The Childhood Obesity Epidemic: How to End It

The Childhood Obesity Epidemic: How to End It

Dr. David Ludwig certainly has his finger on the pulse of childhood obesity—and its causes. He is a pediatrician and endocrinologist at Children’s Hospital Boston and holds the position of Associate Professor in Pediatrics at Harvard Medical School. Dr. Ludwig is the founding director of the Optimal Weight for Life (OWL) Program, described by Child magazine as one of the most comprehensive pediatric obesity programs in the country. Since the early 1990s, he has provided medical care for several thousand overweight children and their families.

“Today, fully one in three children is substantially overweight or obese,” Dr. Ludwig told Organic Connections. “Statistics published recently in the Journal of the American Medical Association showed that the dramatic increase in childhood obesity since 1980 seems to have plateaued. In one sense this is very good news, but in another sense, rates are stabilizing at an unacceptably high level. Even without further increases in prevalence, the toll of childhood obesity will continue to increase for years to come, because it can take many years for excessive body weight in childhood to translate into chronic disease and increased mortality in adulthood.”

In 2007, Dr. Ludwig put his program for handling issues with overweight children into a book, Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World (available in our bookstore),  which has been acclaimed by peers and reviewers alike. With this book (also published in paperback in 2008), families can implement many of the recommendations he makes in his practice.

Isolating the Causes

In his present work Dr. Ludwig targets environmental factors in a child’s life, including diet, but it didn’t start out that way. “I originally did basic research in the laboratory, looking for genes that affect body weight,” Dr. Ludwig said. “While the work was intellectually interesting, I came to realize that the identification of a new gene—added to the dozens of other genes that likely influence body weight—would probably not be the answer to the obesity epidemic. Of course, our genes haven’t changed much in the last 30 years as the obesity epidemic has taken off. So I made a transition to nutrition research and became more interested in the environmental factors affecting body weight; specifically how diet affects hormones, metabolism and body weight. As Hippocrates said more than two thousand years ago, ‘Let food be thy medicine and let thy medicine be food.’ Food is capable of exerting many of the same effects on the body as drugs do, but without the side effects.”

During the course of Dr. Ludwig’s research, he took in an ever widening view of the causal factors for childhood obesity. He now considers them painfully obvious. “We just have to turn on the TV to see the main causes,” he said. “One is the TV itself, which promotes a sedentary lifestyle. Then there are the commercials that promote consumption of the highest calorie, poorest quality foods imaginable. A child today sees an estimated 10,000 food commercials a year, mostly for junk food. And of course junk foods have invaded every walk of life, including school vending machines. At the same time, opportunities for physical activity have declined everywhere. Physical Education class used to be regular and mandatory, but now it’s sporadic and sometimes even voluntary. After-school recreation opportunities have also been cut back to save money—but these cost savings pale in comparison to the costs of caring for an increasingly obese population with life-threatening complications, like type 2 diabetes.

A Confused Public

Are average parents simply uncaring and feeding their children junk? Hardly. It can be difficult for parents to make informed decisions when the information they’re receiving day in and day out, from sources that they trust, is misleading or wrong. Even “studies” conducted to discover the danger levels of fast and junk food can be slanted. “We examined how the funding of nutrition research studies affects study outcomes, focusing specifically on three beverages: milk, fruit juice and sugar-sweetened drinks,” Dr. Ludwig related. “We found that when a food company sponsors a research study, the findings are four to eight times more likely to be favorable to the financial interests of that company. This suggests that it is not just the marketing but the actual conduct of research that may be undermining nutritional health.”

One example Dr. Ludwig uncovered was a study sponsored by the beverage industry showing that soft drinks were a good way to prevent dehydration. “Last time I checked, so was water,” remarked Dr. Ludwig. “And dehydration isn’t exactly a major public health crisis in America.”

There is also the driving force of competition in the food industry. “The problem is that without better regulation, food industry marketing practices tend to fall to the lowest common denominator, especially with regard to children’s diets,” Dr. Ludwig said. “Your competitor is advertising sugary cereal directly to kids on Saturday morning cartoons; if you don’t do the same, as a food company you’ll be at a competitive disadvantage. I think what this calls for is comprehensive national regulation to protect children from food advertising, consistent with the recommendations of the American Academy of Pediatrics and other professional organizations.”

Another major factor that affects consumers—even though many of them may not be aware of it—is that crops, such as corn and soy, that are key components of cheap processed foods are made cheaper by government farm subsidies. “I think that farm subsidies are one of the low-hanging fruit in the battle against obesity in this country,” said Dr. Ludwig. “In an era when obesity is not just the most common nutritional disease but the most common disease of any kind, we shouldn’t be making high-calorie poor-quality foods even cheaper than they already are by farm subsidies targeting commodities. Instead farm subsidies, if they are to exist, should make the higher quality, inherently more expensive foods more accessible, especially to low-income people. That would involve shifting support from the grain-based commodities to vegetables, fruits, legumes and other natural whole foods.”

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A Bastion of Protection

Dr. Ludwig has commented that if we could return to the environmental conditions of the 1960s, the obesity epidemic would largely vanish. It makes sense when you think about it: television was limited to a few channels and more regulated by parents; high-fructose corn syrup and other components that greatly contribute to childhood obesity had yet to be invented; nutritional value of produce was higher; diets in general were more nutritious; and children exercised a great deal more.

But Dr. Ludwig isn’t recommending a time machine, handy as that might be. “The premise of our book, Ending the Food Fight, is that ultimately we want to create a world that is healthier for children to live in,” he said. “But in the meantime we have to create a bastion of protection for children at home—and that is an environment over which parents have 100 percent control. The key to this approach is providing foods and physical activities that support a child’s biology, and age-appropriate parenting practices that support the child’s psychology.”

In terms of guiding behavior, Dr. Ludwig points out what can and often does go wrong. “All too often parents try to manage their kids with coercive measures,” he said. “Approaches like nagging, pressuring the kids to eat certain foods or excessively restricting other foods may succeed in the short term but rarely do so over the long term. Instead, we encourage more powerful, constructive parenting practices that produce long-term behavior change.”

Dr. Ludwig provides an example from his own home. “What you do is more important than what you say,” he said. “I have a 16-month-old who loves to eat tofu, fish, brown rice, and all sorts of fruits and vegetables, just because he sees us eating these things and he doesn’t see us eating junk food. That’s not to say that we never have a treat or a sweet—we do; but we make sure that the main things he sees us eating are healthy, natural whole foods. Because he sees us eating these, he wants to eat them too. This is a key developmental opportunity to prevent problems from coming into being from the first, and it’s a shame to lose that opportunity.”

He also points out that the right kind of physical activity, rather than “exercise,” is vital. “Young kids aren’t designed to spend 20 minutes on a treadmill,” he said. “We need to make physical activities fun again.”

Dr. Ludwig concludes by summing up the actions that can be taken now to bring an end to the out-of-control growth of childhood obesity. “I don’t think we need to aim for an ideal environment—we just need to aim for a better environment,” he said, “one where children have access to natural whole foods much of the time, and where they have an opportunity to exercise their bodies, not just their minds, in school; one in which advertising influences are supportive and not undermining of parental responsibility; where healthful foods are less expensive and junk foods are relatively more expensive; and one in which we have political leadership that creates a comprehensive national strategy to support a healthful lifestyle.”

To find out more about or to purchase Dr. Ludwig’s book, Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World, please visit the book’s website at

The Obesity Epidemic
  • Increase in childhood obesity in the past 25 years: 2.3-to 3.3-fold
  • Estimated increase, in the past 20 years, in the prevalence of childhood diabetes: 10-fold
  • Increase in per capita consumption of soft drinks, 1950s to today: 500%
  • Amount that one additional soft drink per day increases a child’s risk for obesity: 60%
  • Percentage of school districts that have contracts with soft-drink companies, allowing them to sell soft drinks on school premises: 50%
  • Number of food ads viewed by the average child each year: 10,000
  • Percentage of these that advertise fast food, soft drinks, candy, or sugared cereals: 95%
  • Estimated annual amount spent on food advertising aimed at US children: $10 billion
  • Increase in risk for childhood obesity per hour of daily television viewing: 12%
  • Decrease in risk for childhood obesity per hour of exercise: 10%
  • Average charge for coronary bypass surgery: $60,853
  • Estimated average cost of three one-hour sessions with a dietitian at an obesity clinic: $180
  • Annual direct costs of obesity to the American economy: $70 billion

Statistical source: Dream magazine, Winter 2004, published by Children’s Hospital Boston. Children’s Hospital Boston is the primary pediatric teaching hospital of Harvard Medical School