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Childhood obesity

Food for thought: The war against childhood obesity

by Tripp Underwood on August 10, 2011

Daivd Ludwig, MD, PhD

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. Full story »

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Boston Globe comments on state intervention for morbidly obese children

by Tripp Underwood on July 25, 2011

Headlines like “Should Parents Lose Custody of Super-Obese Kids?’’ and “The War on Bad Parenting” conjure up some pretty strong mental images. Outrage and fear may sell newspapers and attract web traffic, but according to Boston Globe columnist Joanna Weiss, sensationalist journalism can also detract from the issues at hand.

“Maybe we tune out the headlines and the fear-mongering and find a way to talk about health issues quietly, one on one,” she wrote in an Op-Ed piece in Sunday’s Boston Globe, commenting on the explosive media coverage of a recent article in the Journal of the American Medical Association (JAMA). The controversial piece, written by David Ludwig, MD, PhD, director of the Optimal Weight for Life (OWL) Program at Children’s Hospital Boston, argues that life-threatening obesity—where a child’s body mass index (BMI) is beyond the 99 percentile and multiple attempts to help the child lose weight have failed—could call for state intervention, and in extreme cases foster care.

The following is an excerpt from Weiss’s editorial, including quotes from an interview she conducted with Ludwig after the JAMA commentary first attracted attention.

“Most people would be horrified if a child were systematically underfed, began to starve, and the state refused to help,’’ Ludwig said. “Why is that fundamentally different from a child who is so overfed that their life is now in danger?’’

It’s a reasonable question, but those have become increasingly hard to ask; you can’t suggest a modest solution to the obesity epidemic without facing a fiery backlash. People howl when Michelle Obama suggests they should eat more vegetables. They cry “nanny state’’ when Mayor Menino bans sugary drinks from vending machines.

And if we can’t agree on small steps, what do we do about these rare, extreme cases when a child’s life is at stake?

To read the full article, please click here.

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Should the state intervene on behalf of morbidly obese children?

by Tripp Underwood on July 13, 2011

When we think of child abuse and neglect, we think of burns and bruises and children left unattended. We don’t think of obesity. But maybe, in some cases, we should.

In a recent commentary in the Journal of the American Medical Association (JAMA), David Ludwig, MD, PhD, director of the Optimal Weight for Life (OWL) Program at Children’s Hospital Boston, argues that life-threatening obesity—where a child’s body mass index (BMI) is beyond the 99 percentile and multiple attempts to help the child lose weight have failed—could call for state intervention, and in extreme cases foster care.

Children in this highest BMI category are at great risk for many serious health complications. We all know that childhood obesity can lead to life-long health complications, but in extreme cases it can be life-threatening in the short term. For example, type 2 diabetes, which is being seen in younger and younger patients as the childhood obesity epidemic continues, can cause very serious complications and even be fatal. Sleep apnea, which often occurs in obese children, can lead to very dangerous heart problems.

Because of these dangers Ludwig says the most severe instances of childhood obesity may justify a child’s removal from the home because of imminent health risks to the child and the parents’ continued failure to address those problems. Full story »

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Obesity prevention for the under 5 crowd

by Tripp Underwood on June 24, 2011

Is there anything cuter than the chubby face of a smiling baby? Maybe not, but in some instances that baby fat should elicit more concern than cooing, according to a report released by the Institute of Medicine (IOM).

The Early Childhood Obesity Prevention Policies report shows that even the youngest children in the United States are at risk of becoming obese. Today, almost 10 percent of infants and toddlers are heavy when compared to their length, and that number doubles for kids between the ages of 2 and 5.

A little baby fat may not be a red flag for health concerns now, but studies show that early obesity can track into adulthood. To prevent future health problems before they occur, the IOM is calling on healthcare professionals, caregivers and policymakers to step up their game when it comes to imparting on parents the importance of nutrition, physical activity and the dangers of sedentary behavior. And the sooner the better; the report stresses that kids should be on the right nutrition and physical activity path before they even enter school.

Elsie Taveras, MD, MPH

“There’s been a lot of evidence accumulating over the past couple years that indicates that the first few years of life are crucial to future health and the prevention of obesity in children,” says Elsie Taveras, MD, MPH, who served on the IOM committee that released the report and is co-director of Children’s Hospital Boston’s One Step Ahead Program. “In the past there’s been a precedent to wait until a problem exists before we intervene, but the point of this report was to stress the importance of prevention. Preventing obesity before it occurs is easier and more efficient than trying to reduce it once its been established.”

Because obesity can’t be prevented by just one single method, the IOM report made several suggestions. Here’s a breakdown of some their more important findings: Full story »

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USDA steps up to the plate

by Tripp Underwood on June 3, 2011

As of Thursday, the U.S. Department of Agriculture (USDA) has officially retired the food pyramid, replacing it with an easy-to-read, plate shaped icon. “MyPlate” is divided into four sections, indicating what types of food (and how much of them) should occupy a person’s plate at each meal. Its designers are hopeful that the simple, meal-by-meal visual guide will be easier for Americans to understand than the pyramid, which has been called both confusing and misleading. (For example, bacon and cold cuts are technically meat products, which could place them in the same category as healthier options like fish, chicken or beans.)

The USDA is counting on the MyPlate to eliminate a lot of the confusion left in the pyramid’s wake, but will it work? To get the skinny on the pro’s and con’s of the new plate icon, we spoke with David Ludwig, MD, PhD, director of the the Boston Children’s/New Balance Foundation Obesity Prevention Center.

Many experts say the old food pyramid is too difficult to understand, possibly even misleading (i.e. some incarnations seemed to imply that ALL fats are bad for you). Now that it’s gone, what are you’re thoughts on the pyramid?

The initial Food Guide Pyramid, released in 1992, gave clear advice to avoid all fats and load up on starch. The advice was wrong, but at least it was specific. Then, in 2005 it was updated to the

2005's MyPyramid may have been an improvement from earlier food pyramids, but not by much

MyPyramid model, but that was a marvel of miscommunication, with colored bands leading to a mixture of foods lying around at the bottom. Looking at MyPyramid, one wonders if an earthquake hit the first pyramid, and knocked all the nicely arrayed food to the ground. Although it may seem funny, the confusion and misunderstanding arising from these icons has negatively impacted public health. Without specific, scientifically informed guidance, products like the “low fat Twinkie” have been marketed as a health food, when in reality they aren’t much different from a bowl of sugar. Hopefully, with release of the new Plate icon, the Pyramids will remain permanently in Egypt.

In what way is MyPlate a step-up from the pyramid?

The new icon is a huge improvement, with clear, unambiguous and simple advice. The most notable change is the recommendation to cover half the plate with vegetables and fruits, dietary categories that are greatly underconsumed by all Americans, especially children. In addition, portion size of starchy foods like grains is, by implication, smaller now, limited to a quarter of the plate. (No, the 16 oz portion of pasta is no longer compliant). Full story »

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AAP comes out strongly against sugary sports drinks

by Claire McCarthy on June 1, 2011

David Ludwig, MD, PhD, director of the Boston Children's/New Balance Foundation Center for Obesity Prevention.

The American Academy of Pediatrics (AAP) sent a strongly worded message to parents this week: your children should not drink sports drinks or energy drinks.

The ads for these drinks are full of athletes exercising and the message is clear: sports drinks will help us be faster and stronger. More than that, the message is that we need them for exercise, because they replace the fluid we lose in sweat. “Energy and sports drinks are marketed in a way that imbues them with a healthy halo,” says David Ludwig, MD, PhD, director of the New Balance Center for Obesity Prevention at Children’s Hospital Boston.

“Over the last decade, many studies have highlighted the adverse effects of the traditional sugar-sweetened soda,” says Ludwig. With declining consumption rates of these drinks, the food industry has tried to create a submarket of alternative beverages. Sports drinks are still sugar-sweetened, but they typically have about 25 percent less sugar and some electrolytes. Full story »

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Do we really need cafeteria cameras?

by Tripp Underwood on May 18, 2011

When your kids smile for the camera, do they say ‘cheese’ or show it? For some Texan elementary school kids, the answer could be both.

Health officials in San Antonio recently received a $2 million dollar grant to pay for a surveillance and analytical program that would more accurately study what kids eat while at school. According to a report on CNN, small cameras in the cafeteria would take pictures of some children’s lunches and analyze its nutritional value. Then, once the student returns his tray, a second video is taken, recording what was (and wasn’t) eaten so the program can calculate the total nutritional intake for that meal.

It may sound like high tech science fiction, but the program’s creators say it has much more in common with the old saying “the camera never lies,” than with George Orwell’s 1984.

According to the program’s designers, when researching childhood obesity, camera-based food analytics provide more accurate data than self-reported surveys, because in many cases parents and kids often underreport the amount of junk food they’re eating. If too many people involved in an obesity study turn in falsified data, researchers are left with an inaccurate picture to make their recommendations with. In theory, cameras would help eliminate some of that fudged data.

Fried and processed school lunches are under the microscope

Using surveillance equipment to study kids’ lunch habits is sure to jar some medical ethicists, but the San Antonio program isn’t as covert as it sounds. For starters, it’s voluntary; parents must give permission for their child to be entered into the program so no one is unknowingly monitored. Secondly, the cameras will record and track students’ lunch habits through a barcode system—no faces will be recorded—which will provide a better sense of anonymity for the children involved. Once collected, school officials will use the information to determine what kids are eating, and plan school meals around the more popular healthy menu items. Parents who request to see their child’s lunch record will have access, which could help them plan home meals that balance out their child’s diet based on what was eaten at school. Full story »

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Walking the balance beam—giving the best messages to your teen about diet and exercise

by Claire McCarthy on April 12, 2011

Dr. Claire McCarthy is a primary care physician and the Medical Communications Editor at Children’s Hospital Boston. Along with her blogs here on Thriving, you can find her at the Huffington Post and Boston.com. Follow her on Twitter @drClaire.

Sometimes, parenting can be like walking on a balance beam. You lean too far either way and, well, bad things can happen.

This is especially true when it comes to teaching your kids healthy eating and exercise habits. You don’t want your child to be obese—and yet, you don’t want to say things that might push them toward an eating disorder. Since both obesity and eating disorders are on the rise, this is a real issue for parents today.

It can be particularly tough when kids are adolescents. Their bodies are changing, peer pressure and hormones rule their lives, they are exploring their independence and their identities. An offhand comment can have unexpected consequences.

Sarah Forma, MD

I was talking about this the other day with a friend of mine from medical school, Dr. Sara Forman. She’s the director of the Eating Disorders Program at Children’s Hospital Boston, a primary care doctor and the mom of two teens. This is territory she knows well.

“You want to encourage healthy behaviors, but you don’t want to be too controlling,” she said. “Kids need some degree of guidance, but you need to know when to back off.” Full story »

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