Solving For Joy

Jill Castle (00:00)
Like how do you build that? I believe you,

actively have to plant the seeds of self love. You need to teach your children to find things that make them feel good.

Chrissie Ott MD (she/her) (00:12)
we know what it's like to hold multiple truths at once, to live in that scientific evidence, and also to love somebody so fiercely that the usual advice is impossibly inadequate.

Jill Castle (00:24)
I know even somebody is an adult or a child is taking these medications, they aren't the...

End all cure all, you still need these lifestyle habits. You still need to work on self love. You still need a family culture that's supportive and caring and non-stigmatizing.

Chrissie Ott MD (she/her) (00:36)
100%.

Yes. Yes. Yes.

Chrissie Ott (00:45)
You're listening to Solving for Joy. I'm your host, Dr. Chrissie Ott, a multi-boarded integrative physician and professional certified life and career coach.

Chrissie Ott (00:55)
This podcast is about joy, what it means, how we find it, and the creative ways people are solving for it in their

Chrissie Ott (01:03)
own lives.

I'm so glad you're here.

Chrissie Ott MD (she/her) (01:10)
Hello friends and welcome to today's episode of Solving for Joy. I never expected to write publicly about my own family's experience with childhood obesity and yet doing so has opened a door to conversations I did not even realize I was longing for. One of the people who reached out after that piece was published is Jill Castle.

a pediatric dietician and author whose work immediately resonated with me. Jill has spent decades helping families find their way out of shame and confusion around food and weight into a more grounded, compassionate approach to Her book, Kids Thrive at Every Size, is an incredible resource for parents and families and professionals

who want to support both their child's health and their child's spirit at the same So as a mom and a doctor, and for you Jill, as a mom we know what it's like to hold multiple truths at once, to live in that scientific evidence, and also to love somebody so fiercely that the usual advice is impossibly inadequate. So we are gonna talk about that middle space today.

the messy human complicated places where parents live when a kiddo's body doesn't neatly fit into the narrative of our culture or some of our growth curves and how to support them without shame. So

thank you for being here with me, Welcome

Jill Castle (02:49)
Thank you, thanks for having for offering this conversation, which I think is a really important Wherever it may go, yeah, yeah.

Chrissie Ott MD (she/her) (02:56)
is an important one. Absolutely.

I can't wait to see where it goes. And because this is the Solving for Joy podcast, I am going to ask you to tap in to what is bringing you joy right now and share that with our listeners. Where is joy feeding you in your work in life today?

Jill Castle (03:18)
two main areas I would say. Number one, my own clients and patients that I work with and just connecting with them on a regular basis every single week and taking them through a journey to help them feel more connected with their child, feel more purposeful and confident.

in how they are feeding and nourishing and moving and all kinds of different things that they do with families. But watching the transformation of them, of parents and caretakers becoming more confident and happy then the inevitable result of watching their children just blossom as a result of their.

confidence and knowledge and so that's one area and then the second area would be just Writing a little bit differently and on different topics than I have spent my entire career doing so that's bringing me a little bit of joy in that I'm feeling pulled to it, which is really fun as a writer,

or as a communicator, don't even really like the word writer, as a communicator to feel very drawn to communicating thoughts and ideas that are living in my head and putting them down on paper a little bit, albeit selfishly, but also hopefully tying it to the benefit of others as well.

Chrissie Ott MD (she/her) (04:49)
Absolutely. As you were speaking, I could feel like that creative impulse of both head and heart together. Like this is what's my gift to give in the world and to give it is a joy and to have it be so authentically called forth and to have the expertise and lived experience to communicate about it so that it can be a benefit for as many people as possible. so wonderful.

Jill Castle (05:02)
Mm-hmm. Yes.

Yeah.

Chrissie Ott MD (she/her) (05:17)
I, you this may be a little bit out of order, but I'm wanting to invite you to just share a little bit about how you currently work with families and patients around building that confidence. Because I don't know that everybody understands that this type of service is available in the field.

Jill Castle (05:40)
Mm-hmm. Mm-hmm. So I work in private practice and this is my third iteration of a private practice and I've sort of changed it over the years to fit what I believe is a model that actually works for families and gets them into a better place. And so on a lot of levels, you could call me sort of a parent coach in a way.

Chrissie Ott MD (she/her) (05:57)
Thank you.

Jill Castle (06:07)
because I'm not really doing medical nutrition therapy where I'm using insurance and things of that nature. I am working with families on a three to six month basis. I work with them every week and we work on what they and I together have decided are their goals. And oftentimes families are struggling with a child who might be growing up in a larger body.

who might be growing up in a smaller body, who have developed eating habits that are concerning and worrisome for the family, who also, you know, the family itself may be just struggling with their way they're connecting, the way they're communicating. And so my work is really trying to help them, of course, bring, you know, nutritious foods into their children's lives.

and overcome whatever barriers and obstacles that they're dealing with, but also facilitating cohesiveness and communication and the attitudes and beliefs that I think for lots of kids need to be actively cultivated and helping families understand some of these attitudes and beliefs are.

Contrary to what they are seeing on social media in the news and the magazines what they might be hearing from other health care providers or teachers or Adults that are influencing their children's You know trying to help them understand that some of these messages and some of these sort of social norms are quite harmful to their children and helping them understand that it doesn't have to be that way that they're

different ways to think about things and different ways to promote health and promote wellbeing that rides sort of counter to what we've been brought up to believe is the way to go about it.

Chrissie Ott MD (she/her) (08:06)
Yes, I am struck by how many different skills you're bringing to bear in supporting them because of course addressing attitudes and beliefs is far more than sharing accurate portion sizes and macro and micro nutrient information, which of course back fills the information that you offer absolutely necessary but.

Jill Castle (08:27)
Mm-hmm.

Chrissie Ott MD (she/her) (08:31)
absolutely not sufficient to walk people across the bridge of not knowing what to do to feeling confident about how to respond.

Jill Castle (08:39)
Mm hmm.

Right. Right. Of course, you know, my training is in pediatric nutrition. I've spent 35 years working in this field, but I'm also a mom and have raised four children and I've seen all of their friends and I've seen just like lots of behaviors and beliefs and and just, you know, after 35 years, not that I'm, you know,

Chrissie Ott MD (she/her) (09:02)
Yeah.

Jill Castle (09:08)
the end all be all, but I've observed a lot of things and I've seen a lot of things work and a lot of things not work. And I have sort of the experience to be able to go a little bit deeper, you know, help families recognize the child that they are raising, not the social norm child that we're supposed to be, you know, achieving. And that oftentimes for families looks very different, right? Every child is different.

Chrissie Ott MD (she/her) (09:29)
Yeah.

So

true. And those stories stay with us for so many years in so many cases. So intervening with a loving intervention during childhood can make such a long lasting difference. I imagine, you know, one of the things that I shared in the article was how my own expertise as somebody with, you know, this human nutrition and food science degree, just like a dietician.

and being a pediatrician for a couple of decades did not adequately prepare me to support my own child in ideal ways. That I was still stuck for a long time. That expertise met with reality in a way that was very humbling and opened my eyes and has inspired me to step further into the space of being part of the solution, even with

you know, ongoing humility around there's so much I still want to learn and so many ways we can offer people that help. How was it for you as a parent with such depth of expertise? Did you trip through this whole parenting thing without a hiccup or were there tricky times even for you, Jill?

Jill Castle (10:49)
Not at all.

I did not sail through parenthood. ⁓ Actually, my very first child was quite, being a parent to her was quite humbling. at the time I had her, I'd been a pediatric dietician for seven years. I'd worked at Mass General Hospital where I did my training. worked, I was a clinical dietician there and then.

Chrissie Ott MD (she/her) (10:56)
you

Jill Castle (11:17)
was at Children's Hospital in Boston and a nutrition support dietician. So my level of expertise and intensity in these very busy, yeah, was very high. And I was very good at my job. And then I had my first child. And we did okay the first year. When we started Solids, things started to unravel. And at her 18 month checkup, she was underweight.

Chrissie Ott MD (she/her) (11:26)
very high.

Jill Castle (11:45)
And at her one year appointment, she was riding on the fifth percentile at her 18 month appointment. She was anemic and that really rocked my world. You know, at her first had her one year appointment, I was like, I can get her to gain weight. I know how to get kids to gain weight. This is something I can do. And

I wasn't very successful. And then when she was diagnosed with anemia, that just floored me. And, you know, looking back on it, it was really ⁓ just a blessing in a lot of ways because I was so focused on her diet and getting her to eat all the right foods for weight gain. you know, eventually then trying to get her to eat iron rich foods. And the reality was

the root of her problem and my problem more importantly was just the dynamic that was happening between us as I tried to feed her. You know, I was pushing and pressuring and trying to get her to take more bites and keeping her in the high chair to finish her meal and all of that doesn't work with children. And it was a real comeuppance for me, very humbling from the very beginning.

But it definitely took my career down this path of, my goodness, I learned very early on, there's so much more than just food and nutrients here. There's just this whole other aspect of how we adults interact with children. ⁓ that was the start of my journey into what I would describe as the what, how, and why of feeding children.

It's important to know what to feed them, obviously, but the how we do it and why they behave the way they do and why we behave the way we do is also very important ⁓ part of the recipe.

Chrissie Ott MD (she/her) (13:44)
Yes, is this

sort of magical way of almost it's akin to unfocusing your eyes and not looking straight at the problem slash not problem issue of feeding so that you are strategically disinterested in the volume of food that they eat and strategically unimpressed with their, you know, preferences like, oh, you don't like that today.

Jill Castle (14:05)
Yeah.

Yeah. Mm-hmm. Mm-hmm. Very hard though for parents to do because our, you know, oftentimes we feel like we're doing well as a parent when our children are eating well. They're picking the right foods. They're eating the right amounts. They're not overdoing it. They're not underdoing it. And when our, yes, yes, yes, yes.

Chrissie Ott MD (she/her) (14:15)
Moving on.

so hard.

yes, yes. We can really pat ourselves on the back when it's going well.

Jill Castle (14:45)
So yeah, and so, you know, I had a typical picky eater, a developmentally appropriate picky eater, and I pushed too hard and turned her off. And so that's really why she wasn't eating. And so I learned that, you know, no pressure, zero pressure. And that's how the other three of my children were raised. And I also learned that, you know, my firstborn has a temperament that's, ⁓ I would say, spirited.

somewhat intense and that showed up at a very early age. And I knew, I learned that I needed to give her some control. Like I couldn't hold all the control. Like I needed to give her some autonomy. And that honestly works for just about every child anyways. But when you have a spirited child, you, you know, they definitely want to be part of the answer. They want more information. They want to be part of

everything that's going on, part of the decision making. And when we don't allow that, right, exactly, yes. But if we don't allow that, then they respond with their behavior. And so it can really become quite a dynamic.

Chrissie Ott MD (she/her) (15:47)
They want agency, self-determination. How reasonable.

Yes, as a primary care pediatrician for many years, I can still call to mind multiple families with a child who was not gaining weight at the predicted rate or who feeding resistance of this type or the other, picky or aversive or whatever.

Jill Castle (16:19)
Mm-hmm.

Mm-hmm.

Chrissie Ott MD (she/her) (16:30)
And even as the pediatrician who has the background in feeding and nutrition, like it is really hard to convey and communicate that information. ⁓ I often, of course, would rely on Ellen Satter's message about the division of responsibility. And for listeners who aren't familiar, Ellen Satter is a well-known dietitian and author who largely permeated the

culture of feeding children with this concept that it's the adults responsibility to decide what and when with food and the child decides if and how much. And I have been, I'm really curious about your take on this as a child growing up in a larger body satiety signals have had a hard time coming online.

I hypothesize that there is something missing in the division of responsibility model that might not take into consideration phenotypic presentations of hyperphasia.

wonder what you think about that.

Jill Castle (17:42)
Well, I do think a lot about food approach. I don't know if you are familiar with that, but it is sort of genetic. It's genetic, appetitive traits, appetite traits we are born a ⁓ child can have food approach tendencies, which are aligned with eating more.

Chrissie Ott MD (she/her) (17:52)
Love to hear more.

Jill Castle (18:12)
being more interested in food, reactive to food, responsive to food. Sometimes we call that food responsiveness. And it's just a hard wiring within the child. And that's how I explain it to families. ⁓ It's like your child has brown hair and your other child has blonde hair. It's hardwired. It's part of the gene pool. So these appetite traits are part of the gene pool.

Chrissie Ott MD (she/her) (18:18)
asleep.

more dopamine from food. ⁓

Jill Castle (18:41)
There's another one called satiety responsiveness. Children are very responsive to their level of fullness or, know, and you see it, you see it manifested in their slowing down of eating. They're saying they're not finishing their plate of food that you've put in front of them. They're full. They get full faster. They're sensitive to it. They react to it and slow down and stop eating before they're done. Now,

when parents don't understand that these are traits that are built into children. we don't, there's no testing that we can do to say, your child's food responsive and your child's satiety responsive, but we can watch behaviors and sort of, not necessarily label these kids, this is what you are and we've diagnosed you, but sort of put the picture together and.

make a notation that, you know, when parents come to me and say, every time my child goes to a party, they are the one who never leaves the buffet, they are the one that keeps eating, even when they couldn't possibly be hungry for more food, they just keep eating, they don't have a stop button. You know, these are the children that might be ⁓ food responsive. And so

these children don't do well in food abundant environments without guardrails, without the support from the adults in their lives to help them navigate those environments. And it's really hard for families who have to deal with this because it's not like they can control the school. They can't control the birthday party. They can't control the coffee and donuts after church, right? But oftentimes what they can do

is sort of set their home environment up to be more helpful and supportive to that child. So they might not leave food on the counters, right? Because these are the kids that don't walk by the cookies on the plate that's sitting on the counters. They want to have one. And then they're gonna walk by again and take another one and walk by again and try and take another one. ⁓ And so getting back to the Ellen Satter division of responsibility, which I think

is a really good way for parents to understand their job and to respect the job of the child. I think we also have to acknowledge that the propensity to carry excess body fat is also genetic. there could be within children genetic tendencies that are going to promote, as you said, hyperphasia or overeating.

for those who are listening that might not understand what that word is, but overeating and overhungryness or an over preoccupation with food. There's some genetic components to that that I think that we underserve our patients when we don't acknowledge that there could be a bigger, broader picture here that yes, some things we have control over, but other things we may not have control over.

Chrissie Ott MD (she/her) (22:01)
thank you for diving into that. is so tricky to hold space with guardrails that does not involve emotional harm, that does not involve shaming. And when you have, I don't have two children, I have only one child, and plenty of folks have two kids where it looks like the rules are different or the application of

Jill Castle (22:13)
Exactly.

Mm-hmm.

Chrissie Ott MD (she/her) (22:25)
suggestions around eating are different. And, you know, from one perspective, appropriately so, because you have a food approach, ⁓ you know, food responsive child and a satiety responsive child in your household. But emotionally, it's really harmful for one to get, you know, one set of rules and the other to get another set of rules. So ultimately, you know, as a physician,

Jill Castle (22:51)
Absolutely.

Chrissie Ott MD (she/her) (22:55)
and as a parent approaching this increasingly important issue in our culture where childhood obesity is on the rise along with adult obesity and framing it as a medical condition, not a situation or a failure of self-restraint, acknowledging

a genetic contribution, acknowledging the landscape of highly processed, ⁓ you know, very palatable foods that are designed to make us eat more than we need ⁓ without offering a ton of nutrients. ⁓ I want to work towards liberation and find language that supports that. You know, I want to broaden the space.

where we can say you don't have to have any kind of feeling about your body other than loving it and appreciating it. And we can also want to improve your health by reducing your fat mass.

and it's so tricky for adults and then it's many times trickier to hold that space lovingly, supportively for children. So I'm excited to feel into how do you guide people who are wanting to thread that needle so carefully.

Jill Castle (24:25)
Yeah, I mean, I think that my, you know, part of the book that you thankfully thank you for showing that ⁓ earlier part of part of where that came from was my own discomfort with how we as healthcare providers

Chrissie Ott MD (she/her) (24:35)
completely.

Jill Castle (24:47)
how we were threading that needle. Because I feel like if we can't thread the needle, how are we helping parents thread the needle if we can't do it ourselves? And so one of the things I sort of dove into in this book is this whole philosophy that the medical community does have a philosophy of fix size. Like if the size isn't what is perceived to be healthy or perceived to be the social norm, we need to fix it.

Chrissie Ott MD (she/her) (24:52)
Yes, we can do so much corn!

Jill Castle (25:17)
We either help children lose weight, we help them gain weight, and we do that in a variety of ways, but mostly with children, we're embracing healthy habits, right? Habits that we know work. And this is, we talked about this, I think, before, Chrissy, where I'm talking the platform, I'm not talking ⁓ sort of ⁓ severe levels of excess body fat that are really causing

medical problems like pre-diabetes, like cardiovascular disease. I'm talking about the child who is carrying extra body fat, but we're not seeing yet any changes in their metabolic health. We might be seeing some changes in their psychological health because of their size.

we might be seeing some changes in their physical health because perhaps they're not sleeping well because they have apnea or it's painful to move. So they're not able to move as much. when I'm, you know, when we're talking about fixed size, unfortunately, you know, our society views even five or 10 extra pounds of weight as detrimental and in children, it may not be.

Right? You're a pediatrician. You know that that might not be the case. And then we have another philosophy, which is embrace size. Let's not do harm. Let's embrace this child as is. Let's not do anything to change their size. And let's focus on healthy habits. And these two can feel like they're opposing philosophies. And this is where

sort of my idea for the book came about because I really was feeling that tension between the two. I want kids to be healthy, physically healthy, metabolically healthy, and I also want them to be psychologically healthy. So how do we, how do we get all of that in one approach? And, you know, I, for me, what, what spoke to me was the fact that both sides embrace health habits.

both sides ⁓ look at lifestyle behaviors as a key component to health and happiness, right? We have an abundant amount of research behind the role of sleep and the role of movement and the role of nutritious foods and the role of minimal screen time and just these habits that are daily living habits that produce healthy outcomes like health.

physically, metabolically healthy outcomes, but they also promote emotional and psychological wellbeing. And so that's what sort of spurred my approach when I work with these families. It's, I'm working on all these different elements. We're working on sleep patterns that are productive. We're working on self-love. Like how do you build that? You actively in today's world, I believe you,

Chrissie Ott MD (she/her) (28:34)
this.

Jill Castle (28:37)
actively have to plant the seeds of self love. You need to teach your children to journal. You need to teach your children to find things that make them feel good. You need to restrain from making comments about other people's bodies. You need to not make comments about your own body and especially not comments about your child's body. And I have to tell I have to tell my clients

Chrissie Ott MD (she/her) (28:42)
Yes.

Yes.

Yes.

Jill Castle (29:06)
Do not speak about food and eating and bodies at the one time during the day you're together with your child and that's family dinner oftentimes. Don't make table talk about bodies and healthy food and toxic food and that's not planting the seeds of self love. It really can stigmatize a child and make them feel less than.

Chrissie Ott MD (she/her) (29:35)
Yeah, I feel the truth of those words and I want to take a moment to tell folks about the the 10 pillars of wellness, which are really the, you know, it's the structure and the scaffolding of this wonderful book. But family culture comes first and we never ever put something first on accident. family culture is first and sleep is second movement.

Feeding, which we've addressed a little bit. Actually eating. Food itself. Screens and media. And then finally, again, we don't ever close with something on accident is self-love.

Jill Castle (30:20)
Yeah, so.

Chrissie Ott MD (she/her) (30:21)
I love

the fact that all those are there. And I think it's so, it is separate from fixed size. ⁓ Even though I have seen that some fixed size oriented approaches end up making some of those other things easier.

Jill Castle (30:42)
Mm-hmm. Yep.

Chrissie Ott MD (she/her) (30:43)
but pulling ourselves back from being face planted in and blinders on with a fixed size approach is, ⁓ gosh, it's so important.

Jill Castle (30:57)
Well, and I'm sure you've worked with parents and caretakers over the years that have experienced their own trauma. I will say the word trauma around their childhood and going to Weight Watchers as a eight year old and, you know, being told your whole life that nobody will ever love you because you're too big. I mean, these are traumatic, traumatic things that people don't shed.

Chrissie Ott MD (she/her) (31:10)
Yeah.

right.

Jill Castle (31:27)
lightly. And oftentimes when parents, when adults have had these experiences as children, and then they have their own children, it's very confronting to have to, you know, work through some of those very, very painful memories and challenges. And so some of the families that I work with are these are the experiences of the parents and, they come and they say, there's a problem or

Chrissie Ott MD (she/her) (31:28)
Yes.

Jill Castle (31:57)
You know, there's a pediatrician has told us we have a problem with our child or I can see my child going down this unhealthy path. I want to help them. But my goodness, I've had, I have this history myself. I have no idea how to do this because I was harmed and I do not want to harm my child.

Chrissie Ott MD (she/her) (32:18)
Yes, yes. I'm so glad that you're naming that because this work is so healing for the parents and caregivers too. Just this past weekend, I was sitting next to a friend at a meal, sharing with her that I'm entering the practice of weight management medicine. I almost am looking for another way to even title it, right? Because I don't really want to...

keep calling it obesity medicine, but weight responsive medicine or something like that. Anyway, you know, she lived in a household where she was the average child, average sized child and her sister carried excess weight and her sister was harmed in the ways that you imagine and described just now. And as a result, that sister's child got no guardrails, but still came.

genetically with a food responsive, you know, expression of self and is now living in a very large body ⁓ with some serious medical challenges. And ⁓ it has some unnecessary suffering because that harmed parent was not willing to investigate a middle way and was not able to access healing.

around those harms. So stopping the cycle is, ⁓ it's such a service.

Jill Castle (33:48)
Yeah, think it's, yeah.

You know, I oftentimes will say to parents who I'm working with for six months, there's no guarantee that, ⁓ well, first thing I say is if you're looking for a weight loss relationship with me, that is not my goal for, that's not my approach and that's not my goal. My goal is to help you parent, you understand the child that you have and adjust your parenting and your feeding.

to bring out ⁓ the healthiest and happiest version of your child you can.

Oftentimes because we are putting together or revamping or initiating habits that these families haven't put into place before or have gotten off track with, things move in a positive direction on both trajectories, healthiness and happiness. But we never have to talk about weight loss. We don't do weighing. We don't do a calorie controlled diet. We just...

do what's right for the child that they have, the age and ⁓ conditions of the child that they have, and things move in a better place.

Chrissie Ott MD (she/her) (35:10)
This is maybe a little bit of a risky question. But as I am a prescriber who is stepping into this space, one of my perspectives, and it's informed by my role as a parent, is that my own child who's very food responsive and has ADHD with some impulse control and...

all the things executive function that go along with that diagnosis. I found that interventions, prescription interventions that interrupt the neuro gut access of toward excess feeding have been liberating, really taken the internal pressure off of

my child. And again, it is a sticky wicket. It's a bit of a hard needle to thread because I never want her to feel wrong in her body. And yet intervening with this for me, as I am viewing it at this time in my, you know, lived life experience as a relief to her that has made it actually possible to approach the healthy habits that are available.

Jill Castle (36:13)
Mm-hmm.

Chrissie Ott MD (she/her) (36:32)
⁓ So I'm wondering if you often see families who are also working with a prescriber, if you have sort of a flashing yellow light or if you have an inclusive, you know, sense about this question as we are in a moment where more, you know, weight medicine specialists will be prescribing, ⁓ Fentermine and Fentermine topiramate and GLP ones for kiddos.

Jill Castle (36:55)
Mm-hmm.

Yeah, I mean, I

I don't have a horse in that race. Like, I don't want to say, well, I'm over there in my lane, and I would never say to a family, you shouldn't do that, or you should do that. I, to me, it feels like that is such a personal decision for a family, and I know in my heart that no family takes that decision lightly. And, ⁓

Chrissie Ott MD (she/her) (37:09)
You're like, I'm over here in my lane.

Mm-hmm. Mm-hmm.

Mm-hmm.

Mm-hmm.

Jill Castle (37:33)
I feel like my role is not to judge or help make a decision one way or the other, but to really support families in whatever mode that they choose and feel is best for their child. Because I know even if somebody is an adult or a child is taking these medications, they aren't the...

End all cure all, you still need these lifestyle habits. You still need to work on self love. You still need a family culture that's supportive and caring and non-stigmatizing. You still need to move your body. You still need a good night's sleep. Like to me, that's my job. That, that piece of it is my job. My job is not to encourage or discourage one way or the other. It's what is, is what is. And let's

Chrissie Ott MD (she/her) (38:02)
100%.

Yes. Yes. Yes. Right.

Yes.

Mm-hmm.

Mm-hmm.

Jill Castle (38:27)
Like I care about that child. Like to me, I want that child to feel good in their body. I want them to be happy. I want them to be healthy. I want them living and thriving in the world.

Chrissie Ott MD (she/her) (38:39)
yes, yes. And sometimes I can...

Jill Castle (38:41)
And I want the parent to feel

good about that too.

Chrissie Ott MD (she/her) (38:45)
Sometimes I can imagine that we see a child who is now thriving in the world, who is more healthy in their body, who is more happy in their body, who has also reduced their excess weight. And our brains, who really like to simplify things, can just focus on the lost weight without stopping along the way to say, and they're sleeping better, and they're taking more social risks.

and they are moving and more ⁓ flexibly on the softball field or whatever the activity might be. I am seeing my own child in her journey, taking more social risks, feeling pleased with herself, and engaging in more supportive habits as the excess weight that she was carrying reduces. So I think that they are related.

but I am also really interested in restraining myself from placing all of that as a binary relationship to weight as the only factor. This is not.

Jill Castle (39:55)
Right.

No, and ⁓ I think, you know, as much as our society has pushed us with this idea that thin is perfection and you're only valuable if you are thin, I also think the opposite or a counter danger could be that, you know, portraying

GLP-1 medications without supportive lifestyles as the answer as well. And I think that could be a slippery slope as well.

Chrissie Ott MD (she/her) (40:33)
it's problematic.

Very problematic because we know that stopping the medication results in, you know, a large amount of weight gain if those healthy habits are not very, very clearly established and loss of muscle mass. And, you know, I could go down and get into the weeds, but I won't.

Jill Castle (40:54)
I do like to emphasize to families that, you know, when all is said and done at the end of the day, whether your child, cause a lot of families are afraid about, afraid of whether their child will be on this for the rest of their lives. And, ⁓ there's a good chance they won't be right. Because that's a long time. And you know, you've heard, you've heard the, you know, the big question mark is what is, you know, longterm.

exposure, what does that look like down the road? Right. And so that I do feel that, you know, there's always this place for lifestyle intervention. It might not be the primary thing that will get a person with excess body fat to a better place. It might not, it might not do that for them. It might not be powerful enough to

Chrissie Ott MD (she/her) (41:37)
always.

Jill Castle (41:54)
You know, reduce somebody who carries, a large amount of excess body fat. Lifestyle behaviors might not turn that around, right? For some people it does, but it might not for others. And that's why I still believe that, you know, there is a role for lifestyle behaviors because it's not just about weight. It's, you know, it helps you feel confident. It helps you feel.

Chrissie Ott MD (she/her) (42:13)
Thanks

Jill Castle (42:19)
rested, helps you, you know, sleep helps you process your emotions, right? There are just so many things. I mean, we know that we know there's some really good evidence around adequate sleep and appetite regulation and social emotional processing and mental health, right? And so it's not just about the physicality that happens as a result of sleeping regularly. There's all this internal stuff that's happening.

Chrissie Ott MD (she/her) (42:22)
healthy.

Yeah.

Yes.

Jill Castle (42:48)
that's super beneficial.

especially to

so one of the things I will say is that every family is different and every child presents differently and that's part of the work that I find really very interesting. I can have a family who has a food responsive child. I can have a family who has a child with ADHD and has impulse control around food. I can have a family who,

is super, super healthy, but somehow the portion sizes and the frequency of access to food has gotten off track. I can have a family that wants to be active, they think they're active, but they're really not active, right? So there's like, and oftentimes families come with three or four, five things that we can work on. again,

A lot of parents come to the table with this issue and they have their own baggage, but they also don't have quite the knowledge around nutrition and might not have ever heard about feeding and have no idea how eating habits are established. And so there's a lot of like, there's a lot of good work that can be done. And that's, I think where the confidence

builds because a lot of people think, if I just had the right diet, if I just had, you know, if I just didn't eat that ice cream or, have all those snacks, things would be different. And they really focus on the food and I need you to give me a healthy diet. I need a meal plan so I can do this. And I sit there and I have like a little chuckle on the inside because I'm like, ⁓ by the time I'm done with you, you're going to see it so much more.

than extra ice cream or a meal plan.

Chrissie Ott MD (she/her) (44:40)
Yes, yes, I'm sure you're like, that's cute. And I'm gonna wait till I get done with you. Yeah, you know, for my sweet food responsive child, her pediatrician sent her to a dietician who, you know, did her level best, but was basically conveying just portion size and nutrient information. And it was only like one meeting and

Jill Castle (44:44)
I'm like, mm.

Chrissie Ott MD (she/her) (45:10)
I feel like, I mean, that's just an afternoon lost basically. She was like nine years old and she's not getting this info. And if she is, she's probably filing it away in a place of self criticism or concern. And we have to talk about like that weight-based bias that's happening to kids at school as we live in a culture full of stigma.

Jill Castle (45:27)
Right. And that, guess I didn't.

Yes.

Absolutely. And I didn't overtly state this, but I don't work with the children. I work with the parents because I don't want to stigmatize a child. I don't want a child to come to me and be like, I have to go see the dietician. There's something wrong with me. There's something wrong with my body. There's something wrong with what I eat, what I like. I don't want anything to do with that. I really don't. Like I feel like I can have an effect on the parenting.

piece of it. And I don't think that the parents have to talk about weight and food and things of that nature, just really setting up the environment and modeling boundaries, which a lot of parents are challenged by these days saying no is very hard. so equipping parents with their food parenting strategies and toolbox is really what I see.

rewarding for myself and effective for them.

Chrissie Ott MD (she/her) (46:32)
Yeah.

As a person entering

this field of medicine, you know, at this late stage of my career, one of my primary first messages is it is not only okay, but it is preferable to have the first visit without the child present because they do not need to hear all of the parents' distressed thoughts about growth, their size, their habits around food. They don't need to be exposed to that processing.

that processing needs to be done on their behalf, but not in the same visit where their ears are. No, like I would rather, and one of the primary principles is asking, you know, if it is okay to talk about someone's weight. And I would even take it back one step further. Is it okay today if we talk about your health as it relates to your weight? Can we just like take the focus one degree off even more?

Jill Castle (47:25)
Mm-hmm. Mm-hmm.

or even can we talk about your health?

Chrissie Ott MD (she/her) (47:36)
Yes, please. Yes.

Jill Castle (47:37)
Yeah,

yeah, because I think, and you tell me what you think about this, Chrissy, but we've intricately tied weight and health together, and it's not always tied together. You can be a larger...

Chrissie Ott MD (she/her) (47:55)
Right, right. We have healthy people in large bodies and unhealthy

people in thin bodies. They both absolutely exist. It's not one to one. And we also know that there is a very strong correlation with carrying lots of excess weight and a bunch of disease states. opening the field to multiple truths at one time. know, fat does not equate unhealthy across the board.

Jill Castle (48:01)
Exactly. Exactly.

correct.

Yes.

Chrissie Ott MD (she/her) (48:23)
nor does then equate healthy. But we do need to acknowledge the important overlap in the Venn diagram and address that supportively.

Jill Castle (48:23)
Mm-hmm.

Sure,

sure, absolutely. And I think that, you know, getting curious and not making assumptions. You mentioned weight stigma.

And a lot of the weight stigma comes from just making an assumption. I see a person with extra body fat and I assume they're not healthy. I see a larger body child and ⁓ that parent must not have their act together and that child must be unhealthy. These are biases and they cause a lot of harm. And so even taking, know, stepping back and just being curious, you know, let, there's a lot of pieces of information that we can.

Chrissie Ott MD (she/her) (49:01)
Yes.

Jill Castle (49:12)
talk about and discover and learn about a person before we make an assumption or a label about their health.

Chrissie Ott MD (she/her) (49:20)
Yes.

Or assuming we know anything about their dietary habits based on their body size. We don't. We do not.

Jill Castle (49:26)
Mm-hmm. Yeah. Nope.

Not at all.

We have to ask.

Chrissie Ott MD (she/her) (49:33)
Stay curious. Yeah.

I am so grateful to have this conversation and just get to dive into this topic that we are both very, very passionate about. is giving you hope about how this next generation is going to approach these things differently?

Jill Castle (49:56)
Well, my hope is, I mean, I have four young adults right now and they question everything and I love that. They really, they really aren't buying on a lot of levels, the social norms that I think we did when we were younger. Yeah, that gives me a lot of hope.

And I'm seeing a lot of young mothers who are very intentional and conscientious about how and what they feed their children. Now, I also see some that are, and fathers too. And I will say that I do see some that take it a little bit too far and are too worried about it and too rigid about it.

Chrissie Ott MD (she/her) (50:32)
and I'll put a plugin for fathers too.

Jill Castle (50:49)
And I, you I always feel like flexibility is the goal here. Cause nobody's going to be perfect on one end or the other. It's just like, how do you ping pong like a ball? How do you rebound back and forth from either ex either end of the court? ⁓

Chrissie Ott MD (she/her) (50:58)
Absolutely.

Yes, yes, in

our house, it's boba. We ⁓ love the boba. Issa loves the boba. She wants the boba. I'm like, we can have it once a week. Absolutely. Maybe once every one to two weeks. It's not a super more frequent than that situation, but it's got to be included. It's pleasure. It's fun. Right? I was sitting with another parent recently whose child also like your young adult is questioning everything.

Jill Castle (51:15)
Mm-hmm.

Chrissie Ott MD (she/her) (51:32)
and were talking about healthy habits and they were talking about health in general. And this young woman has already realized that healthy is often coded for thin. And she's like not having it. I'm not having it. I just celebrate that.

Jill Castle (51:46)
Mm She's right. Yeah. Yeah. She's right.

Yeah. Yeah. And there's flexibility with food too. I mean, I have families that I work with that we, you know, their children have grown very accustomed to having multiple sweet treats a day, you know, and how do you take that and get that down?

where you haven't completely eliminated it because these kids have grown used to having it several times a day. How do you, how do you create a new balance that works for everybody? And again, every family is going to be different, right? And how children respond to the rules in the home, the food rules in the home is I'm also curious about as well. You know,

Chrissie Ott MD (she/her) (52:39)
Absolutely. Yeah, fewer food rules is better.

Jill Castle (52:44)
Yeah, I mean, I think it's every family is different. Boundaries, systems, routines, structure, all of those things. Yeah.

Chrissie Ott MD (she/her) (52:45)
food rules but boundaries.

Mm-hmm.

structure. Absolutely.

The book, my friends, is Kids Thrive at Every Size, highly, highly recommended as every source. And Jill's practice can be found online at jillcastle.com. I am so grateful to just participate in reframing the topic of nourishing our children inside and out with you today, Jill. ⁓ Any last thoughts and takeaways for our listeners?

Jill Castle (53:24)
Yeah, I mean, I think that as you, your whole podcast is about joy. And I just want to remind the listeners who may be parents or caretakers out there that there can be great joy in feeding our kids and raising them and helping them establish lifestyle habits that really do help them be happy and healthy. And the joy is not in just telling our children what to do, but

in participating with them in all of these lifestyle habits. It's great for the whole family. So don't lose the joy. I'm always trying to tell parents, reclaim the joy, find the joy, because there is joyfulness. And even when it feels frustrating or scary or worrisome, we look for the joy in it because it's the connection, it's the communication, it's the cohesiveness of the family that will carry your child forward.

Chrissie Ott MD (she/her) (54:23)
What a perfect message to end on. Thank you so much, Jill.

Jill Castle (54:28)
Thank you for having me.

Chrissie Ott MD (she/her) (54:33)
Thank you to Jill Castle for this heart-centered and deeply human conversation about how we feed not just our children's bodies, but their confidence, curiosity, and joy. Her work reminds us that nourishment is emotional as much as it is nutritional, and that healing begins when we model self-compassion at the table and beyond. Next week, we'll explore another dimension of wellbeing with Dr. Artashir Mehran.

psychologist, researcher, and creator of the emotional rights framework. His approach invites us to see depression and anxiety not as flaws to fix, but as signals guiding us back to meaning, connection, and wholeness. It's a powerful conversation you won't want to miss. And if you're craving your own reset, the Physician Coaching Summit is right around the corner.

In two short weeks, join us November 6th through 8th at Civana Wellness Resort and Spa in Carefree, Arizona for a CME accredited weekend of restoration, learning and connection with an optional full moon yoga nidra on November 5th to start your experience off. As always, a gentle reminder, I'm a doctor, but not your doctor. Nothing in this episode is intended as medical advice.

please consult your own trusted clinician. Special thanks as always to Kelsey, our fabulous producer, and my partner in life, Su. May you care for your body, your mind, and your spirit with the same grace you offer others. See you next time on Solving for Joy.