Modern Metabolic Health with Dr. Lindsay Ogle, MD

Pediatric Obesity With Dr. Lisa Tritto, MD

• Lindsay Ogle, MD

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We talk with Dr. Lisa Tritto about why pediatric obesity is a chronic, biology-driven disease and how shame-based advice keeps families stuck. We share how we evaluate kids and teens, where mental health and ADHD fit in, and how we think about treatment options from lifestyle support to modern anti-obesity medications.
• why pediatric obesity needs a disease-based model, not willpower narratives
• how environment, genetics, stress, and family systems shape weight and health
• what first visits look like, including parent and teen questionnaires and screening for eating disorders
• the ADHD-obesity connection, including impulsivity, dopamine-seeking, and sleep disruption
• metabolic complications we commonly see, including insulin resistance, prediabetes, fatty liver disease, sleep apnea, anxiety, and depression
• how we decide on medication, including Wegovy for ages 12 to 17, Zepbound for 18 and up, and Qsymia as an accessible option
• setting expectations for long-term treatment and why early intervention can change outcomes
• why we do not set rigid weight goals and instead focus on health, function, and a healthier relationship with food
If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health.

Dr. Lisa Tritto is a board-certified pediatrician and obesity medicine specialist who is passionate about changing the way we understand and treat pediatric weight and metabolic health. Dr. Tritto is fellowship-trained in Pediatric Obesity Medicine and cares for children, adolescents, and young adults through her practice, Evora for Kids, which is based in St. Louis, Missouri.

Dr. Tritto takes a compassionate, science-driven approach, helping families move beyond outdated “eat less, move more” messaging to better understand the roles of biology, behavior, and mental health. She offers individualized care that may include nutrition, lifestyle support, and modern medical therapies, including anti-obesity medications when appropriate.

Her goal is to create a supportive, non-judgmental space where patients and families feel empowered to make meaningful, lasting changes.

Learn more at:
Website: evoraforkids.com
Blog: evoraforkids.com/blog-1
Instagram: @evoraforkids OR @lisatrittomd
Facebook: facebook.com/evoraforkids

👩🏼‍⚕️ Live in Missouri? Want to be my patient?
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Welcome And Medical Disclaimer

Dr. Lindsay Ogle, MD

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, board certified family medicine and obesity medicine physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatment. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you.

Meet A Pediatric Obesity Fellow

Dr. Lindsay Ogle, MD

Welcome back to the Modern Metabolic Health Podcast. Today I have Lisa Tritto, Dr. Lisa Tritto. She is a board-certified pediatrician and obesity medicine specialist who I met during an obesity mastermind for doctors who are going into the field of obesity medicine. And she is a true treat here today because she is one of the very few fellowship-trained pediatric obesity medicine specialists. She is passionate about changing the way we understand and treat pediatric, weight, and metabolic health. She takes a compassionate, science-driven approach, helping families move beyond outdated, eat less, move more messaging to better understand the roles of biology, behavior, and mental health. She offers an individualized care that may include nutrition, lifestyle support, and modern medical therapies, including anti-obesity medications when appropriate. Her practice is called Ebora for Kids, which is based in St. Louis, Missouri, but she's licensed in many other states and will see patients throughout in some states throughout the country. So thank you so much, Dr. Trito, for being here. I'm so happy to have you.

Dr. Lisa Tritto, MD

Yeah, thanks. I'm very excited to talk about my favorite subject. And it's nice seeing you again as well.

Dr. Lindsay Ogle, MD

Yeah. And right before we jumped on, I was curious. So I Googled how many fellowships for pediatric um or pediatric obesity medicine fellowships there are. And I only saw that there's two. Is that right?

Dr. Lisa Tritto, MD

That's about right. Yes. Yeah. So I feel like I I know everybody who's been through the fellowships because it was basically all the people who preceded me. So they're just a handful, yeah, handful of us in the country.

Dr. Lindsay Ogle, MD

Yeah. So again, so fortunate to have you here. Thank you for taking the time.

Dr. Lisa Tritto, MD

Yeah.

Dr. Lindsay Ogle, MD

Um, well, actually, before we get started, I would just love to hear what prompted you to get into this specialty.

Dr. Lisa Tritto, MD

Sure. So many reasons. Um, I struggled with weight myself as a teenager and adult. Um, family members also the same. And um also my patients. So, you know, I always knew that there was more to it than, you know, eating less, moving more, as the as people tend to say, um, because I was doing all the right things and I thought I was doing all the right things for my family, and I was telling my patients the things, and it it didn't work and it didn't add up. And so after being in general pediatrics for well over 20 years, I had an opportunity to shift gears in my career, and so I chose to go do this um year uh training program, and I'm so glad, so glad that I did because really the science that I learned in medical school has changed. In fact, we didn't learn any science about weight management and metabolism in that regard in medical school, and it's so been so fascinating to learn about it and now to be able to apply it. So that's sort of how I how I got there. And um, I really wanted also a shift from the pace of general pediatrics to being in a specialty situation where I can spend a lot of time with my patients and really help them get to whatever their individual needs are.

Obesity As Disease Not Willpower

Dr. Lindsay Ogle, MD

Yeah, yeah. Well, how should parents and clinicians think about pediatric obesity today and what have we gotten wrong in the past or continue to still get wrong about pediatric obesity?

Dr. Lisa Tritto, MD

Yeah, just with same as with adult obesity that we know now that it is really a disease process, that there's biological, biochemical processes going on in the body that we can't see. And um it is um what am I trying to say? Uh it's it's very complicated. So there are so many factors. There are mental health factors. There um we now live in an environment where, as I tell my patients all the time, it's not your fault that food is everywhere and food is delicious, and we don't have to move our bodies like we used to. Um, so if you are sort of predisposed biologically to have that sort of environment affect your weight, then you're gonna carry extra weight. And some people can live in that environment, but they don't have that biological predisposition. And that's why, you know, uh one patient looks completely different than their friend, and they seemingly have the same lifestyle, lifestyle.

Dr. Lindsay Ogle, MD

Yeah, there are so many factors, and um in obesity, as we know, is a chronic medical condition, multifactorial condition. And what I think is unique and what I find difficult, I'm family medicine trained, so I um helped um kids and adults. But what was always so difficult with kids is you know, they aren't they don't have full control over their choices because the parents are usually the ones, you know, doing the grocery shopping and you know, helping with ordering when when out and and that sort of thing. So it adds even another layer of complexity to pediatric obesity care versus um adult obesity care.

Dr. Lisa Tritto, MD

Right, right. Yeah, it's definitely, you know, it's a family approach. It's certainly not directed all at the child, that that's for sure, because yeah, they do they need our help. So um, yeah.

Dr. Lindsay Ogle, MD

And uh this is a kind of a tangent there, but for your appointments, do you who is at the appointments for your pediatric um patients?

Dr. Lisa Tritto, MD

It will be the the patient and at least one parent, usually, um, one or both. I have them, um I have the parent fill out a very lengthy questionnaire before I see them, so I get a real good feel of what their home environment is like, with their perceptions of what's going on with the child and what their goals are. And then if I have an adolescent patient, then I also have them fill out their own questionnaire privately so we can look for things like eating disorders and how how is their weight affecting their sort of mental health. Um yeah, so it's you know, it's both both together. And then usually I have a little bit of time um individualized with the patient too. That's sort of how our first visits tend

ADHD Eating Impulses And Sleep

Dr. Lisa Tritto, MD

to go.

Dr. Lindsay Ogle, MD

Yeah, great. Yeah, that history is so important. And that was one of my well, one of my questions was the link between mental health and weight and specifically ADHD. Can you tell a little bit about um your experience and your practice with that connection and what science and studies are saying about that?

Dr. Lisa Tritto, MD

Sure, yeah, I see a lot of ADHD in my practice, particularly when I see a younger patient, maybe somebody who's maybe eight years old, um, a lot of times they've had sort of undiagnosed ADHD. And as a general pediatric background, I'm very comfortable with evaluating and diagnosing with ADHD. So I find myself at times ending up doing a kind of a workup for ADHD at the same time. And then I find that when we treat the ADHD, some of the eating behaviors do improve. Um the with ADHD, these kids tend to have eating for you know many reasons other than hunger. So there's impulsivity around eating, there's boredom eating, there is um uh problems with sleep with kids with ADHD and there and problems with sleep can lead to overeating. Um and we do, you know, the science shows that if you have obesity, you have a higher risk of having ADHD, if you have ADHD, you have a higher risk of having obesity. And we know that um a lot of these um circuits in the brain are are are similar or overlapped with with our what we know about obesity and ADHD. So there's a sort of this um pleasure-seeking, dopamine-seeking nature of of uh those with ADHD.

Dr. Lindsay Ogle, MD

Yeah, so fascinating.

Insulin Resistance Fatty Liver Sleep Apnea

Dr. Lindsay Ogle, MD

Um and we're gonna talk about GLP1 medications and and their role um in management of pediatric obesity, but before we get to that, I'd also like to hear some other medical conditions that you see your patients for that um maybe weight related or some other things that you help your patients with.

Dr. Lisa Tritto, MD

Yeah, I will see kids with signs of insulin resistance, which we know is part of that metabolic syndrome. And sometimes it's when they're younger, it can be just something that I find on their physical exam, like there's a particular rash behind the neck that can indicate um that they are having blood sugar issues. The way I explain it to my patients is I say this is a sign that your body's working really hard to keep your blood sugar normal. Um, so I see that sort of on the early end spectrum of insulin resistance, and then I will treat kids that have prediabetes. I can diagnose diabetes, I don't manage diabetes, um, I also see um fatty liver disease related related to weight. Um, and that can show up in different ways. Um not uncommonly, especially during my fellowship training, we would have a referral of a patient who is carrying extra weight and had some sort of abdominal imaging for some other reason, and they found that the child has a fatty liver. So before their labs have even changed, um, they are starting to develop signs of you know metabolic dysfunction. So I would see that, and I can manage that up to a certain level, and then so they don't all need to go see a gastroenterologist first, they can see me and I can manage most of it unless it's their levels are very high. Um we'll evaluate for other conditions related to weight, like sleep apnea, um and then anxiety, depression, and also go along with that as well. Um, autism is another medical condition. I don't manage it specifically, but it often is co-occurring in patients as well. It that increases their risk of obesity.

Dr. Lindsay Ogle, MD

Yeah, and that so that highlights the you know how much you're pulling in um not only from your fellowship training and pediatric obesity, but also just your general and pediatric experience as well. So that's wonderful that you have that solid baseline.

Dr. Lisa Tritto, MD

Yeah, yeah, it is really good. Yeah.

GLP-1s Wegovy Zepbound And More

Dr. Lindsay Ogle, MD

Um so like I said, I want to talk about our um anti-obesity medications or obesity management medications um most popular right now, we go V and Z-Bound. What from a you know pediatric obesity physician perspective, what is your approach for using medic these medications? And again, what do the studies show with these medications?

Dr. Lisa Tritto, MD

My approach is first sort of that getting that big medical history and personal history, family history, social history, all of this. Um and then deciding together with a family if they I should back up. I would explain all the factors going into their child's particular situation, and then we would decide together if they're interested in medication. Once they sort of understand the underlying, you know, pathophysiology, they can understand how medication will work for their child, and that it's not it's not taking an easy way out or it's not um cheating and somehow. Um then you know, to decide is a does a child need medication, do they qualify for medication? Um, it's it depends. Uh, you know, if they we still use BMI for kids to determine whether they have obesity or not, but also in my office we do um bone body composition as well. So I could have somebody who's sort of borderline on weight, but they carry a lot of body fat and not a lot of muscle, um, they we could qualify them as having obesity too. Um so depend so it depends. So it's a it's a joint decision. Um, if a child's weight is sort of, I would say, kind of not that bad, and they want to work on lifestyle stuff first, we absolutely will do that. If somebody comes in, they're really carrying a lot of extra weight, they already have signs that their body is not functioning well, like abnormalities on their labs, um, then we'll start medication right away. And then always working with um diet and activity and all the other factors that are going into their way. That happens for everybody, whether they're on medication or not. Um and we use I do use the GLP one medications, usually in kids that are 12 and above. So Wagovi is the only one that's um approved for 12 to 17 as far as the GLP ones go. And then setbound if I'm seeing an 18-year-old or over, and I do see kids in through college, so I do use setbound with them a fair amount. Um, and then there's another medication that most people have never heard of qsimia, which is combination of fentramine and topiramate. And that's a pill, and it's much less expensive, and it's much more accessible. And I've had patients do really well with that. I've had some that just need a very small dose, and that's just enough to help them um start making some changes in in their diet. And um I've had one patient who lost 100 pounds taking that medication, and I've always told her, You are my example. I'm going to tell everybody about you. I know this is how well this medication can work for the right person. So um, so yeah, so we go over sort of all those options and decide like what is the what makes the most sense for their child, or if one doesn't seem to be the right fit, then we, you know, pick a different one as well. So yeah.

Dr. Lindsay Ogle, MD

Yeah, thank you for um bringing up kusemia. I agree. Sometimes we forget our other medication options, and that can be a reason why seeing an obesity medicine specialist can be so beneficial because there are multiple medication options, and some um are less expensive than others, or just fit better for that person for one reason or another. And so having somebody who's familiar with all the options available can really make a difference. Um, and for like you said, for pediatrics, there's different FDA um, I guess, indications, limitations, um, and depending on the person, um, I know sometimes medications are used off label and you know all populations. And so um, of course, you're talking about risk, risk and benefit with um with all of your patients there.

How Long Meds Last Expectations

Dr. Lindsay Ogle, MD

Um, I guess thinking about medications for obesity from um like a thinking about like a from a philosophy standpoint, um, what are some of the things that you like to emphasize when you're considering a medication or starting a medication? And I'm thinking first thing that comes to mind is like duration of treatment. Like what are some of those expectations that you like to go over with patients and their families?

Dr. Lisa Tritto, MD

Um well, we do talk about that we don't know whether their child will need to be on this medication forever. We know that in research studies, when the medications were stopped, people gained weight. Um but that said, I also have had plenty of patients who could come off of it. And I think it sort of depends on where they were to start. So if they had a lot of improvement to make in their diet and activity and they made major changes, those patients might do okay. Or if they lost access, for example, maybe they lost access to medication for costs or whatever reason, they've um established a, you know, a different um lifestyle that they're able to sustain without medications, but it could they could need that medication you know for their lifetime, which is um, you know, what I tell them is what Dr. Frank Avilla used to say, you know, whatever you do to lose weight is what you have to continue to do to keep it off. So um, so that goes with medications and with sort of lifestyle changes. So whenever we're trying to decide on, you know, some probably some tiny little thing, like are you, you know, walking 5,000 steps a day or something like that, you know, I'll tell them, don't tell me you're gonna do this if you don't think you can continue doing this, you know, forever. So it makes it easier to sort of make those um set those goals as as well. So, you know, the expectation is that yes, they might need it forever, maybe they don't. I'm hopeful that maybe a pediatric brain or a developing brain, maybe, you know, maybe they could be reset, you know, with early intervention. And I definitely have seen that in a few of my patients, but I don't know what the research would shows on that. I don't think that's a real that's a really hard thing to track.

Dr. Lindsay Ogle, MD

Yeah, and um, and I agree, and it can be hard to predict, but something that I've seen in my practice is the earlier on in the disease course and any disease that we're talking about, and today we're talking about obesity. So earlier on in that um trajectory that we intervene, um then the better outcomes that we're gonna see, and the more likely that somebody is to maybe be able to wean off of a medication if that's what we're using, and then have sustainable results. And so that's what I've seen with um with my adult patients or you know, young adult patients specifically. Um, and I think that that's one of the I guess arguments for treating um weights in the pediatric population because it can have such a profound impact to uh um later on as adults. Um, so I don't know if that's kind of what you were taught in your training or that's what you've experienced as well.

Dr. Lisa Tritto, MD

Yeah, definitely what I've experienced. And I I definitely have many of my patients come to me with parents who also have obesity, and they say, I don't want my child to go through what I went through, and that's why they want to intervene earlier as well. So yeah, I I would I would agree. And you know, recently there was a study that was published um out of Sweden where they were following um following children with obesity into adulthood, maybe into age 30 or so, and they they classify them in two groups. So um obesity, but sort of healthy, meaning normal labs, normal blood pressure, and then obesity with some some complication like abnormal labs or blood pressure, and they followed them into adulthood to see what is their risk of developing diabetes or other, you know, high cholesterol weight-related um conditions, and they found that the ones, the the children with obesity who had sort of unhealthy obesity, you could say, had a much higher risk of developing these conditions. But also the children who had obesity but did not show any complications, they also had a higher risk, not as high as a risk. So just yeah, so the reset, I think, at an early Is is very reasonable and a good, yes, a good reason to to intervene sooner.

Parents Are Not To Blame

Dr. Lindsay Ogle, MD

Yeah, thanks for sharing that. So we've mentioned parents a few times throughout this talk. Obviously, they play a very important role in pediatric care. So what what if there was one thing that you wish every parent would know, what would you want to share with them?

Dr. Lisa Tritto, MD

Basically, that it's not their fault. You know, as parents, um, particularly mothers, we tend to blame ourselves with anything that goes not quite as we would like with our children. Um, and so it's really, you know, it's really not their fault because of what our environment is like now and how stressful life is and how much more stress their children are under than probably they went through as children. Um, so yeah, definitely that it's not your fault, and that I understand what they're going through. Um, that really seems to bring parents, puts them at ease when I see them in the office. You can kind of see the tension leave their body when they realize they're not being shamed and blamed for what's going on.

Dr. Lindsay Ogle, MD

Yeah, yeah. That compassion goes so far. Um, so I'm glad that you have that approach, approach not only with your patients, but also their families. So that's wonderful to hear. Yeah. Um anything that you think we miss that would be important for viewers to be aware of when it comes to pediatric obesity?

Dr. Lisa Tritto, MD

Yeah, I think a few things. Um I one is I think expectations when they come in to see me. I think they are worried or concerned that they're gonna come in and I'm gonna give them a weight goal and a calorie counting plan and a very specific guideline of what they need to do. And it's not like that at all. We don't, I don't set weight goals. In fact, I barely even talk about weight or the number on the scale. We talk about it more in terms of health, of being quote, healthy on the inside, um, feeling good in your body, feeling good about yourself, having a healthy relationship with food. That's more of our goal. Um, so I definitely don't feel the need to bring patients into, you know, a middle of the road BMI. Um, we really are looking to just find what's right for them. So I think that's what people do. Don't they don't expect that when they're when they're coming in. They expect, I think that they're nervous that they're gonna get a very regimented um approach. And it's really gonna be very individualized to their to their kid.

How To Find Dr Tredo

Dr. Lindsay Ogle, MD

Yeah, I think that's great. Um well, thank you so much for taking the time out of your busy schedule. You're doing such important work. Um, if anyone was wanting to find you and maybe, you know, bring their child to become a patient, where should they go?

Dr. Lisa Tritto, MD

Uh, they can go to evoraforkids.com, e-v-o-r-a-f-o-r-k-i-d-s dot com. We have also Instagram and a Facebook page under the same name. They can go on there, they can they can self-schedule a 15-minute visit with me just to talk about whether we are the right fit for one another. Um, and if we're not the right fit, I might just help direct them to what they do need. So um that's really the best way to it. I have a blog that I post on my website as well, which really talks a lot about my approach and um some of the topics that come up in my visits, you know, pretty frequently. So when I have the same conversation over and over again, I think I should write a blog on this. And so then I do and post it up on there. So that's a good place to get good information as well.

Dr. Lindsay Ogle, MD

Wow, that's a great resource. Um, I will make sure to include all of those links um in the show notes um below so anyone can easily find you. Um, but yeah, thank you so much again. Um and hopefully I'll have you on in the future to talk more about this important topic. Very loved too. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.