Stories about: David Ludwig

Are all calories created equal?

David Ludwig, MD, PhD Boston Children's Hospital

Historically, people who lose weight have a hard time keeping it off long-term. Most people believe it’s due to lack of adherence to diets or lost motivation, but recent research finds that not all calories are the same—and that following a low-glycemic diet that works with a person’s changing metabolism could help maintain weight loss.

Researchers Cara Ebbeling, PhD, and David Ludwig, MD, PhD, of the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital considered that after people lost weight, the rate at which they burned calories slowed down, making it harder to maintain weight loss. The challenge was to find a diet that would work with the body’s changing metabolism and help people continue to burn calories at a rate that would help them maintain their weight loss.

“Keeping weight off—even under the best circumstances—is difficult,” says Ludwig. “But lining up biology and behavior can help.” Ludwig and Ebbeling studied the affects of three diets with the same amount of calories in each:

  • Low-fat, which is typically recommended by the U.S. government and American Heart Association, aims to reduce overall fat intake.
  • Low-carbohydrate, modeled after the Atkins diet, reduces almost all carbohydrate intake.
  • Low-glycemic, which aims to keep blood sugar levels steady by choosing natural foods and high-quality protein, carbohydrates and fats.

Even though all three diets consisted of the same amount of calories, the low-glycemic diet came out on top: Aside from helping to stabilize metabolism even after weight loss, existing research suggests that low-glycemic diets help people feel fuller longer and experience improved sense of well-being, as well as improved mental and physical performance.

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Soda’s tax-free status: right or oversight?

New York City’s Mayor Bloomberg isn’t sugarcoating his views on soda. Citing sugary drinks as a leading cause of obesity, Bloomberg is pushing for legislation that would ban the sale of large sodas and other sugary drinks at restaurants, movie theaters and street carts in the Big Apple.

Under Bloomberg’s proposed law, any sugary drink larger than 16 fluid ounces—smaller than many single serving soda bottles—would be banned at any establishment regulated by New York’s health department. Grocery stores, convenience stores and vending machines wouldn’t be affected.

Lawmakers in Massachusetts are proposing new legislation regulating sugary drinks as well, though less drastic than their peers in New York. Currently, food products in Massachusetts are exempt from the state’s standard 6.25 percent sales tax. Governor Deval Patrick is suggesting that soda and candy no longer be exempt from that tax, and the additional money raised—estimated at $51 million each year—go towards new and existing health programs to help combat obesity. Representative Kay Khan (D-Newton), House Chair of the Joint Committee on Children and Families, is also proposing a similar legislation.

“The proposal is in the public’s best interest,” says David Ludwig, MD, PhD, who has led the way in researching the link between sugar-sweetened beverages and obesity at the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital. “It will reduce exposure to unhealthy food products while raising much-needed funds for obesity prevention and other necessary public measures.”

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Do low-carb diets work for kids?

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.

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How would you support a child trying to live healthier?

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.

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