This week on Fat Science, Dr. Emily Cooper, Mark Wright, and Andrea Taylor talk with pediatric eating disorder specialist Dr. Julie O’Toole (Kartini Clinic) and pediatric obesity expert Dr. Evan Nadler about what childhood obesity really is: a biologic, metabolic disease—not a willpower problem and not a failure of parenting.

They explore how excess weight, constant hunger, and disordered eating in kids are often signs of underlying metabolic dysfunction and genetics—and why the old “eat less, move more” advice can do real harm, especially when children are shamed or restricted in the name of “health.”

Key Questions Answered

• Why is childhood obesity a metabolic disease, not a behavior problem?
• How are obesity and eating disorders deeply connected instead of opposite extremes?
• What role do GLP-1 medications play in children—and how do we protect against under-fueling?
• When should parents suspect genetic drivers like hyperphagia or MC4 mutations?
• How can medical treatment for obesity actually reduce disordered eating behaviors?
• When does excess weight become a medical issue requiring metabolic evaluation—not another diet?

Key Takeaways

• Weight is a symptom. Childhood obesity is often a sign of metabolic dysfunction, not overeating.
• Obesity & eating disorders overlap. Restriction can trigger disordered eating; disordered eating can worsen obesity.
• “Eat less, move more” harms. Shame-based approaches delay treatment and increase risk of eating disorders.
• GLP-1s work metabolically, not just through appetite suppression. Kids still need consistent fueling.
• Genetics matter. Single-gene differences can drive severe childhood hunger & rapid weight gain.
• Not treating is harm. Avoiding obesity care violates first, do no harm.

Dr. Cooper’s Actionable Tips

• If your child is gaining weight or constantly hungry, request metabolic labs (insulin, glucose, lipids, liver, hormones).
• If the doctor only says “eat less, move more,” ask: “How are we evaluating metabolism and genetics?”
• On GLP-1s? Monitor for under-fueling (skipped meals, low energy, food anxiety) and intervene promptly.

Notable Quote

“Not treating childhood obesity is doing harm. It’s a disease, not a lifestyle choice.” — Dr. Evan Nadler

Links & Resources

• Podcast Home: Fat Science Website
• Episodes & Show Archive: Cooper Center Podcast Page
• Education & Metabolic Resources: coopermetabolic.com/resources
• Submit a Show Question: [email protected]
• Email Dr. Cooper Directly: [email protected]

Connect with Our Guests

Dr. Evan P. Nadler, MD, MBA – Founder, ProCare Consultants & ProCare TeleHealth
Website: obesityexplained.com
YouTube Channel: Obesity Explained

Dr. Julie K. O’Toole, M.D., M.P.H. – Chief Medical Officer & Founder, Kartini Clinic
Website: kartiniclinic.com
Books: amazon.com/author/julieotoole

*Fat Science breaks diet myths and advances the science of real metabolic health. No diets. No agendas. Just science that makes you feel better. This episode is informational only and not medical advice.