dense, brightly colored, sweet, salty, and fatty foods. Food companies and marketers capitalize on this and create irresistible foods that humans have a tough time refusing. These foods cause us to eat more than we should, leading to weight gain.” Dr. Ettinger further clarified a big issue in obesity: Genetics aren’t the only things that run in families. There are also recipes, eating habits, access to healthy food, and whether or not the family values physical activity.

Additionally, Dr. Ettinger explained that over the 200,000 to 250,00 years of human evolution, we lived in an environment of food scarcity. We had to hunt and gather to get our food. This took the time (call that intermittent fasting) and work (call that exercise). Now our environment is full of ready-to-eat, easy-access calories. Dr. Ettinger described it as being “in a flood of calories. We haven’t evolved all the adaptations needed to manage all the calories we are being flooded with. The grocery stores make the quick calories very easy to find. Eating a whole food plant-based diet creates scarcity again in a way because eating healthy foods that are naturally high in fiber, we mostly shop in the produce section. Because of this, the supermarket becomes smaller. Eating WFPB, we don’t even go down most of the aisles in the supermarket.

Lifestyle choices are critical. Children who eat a diet high in calories and low in nutrients, and who have limited opportunities for physical activity, are more likely to become obese. Children who watch a lot of television or spend a lot of time on electronic devices, such as smartphones and tablets, are also at increased risk. Environmental factors are also a determining factor in obesity development. Children who grow up in environments that are not supportive of healthy habits, such as those lacking access to healthy food sources or safe places to play, are more likely to become obese. Children from low socio-economic status families, who experience adverse events during childhood, or generational racism, are also at higher risk.

Consequences of Childhood Obesity

Childhood obesity has serious consequences for children’s health and well-being. Some of the most common consequences of childhood obesity include:

  • Increased risk of chronic health problems: Children who are obese are more likely to develop chronic health problems, such as heart disease, diabetes, joint problems, high blood pressure, and even some cancers early in life. Dr. Ettinger pointed out that sleep apnea is another serious medical condition that can cause real problems for children. He said, “A lot of people worry about obesity in 10, 20, 30 years, or 50; there’s going to be a heart attack or diabetes. But the kids, are actually having problems now. Sleep apnea can be very common in people with obesity because it can affect school performance. If you’re not getting a good night’s sleep, you’re not going to perform as well in school the next day. Obesity causes active issues that affect the child right now, not just somewhere down the road.
  • Reduced quality of life: Childhood obesity can harm children’s self-esteem and social relationships, leading to social isolation, anxiety, depression, disordered eating, and potentially, more dangerous forms of self-harm.
  • Increased healthcare costs: The healthcare costs associated with childhood obesity can be significant, as children who are obese are more likely to require medical care and treatment for related health problems.

Management of Childhood Obesity

In January of this year, the American Academy of Pediatrics issued its first-ever Clinical Practice Guidelines, The Evaluation and Treatment of Children and Adolescents With Obesity. The new guidelines include recommendations for intensive behavior and lifestyle treatment and referrals for support. Instead of the “watchful waiting” employed in the past, the guidelines now recommend Weight Loss Medication for children as young as 12 years of age who struggle with obesity. Doctors may recommend bariatric surgery when the child reaches 13 years of age.

It is important to note that the AAP guidelines stress lifestyle interventions first. Sadly, the AAP only makes vague dietary suggestions. Dr. Ettinger read me the AAP’s one-line statement about diet: “The lifestyle treatment should include physical activity and nutrition programming…a non-diet lifestyle modification approach that teaches families to set goals for meal preparation, grocery shopping, and learning skills, including portion size and label reading.” There is no recommendation for the type of food to be encouraged or eaten. So what can we do besides medicines and surgeries?? To address the problem of childhood obesity, parents, healthcare providers, insurers, schools, and communities must purposefully coordinate their efforts in the children’s best interest. Here are
some suggestions.

  • Communities, schools, and parents must work together to ensure that all children are encouraged to eat healthy, whole food plant-based foods and participate in safe, regular physical activity, especially in educational settings.
  • Healthcare providers can play an important role by taking the time needed to educate children and families about the importance of a healthy lifestyle. The education given would have to be far beyond the watered-down vague recommendations commonly provided currently.
  • Medical providers can also screen children for obesity and refer the whole family to programs and resources that can help them to achieve and maintain a healthy weight. Insurance companies should be required to cover these expenses.
  • Communities can make a difference by creating environments that support healthy choices. This could include investing in parks and recreational facilities and requiring scheduled physical activity during the school day for children from grades K-12.
  • Communities must also ensure that healthy food options are available in all neighborhoods. In other words, eradicating food desserts should be as important as requiring infants to ride in car seats.
  • Schools should promote and serve only healthy foods that support our children’s physical, emotional, and psychological health. This would require a thorough overhaul of the current school food environment. It would require the involvement of knowledgeable
    healthcare professionals, parents, and community stakeholders committed to our children’s immediate and long-term health. Financial gain should never take priority over our children’s health.

In conclusion, while many factors contribute to childhood obesity, the AAP guidelines are but one path that parents and children can take to manage obesity. Regardless of our approach, lifestyle will always be a critical aspect of overall health in the long and short term. Lifestyle, including a high intake of whole plant foods, sufficient water intake, adequate restful sleep, and effective stress management, will continue to be the best foundation for health as long as we have a physical body—time to teach our children more and better.

People can reach Dr. Leigh Ettinger 



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