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Ending the Food Fight
by David M. Ludwig, M.D., Ph.D.
with Suzanne Rostler, M.S., R.D.

"With childhood obesity soaring, it is essential to draw on cutting-edge research in nutrition to develop effective programs for prevention and treatment. Ending the Food Fight does just that. I highly recommend it." — Andrew Weil, M.D.

"Dr. David Ludwig has written the definitive book on childhood nutrition. It is must reading for all parents who are concerned with their children's eating habits." — Arthur Agatston, M.D., author of The South Beach Diet

About the Book

No one is more qualified to offer guidance to families of overweight children than the Harvard endocrinologist Dr. David Ludwig. He is the cofounder and director of the Optimal Weight for Life (OWL) Program at Children's Hospital, Boston, the premier weight-loss clinic for kids in America, and a pioneer of the groundbreaking low-glycemic diet, the basis for some of the most successful diets of the last decade, including the South Beach Diet and SugarBusters. In Ending the Food Fight, Dr. Ludwig provides parents with the tools they need to win the food fight, once and for all.

Never before has there been a generation in which so many kids are so overweight from so early in life. The percentage of overweight children ages six to eleven has doubled in the United States in the past twenty-five years, and it has tripled for teenagers. One out of three children — a staggering thirty million kids — are too heavy. To combat the dramatic and unprecedented increase in childhood obesity, Dr. Ludwig and his team at OWL tailored his low-glycemic diet for children and combined it with a powerful nine-week progressive plan that benefits the patient and the entire family.

This scientifically proven approach addresses, for the first time, all three key factors affecting body weight — biology, behavior, and environment — and integrates them into a practical and powerful prescription for weight loss. It also recognizes the challenges children and their parents face in today's toxic food world, a physical and social landscape ideally designed to make children fat. Ending the Food Fight takes us inside the examining room and the lives of parents struggling with this issue and teaches them how to

• give kids age-appropriate information about food and eating to help them make better choices for their bodies

• help children avoid "fake foods" — nutrient-poor processed foods unlike anything found in nature — so they lose weight without feeling hungry or rundown

• harness the clinic's nine-week progressive plan — complete with weekly program guidelines, menu plans, recipes, food lists, and motivational tools — to permanently improve a family's lifestyle and eating habits

More than 3,500 families have been effectively treated at the OWL clinic. Now, with Ending the Food Fight, Dr. Ludwig's expertise is available to all families as he guides them from conflict to cooperation along the road to health.

About the Authors

Dr. David Ludwig is an associate professor of pediatrics at Harvard Medical School, as well as director of the OWL Program at Children's Hospital, Boston. He has published over seventy articles in major scientific journals. Dr. Ludwig's research, including reports on the relationship between childhood obesity and the consumption of fast food and soda, is regularly covered in national media. He is available for interviews.

Suzanne Rostler is the lead dietician at the OWL clinic. She received an M.S. in clinical nutrition from New York University and is a former health journalist who has contributed to books and magazines. Rostler is also available for interviews.

A Conversation with Dr. David Ludwig

What is Ending the Food Fight about?

Ultimately, the solution to obesity is simple: eat less and exercise more. However, for the vast majority, and especially children, this simple solution hasn't worked. According to recent surveys, about one out of three men and one half of all women are trying to lose weight. Countless weight-loss books have been published in recent years, all offering easy answers. Yet rates of obesity and diabetes continue to soar. To address the problem at its roots, I use the metaphor of a battle that takes place on three levels.

The first battle occurs within the individual, when we eat foods that work against our basic biological makeup. A diet based on highly processed, high-glycemic foods sets into action hormonal changes in our body that lead to increasing hunger and falling metabolic rate. The mind might say, I'm too heavy, I need to eat less, but the body says, I'm hungry, feed me. And in the battle between mind and metabolism, metabolism usually wins, especially with children.

The second battle takes place within the home, when a child with unhealthy eating and activity habits starts to get heavy. At some point, the parents become alarmed and try to control the situation with coercive behavior-change methods (criticisms, punishment, nagging, pressure to eat certain foods, etc.). All too often, however, these attempts only make matters worse, as the child rebels against well-meaning but misguided parenting practices. Ground zero is, of course, the dinner table.

The third front is all around us, in our communities and our society. The government exhorts us to eat well and lose weight. We hear that the childhood obesity epidemic may shorten life expectancy in the United States and bankrupt the health care system. But parents' efforts are undermined at every turn: TV commercials for junk food targeted at young children; schools that have literally franchised their cafeterias to fast-food companies; neighborhoods that lack sidewalks and parks, discouraging physical activity.

Bookstore shelves are lined with simplistic weight-loss plans that address just part of the problem. But even the best diet won't work if people can't (or lack the motivation to) follow it. Conversely, the best behavior-change plan will ultimately fail if it advocates a diet that exacerbates hunger and diminishes energy level. Ending the Food Fight aims for a comprehensive solution. First, we must make peace within ourselves by learning to eat in a way that works with our basic biology. Next, parents must learn effective, age-appropriate strategies so that they and their children work together, not fight. In our present "toxic" environment, the family is the last bastion of protection for children. Finally, having brought healing to our own children, we must turn our efforts outward, making changes in society that will support a healthful lifestyle for all of us. Then we can lay down our arms as the food fight ends.

Isn't obesity mostly a question of biology? If you happen to be born with "fat genes," isn't there really very little you can do about it?

It can seem overwhelmingly difficult to maintain a healthy body weight in America today. But this hasn't always been the case. Since World War II, most people in America and Europe have had plenty to eat, but obesity rates didn't start rising until the 1970s in the United States and the 1980s or '90s in Europe.

Just as there are biological forces that push body weight up, there are powerful forces that keep weight down. Just think about having a large Thanksgiving dinner: afterward, you don't even want to look at food for a while, and you will probably eat less the next day.

The bottom line is that the obesity epidemic is caused by our environment, not our genes. If we could return to the environmental conditions of the 1960s, the obesity epidemic would vanish. It may take some time to make the world a healthier place to live. But until then, we can create a protective environment for our children at home. We can guide them toward a healthy weight, as thousands of families in the Optimal Weight for Life (OWL) Program have done over the past twelve years.

What is the Optimal Weight for Life Program?

The OWL Program, based at Children's Hospital, is among the oldest and largest clinics anywhere in the country for overweight children and their families. Because many factors affect body weight — including biology, diet, physical activity level, emotional well-being, family dynamics, and our environment — we have a multispecialty staff that includes pediatricians, nurses, dietitians, and experts in child behavior. The OWL Program and our patients have been featured extensively in local and national media, and clinical outcomes have been published in prestigious medical journals. Ending the Food Fight translates years of OWL experience into a practical and scientifically proven plan that families can follow at home. Dozens of actual OWL patients and their families share their real-life stories of struggle and transformation with the reader.

Your book gives families a nine-week program and recipes to follow at home. Why not just skip the science?

Some people can be intimidated by science, though I mostly blame this problem on scientists who use too much jargon. I find that most people, and especially children, are fascinated by the inner workings of the body, and by the remarkable events that take place inside us every time we eat. This knowledge can give us a visceral understanding of what the body needs to be healthy and can help increase motivation to take good care of ourselves. But science also helps to focus our energies on lifestyle changes that really make a difference and to avoid wasting time and energy on ineffective approaches. For many people, trying to lose weight is like pedaling a bike in the wrong gear: we go through a lot of motion but don't get very far. Science helps line up biology and behavior, shifting weight loss into high gear.

Even young children can learn the basics of healthy nutrition if the science is explained in an interesting and accessible way. In five minutes, five-year-olds can learn the difference between real food (from nature) and fake food (from a factory), or that too much refined carbohydrate sends blood sugar on a roller coaster ride that makes them hungry a short time after eating.

Where have previous weight-loss diets gone wrong?

For much of the last half-century, the most common approach to preventing and treating obesity has been a low-fat diet. It seemed to make sense: if you don't want fat on your body, don't put fat into your body. The problem is that it didn't work. Recent research from our group and others has shown that the relative amount of fat in the diet isn't an important determinant of body weight. And low-fat diets have been notoriously unsuccessful. In the past five years, the pendulum has swung very far in the other direction, with the enormous popularity of the Atkins-type, very low carbohydrate diets. These diets do produce significant weight loss for a few months. However, studies show that by one year, much of the weight is regained. How long can one go on eating bacon double-cheeseburgers, hold the bun? The basic problem with many diets is that they lack an accurate understanding of how food affects our hormones and metabolism, and ultimately our well-being. Diets that restrict an entire class of nutrients — fat or carbohydrate — produce biological and psychological deprivation that we can ignore for only a short time. Instead, we advocate a low-glycemic diet designed to stabilize blood sugar and insulin after the meal, promoting long-term satiety and supporting metabolism. This approach, focused on nutrient quality rather than quantity, offers the widest possible range of food choices, providing a sense of abundance instead of deprivation. Dozens of scientific studies suggest that this approach may be remarkably effective, not just for weight loss, but also to prevent heart disease and diabetes.

Why is it so hard to stick to an exercise program?

It's no surprise that Americans are remarkably sedentary. Many teenagers, especially girls, do virtually no physical activities apart from gym at school (and due to budget cuts, gym isn't offered very often these days). Most conventional weight-loss programs aim to get sedentary people involved in regular vigorous exercise. Unfortunately, most exercise programs don't produce significant weight loss. The problem is that jogging, for example, burns off only about 70 calories per mile, whereas just one super-size fast-food meal can contain over 2,000 calories — equal to jogging four miles a day for an entire week! Children, especially younger ones, are not well suited for sustained vigorous exercise: their bodies aren't built for it, and they lack the ability to concentrate on one activity for long. A more effective approach is to discourage sedentary pursuits (especially TV, the granddaddy of them all) and encourage all sorts of physical activities in daily life: play (the most natural physical activity for children), sports, dance, walking, active chores, and so on. Don't even mention the e-word.

What is the most common mistake that parents make when dealing with an overweight child?

When it comes to behaviors affecting body weight, some parents raise young children permissively, perhaps in reaction to the excessive strictness they experienced in childhood. But if parents don't provide firm limits and guidelines, our commercial culture will happily fill the vacuum. The extremely unhealthful eating and activity habits taught by TV and other media become deeply ingrained over time, often causing a weight problem by adolescence. At this point, parents become alarmed and try to clamp down. But strict limit-setting at this developmental stage usually makes matters worse, resulting in an escalating power struggle. Coercive parenting practices (criticisms, punishment, nagging, pressure to eat certain foods, etc.) at any age may seem to work in the short term, but they can be very counterproductive. These practices take a toll on the parent-child relationship, leave children feeling upset (and no one learns well when upset), and actually keep children from accepting responsibility for their behavior.

The key to successful parenting is to establish a parent-directed system that provides firm limits and guidance when the child is young. These limits are gradually released as the child matures, giving rise to a child-directed system that encourages autonomy and responsibility. With proper parenting practices, we can avoid many of the problems that commonly occur in families with overweight children and possibly help prevent overweight from developing at all. When conflicts do occur, constructive parenting practices (modeling, praise, goal-setting, problem-solving, and self-monitoring, for example) can help us avoid making matters worse and begin to turn things around.

Advance Praise for Ending the Food Fight

"At a time when obesity in children has already become an epidemic, this book should be a must for all parents." — T. Berry Brazelton, M.D., professor of pediatrics emeritus, Harvard Medical School

"I consider David Ludwig to be one of the most knowledgeable and compassionate physicians in the world of childhood nutrition. This book is an extremely valuable resource for any parent, as it contains very practical and clinically proven advice. If you care about having your child avoid the consequences of the growing epidemic of childhood obesity, then this is a must-have book in your home." — Barry Sears, Ph.D., author of The Zone

"Ending the Food Fight is impeccably researched and brilliantly practical. It is a beacon of light in a culture overburdened by the human cost of obesity. Thank you, thank you, Dr. Ludwig." — Christiane Northrup, M.D., author of Mother-Daughter Wisdom and The Wisdom of Menopause

"A remarkable and enlightening book written by a caring doctor and seasoned scientist that provides an honest discussion of the many challenges facing overweight children. Dr. Ludwig gives parents concrete tools to win the food war at home, at school, and in the community." — Melinda S. Sothern, Ph.D., author of Trim Kids

"David Ludwig's gentle, encouraging, and inspiring book will lead you and your children down the path to lifelong weight control. This is not a gimmicky diet book but a safe, tried, and tested program from the best children's hospital in the world. I wish I'd had this book when my children were young." — Jennie Brand-Miller, Ph.D., coauthor of The Low GI Diet Revolution

"Dr. Ludwig brings his invaluable research from the OWL Program at Children's Hospital, Boston, into our kitchens and homes for a personal and very practical approach to enabling health, empowerment, balance, and peace for both parents and their children." — Hale Sofia Schatz, author of If the Buddha Came to Dinner: How to Nourish Your Body to Awaken Your Spirit

"Dr. Ludwig, a leading authority on childhood obesity, takes you right into his clinic and provides a simple, practical, powerful plan for improving the health of children and their families. I recommend it highly." — Janet King, Ph.D., chair of the USDA Dietary Guidelines Advisory Committee and professor at UC Berkeley

"David Ludwig has done what no one else has done in the fight against obesity — he has stood up from his research enclave to tell the truth about why our children and the rest of us are facing rampant obesity and declining life expectancy. Dr. Ludwig removes blame from the children and the parents, while guiding us all with a practical plan to overcome the toxic food environment once and for all. Dr. Ludwig is our hope for a healthier, saner society." — Mark Hyman, M.D., author of Ultrametabolism: The Simple Plan for Automatic Weight Loss

"Dr. Ludwig has brought together the best available scientific evidence on weight control and his personal insights from years of clinical experience working with overweight children. Anyone caring for children will want to read this book." — Walter Willett, M.D., author of Eat, Drink, and Weigh Less and chair of the Department of Nutrition, Harvard School of Public Health

"This roadmap will enable not just overweight children but all children and their families to understand how to be healthy and well. It is all the information needed to know how to navigate our complex and often toxic world, and win." — Francine Kaufman, M.D., author of Diabesity and past president of the American Diabetes Association

"Dr. Ludwig's novel approach to treating childhood obesity is backed by powerful research and offers practical solutions. This is a must-read for families, health care practitioners, and policymakers alike. This book has the potential to revolutionize the way we deal with childhood obesity." — Sandra Woodruff, R.D., author of The Good Carb Cookbook and past president of the Florida Dietetic Association

"This book comes from a wise and caring physician and nutritionist whose compassion and devotion to children's health shines through on every page. What they say should give hope and courage to any parent wondering how best to help an overweight child." — Marion Nestle, Ph.D., author of What to Eat and professor of nutrition, New York University

"Insightful, compassionate, and clear-sighted as a practitioner — and trailblazing in his research contributions over the decades — Dr. Ludwig now shares his broad experiences from both fronts in this long-anticipated book. The language is warm and accessible, and the information invaluable to anyone who cares about human well-being." — Mollie Katzen, author of The Moosewood Cookbook and coauthor of Eat, Drink, and Weigh Less

"With childhood obesity soaring, it is essential to draw on cutting-edge research in nutrition to develop effective programs for prevention and treatment. Ending the Food Fight does just that. I highly recommend it." — Andrew Weil, M.D.

"Dr. David Ludwig has written the definitive book on childhood nutrition. It is must reading for all parents who are concerned with their children's eating habits." — Arthur Agatston, M.D., author of The South Beach Diet

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