For David Ludwig, MD, PhD, one of health’s most fundamental truths can be traced back to a 2,000-year-old quote from Hippocrates, the father of modern medicine: “Let food be thy medicine and let medicine be thy food.”
It’s a simple but powerful philosophy, and when combined with current research in obesity prevention, it’s one of the cornerstones of Children’s Hospital Boston’s Optimal Weight for Life (OWL) Clinic. “Hippocrates was right, nutrition really is the foundation for health and well-being,” says Ludwig. “He understood that intuitively, without access to the modern science and technology.”
Founded by Ludwig in 1996, OWL is a multidisciplinary clinic with a staff that includes physicians, nurses, dietitians and experts in child behavior. With Ludwig at the helm, OWL has spent the past decade and a half researching childhood obesity while serving over 1,500 patients a year, making it one of the largest and most respected childhood obesity clinics in America. Now, thanks to a $7 million grant provided by the New Balance Foundation, Ludwig and his team will be able to expand their clinical research, patient care and community health programs. The newly created New Balance Foundation Obesity Prevention Center will bring Ludwig’s message to even more children and communities struggling with weight issues.
Since he was 8 years old, Ludwig has been captivated by the inner workings of the human body. By the time he finished the fourth grade he had read every physiology book on the shelves of his local library.
That fascination stayed with him throughout his education. When he began his pediatric endocrinology fellowship at Children’s, he focused his studies on diet and weight, researching how brain function affects body size, as well as the role genetics plays in why some people become obese and others do not.
But with childhood obesity already reaching epidemic status by the mid-1990s, Ludwig felt a more preventive approach was needed to remedy the mounting health problems that overweight children would face in the future.
“Our genes, though important, haven’t caused the epidemic—so we need to look to the environment for the answers,” he says.
Fighting the odds
While OWL may have achieved a great deal of success in its 15-year fight against childhood obesity, Ludwig and his team are still up against difficult odds. One-third of all American children are either overweight or obese, meaning that the issue is three times as prevalent as it was a generation ago.
Seth Knoblaugh, a 10-year-old from Dracut, Massachusetts, is one of the millions of American children struggling with his weight. His mother, Charise, has been trying to help him lose weight for years, but with little success. A recommendation from his pediatrician recently sent them to OWL, where Charise says Seth has begun to realize the potential health problems his weight could cause for him down the road.
“Doctors told him that he’s at risk for developing diabetes if things don’t change, which was a real wake-up call for him,” Charise says. “But at OWL they don’t just say ‘you need to lose weight,’ they help you find ways to do it as a family. They really stress that healthy weight isn’t just about diet, it’s about changing your family’s whole lifestyle.”
Unhealthy eating and exercise habits in children could lead to serious medical concerns like diabetes, high blood pressure and high cholesterol. But by helping people like Seth and his mother focus on small, achievable goals, Ludwig says the problem doesn’t seem so insurmountable.
“If we were trying to change the world overnight, it would be an overwhelming task. But even the longest journeys are taken one step at a time,” Ludwig says. “If a patient is very heavy, it’s usually best not to focus on losing many pounds right away. Instead, start by making just one healthful change. If you can make that one successful change then you can make another, and another, until you’ve reached your goal.”
To help patients achieve their goals, OWL nutritionists recommend foods like vegetables, fruits, beans and whole, minimally processed grains because they have a low glycemic index (GI). Foods with a low GI have carbohydrates that break down slowly, gradually releasing glucose into the bloodstream, which makes the eater feel full for a longer period of time.
To manage the behavioral and emotional aspects of their treatment, patients in the OWL clinic meet with behavior specialists for a combination of individual and family sessions, focusing on increasing motivation to improve diet and physical activity levels. These treatments may also help children cope with the emotional stresses associated with being overweight and boost their confidence in the process.
It’s worked for Nikki, a 10-year-old Bostonian who, after a year in the OWL program, is just starting to recognize the emotional roots of her overeating. With help from Emily Israel, PhD, a clinical psychologist and associate director of the Obesity Prevention Center, Nikki and her father, Pierre, now see how her emotional state often triggers compulsive eating, and are working on ways to address those feelings.
“Before we came to OWL and spoke with people like doctors Ludwig and Israel, I didn’t understand how stress from our family situation was affecting Nikki’s attitude about food and portion sizes,” says Pierre. “Knowing that is very powerful because it gives me a better idea of how to help her.”
“Nikki and Pierre have worked together as a family to make healthy lifestyle changes and aren’t afraid to confront the stress that was negatively impacting Nikki’s overall health,” says Israel. “They’ve made great efforts to understand the many variables that contribute to emotional eating and have made it a priority to overcome those challenges. I’m incredibly proud of all of their hard work.”
In addition to overcoming personal obstacles, Ludwig says Seth, Nikki and their parents must contend with powerful forces in the food and pharmaceutical industries, both of which have profited from the childhood obesity epidemic for years. Overcoming the influence of profitable special interests won’t be easy, but Ludwig is confident it can be done if the public takes a greater interest in their own health.
“People need to support elected officials who won’t kowtow to giants in the food industry,” he says. “We need to strive to create a society that doesn’t promote short-term profit over the health of our children.”
Looking toward the future
While patients like Nikki and Seth may have many things in common, a weight-loss program that works for one may not be successful for the other. Focusing on this individualized approach, Ludwig and Cara Ebbeling, PhD, associate director for Research and Training in the Obesity Prevention Center, recently discovered that the rate at which a person’s body secretes insulin could determine the type of diet that would work best for that person. It’s an important discovery, and one that Ludwig and Ebbeling believe could become a key factor in the next generation of obesity treatment.
“In the future we are going to hear a lot more about personalized medicine, and personalized dieting will be a big part of that conversation,” says Ludwig. “Based on what is being studied now, it’s likely that doctors will one day be able to know which diet pattern will be most beneficial for people trying to lose weight. With that information, an overweight patient may be able to make a little effort go a long way.”
However, Ludwig is quick to point out that it’s not up to science alone to help turn the tide against childhood obesity. Parents still play a pivotal role in helping their children get healthy, and in some cases, well-intentioned parents may do more harm than good when trying to encourage their children to lose weight. Ludwig says he’s seen many parents unsuccessfully try to enforce weight-loss though coercive methods like excessive food restriction or nagging, only to have them backfire when the child rebels. To break this vicious cycle, OWL staff use education and counseling to promote easier transitions to healthy food practices, all with less stress and conflict.
“One of the fundamental purposes of OWL is to help parents learn proven parenting methods that support healthier home environments,” Ludwig says. “Young children need firm guidance when it comes to food, whereas older children need support and autonomy to make their own good food decisions. If this is to happen, parents and children need to be working together.”
Making adjustments to his parenting and cooking styles hasn’t been easy for Pierre, but he says it’s worth the effort. “I’ve come to realize the only way Nikki can change is if I change too,” he says. “I don’t always like it, but I care more about her health than my comfort. As a dad, it’s worth the sacrifice.”
Ludwig’s support of a family-centered approach started in the lab and extended to the OWL clinic, but now is moving into the community to help people learn about good nutrition before obesity becomes a problem.
The OWL on the Road program is a mobile version of the OWL clinic that sends Children’s obesity health specialists to Boston area community health centers. While there, OWL staffers educate children and their parents about obesity and the importance of maintaining a healthy lifestyle. With funds provided by the New Balance Foundation’s recent donation, the Obesity Prevention Center’s OWL on the Road program will be better equipped to help Children’s clinicians address childhood obesity in high-risk, underserved populations by increasing the program’s reach. It’s a proactive approach, and one that Ludwig says could eventually reduce many health problems associated with childhood obesity.
“The New Balance Foundation grant will help us take our message to people who need it most,” he says. “These funds will not only support OWL on the Road, but also clinical research that we can then use in community education initiatives and community-based interventions. That type of synergy will be key in preventing obesity before it starts.”
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