By Vivian McNeeley

Angela

When I gave birth to my daughter, Angela, in the summer of 2005, she was a perfect, healthy, happy baby and we were thrilled to welcome our first daughter into our family.

As Angela grew she amazed us in every way. She was outgoing, smart, funny and not at all shy. She had a way about her that was all her own. I was a little concerned that she seemed to be a tad clumsy and unsteady at times, but figured that was just another part of the person she was becoming. When I asked her pediatricians about it they said not to worry, but as time went on there was no denying that her funny little swagger had turned into a noticeable limp.

After being referred to an orthopedic doctor at Boston Children’s Hospital, Angela was diagnosed with developmental dysplasia of the hip, which means she had a problem with formation of her hip joint. She was 5 years old at the time.

By most standards, 5 is still very young, but when it comes to catching and correcting hip dysplasia, it’s considered quite late. If identified between infancy and the baby’s first birthday, doctors can usually treat it with special harnesses or casts, but for a child Angela’s age, treatment is much more difficult and often involves multiple surgeries.

All of a sudden, we were in a whirlwind. Our daughter had a condition that we knew nothing about, and she needed immediate care. I started researching hip dysplasia in children as soon as I could. I wanted to take her to the doctors who were most familiar with the condition, especially in older children who have had a late diagnosis. I wouldn’t have to go far—all my research brought me right back to Boston Children’s.

Angela’s journey to repair her hips began immediately. MRIs various tests, and consultations followed. A team of hip specialists discussed Angela’s case at depth, and a treatment plan was formed.

Throughout the entire process, communication with the doctors was seamless. They taught us about hip dysplasia and answered every question we had. They were patient with us and allowed us all the time we needed to take everything in and fully understand what was happening to our daughter. They also spoke directly to Angela, making her part of the process. She was immediately very comfortable with her doctors and wasn’t as scared about what was happening.

Angela had her first surgery earlier this year in March. After 10 hours of surgery we finally got to see our little girl. She was lying in recovery in a hip spica cast and, nestled next to her, among all the tubes, was her stuffed bear who had also been fitted with a tiny spica cast. After surgery, the doctors had cast her bear in order to make her feel like she wasn’t alone.  This small gesture, by a team of weary doctors after a long, complicated surgery, made us realize we were in a very special place.

Angela post surgery

Angela will need future surgeries and will remain in the care of Boston Children’s Hospital into her adulthood. But she is doing wonderfully and, for the first time in her life, she can run without limping. It’s a new run for her, one without the funny little limp we thought was just part of who she was.

Watch this video learn more about how Boston Children’s treats developmental dysplasia of the hip.

Tonight at 8 pm, HBO will debut a four-part documentary series, The Weight of the Nation, an unflinching look at the severity of the obesity crisis in America, and its crippling effect on our nation’s health and economy.

HBO and the Institute of Medicine of the National Academy of Sciences have joined forces to bring together the nation’s foremost experts on weight and weight loss for a frank and educational look at obesity in America. The series explains how weight became such an issue in this country and provides answers for how we can get to a healthy weight by overcoming the forces that drive us to eat too much and move too little.

Elsie Taveras, MD, MPH

Boston Children’s Hospital’s Elsie Taveras, MD, MPH, is featured in the series, focusing on how obesity affects America’s children. As Co-Director of our One Step Ahead Program, Taveras knows how serious a problem obesity is for young people, and has advice for parents on how to turn the tide against the epidemic. Her advice couldn’t come at a better time. Did you know:

• Childhood diabetes has increased ten-fold in the past 20 years.
• Sugary drinks are a leading contributor to increasing obesity rates and children today drink 500 percent more soda than they did in the 1950s.
• Kids see 10,000 food commercials a year, 95 percent of which sell fast food, soft drinks, candy or sugared cereals.
• For every hour of TV a child watches, he increases his risk for obesity by 12 percent.

These are eye-opening statistics, but Taveras and her team at One Step Ahead are working hard to change things. Their program is designed to teach children and families about healthy lifestyle habits, and offers advice on how to make physical activity and healthy food choices part of their lives. Services include:

• Answering questions about healthy activity and nutrition
• Helping parents learn how to best manage their child’s weight
• Providing families with ideas on how to be more active

If your child is struggling with weight loss and you are unsure of how to help, please use the following links to contact the experts at Boston Children’s One Step Ahead Program, or the team from New Balance Foundation Obesity Prevention Center Boston Children’s Hospital.

My latest (by no means the first, and certainly not the last) embarrassing parenthood moment happened two weeks ago.

It was the evening of the district-wide art show. This is a semi-big deal in our town; the art teachers pick their favorite projects from the school year, from all the grades, and put them on display for everyone to see. There is an opening reception when all the families and friends come to look at all the wonderful art, eat hors d’oeuvres, and do all the appropriate oohing and aahing.

Both of my younger children, Natasha (11) and Liam (6) had pieces in the show, but we didn’t know what or where they were. We hunted around, and as we turned a corner Liam said, “There it is! There’s mine!”

My son had drawn a picture of McDonald’s food—of the French fries, really. They had Exalted Lines around them to show just how special they were.

Great. Of all the things my son could have drawn, he draws McDonald’s French fries. The food I tell him—and his siblings and all my patients—is bad for him.  He didn’t just draw them, he drew an ad for them. McDonald’s should pay him.

Immediately, the I-screwed-up stuff started in my head.  I should have been more strict, I told myself. I should have taught him that McDonald’s food is poison. We should never have gone there. Not that we go all that often…but here and there we do, when we need some quick food and happy kids. (Those golden arches were a sight for sore eyes in March after being stuck for hours in traffic on a family vacation.) Liam goes to McDonald’s maybe eight times a year (we go less than that, but my mother-in-law sneaks in some trips). That’s not much. But then again…

Maybe I’m too strict.  Maybe that’s it. Maybe it’s the whole Forbidden Fruit thing. Maybe if we didn’t make a big deal about limiting his access to McDonald’s it wouldn’t seem so wonderful to him.

But…maybe I just didn’t make the healthy foods appealing enough.  Maybe if I’d done a better job of making kiwi or zucchini or tofu seem like the very bestest food around, if I’d found the fun recipes and been really creative, he would have drawn an elegant kiwi-zucchini-tofu still life instead.

Or…it’s those darn Happy Meal toys. I’ve never really bought into the controversy on this one; to be honest, I like the Happy Meal concept. The portions are small, and the toy sometimes distracts them from finishing the food. But suddenly I felt bamboozled. McDonald’s had won: my son wants the food even more because of the toys.

We wandered around the art show. Natasha showed me her really great self-portrait. Liam showed me his other piece, which involved a volcano, a pig and something that looked like a flying orange manatee. We ate cookies and found the artwork of friends, chatted with all sorts of people we hadn’t seen in a while, and I found myself thinking…

Why do I care?

It’s not that I really think that Liam is obsessed with McDonald’s French fries. He loves them (he says that they have the perfect amount of salt and grease), but he manages very well without them 357 days out of the year. He may not have the ideal diet, but he is offered lots of very healthy food on a regular basis. I don’t really think I screwed up.

Here’s what it was: I was embarrassed. I mean, I’m a pediatrician! I’m supposed to be a proponent of healthy foods, which McDonald’s is not. I felt like the picture made me look bad. And maybe it did. Maybe the people who saw it (like the woman from church who said, “that’s your son’s drawing?” with a funny look on her face) think I don’t know anything about healthy nutrition, or that I feed my kids fast food all the time. But as much as we might like them to, it’s not the job of our kids to make us look good.

Wouldn’t it be nice if our children were always perfectly behaved, got straight A’s, never tried a cigarette or a beer, never got in a fight or said a bad word—and ate kiwi, zucchini and tofu and never even wanted McDonald’s? How amazing would that be? Everyone would think we were perfect parents.

But our kids are human, just like we are. And you know what? It’s better that way. Perfect isn’t all it’s cracked up to be—and those French fries do taste good.

“It’s a great drawing,” I told Liam. Who knows—maybe he has a future in marketing.

A new study that looked at which diets work best for kids found that compared to portion control and low-glycemic index (GI) diets, low-carb diets work just as well for weight loss, but are more difficult for kids to stick with long-term.

The study also showed that low-GI diets, which promote foods like fruits, vegetables and whole grains yielded similar weight-loss success, but showed greater long-term compliance a year later. This diet is part of the innovative clinical research conducted by David Ludwig, MD, MPH, director of the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital, and its Optimal Weight for Life (OWL) Clinic.

Since long-term habits are the foundation of healthy living, Ludwig and his colleagues focus on choosing the right combination of foods to limit hunger and overeating, rather than encouraging people to eliminate entire classes of nutrients, like carbohydrates. Ultimately, this method makes it easier for a child to accommodate his or her personal and cultural preferences, allowing the diet to more easily become a lifestyle.

“When you line up biology and behavior, you can accomplish greater results with less work,” says Ludwig. “On a bicycle, if you’re in the wrong gear, you can pedal a whole lot and still not get very far. When you find the right gear, however, suddenly that effort pushes you forward more efficiently.” The same is true for choosing the right weight-loss plan for a child.

Carb filled snacks that are easily available can hurt low-carb diet attempts

But as the study’s findings show, there are plenty of obstacles that keep kids and families from sticking to healthy habits long-term.

“The greatest obstacle that families face today is our toxic environment, which is optimally designed to cause weight gain, heart disease and diabetes,” he says. “The food industry spends billions of dollars a year to make the highest calorie, lowest quality products look attractive to children and adults.”

The challenge is even more intense for inner city and low-income families, who may live in “food deserts” where fast food restaurants and convenience stores prevail, and quick access to fresh fruits, vegetables and whole grains is limited.

The solution, Ludwig says, is to create a nutritional safe zone at home, thereby reducing outside temptations.

“Each family has to work toward making the home a sacred healthy environment,” says Ludwig. “It’s OK to enjoy a treat once in a while, but we should make the home a place where the only foods available are healthy and nutritious.” Ludwig encourages parents to model healthy behaviors at home as well, and set healthy examples from which even lean family members can benefit.

To help with the process, Ludwig suggests consulting with your family’s doctor, psychologist and nutritionist, who can create a personalized approach for weight loss. Boston Children’s Hospital’s OWL clinic does just that, by offering a multidisciplinary team to provide patients with customized, age-appropriate weight management at both the Children’s Hospital Longwood campus and its suburban location in Waltham, MA. This summer, the center will also expand to Peabody.

David Ludwig, MD, PhD

For families whose children have less significant weight problems and may not need intense personalized therapy, Ludwig’s book “Ending the Food Fight” translates the science of the OWL approach into a practical nine-week program for families to follow at home.

For more information on Boston Children’s Hospital’s work on preventing obesity and helping children achieve healthy weight, visit the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital.

Read more about the future of personalized weight loss, and watch a video about one patient’s experience at the OWL program.

As a pediatrician I am embarrassed to admit this, but my 6-year-old son has a terrible diet.

Well, not terribly terrible. He doesn’t live on chips and soda. But it’s remarkably lacking in the things I always tell my patients to eat, like fruits, vegetables, low-fat dairy and whole grains.

It’s not for lack of trying on my part. I serve these foods to him regularly, including in the snack I pack him for school. As I encourage parents in my practice to do, I pack things like grapes and string cheese—which often come back uneaten. I think it was out of sheer exasperation that he wrote the note to us (in his best kindergarten spelling) that I found in his backpack.

Cheese isn’t the only food that gives Liam a “hedache”. So do apples, carrots, mandarin oranges and any green grapes that have even a little bit of brown on them. Yogurt is a problem too, as is salad, spinach, tomatoes, brown rice and finishing his milk. The genius of his approach cracks me up. He’s not saying he doesn’t like the foods or understand that they are healthy. He’d be happy to eat them if they didn’t give him a headache.

Crackers, pretzels, mashed potatoes, popcorn, pasta, Oreos, Cheezits, French fries, white rice, candy and bagels do not give him a headache. Basically, the diet that suits him best is the White and Sugar diet. Which, interestingly, is the exact same diet that suited his older brother Zack best. (Since my daughters eat pretty well, I can’t help wondering if my husband gets the genetic blame.)

I see this all the time in my practice. Well, not the headache part. But when I ask parents if their children are eating fruits and vegetables and other healthy foods, it’s really common for me to hear, “He won’t eat them.” It’s really true that once kids are no longer babies, once you are no longer literally spooning the stuff into their mouths, it’s hard to get them to eat things they don’t want to eat.

I’ve tried everything I tell parents to do. I started early with healthy foods and have offered them consistently. Our house is stocked with healthy snacks (just ask the older kids, who are always complaining, “there’s no sugar in this house!”). We set an example by eating well ourselves—Liam is surrounded by good examples, including his 11-year-old sister who happily eats the fruit and cheese I pack for her every day. But nothing has worked. As was the case with Zack, he just doesn’t like them and will not eat them.

Like I said: embarrassing.

So, having left ideal in the dust, meals are about compromise. Since peas, corn and the very top of broccoli crowns do not give him headaches, we try to serve them often. We buy fresh grapes every week so as to increase the chances of finding ones that have no brown spots. We have a Three Bite Rule when it comes to foods he doesn’t want to eat (mostly this works out okay, although there have been some OK Corral moments over eating three bites of certain vegetables or casseroles that have made me wonder if it’s always a good idea). We negotiate over how much milk he needs to drink (we use numbers of gulps or how low he needs to get on the cup). And we give him a multivitamin every day.

Over time, Zack’s diet did improve (a lot, actually). He didn’t listen to us, but he did listen to coaches and others who told him that a healthy diet would make him a faster swimmer—and give him a leaner, meaner physique. He discovered that he liked chicken Caesar salads and that carrots weren’t evil. It took until late in high school, but that’s okay—I’m all about better late than never when it comes to healthy habits.

So I’m holding out hope that one day cheese won’t give Liam a headache. Until then, I’ll keep trying and compromising. Which, sometimes, is the best we can do as parents—or doctors.

It seemed like such a great idea.

We need kids to be more active. With a third of US kids overweight or obese, and studies showing that childhood obesity leads to adult obesity, getting the recommended hour a day of activity is more important than ever. Problem is, kids aren’t doing it. For all sorts of reasons, some good and most bad, our kids are turning into couch potatoes.

I was getting really frustrated with my inability to get my patients moving. Then I heard about active video games, like Wii Fit and Just Dance and Dance Dance Revolution, and I thought: this is perfect. Kids love video games.

I loved this idea. I didn’t even freak out when my mother-in-law bought my daughter a Wii console; they will play active games, I thought, and it will be great for those stuck-inside days or the days when I’m just too busy with chores to take the kids to the park or pool. I loved this idea for my patients, as well.  I work in Boston, and some of my patients live in neighborhoods where playing outside isn’t safe. Even the kids who didn’t like sports perked up when I talked about video games. I started recommending active video games to my overweight patients. Everybody was enthusiastic. It was great.

Well, maybe not so much.

In a study just published in the journal Pediatrics, researchers gave Wii consoles to around 80 kids (now there’s a cool study to be part of), along with accelerometers to measure activity level.  Half the kids were given active games, and the other half were given inactive ones. They didn’t tell the kids what to do with the games, and they didn’t stop them from buying or using other games. They wanted to see what they did on their own.

Guess what? They didn’t do anything. The kids who got the active video games weren’t more active (nobody in either group was). They might have played the games, but they sat down more afterwards to make up for it, because the net increase in exercise was essentially zero. Having the Wii did squat.

To be honest, this does reflect my own experience as a parent and pediatrician. My kids like Super Mario Kart more than Just Dance; given the choice between an active game and no game they choose no game more often than not. And when I see my patients again and ask them how much they are playing active video games, there are a lot of embarrassed silences and averted eyes.

The problem is that left to their own devices, kids these days don’t tend to choose physical activity.

Getting kids active isn’t as easy as giving them a Wii, it turns out. Because the problem isn’t that we haven’t made being active interesting enough. The problem is that left to their own devices, kids these days don’t tend to choose physical activity. And that’s a really, really big problem.

We think of childhood as being a more active time than adulthood—but according to the Centers for Disease Control about half of adults are getting enough exercise, while only a quarter of high-schoolers are. Given that being active is something of a learned habit, this isn’t a good trend. Two-thirds of adults are overweight or obese now; it’s scary to think where we are headed.

In retrospect, I don’t know what I was thinking. I should have realized that there is no quick fix. There is no pill to melt the pounds away, no vitamin or sweet drink that takes the place of eating vegetables, no cool video game that will get everyone off the couch. This takes effort, plain and simple.  Not just on the kids’ part, but the parents’ too.

That’s the real take-home of the study: if you want your kid to be healthy not just now but for life, you have to get them moving. You. Not the Wii. Not your kid’s gym teacher. You.

Actually, I take that back. Not just you. Us. We all need to get kids moving. If we want the next generation to be healthy, it will have to be a group effort.  So let’s get at it, all of us parents and doctors and teachers and community leaders and neighbors and everyone: let’s get kids exercising.  Their future, which is our future, depends on it.

Want to learn more about active video games? Read a Dream story on this topic, featuring David Bickham from the Center on Media and Child Health.

Daivd Ludwig, MD, MPH

Every month the Journal of the American Medical Association (JAMA) publishes an article called Clinical Crossroads, where a patient case is presented and medical professionals are invited to share their thoughts on how they might treat that person. A few weeks later the case is presented again, this time with commentary from an expert who specializes in the medical condition profiled in the article.

The most recent Clinical Crossroads was written by David Ludwig, MD, PhD, director of the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital. Ludwig’s case focuses around Ms K, a 14 year-old girl struggling to lose weight.

Unlike typical medical case studies that focus on diagnosis and treatment of acute illness, Clinical Crossroads often takes into account the ethical, emotional and economic issues related to the patient’s health and treatment. All three of these elements figure heavily in Ms K’s story, making it ideal for the Clinical Crossroads treatment.

But as Ludwig himself would tell you, overcoming childhood obesity isn’t just the job of pediatricians and their patients; parents play a vital role in helping children achieve and maintain a healthy weight and lifestyle too. With that in mind, we are presenting Dr. Ludwig’s Clinical Crossroads piece to you on Thriving and asking for your input as parents.

Given the following situation, what are some ways Ms K and her parents could work as a team to help her live healthier? If you were her mother or father, what would you do to support her efforts?

Ms K is an obese 14-year-old girl who is struggling with weight loss. She lives in the greater metropolitan Boston area. Ms K began to gain weight at age 8 years. Over the past 7 years, her weight has gone up by 20 to 30 lb annually … She reports trying various weight loss programs but either she did not follow through or they did not work. She has never lost more than 5 lb with any focused effort.

On a typical day, Ms K skips breakfast, so her school lunch is her first meal of the day. She eats whatever is served there, often something “greasy,” with a small salad and chocolate milk. When she comes home from school, she begins to snack on “good” junk food. Over the course of the afternoon, she might have several of the following: baked chips, a cereal bar or 2, 2 or more “100-calorie packs,” a glass of (1%) milk, crackers, or pasta with cheese. She eats dinner with her parents, which is often fried chicken, pasta with cheese, or a hamburger. There are rarely vegetables on the plate. After dinner, she will routinely eat more, ingesting 1 to 3 snacks while working on her computer. She does not routinely eat dessert at dinner and does not drink sugar-sweetened beverages. She does not watch television regularly. She used to ride a horse several times a week but has not done so in several years. Her only regular activity is walking home from school, about mile daily.

Ms K was told by her pediatrician that she needed to lose weight or she might develop diabetes. She has experienced harassment at school and online related to her obesity. There has also been significant tension between Ms K and her parents—especially her mother—about her eating habits and progressive weight gain.

   Ms K’s mother was interviewed for the piece, and said the following:

“Probably the biggest challenge that my husband and I have had is backing off. I constantly watch her, correct her, and stop her from doing things. I am almost obsessive about what she eats, what she doesn’t eat. My husband and I went to a counselor locally, and he was the one to tell us we need to back off because it is making things worse. That’s been the biggest challenge. I think I feel like I am the food police sometimes.”

Please share your ideas with us on how families can work together to improve eating habits by commenting on the blog, leaving a message on our Facebook wall or connecting with us @ThrivingKids on Twitter.

To speak with a member of the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital please visit their website.

Have you seen the anti-childhood obesity ads from Georgia?

With 40% of the kids in Georgia overweight or obese (only Mississippi is worse), health advocates decided that it was time for “a wake-up call.”  So the Strong4Life campaign and Children’s Healthcare of Atlanta have released print and TV ads with obese kids and slogans like “It’s hard to be a little girl when you’re not.”

Ouch. I mean, really. Imagine being on a playground and having some kid point at you and say, “You look like the fat girl on TV!”  What were they thinking?

Actually, I get what they were thinking. It’s a desperate-times-call-for-desperate-measures thing.

We do need a wake-up call. It’s not like Georgia is the only place with a childhood obesity problem. Nationwide, a third of US kids are overweight or obese, and studies show that overweight kids tend to grow up into overweight adults. Being overweight brings with it a higher risk of health, emotional, and even financial problems. That’s not what we want for our children—of course it’s not.

So we just tell people to eat less and exercise more, right? After all, weight gain or loss is an energy equation. If you take in more calories than you burn off you gain weight—take in fewer calories or burn off more of them, you lose weight. Simple stuff, no problem, right?

Wrong. Big problem.

I’ve been doing primary care pediatrics for twenty years now. I have helped all sorts of kids with all sorts of problems get better.  But obesity is one problem I can’t seem to make better. I’ve been feeling pretty desperate myself.

I’ve tried everything. We talk in detail about foods they should and shouldn’t eat and drink. I give them recipes and shopping lists. We make specific diet plans. We make specific plans for exercise, thinking together about what’s easiest and most fun. I try to make all the plans with them instead of for them, setting small goals, so that everything I ask them to do is realistic. We talk a lot about why it’s important to be at a healthy weight, and why being overweight is bad for them. I connect them to nutritionists, weight loss programs, community resources, exercise programs, psychologists and anyone else who might help. I see them regularly to check on their progress and try out new ideas.

And for the most part, I get nowhere. Really. It’s amazingly discouraging. I feel like a failure as a doctor—and I feel desperate about the future of my patients.

Part of the problem (by no means the whole problem!) is that many families don’t take things seriously enough, no matter what I say. They think it’s baby fat that the kids will grow out of. Or they don’t even think the kids are overweight, often because the entire family is overweight; it seems normal to them. I guess it’s this stuff that the folks in Georgia were trying to tackle with the ad campaign, and I applaud them for trying to do something.

But no solution should involve shaming children.  That’s taking desperation too far.

People say it’s like the gross pictures on the cigarette labels, meant to shake people up and make them rethink their habits. But the ones who really need to rethink things are the parents. Maybe pictures of obese adults, with captions like: “this is your kid in 10 years if you don’t start making changes now,” would be better. Same message, no shaming of children.

These really are desperate times, and we really do need desperate measures. We desperately need more safe outdoor and indoor spaces for exercise.  We desperately need affordable healthy foods. We desperately need more afterschool programs and other supports for families who are working so hard to make ends meet that they truly don’t have time to take their kids to the park or make healthy home-cooked meals. We desperately need to get people to shut off TV’s and other screens. We desperately need fast food to be healthier (we can’t stop people from buying quick, cheap food). There is so much we desperately need.

We do not, however, desperately need to make children feel shamed.

For information on what Children’s Hospital Boston is doing to fight childhood obesity, visit the website of the Optimal Weight for Life (OWL) Program and read about the Fitness in the City program as well as about our advocacy efforts, such as working for better school nutrition.